On December 9, 2002, the Commissioner of Insurance adopted 28 Texas Administrative Code §§21.3401-21.3409 concerning the collection and reporting of data related to mandated benefits and offers of coverage (see rule and subsequent amendments at http://www.tdi.state.tx.us/rules/1209-059.html; and http://www.tdi.state.tx.us/rules/1121-059.html). The Commissioner adopted these rules pursuant to Subchapter F, Chapter 38 of the Texas Insurance Code, as added by the 77th Texas Legislature. The rule requires insurers to comply with the reporting requirements if their most recently filed annual statement indicates Texas business of $10 million or more in direct premiums for group accident and health insurance policies, or $2 million or more in direct premiums for individual accident and health insurance policies. Health Maintenance Organizations (HMOs) must file a report if their most recently filed annual statement shows a total of $10 million or more in direct commercial premiums earned in Texas. If your company does not meet the minimum premium requirements, then you do not need to report and are not required to request an exemption. The rule clearly outlines the conditions which require carriers to report. Whether a company is required to report may change from year to year. Insurers and HMOs will need to re-evaluate each year whether they are required to file a report, based on the premiums reported in their most recently filed annual statement.
At the time of initial adoption, all reports were due on March 1 of each year. However, at the request of insurer representatives, the Department subsequently amended the rule to change the reporting date so that it did not coincide with the annual statement filing date. For the first reporting year, the mandated benefit report is due April 1, 2004 and is based on claims paid during the 2003 calendar year. All subsequent reports will be due annually on December 1 and will be based on claims paid during the period of October through September immediately prior to the reporting date. Because the rule refers to the "most recently filed annual statement" as the criteria for determining whether a carrier meets the minimum premium threshold for reporting, for this first year, carriers must determine whether they are required to comply based on the annual statement that will be filed March 1, 2004. Although the annual report is not filed until March 1, you should already have access to your company's premium volume information that will be filed in that report. The Department urges you to determine as soon as possible whether you will be required to file the mandated benefit report due April 1, 2004 so that you can immediately begin collecting the required information.
The rule requires companies to file their reports through an electronic database which will be available on our website beginning March 1, 2004. Until that time, you may view the data reporting requirements and instructions through a temporary file which is available at http://www.tdi.state.tx.us/company/mbindex.html. Please note you may view and print the instructions and forms, but you will not be able to enter data at this location. Due to the volume and complexity of the data involved, the Department strongly recommends that carriers print the forms and begin collecting the required data as soon as possible.
To facilitate web-based reporting, the Department has created a unique user name and password for each company to ensure that all data submitted will remain secure. Due to privacy concerns, carriers must request their user name and password prior to accessing the on-line database. You may send your password request at anytime by e-mailing the Department at mbsurvey@tdi.state.tx.us. Please note that you must send the message from a business e-mail address.
Thank you in advance for your attention to this matter. If you have any questions, please contact Dianne Longley via e-mail , or via phone at 512-305-7298.
Sincerely,
__________________________
Kimberly Stokes
Senior Associate Commissioner
Life, Health & Licensing