| (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.
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