1. (a) A health benefit plan issuer shall submit the data required by this section electronically by accessing a link designated on the Department's Web site, www.tdi.state.tx.us, for reporting of the required information.

2. (b) Each health benefit plan issuer shall provide the following information for the reporting year:

   1. (1) the year for which the data is being reported;
   2. (2) the health benefit plan issuer's NAIC Number;
   3. (3) the health benefit plan issuer's company name;
   4. (4) the health benefit plan issuer's mailing address;
   5. (5) if applicable, any group NAIC number and group name;
   6. (6) the name, title, direct telephone number, mailing address and email address of an individual who is responsible for the report;
   7. (7) the total direct premiums earned in the state of Texas for group accident and health insurance policies or contracts which are subject to one or more of the mandates set forth in §21.3406(a) of this subchapter (relating to Mandates for Which Data Must be Reported);
   8. (8) the total direct premiums earned in the state of Texas for individual accident and health insurance policies or contracts which are subject to one or more of the mandates set forth in §21.3406(b) of this subchapter;
   9. (9) the total dollar amount of claims incurred for the reporting year on all group policies or contracts for which premium is being reported; and
   10. (10) the total dollar amount of claims incurred for the reporting year on all-individual policies or contracts for which premium is being reported.

3. (c) Each health benefit plan issuer shall provide for each of the mandates set forth in §21.3406(a) of this subchapter the following information for the reporting year:

   1. (1) The number of claims incurred;
   2. (2) The total dollar amount of the claims incurred;
   3. (3) The number of policies, contracts or certificates about which information is being reported; and
   4. (4) The total dollar amount of administrative costs incurred during the reporting year.

4. (d) Each health benefit plan issuer shall provide, for each of the mandates set forth in §21.3406(b) of this subchapter, the following information for the reporting year:

   1. (1) The number of claims incurred;
   2. (2) The total dollar amount of the claims incurred;
   3. (3) The number of policies, contracts or certificates about which the information is being reported; and
   4. (4) The total dollar amount of administrative costs incurred during the reporting year.
5. (e) Each health benefit plan issuer shall provide, for each of the mandates set forth in §21.3406(a) of this subchapter, the average annual premium per policy, contract or certificate attributable to each mandate for each group certificate about which data is being reported, and must report separate data for certificates providing individual coverage and certificates providing family coverage during the reporting year.
6. (f) Each health benefit plan issuer shall provide the total number of group certificates issued or renewed during the reporting year, and the total number of certificates in force on a date to be provided by the department in the reporting form, and must report separate data for the total number of certificates providing individual coverage and the total number of certificates providing family coverage during the reporting year.
7. (g) Each health benefit plan issuer shall provide the total number of lives covered under group certificates issued or renewed during the reporting year, and the total number of certificates in force on a date to be provided by the department in the reporting form, and must report separate data for the total number of certificates providing individual coverage and the total number of certificates providing family coverage during the reporting year.
8. (h) Each health benefit plan issuer shall provide, for each of the mandates set forth in §21.3406(b) of this subchapter, the average annual premium attributable to each mandate for individual policies about which data is being reported on a date to be provided by the department in the reporting form, and must report separate data for policies providing individual coverage and policies providing family coverage during the reporting year.
9. (i) Each health benefit plan issuer shall provide the total number of individual policies issued or renewed during the reporting year, and the total number of policies in force on a date to be provided by the department in the reporting form and must report separate data for total number of policies providing individual coverage and the total number of policies providing family coverage during the reporting year.
10. (j) Each health benefit plan issuer shall provide the total number of lives covered under individual policies issued, renewed or in force during the reporting year and must report separate data for the total number of policies providing individual coverage and the total number of policies providing family coverage during the reporting year.

Source Note:The provisions of this §21.3407 adopted to be effective December 29, 2002, 27 TexReg 11990.