1. (a) Not later than September 1 of each year, each plan and health benefit plan issuer identified in §21.4502(a) and (b) of this subchapter (relating to Applicability) is required to submit to the department the data required 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).
2. (b) Notwithstanding the requirements of subsection (a) of this section, the first reporting date for the submission of data required by this subchapter is 60 days from effective date of rule for data regarding claims payments from January 1, 2010, to June 30, 2010.

3. (c) The data filed pursuant to this section is required to be filed electronically in Excel format by:

   1. (1) accessing a link designated on the department's website, http://www.tdi.state.tx.us/forms/form10accident.html, to obtain Form No. LHL616 (Health Care Claims Reimbursement Rate Report);
   2. (2) completing the report in accordance with the form's instructions; and
   3. (3) emailing the completed report to the department at ReimbursementRates@tdi.state.tx.us.
4. (d) To access the report form, the user must indicate acceptance of the End User Agreement concerning use of Current Procedural Terminology. Acceptance is indicated by clicking the button labeled "Accept." The content of the End User Agreement is provided in Figure: 28 TAC §21.4506(f) of this subchapter.

5. (e) Notwithstanding subsections (a) - (d) of this section, a group health benefit plan issuer as specified in §21.4502(a) of this subchapter may submit to the department an exemption statement and the data required in Section B of Form No. LHL616 (Health Care Claims Reimbursement Rate Report) to support an exemption in place of the full report described in subsections (a) - (d) of this section. The group health benefit plan issuer asserting an exemption shall certify that the group health benefit plan issuer is exempt from the reporting requirement applicable to its health benefit plans for one of the following reasons:

   1. (1) the total number of all covered lives in private market preferred provider benefit plans operating under the Insurance Code Chapter 1301 and offered by the health benefit plan issuer in Texas does not exceed 10,000 persons as of December 31 of the year preceding the report; or
   2. (2) the total number of all covered lives in the private market health maintenance organization plans operating under the Insurance Code Chapter 843 and offered by the health benefit plan issuer does not exceed 10,000 persons as of December 31 of the year preceding the report.
6. (f) The content of the End User Agreement is as follows:
   Attached Graphic
   

Source Note:The provisions of this §21.4506 adopted to be effective January 9, 2011, 35 TexReg 11868.