REPORTING PERIOD: OCTOBER 1, 2011, TO SEPTEMBER 30, 2012
Certain accident and health insurers, HMOs, and TPAs, collectively referred to as respondents, are required to submit data to the Texas Department of Insurance relating to mandated health benefits and mandated offers of coverage. The Texas Insurance Code Chapter 38, Subchapter F, relating to "Data Collecting and Reporting Relating to Mandated Health Benefits and Mandated Offers of Coverage," and 28 TAC Sections 21.3401 - 21.3409 require this reporting.
Applicability
This data call applies to respondents that meet any of the following earned premium threshold criteria:
(1) A health benefit plan issuer that reported $10 million or more in direct premiums earned for group accident and health insurance policies in Texas on its 2011 annual statement.
(2) A health benefit plan issuer that reported $2 million or more in direct premiums earned for individual accident and health insurance policies in Texas on its 2011 annual statement.
(3) A health benefit plan issuer that is a basic service health maintenance organization and reported $10 million or more in direct commercial premiums earned in Texas on its 2011 annual statement.
(4) A licensed third party administrator that performs claims payment services for any health benefit plan issuer that meets the requirements of (1) - (3) above.
A health benefit plan issuer, as defined in 28 TAC Section 21.3402(5), is "An insurer or health maintenance organization that issues a plan that provides benefits for medical and surgical expenses incurred as the result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document."
Submission Requirements
Respondents are required to complete the 2012 Mandated Benefits Data Call using interactive PDF form LHL657 located at http://www.tdi.texas.gov/health/mbindex.html. This link contains instructions, code lists, and other information pertaining to the data call. Submissions are due to TDI by December 1, 2012.
If you have questions concerning this bulletin, please contact the Texas Department of Insurance via email at MBSurvey@tdi.state.tx.us.
Eleanor Kitzman
Commissioner of Insurance