| (a) This subchapter applies to a payor that issues,
sponsors, or administers a plan subject to reporting under subsection
(b) of this section.
(b) Payors must submit data files as required by this
subchapter with respect to each of the following types of health benefit
plans or dental benefit plans issued in Texas:
(1) a health benefit plan as defined by Insurance Code §1501.002,
concerning Definitions;
(2) an individual health care plan that is subject
to Insurance Code §1271.004, concerning Individual Health Care
Plan;
(3) an individual health insurance policy providing
major medical expense coverage that is subject to Insurance Code Chapter
1201, concerning Accident and Health Insurance;
(4) a health benefit plan as defined by §21.2702
of this title (relating to Definitions);
(5) a student health plan that provides major medical
coverage, consistent with the definition of student health insurance
coverage in 45 CFR §147.145, concerning Student Health Insurance
Coverage;
(6) short-term limited-duration insurance as defined
by Insurance Code §1509.001, concerning Definition;
(7) individual or group dental insurance coverage that
is subject to Insurance Code Chapter 1201 or Insurance Code Chapter
1251, concerning Group and Blanket Health Insurance;
(8) dental coverage provided through a single service
HMO that is subject to Chapter 11, Subchapter W, of this title (relating
to Single Service HMOs);
(9) a Medicare supplement benefit plan under Insurance
Code Chapter 1652, concerning Medicare Supplement Benefit Plans, if
the payor elects to submit such data;
(10) a health benefit plan as defined by Insurance
Code Chapter 846, concerning Multiple Employer Welfare Arrangements;
(11) basic coverage under Insurance Code Chapter 1551,
concerning Texas Employees Group Benefits Act;
(12) a basic plan under Insurance Code Chapter 1575,
concerning Texas Public School Employees Group Benefits Program;
(13) a health coverage plan under Insurance Code Chapter
1579, concerning Texas School Employees Uniform Group Health Coverage;
(14) basic coverage under Insurance Code Chapter 1601,
concerning Uniform Insurance Benefits Act for Employees of the University
of Texas System and the Texas A&M University System;
(15) a county employee health benefit plan established
under Local Government Code Chapter 157, concerning Assistance, Benefits,
and Working Conditions of County Officers and Employees;
(16) group dental, health and accident, or medical
expense coverage provided by a risk pool created under Local Government
Code Chapter 172, concerning Texas Political Subdivisions Uniform
Group Benefits Program;
(17) the state Medicaid program operated under Human
Resources Code Chapter 32, concerning Medical Assistance Program;
(18) a Medicaid managed care plan operated under Government
Code Chapter 533, concerning Medicaid Managed Care Program;
(19) the child health plan program operated under Health
and Safety Code Chapter 62;
(20) the health benefits plan for children operated
under Health and Safety Code Chapter 63;
(21) a Medicare Advantage Plan providing health benefits
under Medicare Part C as defined in 42 USC §1395w-21, et seq .;
(22) a Medicare Part D voluntary prescription drug
benefit plan providing benefits as defined in 42 USC §1395w-101, et seq .; and
(23) a health benefit plan or dental plan subject to
the Employee Retirement Income Security Act of 1974 (29 USC §1001 et seq .) if the plan sponsor or administrator
elects to submit such data.
(c) Data files required by this subchapter must include
information with respect to all Texas resident members, as defined
in §21.5402(16) of this title. Information on persons who are
not Texas resident members is not required.
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