| (a) Each participating health benefit plan issuer or regional or local health care program shall submit to the commissioner necessary claims data in connection with its annual submission of requests for reimbursement from the fund. Each participating health benefit plan issuer or regional or local health care program also shall provide the commissioner with such additional data, as deemed necessary by the commissioner, to oversee the operation of the fund and the Healthy Texas Program. Reports pertaining to reimbursement or loss ratio shall be certified, by an officer of the submitting entity, as to their accuracy and completeness. Data to be submitted may include the following: (1) the total number of plans issued or groups enrolled in a regional or local health care program within the reporting period and the total number of plans in force or groups enrolled in a regional or local health care program that are covered by the fund; (2) the total number of primary insured persons or primary covered persons, the total number of dependents covered, and the total number of child dependents covered; the commissioner may require that such totals be specified by geographic region; (3) total premium earned, and per-enrollee per-month premium earned, for all plans covered by the fund for the reporting period; (4) claims payment data, reported individually for each enrollee and/or for each enrollee for whom the participating health benefit plan issuer has paid claims eligible for reimbursement; (5) total claims eligible for reimbursement year-to-date; and (6) other data and information as necessary to determine continuing program compliance. (b) Data reporting periods may be other than a calendar year and reporting frequency for some data may be as often as monthly, as determined by the commissioner to be reasonably necessary to determine or monitor ongoing effective and efficient operation of the fund and the Healthy Texas Program and continuing attainment of program objectives. Claims payment data shall state clearly both the date the claim was incurred and the date the claim was paid. Claims payment data also may be requested on a cumulative basis or in the form of aggregates, specific categories, and averages. (c) A participating health benefit plan issuer shall use a coding system to ensure the privacy of insured individuals. |
