Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter TT - ALL-PAYOR CLAIMS DATABASE › Section 21.5401 - Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter applies to a payor that
				  issues, sponsors, or administers a plan subject to reporting under subsection
				  (b) of this section.
(b) Payors
				  must submit data files as required by this subchapter with respect to each of
				  the following types of health benefit plans or dental benefit plans issued in
				  Texas:
(1) a health benefit plan as defined
				  by Insurance Code §
											1501.002, concerning
				  Definitions;
(2) an individual
				  health care plan that is subject to Insurance Code §
											1271.004,
				  concerning Individual Health Care Plan;
(3) an individual health insurance policy
				  providing major medical expense coverage that is subject to Insurance Code
				  Chapter 1201, concerning Accident and Health Insurance;
(4) a health benefit plan as defined by
				  §
											21.2702 of
				  this title (relating to Definitions);
(5) a student health plan that provides major
				  medical coverage, consistent with the definition of student health insurance
				  coverage in
				  45 CFR §
												147.145, concerning Student Health Insurance
				  Coverage;
(6) short-term
				  limited-duration insurance as defined by Insurance Code §
											1509.001, concerning
				  Definition;
(7) individual or group
				  dental insurance coverage that is subject to Insurance Code Chapter 1201 or
				  Insurance Code Chapter 1251, concerning Group and Blanket Health
				  Insurance;
(8) dental coverage
				  provided through a single service HMO that is subject to Chapter 11, Subchapter
				  W, of this title (relating to Single Service HMOs);
(9) a Medicare supplement benefit plan under
				  Insurance Code Chapter 1652, concerning Medicare Supplement Benefit Plans, if
				  the payor elects to submit such data;
(10) a health benefit plan as defined by
				  Insurance Code Chapter 846, concerning Multiple Employer Welfare
				  Arrangements;
(11) basic coverage
				  under Insurance Code Chapter 1551, concerning Texas Employees Group Benefits
				  Act;
(12) a basic plan under
				  Insurance Code Chapter 1575, concerning Texas Public School Employees Group
				  Benefits Program;
(13) a health
				  coverage plan under Insurance Code Chapter 1579, concerning Texas School
				  Employees Uniform Group Health Coverage;
(14) basic coverage under Insurance Code
				  Chapter 1601, concerning Uniform Insurance Benefits Act for Employees of the
				  University of Texas System and the Texas A&M University System;
(15) a county employee health benefit plan
				  established under Local Government Code Chapter 157, concerning Assistance,
				  Benefits, and Working Conditions of County Officers and Employees;
(16) group dental, health and accident, or
				  medical expense coverage provided by a risk pool created under Local Government
				  Code Chapter 172, concerning Texas Political Subdivisions Uniform Group
				  Benefits Program;
(17) the state
				  Medicaid program operated under Human Resources Code Chapter 32, concerning
				  Medical Assistance Program;
(18) a
				  Medicaid managed care plan operated under Government Code Chapter 533,
				  concerning Medicaid Managed Care Program;
(19) the child health plan program operated
				  under Health and Safety Code Chapter 62;
(20) the health benefits plan for children
				  operated under Health and Safety Code Chapter 63;
(21) a Medicare Advantage Plan providing
				  health benefits under Medicare Part C as defined in
				  42 USC §
												1395w-21,
et seq
.;
(22) a Medicare Part D voluntary prescription
				  drug benefit plan providing benefits as defined in
				  42 USC §
												1395w-101,
et seq
.;
				  and
(23) a health benefit plan or
				  dental plan subject to the Employee Retirement Income Security Act of 1974
				  (29 USC §
												1001
et seq
.) if the plan
				  sponsor or administrator elects to submit such data.