1. (a) The following is a list of mandates about which data relating to a group health benefit plan must be filed under §21.3403 of this subchapter (relating to Collection of Data Necessary to Provide Report):

   1. (1) In Vitro Fertilization Procedures, Insurance Code Article 3.51-6, Section 3A and §11.510(1) of this title (relating to Mandatory Offers);
   2. (2) HIV or AIDS Related Illnesses, Insurance Code Articles 3.51-6, Section 3C; 3.51-6D; 3.50-2, Section 5(j)(1); 3.50-3, Section 4C(1); and 3.51-5A(a)(1) and §3.3057(d) of this title (relating to Standards for Exceptions, Exclusions, and Reductions Provision);
   3. (3) Chemical Dependency, Insurance Code Article 3.51-9, and Subchapter HH, §§3.8001-3.8030 of this title (relating to Standards for Reasonable Cost Control and Utilization Review for Chemical Dependency Treatment Centers);
   4. (4) Serious Mental Illnesses, Insurance Code Articles 3.51-14, 3.50-2 and §11.509(5) of this title (relating to Additional Mandatory Benefit Standards: Group Agreement Only);
   5. (5) Serious Mental Illnesses, Insurance Code Articles 3.50-3 and 3.51-5A(a)(2) and (b);
   6. (6) Treatment in Psychiatric Day Treatment Facility, Insurance Code Article 3.70-2(F) and §§11.509(5) and 11.510(3) of this title;
   7. (7) Loss or Impairment of Speech or Hearing, Insurance Code Article 3.70-2(G) and §11.510(2) of this title;
   8. (8) Low Dose Mammography, Insurance Code Article 3.70-2(H);
   9. (9) Phenylketonuria (PKU), Insurance Code Article 3.79;
   10. (10) Prescription Contraceptive Drugs and Devices and Related Services, Insurance Code Article 21.52L;
   11. (11) Temporomandibular Joint Procedures, Insurance Code Article 21.53A and §11.509(6) of this title;
   12. (12) Osteoporosis, Detection and Prevention, Insurance Code Article 21.53C;
   13. (13) Immunizations, Insurance Code Articles 21.53F,and 20A.09F and §§11.506(2) and 11.508(a)(9)(G) of this title (relating to Mandatory Contractual Provisions: Group, Individual, and Conversion Agreement and Group Certificate, and Mandatory Benefit Standards: Group, Individual and Conversion Agreements);
   14. (14) Prostate Cancer Testing, Insurance Code Articles 21.53F and 3.50-4, Sec. 18D and §11.508(a)(9)(E) of this title;
   15. (15) Diabetes Care, Supplies, and Services, Insurance Code Articles 21.53D and 21.53G and §§21.2601 - 21.2607 of this title (relating to Diabetes);
   16. (16) Hearing Screening for Children, Insurance Code Article 21.53F;
   17. (17) Telemedicine/Telehealth, Insurance Code Article 21.53F and §11.1607(i), (j) and (k) of this title (relating to Accessibility and Availability Requirements);
   18. (18) Reconstructive Surgery Incident to a Mastectomy, Insurance Code Article 21.53I and §11.508(a)(5)(A) of this title;
   19. (19) Certain Benefits Related to Acquired Brain Injury, Insurance Code Article 21.53Q;
   20. (20) Certain Tests For Detection of Colorectal Cancer, Insurance Code Article 21.53S;
   21. (21) Reconstructive Surgery for Craniofacial Abnormalities in A Child, Insurance Code Article 21.53W; and
   22. (22) Oral Contraceptives, §21.404(3) of this title (relating to Underwriting) and Prescription Contraceptive Drugs and Devices and Related Services, Insurance Code Article 21.52L

2. (b) The following is a list of mandates about which data relating to individual health benefit plan must be filed under §21.3403 of this subchapter:

   1. (1) HIV or AIDS Related Illnesses, Insurance Code Articles 3.51-6, Section 3C; 3.51-6D; 3.50-2, Section 5(j)(1); 3.50-3, Section 4C(1); and 3.51-5A(a)(1), and §3.3057(d) of this title;
   2. (2) Immunizations, Insurance Code Articles 21.53F and 20A.09F, and §§11.506(2) and 11.508(a)(9)(G) of this title;
   3. (3) Prostate Cancer Testing, Insurance Code Articles 21.53F and 3.50-4, Sec. 18D and §11.508(a)(9)(E) of this title;
   4. (4) Diabetes Care, Supplies, and Services, Insurance Code Articles 21.53D and 21.53G, and §§21.2601 - 21.2607 of this title;
   5. (5) Hearing Screening for Children, Insurance Code Article 21.53F;
   6. (6) Telemedicine/Telehealth, Insurance Code Article 21.53F and §11.1607(i), (j) and (k) of this title;
   7. (7) Reconstructive Surgery Incident to a Mastectomy, Insurance Code Article 21.53I and §11.508(a)(5)(A) of this title;
   8. (8) Certain Benefits Related to Acquired Brain Injury, Insurance Code Article 21.53Q;
   9. (9) Certain Tests For Detection of Colorectal Cancer, Insurance Code Article 21.53S;
   10. (10) Reconstructive Surgery for Craniofacial Abnormalities in A Child, Insurance Code Article 21.53W;
   11. (11) Oral Contraceptives, §21.404 of this title (relating to Underwriting) and Prescription Contraceptive Drugs and Devices and Related Services, Insurance Code Article 21.52L; and
   12. (12) Low Dose Mammography, Insurance Code Article 3.70-2(H).
3. (c) The Department will provide, on the Department's Web site, www.tdi.state.tx.us, suggested procedure and diagnosis codes that may be used in capturing the required data for the report. Regardless of whether a health benefit plan issuer uses the suggested codes or some other method of capturing the required information, each health benefit plan issuer shall maintain information and documentation supporting the accuracy and completeness of the data and the report, including, but not limited to, a list of all procedural and diagnosis codes used in collecting data for the report for five years following the submission of the report upon which the information was based. Upon receiving a request from the department, a health benefit plan issuer shall make available the supporting information described in this subsection.

Source Note:The provisions of this §21.3406 adopted to be effective December 29, 2002, 27 TexReg 11990.