Issuers of major medical comprehensive health plans offered in 2024 are statutorily required to submit health plan data. This includes PPO, HMO, and EPO plans, including those that are not listed on the federal health insurance marketplace (health exchange).
Report due date – will be announced in the fall.
This page has the following sections:
Beginning this year, we will collect the data using a prescribed reporting form.
Non-HMO health plan issuers may submit a condensed report if they have:
- group coverage premiums of $10 million or less; or
- individual coverage premiums of $2 million or less.
The information issuers submit will be made available to the public on our website.
Reporting formTDI will send individualized reporting forms to issuers in early October.
What is the purpose of this data report?
Texas law requires health plan issuers to report information about plan costs, premium costs, copayments, and deductibles each year. We will post this information to the Texas Health Plan Compare website, which will be available to the public in a user-friendly format.
When is this data report due?
By statute, the report covering the prior calendar year is due March 1. This state law existed before the Affordable Care Act was passed; and the yearly open enrollment periods began.
We understand that the first quarter of each year is a busy time for insurers to complete and file all the required state and federal regulatory filings. We also recognize that the information is most valuable to consumers as open enrollment begins each fall. For these reasons, we will allow health plan issuers to report data after March 1 so the data is current when open enrollment begins on November 1, 2023.
From which periods does the report collect information?
Most of the general company information collected, including enrollment, complaints, and financial statements, will be from the calendar year 2022. However, information specific to the actual health plans, such as premiums, deductibles, and copays, will be for plans that will be offered at the upcoming open-enrollment period (beginning November 1, 2023) for coverage in 2024.
Why is TDI prefilling data in the reporting form?
We will provide a reporting form to health plan issuers. This form will have known information already filled in to ensure that the information we present on the Texas Health Plan Compare website is uniform. It will also help health plan issuers save time filling out the form.
Where will TDI get data to prefill the report?
We will use existing resources to get data for the report, such as:
- Data available through the NAIC.
- Centers for Medicare and Medicaid Services.
- Internal sources like our Consumer Operations division.
We may also look to other sources for information, such as accrediting entities.
Will issuers be able to edit the prefilled information?
Yes. Issuers will be able to edit the prefilled information. Issuers will also need to provide information that is not prefilled in the reporting form.
If we offer a plan that is not prefilled in the reporting form, are we required to add it?
Yes, all major medical comprehensive health plans are statutorily required to submit complete plan information, regardless of whether they are PPO, HMO, or EPO plans. Data for plans that are not listed on the federal health insurance marketplace (health exchange) must also be submitted.
What will happen to the information that issuers send to TDI?
We will review the information to make sure it’s complete and accurate and will contact issuers with any questions. Once we accept the report, we will upload it to the Texas Health Plan Compare website for the public to view before open enrollment begins.
What if health plan issuers see data that is wrong on the Texas Health Plan Compare website?
If a health plan issuer sees information that is wrong after information is uploaded to the Texas Health Plan Compare website, it should contact HealthPlanInfo@tdi.texas.gov.
What will consumers be able to do with this information?
Consumers will be able to use the Texas Health Plan Compare website to:
- View information about each issuer, including links to their websites.
- Search and compare health plans in their area.
- Get premium and cost-sharing estimates.