The purpose of this Bulletin is to assist insurers and HMOs to comply with the relevant PPACA provisions prior to September 23, 2010. Policy and contract forms required to be filed with the Texas Department of Insurance ("Department") must be in compliance with PPACA on or before September 23, 2010. The Department provides the following guidance on how to submit compliant filings and obtain the Department approval in an expedited manner.
FORMS
Insurance companies are encouraged to file amendatory form language to bring their policies into compliance with PPACA, under the filing opportunity available in TEX. INS. CODE §1701.052 which provides that the form filed may be immediately used if when filed, the form is accompanied by the proper certification. An amendment or rider filing that includes a completed LHL020 Rev. 01/10 required by 28 TEX ADMIN CODE §3.3 and is accompanied by a completed National Association of Insurance Commissioners (NAIC) "PPACA Uniform Compliance Summary" will be reviewed as soon as possible. Insurers may combine Grandfathered and Non-Grandfathered amendments and riders in the same filing.
There is no "file and use" opportunity under the HMO filing laws, however, HMOs filing amendatory contract language accompanied by a completed LHL259 Rev.03/05 required by 28 TEX ADMIN CODE §3 and §11.301 and accompanied by a completed NAIC "PPACA Uniform Compliance Summary" will be reviewed as soon as possible. HMOs may combine Grandfathered and Non-Grandfathered amendments and riders in the same filing.
Insurers and HMOs that choose not to include the NAIC "PPACA Uniform Compliance Summary" may file under the standard filing opportunities; however, the filing will not be expedited. Due to the expected volume of filings, the Department requests that health benefit plan issuers to limit form filings to conforming amendments for PPACA purposes, utilizing the PPACA Uniform Compliance Summary. The Department is dedicating its resources to PPACA filings and will review such filings as soon as possible. As a courtesy, please consider the Department's efforts before filing non-PPACA related forms.
The Department looks forward to the cooperation of the insurance industry in this process.
If you have any questions concerning the information presented in this bulletin, please contact the HWCN Division at 512-322-4266 or the Accident & Health Section 512-322-3409 or at LIFEHEALTH@tdi.state.tx.us.
Matt Ray
Deputy Commissioner of Licensing Division
Life, Health & Licensing Program