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Texas Department of Insurance
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Life Health Small Group Certification Forms

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TDI form number Description Format Language
LAHR334 Annual Small Employer Health Benefit Actuarial Certification
1212 Cert Actuarial - Small Employer Carrier Status Certification - Figure 47
HTML English
LAHR335 Annual Small Employer Health Benefit Plan Report
1212 Cert Actuarial - Large Employer Carrier Status Certification - Figure 48
HTML English

For more information, contact: LifeHealth@tdi.texas.gov