Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter KK - HEALTH CARE REIMBURSEMENT RATE INFORMATION
Section 21.4502 - Applicability
Current through Reg. 50, No. 13; March 28, 2025
(a) This subchapter applies to the issuer of an applicable health benefit plan as defined in § 21.4503 of this title and as provided by Insurance Code § 38.353(a):
(b) As provided in Insurance Code § 38.353(b), and notwithstanding any provision in Insurance Code Chapters 1551, 1575, 1579, or 1601 or any other law, this subchapter applies to:
(c) Under Insurance Code § 38.353(d), this subchapter does not apply to:
(d) Notwithstanding subsection (c)(1) of this section, an applicable health benefit plan issuer is not prohibited from electively including data concerning reimbursement rates for standard health benefit plans provided under Insurance Code Chapter 1507 in its submission of the report required in § 21.4506 of this title for purposes of administrative convenience. Data from all other plans identified in subsection (c) of this section must be excluded from the report.
(e) An applicable health benefit plan issuer with fewer than 20,000 covered lives in comprehensive health coverage as reported on Part 1 of the National Association of Insurance Commissioners Supplemental Health Care Exhibit as of the end of the applicable reporting period is not required to submit a report under §21.4506.
(f) Under §38.353(e), this subchapter does not apply to: