Why do we have to report this data?
In 2007, the Texas Legislature passed legislation authorizing TDI to collect and publish data about health benefit plan reimbursement rates (Insurance Code Chapter 38, Subchapter H). In 2010, TDI adopted 28 TAC §§21.4501- 21.4507, which created the methodology for the reimbursement rate data call. TDI amended the rule in 2016 to improve the consistency and accuracy of the data collected and reported by the issuers.
How do you determine which issuers are subject to the data call?
Generally, issuers offering private-market major medical group health coverage under Insurance Code Chapters 843 or 1301 are subject to reporting. State employee health plans administered by ERS, TRS, UT, and A&M under Insurance Code Chapters 1551, 1575, 1579, and 1601 are also subject to reporting.
This data call applies to issuers of comprehensive group health plans who report to NAIC at least 20,000 covered lives as of the last day of the applicable reporting period. Only issuers who meet this threshold are required to report. lssuers with enrollment below this threshold are not expected to submit reports.
What is the reporting period and when is the report due?
The reporting period is January 1 through December 31 of the previous year. The report is due by the close of business on May 1 each year. The reporting deadline is set in the rule (TAC 28 §21.4506). When the deadline falls on a weekend, the report is due by the close of business on the first Monday in May.
Can we use previous versions of the reporting template?
No. lssuers or their authorized agents must submit the data electronically using the updated Microsoft Excel data template available on the TDI website on the Health Care Reimbursement Rate Data page. The current version is 4.0.
How do we submit the report?
Submit the completed report by email to ReimbursementRates@tdi.texas.gov.
Do we have to complete the cover page?
Yes, the cover page includes necessary company information, including the data certification. Make sure to include the name of the individual certifying the data.
Can we revise the information shown in columns A, B, C, and O on the data tab of the template?
No, issuers should not change the information in these columns of the data tab. TDI staff uses this information to analyze the data and any revisions or omissions can delay the process.
Other than adding rows to account for 3-digit ZIP reporting, can we make other revisions to the data template?
No. Do not make any other changes to the reporting template. This includes not adding columns to the data template, not submitting data in tables within the template, and not adding tabs to the workbook. Any revisions or omissions can delay processing the data for analysis.
Does the template include data validations?
No, none of the template fields include data validations. lssuers need to make sure the data being reported is accurate before submission.
What if we have other questions about the data call?
You can send any questions you have by email to ReimbursementRates@tdi.texas.gov.