Tex.
Ins. Code Section 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.(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 (Contents of Application)(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.(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 (Contents of Application)(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 (Coverage Required);(iii)
Subchapter A (Applicability of Certain Definitions), Chapter 1452 (Physician and Provider Credentials);(iv)
Subchapter B (Purpose), Chapter 1507 (Consumer Choice of Benefits Plans);(v)
Chapters 222 (Life, Health, and Accident Insurance Premium Tax), 251 (General Provisions), and 258 (Health Maintenance Organizations), as applicable to a health maintenance organization; and(vi)
Chapters 1271 (Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges) and 1272 (Delegation of Certain Functions by Health Maintenance Organization).(c)
Sections 36.108 (Filing Date of Report, Financial Statement, or Payment Delivered by Postal Service) and 201.055 (Filing Date of Report or Payment Delivered by Postal Service) and Chapter 802 (Annual Statement) 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.
Source:
Section 843.155 — Annual Report, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm#843.155 (accessed Jun. 5, 2024).
