The following words and terms, when used in this subchapter, shall have the following meaning unless the context clearly indicates otherwise:

1. (1) Administrative costs--A reasonable estimate of all costs directly associated with each mandate other than the claim amounts. Administrative costs should not include any start-up costs unless those costs were incurred during the reporting year.
2. (2) Average annual premium attributable to each mandate--A reasonable estimate of the average annual premium cost per individual policy or group certificate for each mandate based on the health benefit plan issuer's actual experience for the reporting year. If average costs across policies or certificates cannot be determined, the average annual premium must be based on an estimate of the health benefit plan issuer's most commonly issued standard individual or group policy.
3. (3) Direct premium--Premium earned by a health benefit plan issuer in return for coverage, but not including premium received for providing reinsurance.
4. (4) Family coverage--The rating or pricing classification of coverage offered to an employee/member, spouse and all other dependents to be covered by the plan.
5. (5) Health benefit plan issuer--An insurer or health maintenance organization that issues a plan that provides benefits for medical and surgical expenses incurred as the result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document.
6. (6) Mandates--Benefits or coverages listed in §21.3406 of this subchapter (relating to Mandates for Which Data Must Be Reported) that are required to be included in an individual or group health benefit plan or required to be offered and made available to the holder of an individual or group contract or the purchaser of an individual or group health benefit plan.
7. (7) Number of claims paid--The total number of separate, individual claims paid by the health benefit plan issuer.
8. (8) Total number of lives covered--The total number of lives covered under a policy, contract or certificate, including the certificate, contract or policyholder and all dependents covered by the policy, contract or certificate for a reporting year.
9. (9) Reporting year--A one year period, beginning each October 1 and ending the following September 30, during which health benefit plan issuers must collect the data required by §21.3407 of this Subchapter (relating to Reporting of Required Information).

Source Note:The provisions of this §21.3402 adopted to be effective December 29, 2002, 27 TexReg 11990; amended to be effective December 11, 2003, 28 TexReg 10946.