Section 21.5060 - Election Submission Requirements(a) A plan sponsor of a self-insured or self-funded plan may elect to participate under Insurance Code Chapter 1275, concerning Balance Billing Prohibitions and Out-of-Network Claim Dispute Resolution for Certain Plans, by providing identifying information to the Texas Department of Insurance as specified on the department's website at www.tdi.texas.gov, including: (1) the name and contact information of the plan sponsor;(2) the name and contact information of the administrator of the health benefit plan, if applicable;(3) the health benefit plan year start and end dates;(4) the requested effective date, which, except as provided in subsection (d) of this section, must be the same as the start date of the relevant plan year and at least 30 days after the date the identifying information is submitted;(5) the group number of the health benefit plan; and(6) the number of enrollees covered under the health benefit plan.(b) Election under subsection (a) of this section applies only to the relevant plan year. A plan sponsor must elect to apply Insurance Code Chapter 1275 (which includes an election to participate in out-of-network claim dispute resolution for applicable claims incurred during the relevant plan year) with respect to each plan year and must provide or update identifying information required by this section. A plan sponsor that elects to apply Insurance Code Chapter 1275 to a plan for the relevant plan year may not opt out until the end of that relevant plan year.(c) A plan sponsor or its authorized representative may provide the identifying information required by this section.(d) A health benefit plan with a plan year start date between September 1, 2023, and February 1, 2024, may make an election with a requested effective date that is after the first day of the relevant plan year if the information required under subsection (a) of this section is submitted not later than 45 days after the effective date of this section. An election for a plan year with a start date after February 1, 2024, must apply for the entirety of the plan year.28 Tex. Admin. Code § 21.5060
Adopted by Texas Register, Volume 48, Number 52, December 29, 2023, TexReg 8379, eff. 1/3/2024