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You are here: Home . bulletins . 2015 . b-0025-15

COMMISSIONER'S BULLETIN # B-0025-15

October 12, 2015


To: ALL INSURERS LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE IN TEXAS, ALL BASIC SERVICE HEALTH MAINTENANCE ORGANIZATIONS (HMOs), AND ALL OTHER RELATED ENTITIES, INCLUDING CERTAIN THIRD PARTY ADMINISTRATORS (TPAs)


Re: 2015 MANDATED BENEFITS DATA CALL RELATING TO DATA COLLECTION UNDER TEXAS ADMINISTRATIVE CODE, TITLE 28, §§21.3401 – 21.3409

REPORTING PERIOD: October 1, 2014, to September 30, 2015

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 §§21.3401 – 21.3409 require certain accident and health insurers, HMOs, and TPAs, collectively referred to as "respondents," to submit data to the Texas Department of Insurance relating to mandated health benefits and mandated offers of coverage.

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 2014 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 2014 annual statement.

(3)  A health benefit plan issuer that is a basic service HMO and reported $10 million or more in direct commercial premiums earned in Texas on its 2014 annual statement.

(4)  A licensed TPA 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 must complete the 2015 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, 2015.

Questions regarding this bulletin should be directed to: MBSurvey@tdi.texas.gov.

David C. Mattax
Commissioner of Insurance



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Last updated: 10/13/2015

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