COMMISSIONER'S BULLETIN # B-0021-16
September 13, 2016
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: 2016 Mandated Benefits Data Call Relating to Data Collection under Texas Administrative Code, Title 28, §§21.3401 – 21.3409
Reporting Period: October 1, 2015, to September 30, 2016
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 relating to mandated health benefits and mandated offers of coverage to the Texas Department of Insurance.
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 2015 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 2015 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 2015 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.
Respondents must complete the 2016 Mandated Benefits Data Call using interactive PDF form LHL657 located at 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, 2016.
For more information contact:
Last updated: 09/14/2016