REPORTING PERIOD: October 1, 2010, to September 30, 2011
Certain accident and health insurers, HMOs, and TPAs (collectively, "respondents") are required to submit data to the Texas Department of Insurance (TDI) relating to mandated health benefits and mandated offers of coverage. This requirement exists under 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 in 28 Texas Administrative Code (TAC) §§21.3401 - 21.3409.
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 2010 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 2010 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 2010 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 §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 2011 Mandated Benefits Data Call using an interactive PDF form located at www.tdi.state.tx.us/health/mbindex.html. This link contains instructions, code lists, and other information pertaining to the data call. The traditional data entry web page will not be used, and no password requests will be necessary. Submissions are due to TDI by December 1, 2011. Companies unable to respond by this date may request an extension as provided by the data call instructions.
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