Reporting periods – January 1 to December 31 of the previous calendar year.
Report due date – June 1 of the current calendar year.
This page has the following sections:
Background information
As specified by Texas Insurance Code Section 38.252, certain health benefit plan issuers and health maintenance organizations (HMOs) are required to submit data to TDI concerning mandated health benefits and mandated offers of coverage.
Per 28 Texas Administrative Code, Chapter 21, Subchapter Z, this report applies to health benefit plan issuers subject to Texas Insurance Code Section 38.251 (concerning applicability) and who reported to the National Association of Insurance Commissioners (NAIC) for the previous year 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 meeting these requirements must submit data relating to mandated health benefits and mandated offers of coverage.
Issuers not meeting these requirements are not required to submit exempt reports.
Instructions
Data collection instructions (PDF)
Reporting form
A reporting form will be available later.
Additional resources
Data collection methodologies (PDF)
Summary of 2017 rule revisions (PDF)
Code list workbook (XLSX) Updated April 22, 2025.
Frequently Asked Questions
Why do we have to report this data?
In 2001, the Texas Legislature passed legislation requiring TDI to collect and report data about mandated health benefits and mandated offers of coverage (Insurance Code Chapter 38, Subchapter F). In 2002, TDI adopted 28 TAC Sections 21.3401 – 21.3409, which created the mandated benefits data call; TDI amended the rule in 2003 to clarify the reporting periods and revise the reporting deadlines. In 2017, TDI adopted additional rule amendments to improve the integrity of the data collected and reported by the issuers. A summary of the amendments is available in the additional resources section.
How do we determine which issuers are subject to the data call?
The data call applies to health benefit plan issuers subject to Insurance Code Section 38.251 and who report to the National Association of Insurance Commissioners (NAIC) a total of $10 million or more in direct premiums earned in Texas in a particular year 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.
Issuers will need to report data for any enrollees and their dependents covered by plans subject to the mandated benefits and offers regardless of where they reside. This includes situations where enrollees and their dependents live in different states.
When is the report due?
Under 28 TAC Section 21.3404, the report is due by the close of business on June 1st of each year.
Do we have to list the codes in the claims identification section of the report (Part H)?
Yes. You must list the medical billing codes and filters used to identify applicable claims for each mandated benefit and mandated offer of coverage. The information will allow TDI to better understand the data and identify potential causes of data inconsistencies between responding issuers. Also, do not simply state, “See mandated benefits code list” or submit the codes as a separate email attachment. This information must be included in the report.
We noticed that there are codes missing from the code workbook. Are we supposed to report data for claims with these missing codes?
Yes. You must report any data that falls within the scope of each mandate. TDI provides the code workbook to help issuers identify claims data about the various mandated benefits and offers. It is a general reference tool and may not include all possible codes. The workbook does not include modifiers, but issuers will need to use them as necessary to report data accurately for professional and technical services. TDI staff with limited knowledge of medical coding performed the research and compiled the list. TDI asks that you report any discrepancies so staff can make the necessary revisions.