December 1, 2011 Mandated Benefits Data Call Index Page
(October 1, 2010 to September 30, 2011 Reporting Period)
This page contains the following major sections:
- Background Information
- Survey Instructions
- Data Entry Form
- Supplemental Mandated Benefits and Offers Resources
- Contact Information
Background Information
As specified by 28 TAC ยงยง21.3401–21.3409, certain accident and health carriers and health maintenance organizations (HMOs) are required to submit data to TDI annually relating to mandated health benefits and mandated offers of coverage. The Mandated Benefits Data Call for the reporting period of October 1, 2010 - September 30, 2011 is due on December 1, 2011.
This data call applies to companies that meet any of the earned premium threshold criteria outlined below:
- A health benefit plan issuer that reported $10 million or more in direct premiums earned for group accident and health insurance policies in the state of Texas on its 2010 annual statement;
- A health benefit plan issuer that reported $2 million or more in direct premiums earned for individual accident and health insurance policies in the state of Texas on its 2010 annual statement;
- 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 the state of Texas on its 2010 annual statement; or
- A licensed third party administrator that performs claims payment services for any health benefit plan issuer that meets the requirements of (1) - (3) above.
All necessary files are provided below.
Companies not meeting the requirements to provide data responsive to the data call may indicate that they are exempt on the reporting form.
Survey Instructions
Data Collection Instructions (PDF)
Data Entry Form
Active November 2011: LHL657
Supplemental Mandated Benefits and Offers Resources
Texas Mandated Benefit ICD/CPT Codes (PDF)
Texas Mandated Benefits/Coverages and Offers (PDF)
HMO Summary Descriptions of Texas Mandates (PDF)
Accident and Health Insurance (Fee For Service) Summary Descriptions of Texas Mandates (PDF)
Contact Information
Email: mbsurvey@tdi.state.tx.us
For more information contact:
Last updated: 11/21/2011
