Sec. 1301.009. ANNUAL REPORT. (a) Not later than March 1 of each year, an insurer shall file with the commissioner a report relating to the preferred provider benefit plan offered under this chapter and covering the preceding calendar year.
(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 insurer, 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; and
(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 insurer for the plan;
(xi) the credentials of physicians who are preferred providers; and
(xii) the number of preferred providers.
(c) The annual report filed by the insurer shall be made publicly available on the department's website in a user-friendly format that allows consumers to make direct comparisons of the financial and other data reported by insurers under this section.
(d) An insurer providing group coverage of $10 million or less in premiums or individual coverage of $2 million or less in premiums is not required to report the data required under Subsection (b)(3)(C).
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 10, eff. September 1, 2007.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter A. General Provisions
Section 1301.002. Nonapplicability to Dental Care Benefits
Section 1301.003. Preferred Provider Benefit Plans and Exclusive Provider Benefit Plans Permitted
Section 1301.0041. Applicability
Section 1301.0042. Applicability of Insurance Law
Section 1301.0045. Construction of Chapter
Section 1301.0046. Coinsurance Requirements for Services of Nonpreferred Providers
Section 1301.005. Availability of Preferred Providers
Section 1301.0051. Exclusive Provider Benefit Plans: Quality Improvement and Utilization Management
Section 1301.0052. Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services
Section 1301.0053. Exclusive Provider Benefit Plans: Emergency Care
Section 1301.0055. Network Adequacy Standards
Section 1301.0056. Examinations and Fees
Section 1301.0057. Access to Out-of-Network Providers
Section 1301.0058. Protected Communications by Preferred Providers
Section 1301.006. Availability of and Accessibility to Health Care Services
Section 1301.0061. Terms of Enrollee Eligibility
Section 1301.008. Conflict With Other Law