Forms for Employers

Forms for Texas Employers

The forms listed below are in portable document format (PDF). You may print and copy as needed.

• Application for Conversion Policy (PDF)
  
• Application for Reinstatement (PDF)
  
• Change Request Form (PDF)
  
• Continuation or Convert Coverage (PDF)
  
• Large Group Employee Application (PDF)
  
• Medical Questionnaire for Late Enrollees (PDF)
  
• Proof of Incapacity (PDF)
  
• Small Group Employee Application (2-100 employees) (PDF)
  

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