reglab/housing_qa huggingface dataset:
TX Ins Code § 1575.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.152. Health Benefit Plan Must Cover Preexisting Conditions

Sec. 1575.152.  HEALTH BENEFIT PLAN MUST COVER PREEXISTING CONDITIONS.  A health benefit plan offered under the group program, other than a Medicare Advantage plan or a Medicare prescription drug plan, must cover preexisting conditions.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 5, eff. September 1, 2017.|For expiration of Subsections (d) and (e), see Subsection (e).
TX Ins Code § 1575.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.153. Health Benefit Plan Coverage for Retirees

Sec. 1575.153.  HEALTH BENEFIT PLAN COVERAGE FOR RETIREES.  (a) A retiree who applies for coverage during an enrollment period may not be denied coverage in a health benefit plan provided under this chapter for which the retiree is eligible unless the trustee finds under Subchapter K that the retiree defrauded or attempted to defraud the group program.(b)  A retiree who has coverage under a health benefit plan offered under the group program shall pay a monthly contribution, as determined by the trustee.(c)  As a condition of electing coverage under a health benefit plan, the retiree must, in writing, authorize the trustee to deduct the amount of the contribution from the retiree's monthly annuity payment.  The trustee shall deduct the contribution in the manner and form determined by the trustee.(d)  Notwithstanding Subsection (b), a retiree is not required to pay a monthly contribution under this section until the 2022 plan year if the retiree:(1)  has taken a disability retirement under the Teacher Retirement System of Texas on or before January 1, 2017;(2)  is receiving disability retirement benefits from the Teacher Retirement System of Texas; and(3)  is not eligible to enroll in Medicare.(e)  This subsection and Subsection (d) expire at the end of the 2021 plan year on December 31, 2021.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 201, Sec. 49(a), eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 3(a), eff. Sept. 1, 2004;  Acts 2003, 78th Leg., ch. 1276, Sec. 10A.426(a), eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 6, eff. September 1, 2017.|
TX Ins Code § 1575.155 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.155. Coverage for Dependents of Retiree

Sec. 1575.155.  COVERAGE FOR DEPENDENTS OF RETIREE.  (a)  A retiree participating in the group program is entitled to secure for the retiree's dependents group coverage under this chapter for which the dependents are eligible under this chapter or any other law, including requirements established by the trustee.(b)  The additional contribution payments for the dependent coverage shall be deducted from the annuity payments to the retiree in the manner and form determined by the trustee.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.427, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 7, eff. September 1, 2017.|
TX Ins Code § 1575.156 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.156. Coverage for Surviving Spouse or Dependents of Surviving Spouse

Sec. 1575.156.  COVERAGE FOR SURVIVING SPOUSE OR DEPENDENTS OF SURVIVING SPOUSE.  (a)  A surviving spouse who is entitled to group coverage under this chapter may elect to retain or obtain coverage for which the surviving spouse or dependents of the surviving spouse are eligible.(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(2), eff. September 1, 2017.(c)  A surviving spouse who elects under this section to retain or obtain coverage under a health benefit plan offered under the group program for the surviving spouse or dependents of the surviving spouse shall pay a monthly contribution, as determined by the trustee.(d)  As a condition of electing coverage under a health benefit plan, the surviving spouse must, in writing, authorize the trustee to deduct the amount of the contribution from the surviving spouse's monthly annuity payment.  The trustee shall deduct the contribution in the manner and form determined by the trustee.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.428, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 8, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(2), eff. September 1, 2017.|
TX Ins Code § 1575.157 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.157. Coverage for Surviving Dependent Child

Sec. 1575.157.  COVERAGE FOR SURVIVING DEPENDENT CHILD.  (a)  A surviving dependent child, the guardian of the child's estate, or the person having custody of the child may elect to retain or obtain group coverage for which the surviving dependent child is eligible at the applicable rate for a dependent.(b)  A surviving dependent child who has coverage under a health benefit plan offered under the group program shall pay a monthly contribution, as determined by the trustee.  The applicable contributions must be provided by the surviving dependent child in the manner established by the trustee.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.429, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 9, eff. September 1, 2017.|
TX Ins Code § 1575.158 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.158. Group Health Benefit Plans

Sec. 1575.158.  GROUP HEALTH BENEFIT PLANS.  (a)  The trustee shall establish or contract for and make available under the group program a high deductible health plan for retirees, dependents, surviving spouses, or surviving dependent children who are eligible under Section 1575.1582.(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(3), eff. September 1, 2017.(c)  The trustee shall establish or contract for and make available under the group program a Medicare Advantage plan and a Medicare prescription drug plan for retirees, dependents, surviving spouses, and surviving dependent children who are eligible under Section 1575.1582.(d)  Notwithstanding Subsection (c), if the trustee determines that a Medicare Advantage plan or a Medicare prescription drug plan is no longer appropriate for the group program, the trustee may establish or contract for and make available under the group program other health benefit plans to provide medical or pharmacy benefits.(e)  To the extent the group program has available funds, the trustee shall consider implementing a plan design for non-Medicare eligible enrollees in the high deductible health plan established or made available under Subsection (a) that provides assistance in the payment of preventive care, including generic preventive maintenance medications, in a manner that is consistent with federal law.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.430, eff. Sept. 1, 2003.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1214 (S.B. 1458), Sec. 9, eff. September 1, 2014.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 10, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 11, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(3), eff. September 1, 2017.|
TX Ins Code § 1575.1582 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.1582. Eligibility for Group Health Benefit Plans

Sec. 1575.1582.  ELIGIBILITY FOR GROUP HEALTH BENEFIT PLANS.  (a)  A retiree, dependent, surviving spouse, or surviving dependent child who is not eligible to enroll in Medicare is eligible to enroll in a high deductible health plan offered under the group program, subject to any other applicable eligibility requirements, including requirements established by the trustee, but is not eligible to enroll in another health benefit plan offered under the group program.(b)  A retiree, dependent, surviving spouse, or surviving dependent child who is eligible to enroll in Medicare is eligible to enroll in a Medicare Advantage plan or a Medicare prescription drug plan offered under the group program, subject to any other applicable eligibility requirements, including requirements established by the trustee, but is not eligible to enroll in another health benefit plan offered under the group program unless authorized by Subsection (c).(c)  If the trustee makes another health benefit plan available under Section 1575.158(d), any individual otherwise eligible under this section to enroll in a Medicare Advantage plan or Medicare prescription drug plan is eligible to enroll in that health benefit plan.|Added by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 12, eff. September 1, 2017.|
TX Ins Code § 1575.159 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.159. Coverage for Prostate-Specific Antigen Test

Sec. 1575.159.  COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN TEST.  A health benefit plan offered under the group program, other than a Medicare Advantage plan or a Medicare prescription drug plan, must provide coverage for a medically accepted prostate-specific antigen test used for the detection of prostate cancer for each male enrolled in the health benefit plan who:(1)  is at least 50 years of age; or(2)  is at least 40 years of age and:(A)  has a family history of prostate cancer; or(B)  exhibits another cancer risk factor.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 13, eff. September 1, 2017.|
TX Ins Code § 1575.160 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.160. Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim

Sec. 1575.160.  GROUP LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE:  PAYMENT OF CLAIM.  The amount of group life insurance or group accidental death and dismemberment insurance covering a retiree, dependent, surviving spouse, or surviving dependent child on the date of death shall be paid, on the establishment of a valid claim, only to:(1)  the beneficiary designated by the person in a signed and witnessed document received before death in the office of the trustee;  or(2)  a person in the order prescribed by Section 824.103(b), Government Code, if a beneficiary is not properly designated or a beneficiary does not exist.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.431(a), eff. Sept. 1, 2003.|For expiration of Subsections (b) and (c), see Subsection (c).
TX Ins Code § 1575.161 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.161. Enrollment Periods

Sec. 1575.161.  ENROLLMENT PERIODS.  (a)  A retiree eligible for coverage under the group program may select for the retiree and the retiree's eligible dependents any coverage provided under this chapter for which each of those individuals is otherwise eligible:(1)  on any date that is on or after the date the retiree retires and on or before the 90th day after that date;(2)  during a period beginning on the date the retiree reaches 65 years of age and ending on a date set by the trustee by rule; and(3)  during any other open enrollment periods for retirees set by the trustee by rule.(b)  Notwithstanding Subsection (a), the trustee by rule shall provide one opportunity to reenroll in a health benefit plan offered under the group program for an otherwise eligible retiree:(1)  who is eligible to enroll in Medicare;(2)  whose initial enrollment was voluntarily terminated on or after January 1, 2017, and on or before December 31, 2019; and(3)  who opts to reenroll on or before December 31, 2023.(c)  Subsection (b) and this subsection expire September 1, 2024.(d)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(5), eff. September 1, 2017.(e)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(5), eff. September 1, 2017.(f)  An individual enrolled in a health benefit plan offered under the group program may remain enrolled in that health benefit plan as long as the individual remains eligible for that health benefit plan.  If an individual becomes ineligible for a health benefit plan in which the individual is enrolled, the trustee shall enroll the individual in a health benefit plan for which the individual is eligible, if any, in accordance with procedures established by the trustee.|Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.  Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.06, eff. Jan. 11, 2004.Amended by: Acts 2009, 81st Leg., R.S., Ch. 354 (H.B. 1191), Sec. 1, eff. September 1, 2009.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 14, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 15, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(5), eff. September 1, 2017.Acts 2021, 87th Leg., R.S., Ch. 681 (H.B. 2022), Sec. 1, eff. June 15, 2021.|
TX Ins Code § 1575.162 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.162. Special Enrollments

Sec. 1575.162.  SPECIAL ENROLLMENTS.  This chapter does not limit the ability of an individual to enroll in the group program if the individual:(1)  experiences a special enrollment event as provided by the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)), as amended;  and(2)  is otherwise eligible to enroll in the group program.|Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.|
TX Ins Code § 1575.163 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.163. Limitations

Sec. 1575.163.  LIMITATIONS.  The Teacher Retirement System of Texas, as trustee, may not contract for or provide a health benefit plan that excludes from participation in the network a general hospital that:(1)  is located in the geographical service area or areas of the health coverage plan that includes a county that:(A)  has a population of at least 100,000 and not more than 210,000; and(B)  is located in the Texas-Louisiana border region, as that term is defined in Section 2056.002(e), Government Code; and(2)  agrees to provide medical and health care services under the plan subject to the same terms and conditions as other hospital providers under the plan.|Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1, 2003.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1163 (H.B. 2702), Sec. 57, eff. September 1, 2011.|
TX Ins Code § 1575.164 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.164. Disease Management Services

Sec. 1575.164.  DISEASE MANAGEMENT SERVICES.  (a)  In this section, "disease management services" means services to assist an individual manage a disease or other chronic health condition, such as heart disease, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS, and with respect to which the Teacher Retirement System of Texas identifies populations requiring disease management.(b)  A health benefit plan provided under this chapter, other than a Medicare Advantage plan or a Medicare prescription drug plan, must provide disease management services or coverage for disease management services in the manner required by the Teacher Retirement System of Texas, including:(1)  patient self-management education;(2)  provider education;(3)  evidence-based models and minimum standards of care;(4)  standardized protocols and participation criteria; and(5)  physician-directed or physician-supervised care.|Added by Acts 2003, 78th Leg., ch. 589, Sec. 4, eff. June 20, 2003.Renumbered from Insurance Code, Section 1575.162 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(62), eff. September 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 16, eff. September 1, 2017.|
TX Ins Code § 1575.170 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.170. Prior Authorization for Certain Drugs

Sec. 1575.170.  PRIOR AUTHORIZATION FOR CERTAIN DRUGS.  (a)  In this section, "drug formulary" means a list of drugs preferred for use and eligible for coverage under a health benefit plan.(b)  A health benefit plan provided under this chapter, other than a Medicare Advantage plan or a Medicare prescription drug plan, that uses a drug formulary in providing a prescription drug benefit must require prior authorization for coverage of the following categories of prescribed drugs if the specific drug prescribed is not included in the formulary:(1)  a gastrointestinal drug;(2)  a cholesterol-lowering drug;(3)  an anti-inflammatory drug;(4)  an antihistamine; and(5)  an antidepressant drug.(c)  Repealed by Acts 2013, 83rd Leg., R.S., Ch. 1312, Sec. 99(27), eff. September 1, 2013.|Added by Acts 2003, 78th Leg., ch. 213, Sec. 3, eff. Sept. 1, 2003.  Renumbered from Insurance Code Sec. 1575.161 by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.07, eff. Jan. 11, 2004.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 99(27), eff. September 1, 2013.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 17, eff. September 1, 2017.|
TX Ins Code § 1575.1701 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.1701. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services

Sec. 1575.1701.  EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND HEALTH CARE PROVIDERS PROVIDING CERTAIN HEALTH CARE SERVICES.  A preauthorization process used by a health benefit plan provided under this chapter is subject to the same limitations and requirements provided by Subchapter N, Chapter 4201, for a preauthorization process used by an insurer.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1575.171 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle H - Health Benefits and Other Coverages for Governmental Employees|Chapter 1575 - Texas Public School Employees Group Benefits Program|Subchapter D. Coverages and Participation|Section 1575.171. Emergency Care Payments

Sec. 1575.171.  EMERGENCY CARE PAYMENTS.  (a)  In this section, "emergency care" has the meaning assigned by Section 1301.155.(b)  The administrator of a managed care plan provided under the group program shall pay for covered emergency care performed by or a covered supply related to that care provided by an out-of-network provider at the usual and customary rate or at an agreed rate.  The administrator shall make a payment required by this subsection directly to the provider not later than, as applicable:(1)  the 30th day after the date the administrator receives an electronic claim for those services that includes all information necessary for the administrator to pay the claim; or(2)  the 45th day after the date the administrator receives a nonelectronic claim for those services that includes all information necessary for the administrator to pay the claim.(c)  For emergency care subject to this section or a supply related to that care, an out-of-network provider or a person asserting a claim as an agent or assignee of the provider may not bill an enrollee in, and the enrollee does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the enrollee's managed care plan that:(1)  is based on:(A)  the amount initially determined payable by the administrator; or(B)  if applicable, a modified amount as determined under the administrator's internal appeal process; and(2)  is not based on any additional amount determined to be owed to the provider under Chapter 1467.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.15, eff. September 1, 2019.|