Texas Mandated Benefits and Mandated Offers Reporting

The Texas Department of Insurance collects data on state-mandated health coverage benefits and offers of coverage through the Mandated Benefits Report.  Issuers meeting the reporting requirements must submit this completed form before June 1 of each year.

Additional information regarding this report, including information about the reporting requirements, the most recent code list workbook, and answers to frequently asked questions is located on the Mandated Benefits Data Call Index Page of the TDI website.

Report aggregate data for all plans and policies that are subject to mandated benefits and mandated offers for the reporting year.

Total direct premiums earned during the year: Enter the dollar amount of the total premiums earned for all plans subject to mandated benefits and mandated offers during the reporting year. Issuers will round responses to the nearest dollar and not use dollar signs, decimals, or commas.

Total claims incurred during the year: Enter the dollar amount of the total claims incurred for all plans subject to mandated benefits and mandated offers during the reporting year. Issuers will round responses to the nearest dollar and not use dollar signs, decimals, or commas.

Total member months for the year: Enter the total number of member months for enrollees of all plans subject to mandated benefits and mandated offers for the reporting year. Issuers will enter whole numbers and not use decimals or commas.

Issuers must complete the following as applicable:

Claims incurred during the year: Enter the total dollar amount of the claims incurred for each mandated offer during the reporting year. Issuers will round responses to the nearest dollar and not use dollar signs, decimals, or commas.

Number of claims incurred during the year: Enter the total number of separate claims incurred for each mandated offer during the reporting year. Issuers will enter whole numbers and not use decimals or commas.

Total member months for the year: Enter the total number of member months for all enrollees covered for each mandated offer during the reporting year regardless of whether the enrollees incurred claims for the mandated offer. Issuers will enter whole numbers and not use decimals or commas.

Notes about entering data:

• All of the mandates listed may not be applicable to all plan types.
• If a mandate is not applicable, leave the fields blank.
• If a mandate is applicable but has no claims, enter 0 in the claims fields.

Issuers must complete the following as applicable:

Claims incurred during the year: Enter the total dollar amount of the claims incurred for each mandated offer during the reporting year. Issuers will round responses to the nearest dollar and not use dollar signs, decimals, or commas.

Number of claims incurred during the year: Enter the total number of separate claims incurred for each mandated offer during the reporting year. Issuers will enter whole numbers and not use decimals or commas.

Total member months for the year: Enter the total number of member months for all enrollees covered for each mandated offer during the reporting year regardless of whether the enrollees incurred claims for the mandated offer. Issuers will enter whole numbers and not use decimals or commas.

Notes about entering data:

• All of the mandates listed may not be applicable to all plan types.
• If a mandate is not applicable, leave the fields blank.
• If a mandate is applicable but has no claims, enter 0 in the claims fields.

Issuers must complete the following as applicable:

Claims incurred during the year: Enter the total dollar amount of the claims incurred for each mandated offer during the reporting year. Issuers will round responses to the nearest dollar and not use dollar signs, decimals, or commas.

Number of claims incurred during the year: Enter the total number of separate claims incurred for each mandated offer during the reporting year. Issuers will enter whole numbers and not use decimals or commas.

Total member months for the year: Enter the total number of member months for all enrollees covered for each mandated offer during the reporting year regardless of whether the enrollees incurred claims for the mandated offer. Issuers will enter whole numbers and not use decimals or commas.

Notes about entering data:

• All of the mandates listed may not be applicable to all plan types.
• If a mandate is not applicable, leave the fields blank.
• If a mandate is applicable but has no claims, enter 0 in the claims fields.

Issuers must provide the following information:

Medical billing codes: List the medical billing codes and filters used to identify applicable claims for each mandated benefit and mandated offer of coverage.

Issuers must list the medical billing codes and filters in this section of the report. Do not simply state, “See mandated benefits code list” or submit the codes as a separate email attachment. TDI uses this information to better understand the data and identify potential causes of data inconsistencies between responding issuers.

For additional information, please see the methodologies document and code workbook located in the additional resources section on the Mandated benefits data call index page.

Please include any data reported or omitted in this section that needs explanation in the next section for additional information.

Issuers can use the additional information field to provide any important information about their data. This field should contain data clarifications as necessary.  If the issuer has nothing to add, the field may be left blank.

After entering the reporting data, issuers must complete the data certification fields. The form cannot be submitted if these fields are incomplete.

Attestation: Click on the box next to the attestation statement and a checkmark will appear.

Contact information: Provide the name, title, and direct telephone number of a person with authority to certify the data. This individual should be a corporate officer, actuary, attorney, or accountant.

If an authorized agent is completing the data call on behalf of this individual, include both parties in the name field. For example, enter Bob Jones, on behalf of Pam Smith. However, the title field should only specify the title of the person with authority to certify the data. A separate affidavit is not required.