Open Records Decision No. 275
July 6, 1981

Re:  Whether application for certificate of authority filed by health maintenance 
organization is open to the public

Mr. E. J. Voorhis
Commissioner
State Board of Insurance
1110 San Jacinto
Austin, Texas  78786

Dear Mr. Voorhis:

	You have requested our decision under the Open Records Act, article 6252-17a, 
V.T.C.S., as to whether certain information regarding health maintenance organizations 
is available to the public.

	You have received three separate requests.  In the first, a competitor asks for 
copies of certain portions of the application for certificate of authority filed with the State 
Board of Insurance by Central Texas Health Plan, specifically the actuarial report and the 
financial plan.  In the second request, a competitor seeks disclosure of certain portions of 
the application for certificate of authority filed by INA Health Plan of Texas, Inc., 
specifically the schedule of charges and other financial information, as well as the 
marketing plan and projections.  In each instance, you suggest that the information is 
excepted from disclosure by section 3(a)(4) and section 3(a)(10) of the Open Records 
Act.

	Health maintenance organizations are authorized under chapter 20A of the Texas 
Insurance Code.  Article 20A.03(a) thereof prohibits any “person” from establishing or 
operating a health maintenance organization “without obtaining a certificate of authority 
under this Act,” and article 20A.03(b) requires every existing health maintenance 
organization to file an application for certificate of authority.  Article 20A.04 describes 
the procedure for filing an application for certificate of authority.

	Article 20A.27 of the Texas Insurance Code provides:

	All applications, filings, and reports required under this Act 
shall be treated as public documents, except that examination reports 
shall be considered confidential documents which may be released 
if, in the opinion of the commissioner, it is in the public interest.

The Open Records Act does not authorize the withholding of any information which is 
otherwise required to be disclosed.  As a result, we believe it is clear that article 20A.27 
requires the disclosure of all information contained in the applications for certificate of 
authority filed by Central Texas Health Plan and by INA Health Plan of Texas, Inc.

	In your third request, you state that copies of federal health maintenance 
organization (HMO) reports are filed with the State Board of Insurance pursuant to the 
board's rule 059.51.04.003(b).  Article 20A.22 authorizes the board to promulgate “such 
reasonable rules and regulations as are necessary and proper to carry out the provisions 
of this Act.”  Since federal HMO reports are required by rule to be filed, and since such a 
rule is authorized by statute, we believe it may fairly be said that the filing of federal 
HMO reports is “required under this Act.”  Accordingly, it is our decision that copies of 
federal HMO reports filed with the State Board of Insurance by CompCare, Inc., 
constitute public information and must be disclosed.

SUMMARY

	Article 20A.27 of the Texas Insurance Code requires the 
disclosure of all information contained in an application for 
certificate of authority to operate a health maintenance organization.  
Copies of federal health maintenance organization reports filed with 
the State Board of Insurance constitute public information.

Very truly yours,

Mark White
Attorney General of Texas

John W. Fainter, Jr.
First Assistant Attorney General

Richard E. Gray III
Executive Assistant Attorney General

Prepared by Rick Gilpin
Assistant Attorney General

APPROVED:
OPINION COMMITTEE

Susan L. Garrison, Chairman
Jon Bible
Rick Gilpin
Jim Moellinger
Bruce Youngblood
Walter Davis