28 Tex. Admin. Code § 26.20 - Reporting Requirements

(a) Small employer health carriers offering a small employer health benefit plan must file annually, not later than March 1 of each year, an actuarial certification Form Number 1212 CERT ACTUARIAL, Annual Small Employer Health Benefit Plan Actuarial Certification, Rev. 09/16, signed by a qualified actuary stating that the underwriting and rating methods of the small employer carrier:

(1) comply with accepted actuarial practices;

(2) are uniformly applied to each small employer health benefit plan covering a small employer; and

(3) comply with the provisions of Insurance Code Chapter 1501 (concerning Health Insurance Portability and Availability Act) and this chapter.

(b) Form Number 1212 CERT ACTUARIAL is available at www.tdi.texas.gov/forms/forms10smgroup.html through the link for Form Number 1212 CERT ACTUARIAL Annual Small Employer Health Benefit Plan Actuarial Certification.

(c) Not later than March 1 of each calendar year, a small employer carrier must complete and file with the commissioner Form Number 1212 CERT DATA Annual Small Employer Health Benefit Plan Report, Rev. 09/16, available at www.tdi.texas.gov/forms/forms10smgroup.html. This annual filing must include the following information related to the previous calendar year for health benefit plans issued by the small employer carrier to small employers in this state:

(1) the number of small employers that were issued and the number of lives that were covered under health benefit plans in the previous calendar year (separated, if applicable, as to newly issued plans and renewals);

(2) the number of small employers that were issued and the number of lives that were covered under consumer choice health benefit plans; plans offering all state-mandated health benefits; HMO consumer choice health benefit plans and HMO plans, including all state-mandated health benefits in the previous calendar year (as applicable, separated as to newly issued plans and renewals and by groups based on the following covered-employee size ranges: 2 - 9, 10 - 20, 21 - 35, 36 - 50, and more than 50);

(3) the number of small employer health benefit plans in force and the number of lives covered under those plans, broken down by the ZIP code of the small employers' principal place of business in Texas;

(4) the number of small employer health benefit plans voluntarily not renewed by small employers in the previous calendar year;

(5) the number of small employer health benefit plans terminated or nonrenewed (for reasons other than nonpayment of premium) by the health carrier in the previous calendar year;

(6) the number of small employer health benefit plans issued to small employers that were uninsured for at least the two months before issue;

(7) the health carrier's gross premiums derived from health benefit plans delivered, issued for delivery, or renewed to small employers in the previous calendar year;

(8) the name and license information regarding any other small employer carrier whose health benefit plans the health carrier assumed; and

(9) the number of small employers and the number of lives that were covered under plans issued to small employer health coalitions and cooperatives in the previous calendar year (as applicable, separated as to newly issued plans and renewals).

Notes

28 Tex. Admin. Code § 26.20

The provisions of this §26.20 adopted to be effective December 30, 1993, 18 TexReg 9375; amended to be effective April 9, 1996, 21 TexReg 2648; amended to be effective March 5, 1998, 23 TexReg 2297; amended to be effective April 6, 2005, 30 TexReg 1931; Amended by Texas Register, Volume 42, Number 19, May 12, 2017, TexReg 2546, eff. 5/17/2017