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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21TRADE PRACTICES
SUBCHAPTER QQHEALTH INFORMATION TECHNOLOGY
RULE §21.5103Waiver

(a) A health benefit plan issuer may apply to the commissioner for a waiver of the information technology requirements of the Insurance Code Chapter 1661.

(b) Waiver applications are required to:

  (1) be submitted on 8 1/2 by 11 inch paper;

  (2) be legible;

  (3) be in typewritten, computer generated, or printer's proof format;

  (4) be signed by an officer of the health benefit plan issuer; and

  (5) provide specific facts and circumstances in support of the request for a waiver, which must include at a minimum:

    (A) evidence of undue hardship, including financial or operational hardship;

    (B) the geographical area in which the insurer operates;

    (C) the total number of enrollees covered by the insurer and the number of enrollees impacted by the waiver;

    (D) the past and planned actions by the health benefit plan issuer to progress toward compliance;

    (E) the estimated date compliance will be achieved if prior to September 1, 2013;

    (F) the estimated cost of compliance with Insurance Code §1661.002 and an estimate of the increased cost for compliance at an earlier date; and

    (G) whether the issuer is a small business or micro business as defined by the Government Code §2006.001.

(c) Waiver applications must be mailed to Filings Intake Division, Mail Code 106-1E, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104 or 333 Guadalupe, Austin, Texas 78701.

(d) The waiver application is received when the commissioner has received a waiver application containing all specific facts and circumstances as listed in subsection (b) of this section, including any addendums provided by the health benefit plan issuer.

(e) The commissioner may grant a waiver under this subchapter considering the facts demonstrated by the applicant weighed against the purposes of Chapter 1661, including the objective to provide better information to physicians and enrollees regarding what is covered by insurance policies and what portion of the cost is to be borne by the patient, as well as streamlining and simplifying complex and administrative processes of the health insurance systems, thus providing cost savings throughout the health care system.

(f) This subchapter becomes effective June 29, 2011.


Source Note: The provisions of this §21.5103 adopted to be effective June 29, 2011, 36 TexReg 3193

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