SECTION 21.3407. Reporting of Required Information

(a) Reporting data. A reporting entity must submit the data required by this section electronically by completing the Mandated Benefits and Mandated Offers Reporting Form found on TDI's website, www.tdi.texas.gov. A reporting entity must use medical billing codes to identify applicable claims for each mandated benefit and mandated offer of coverage.

(b) Issuer's information. For each reporting year, a reporting entity must provide the following information:

(1) the year for which the data is being reported;

(2) the health benefit plan issuer's NAIC Number;

(3) the health benefit plan issuer's name;

(4) the health benefit plan issuer's mailing address;

(5) the issuer type (insurance or HMO);

(6) whether a third-party administrator is submitting the report;

(7) the name, title, direct telephone number, email address, and mailing address of an individual who is responsible for the report;

(8) whether the contact person's email address can be released;

(9) the submission date; and

(10) whether the health benefit plan issuer meets the reporting threshold for each reporting category (individual, small group, and large group).

(c) Reporting for all covered benefits. For each reporting year, a reporting entity must provide, for all covered comprehensive health benefit plans subject to mandated benefits and mandated offers, the following aggregated data:

(1) the total direct premiums earned;

(2) the total dollar amount of the claims incurred; and

(3) the total member months.

(d) Reporting for all mandated benefits and mandated offers. For each reporting year, a reporting entity must provide the following information for each of the mandated benefits and mandated offers listed in §21.3406 of this title (relating to Mandates for Which Data Must Be Reported), aggregated separately by individual, small group, and large group health benefit plans:

(1) the total dollar amount of the claims incurred;

(2) the total number of individual claims incurred; and

(3) the total member months.

(e) Additional reporting data. A reporting entity must provide the following information:

(1) the medical billing codes used to capture the required data for the report;

(2) any additional information the reporting entity believes is pertinent to the data being reported, if applicable; and

(3) the certification on the data collection form.

Source Note: The provisions of this §21.3407 adopted to be effective December 29, 2002, 27 TexReg 11990; amended to be effective July 6, 2017, 42 TexReg 3384