1. (a) Each group health benefit plan issuer and plan specified in §21.4502(a) and (b) of this subchapter (relating to Applicability) is required to collect the data specified in Form No. LHL616 (Health Care Claims Reimbursement Rate Report) that is adopted by reference in §21.4507 of this subchapter (relating to Report Form) and is required to prepare and file data in accordance with the requirements in §21.4506 of this subchapter (relating to Submission of Report).
2. (b) The six-month reporting period for the data requested in Form No. LHL616 (Health Care Claims Reimbursement Rate Report), including the claims and reimbursement rate data, is January 1 to June 30 of the applicable reporting year. The enrollment data required in Form No. LHL616 (Health Care Claims Reimbursement Rate Report) for private market plans and governmental employee plans is for the total number of lives covered under the plans as of both December 31 of the year prior to the applicable reporting period and June 30 of the applicable reporting year.
3. (c) Notwithstanding subsection (a) of this section, a health benefit plan issuer that is exempt from filing a full reimbursement report pursuant to §21.4506(e) of this subchapter is not required to collect the full data indicated in Form No. LHL616 (Health Care Claims Reimbursement Rate Report) and is required to instead collect enrollment data as necessary to comply with the applicable instructions specified in Form No. LHL616 (Health Care Claims Reimbursement Rate Report) to support an exemption.

Source Note:The provisions of this §21.4505 adopted to be effective January 9, 2011, 35 TexReg 11868.