2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 843 - Health Maintenance Organizations › Subchapter E. Regulation of Health Maintenance Organizations › Section 843.155. Annual Report

Sec. 843.155.  ANNUAL REPORT.  (a)  Not later than March 1 of each year, a health maintenance organization shall file with the commissioner a report covering the preceding calendar year.
Text of subsection as amended by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 9
(b)  The report shall:
(1)  be verified by at least two principal officers;
(2)  be in a form prescribed by the commissioner; and
(3)  include:
(A)  a financial statement of the health maintenance organization, including its balance sheet and receipts and disbursements for the preceding calendar year, certified by an independent public accountant;
(B)  the number of individuals enrolled during the preceding calendar year, the number of enrollees as of the end of that year, and the number of enrollments terminated during that year;
(C)  a statement of:
(i)  an evaluation of enrollee satisfaction;
(ii)  an evaluation of quality of care;
(iii)  coverage areas;
(iv)  accreditation status;
(v)  premium costs;
(vi)  plan costs;
(vii)  premium increases;
(viii)  the range of benefits provided;
(ix)  copayments and deductibles;
(x)  the accuracy and speed of claims payment by the organization;
(xi)  the credentials of physicians of the organization; and
(xii)  the number of providers;
(D)  updated financial projections for the next calendar year of the type described in Section 843.078(e), until the health maintenance organization has had a net income for 12 consecutive months; and
(E)  other information relating to the performance of the health maintenance organization as necessary to enable the commissioner to perform the commissioner's duties under this chapter and Chapter 20A.
Text of subsection as amended by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.042
(b)  The report shall:
(1)  be verified by at least two principal officers;
(2)  be in a form prescribed by the commissioner; and
(3)  include:
(A)  a financial statement of the health maintenance organization, including its balance sheet and receipts and disbursements for the preceding calendar year, certified by an independent public accountant;
(B)  the number of individuals enrolled during the preceding calendar year, the number of enrollees as of the end of that year, and the number of enrollments terminated during that year;
(C)  updated financial projections for the next calendar year of the type described in Section 843.078(e), until the health maintenance organization has had a net income for 12 consecutive months; and
(D)  other information relating to the performance of the health maintenance organization as necessary to enable the commissioner to perform the commissioner's duties under:
(i)  this chapter;
(ii)  Section 1367.053;
(iii)  Subchapter A, Chapter 1452;
(iv)  Subchapter B, Chapter 1507;
(v)  Chapters 222, 251, and 258, as applicable to a health maintenance organization; and
(vi)  Chapters 1271 and 1272.
(c)  Sections 36.108 and 201.055 and Chapter 802 apply to the annual report of a health maintenance organization.
(d)  The annual report filed by the health maintenance organization shall be made publicly available on the department's Internet website in a user-friendly format that allows consumers to make direct comparisons of the financial and other data reported by health maintenance organizations under this section.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.042, eff. April 1, 2009.
Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 9, eff. September 1, 2007.