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Mandated Benefits Data Call Index Page

This webpage reflects the amendments TDI adopted to the mandated benefits data call rule effective July 6, 2017. The updated additional resources are now available; however, the instructions and reporting form will be added later.

Reporting period – January 1, 2017, to December 31, 2017

Report due date – June 1, 2018

This page contains the following sections:


Background Information

As specified by 28 TAC, Chapter 21, Subchapter Z, certain health benefit plan issuers and health maintenance organizations (HMOs) are required to submit data to TDI annually relating to mandated health benefits and mandated offers of coverage.

Rule amendments adopted in June 2017 will apply to the 2017 Mandated Benefits Data Call. The reporting period changed to the calendar year instead of from October to September. The data for the calendar year 2017 reporting period will be due on June 1, 2018. Because of the reporting period change, issuers will not have to report the data from October 1, 2016, to December 31, 2016.

The 2017 data call applies to health benefit plan issuers subject to Insurance Code §38.251 (concerning Applicability) and who report to the National Association of Insurance Commissioners (NAIC) for 2017 a total of $10 million or more in direct premiums earned in Texas for the following:

  • individual comprehensive health coverage,
  • small group comprehensive health coverage, or
  • large group comprehensive health coverage.

Only issuers who meet these requirements are required to submit data relating to mandated health benefits and mandated offers of coverage.

Issuers who do not meet these requirements are not required to submit exempt reports.


Instructions

Data Collection Instructions - Will be added later

Reporting Form

LAH345 - Will be added later


Additional Resources

Mandated Benefits Data Call FAQs  (PDF)

Mandated Benefits Data Call Code Workbook  (MS Excel)

Mandated Benefits Data Collection Methodologies  (PDF)

Summary of 2017 Rule Revisions  (PDF)



For more information, contact:

Last updated: 09/07/2017

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