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Health Care Reimbursement Rate Data

Reporting period – January 1, 2017, to December 31, 2017

Report due date – May 1, 2018

This page contains the following sections:

Background Information

Each year, TDI collects health care reimbursement rate information under Insurance Code Chapter 38, Subchapter H. This subchapter requires the department to collect health benefit plan reimbursement rate information in a uniform format.  This data call applies to issuers of preferred provider benefit plans, exclusive provider plans, health maintenance organization plans, and specified governmental employee plans under Insurance Code Chapters 1551, 1575, 1579, and 1601.  The rules that implement this statute are in 28 TAC, Chapter 21, Subchapter KK.

The data call applies to group health benefit plan issuers with at least 20,000 covered lives in comprehensive health coverage as reported on Part 1 of the National Association of Insurance Commissioners Supplemental Health Care Exhibit as of the end of 2017.

Only issuers who meet this requirement are required to submit reimbursement rate data.

Instructions and Data Template


The reporting template was recently updated. Some of the procedure codes and fields have changed. Please make sure that you are using version 2.3 of the reporting form by checking the version number in the ‘Introduction’ worksheet of the reporting template. Do not submit data on previous versions of the form.

Instructions and Data Template Documents

Summary of Changes


Additional Resources


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Last updated: 4/10/2018