| (a) Except as provided in subsections (b) and (c) of
this section, this subchapter applies to issuers of health benefit
plans as specified in Insurance Code §1662.003, concerning Applicability
of Chapter, that provide major medical coverage for which federal
reporting requirements under 26 C.F.R. Part 54, concerning Pension
Excise Taxes; 29 C.F.R. Part 2590, concerning Rules and Regulations
for Group Health Plans; 45 C.F.R. Part 147, concerning Health Insurance
Reform Requirements for the Group and Individual Health Insurance
Markets; and 45 C.F.R. Part 158, concerning Issuer Use of Premium
Revenue: Reporting and Rebate Requirements, do not apply, including:
(1) issuers providing short-term limited-duration insurance,
as defined in Insurance Code Chapter 1509, concerning Short-Term Limited-Duration
Insurance;
(2) issuers providing grandfathered health plan coverage,
as defined in 45 C.F.R. §147.140, concerning Preservation of
Right to Maintain Existing Coverage; and
(3) a regional or local health care program operated
under Health and Safety Code §75.104, concerning Health Care
Services.
(b) This subchapter does not apply to the following
types of plans:
(1) a plan that is not considered creditable coverage
as specified under Insurance Code §1205.004(b), concerning Creditable
Coverage;
(2) the child health plan program operated under Health
and Safety Code Chapter 62, concerning Child Health Plan for Certain
Low-Income Children;
(3) the health benefits plan for children operated
under Health and Safety Code Chapter 63, concerning Health Benefits
Plan for Certain Children; and
(4) the state Medicaid program operated under Human
Resources Code Chapter 32, concerning Medical Assistance Program,
including the Medicaid managed care program operated under Government
Code Chapter 533, concerning Medicaid Managed Care Program.
(c) Except as provided by subsections (d) and (e) of
this section, with respect to an applicable health benefit plan, an
issuer must begin publishing machine-readable files as required under
this subchapter in the month in which the plan year or policy year
begins.
(d) A health benefit plan issuer with fewer than 1,000
total enrollees in all health benefit plans subject to reporting as
of December 31, 2021, must begin publishing machine-readable files
as required under this subchapter no later than January 1, 2024.
(e) Except as provided by subsection (d) of this section,
an issuer is required to begin publishing machine-readable files no
sooner than 180 days after the effective date of this section and
no later than the earliest date specified in paragraphs (1) and (2)
of this subsection:
(1) the date that the federal Departments of Labor,
Health and Human Services, and Treasury begin enforcing the federal
Transparency in Coverage rules specific to the publication of machine-readable
files for prescription drug pricing, in-network rates, and out-of-network
allowed amounts and billed charges, if the date of enforcement occurs
after the 180th day following the effective date of this section;
or
(2) January 1, 2024.
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