reglab/housing_qa huggingface dataset:
TX Ins Code § 1579.111 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter C. Coverages|Section 1579.111. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments

Sec. 1579.111.  OUT-OF-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER PAYMENTS.  (a)  In this section, "diagnostic imaging provider" and "laboratory service provider" have the meanings assigned by Section 1467.001.(b)  Except as provided by Subsection (d), the administrator of a managed care plan provided under this chapter shall pay for a covered health care or medical service performed for or a covered supply related to that service provided to an enrollee by an out-of-network provider who is a diagnostic imaging provider or laboratory service provider at the usual and customary rate or at an agreed rate if the provider performed the service in connection with a health care or medical service performed by a participating provider.  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)  Except as provided by Subsection (d), an out-of-network provider who is a diagnostic imaging provider or laboratory service provider or a person asserting a claim as an agent or assignee of the provider may not bill an enrollee receiving a health care or medical service or supply described by Subsection (b) 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.(d)  This section does not apply to a nonemergency health care or medical service:(1)  that an enrollee elects to receive in writing in advance of the service with respect to each out-of-network provider providing the service; and(2)  for which an out-of-network provider, before providing the service, provides a complete written disclosure to the enrollee that:(A)  explains that the provider does not have a contract with the enrollee's managed care plan;(B)  discloses projected amounts for which the enrollee may be responsible; and(C)  discloses the circumstances under which the enrollee would be responsible for those amounts.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.18, eff. September 1, 2019.|
TX Ins Code § 1579.151 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter D. Participating Entities|Section 1579.151. Required Participation of School Districts With 500 or Fewer Employees

Sec. 1579.151.  REQUIRED PARTICIPATION OF SCHOOL DISTRICTS WITH 500 OR FEWER EMPLOYEES.  (a)  Each school district with 500 or fewer employees and each regional education service center is required to participate in the program.(b)  Notwithstanding Subsection (a), a school district otherwise subject to Subsection (a) that, on January 1, 2001, was individually self-funded for the provision of health coverage to its employees may elect not to participate in the program.(c)  An educational district described by Section 1579.002(5)(B) that, on January 1, 2001, had 500 or fewer employees may elect not to participate in the program.(d)  Expired.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.152 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter D. Participating Entities|Section 1579.152. Participation of Other School Districts

Sec. 1579.152.  PARTICIPATION OF OTHER SCHOOL DISTRICTS.  Effective September 1, 2005, a school district with more than 500 employees may elect to participate in the program.  A school district that elects to participate under this section shall apply for participation in the manner prescribed by the trustee by rule.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.153 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter D. Participating Entities|Section 1579.153. Participation by Certain Risk Pools

Sec. 1579.153.  PARTICIPATION BY CERTAIN RISK POOLS.  (a)  In determining the number of employees of a school district for purposes of Sections 1579.151 and 1579.152, school districts that, on January 1, 2001, were members of a risk pool established under the authority of Chapter 172, Local Government Code, as provided by Section 22.004, Education Code, may elect to be treated as a single unit.  A school district shall elect whether to be considered as a member of a risk pool under this section by notifying the trustee not later than September 1, 2001.(b)  A risk pool in existence on January 1, 2001, that, as of that date, provided group health coverage to 500 or fewer school district employees may elect to participate in the program.(c)  A school district with 500 or fewer employees that is a member of a risk pool described by Subsection (a) that provides group health coverage to more than 500 school district employees must elect, not later than September 1, 2001, whether to be treated as a school district with 500 or fewer employees or as part of a unit with more than 500 employees.  The school district must notify the trustee of the election, in the manner prescribed by the trustee, not later than September 1, 2001.(d)  For purposes of this section, participation in the program by school districts covered by a risk pool is limited to school districts covered by the risk pool as of January 1, 2001.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.154 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter D. Participating Entities|Section 1579.154. Participation by Charter Schools; Eligibility

Sec. 1579.154.  PARTICIPATION BY CHARTER SCHOOLS;  ELIGIBILITY.  (a)  A charter school is eligible to participate in the program if the school agrees:(1)  that all records of the school relating to participation in the program are open to inspection by the trustee, the administering firm, the commissioner of education, or a designee of any of those entities;  and(2)  to have the school's accounts relating to participation in the program annually audited by a certified public accountant at the school's expense.(b)  A charter school must notify the trustee of the school's intent to participate in the program in the manner and within the time required by rules adopted by the trustee.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.155 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter D. Participating Entities|Section 1579.155. Program Participation: Election

Sec. 1579.155.  PROGRAM PARTICIPATION: ELECTION.  (a)  Effective September 1, 2022, a participating entity may elect to discontinue the entity's participation in the program by providing written notice to the trustee not later than December 31 of the year preceding the first day of the plan year in which the election will be effective.(b)  A participating entity that elects to discontinue participation in the program under Subsection (a) may not elect to:(1)  participate in the program until the fifth anniversary of the effective date of the entity's election to discontinue participation; or(2)  discontinue the entity's participation after an election described by Subdivision (1) until the fifth anniversary of the effective date of that election.(c)  Effective September 1, 2022, an entity that elects to participate in the program shall provide written notice to the trustee not later than December 31 of the year preceding the first day of the plan year in which the election will be effective.  The entity may not elect to discontinue the entity's participation until the fifth anniversary of the effective date of the entity's election to participate.(d)  The trustee by rule shall prescribe the time and manner for making an election under this section and may adopt rules necessary to administer this section.|Added by Acts 2021, 87th Leg., R.S., Ch. 399 (S.B. 1444), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1579.201 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter E. Participation by Employee|Section 1579.201. Definition

Sec. 1579.201.  DEFINITION.  In this subchapter, "full-time employee" and "part-time employee" have the meanings assigned by rules adopted by the trustee.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.202 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter E. Participation by Employee|Section 1579.202. Eligible Employees

Sec. 1579.202.  ELIGIBLE EMPLOYEES.  (a)  Except as provided by Section 1579.204, participation in the program is limited to employees of participating entities who are full-time employees and to part-time employees who are participating members in the Teacher Retirement System of Texas.(b)  An employee described by Subsection (a) who applies for coverage during an open enrollment period prescribed by the trustee is automatically covered by the catastrophic care coverage plan unless the employee:(1)  specifically waives coverage under this chapter;(2)  selects a higher tier coverage plan;  or(3)  is expelled from the program.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.203 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter E. Participation by Employee|Section 1579.203. Selection of Coverage

Sec. 1579.203.  SELECTION OF COVERAGE.  (a)  A participating employee may select coverage in any coverage plan offered by the trustee.(b)  The employee is not required to continue participation in the coverage plan initially selected and may select a higher or lower tier coverage plan than the plan initially selected by the employee in the manner provided by rules adopted by the trustee.(c)  If the combined contributions received from the state and the employing participating entity under Subchapter F exceed the cost of a coverage plan selected by the employee, the employee may use the excess amount of contributions to obtain coverage under a higher tier coverage plan or to pay all or part of the cost of coverage for the employee's dependents.(d)  A married couple, both of whom are eligible for coverage under the program, may pool the amount of contributions to which the couple are entitled under the program to obtain coverage for themselves and dependent coverage.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.204 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter E. Participation by Employee|Section 1579.204. Certain Part-Time Employees

Sec. 1579.204.  CERTAIN PART-TIME EMPLOYEES.  A part-time employee of a participating entity who is not a participating member in the Teacher Retirement System of Texas is eligible to participate in the program only if the employee pays all of the premiums and other costs associated with the health coverage plan selected by the employee.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.205 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter E. Participation by Employee|Section 1579.205. Payment by Participating Entity

Sec. 1579.205.  PAYMENT BY PARTICIPATING ENTITY.  Notwithstanding Section 1579.204, a participating entity may pay any portion of what otherwise would be the employee share of premiums and other costs associated with the coverage selected by the employee.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.251 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter F. Contributions|Section 1579.251. State Assistance

Sec. 1579.251.  STATE ASSISTANCE.  (a)  The state shall assist employees of participating school districts and charter schools in the purchase of group health coverage under this chapter by providing for each covered employee the amount of $900 each state fiscal year or a greater amount as provided by the General Appropriations Act.  The state contribution shall be distributed through the school finance formulas under Chapters 48 and 49, Education Code, and used by school districts and charter schools as provided by Section 48.275, Education Code.(b)  The state shall assist employees of participating regional education service centers and educational districts described by Section 1579.002(5)(B) in the purchase of group health coverage under this chapter by providing to the employing service center or educational district, for each covered employee, the amount of $900 each state fiscal year or a greater amount as provided by the General Appropriations Act.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1328 (H.B. 3646), Sec. 83, eff. September 1, 2009.Acts 2019, 86th Leg., R.S., Ch. 943 (H.B. 3), Sec. 3.085, eff. September 1, 2019.|
TX Ins Code § 1579.252 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter F. Contributions|Section 1579.252. Contribution by Participating Entities

Sec. 1579.252.  CONTRIBUTION BY PARTICIPATING ENTITIES.  A participating entity shall make contributions for the program as provided by Chapter 1581.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.253 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter F. Contributions|Section 1579.253. Contribution by Employee

Sec. 1579.253.  CONTRIBUTION BY EMPLOYEE.  (a)  An employee covered by the program shall pay that portion of the cost of coverage selected by the employee that exceeds the amount of the state contribution under Section 1579.251 and the participating entity contribution under Section 1579.252.(b)  The employee may pay the employee's contribution under this subsection from the amount distributed to the employee under Subchapter D,  Chapter 22, Education Code.(c)  Notwithstanding Subsection (a), a participating entity may pay any portion of what otherwise would be the employee share of premiums and other costs associated with the coverage selected by the employee.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 18.04, eff. September 1, 2005.Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 52, eff. September 1, 2005.|
TX Ins Code § 1579.254 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter F. Contributions|Section 1579.254. Contributions Held in Trust for Fund

Sec. 1579.254.  CONTRIBUTIONS HELD IN TRUST FOR FUND.  A participating entity:(1)  shall hold contributions required by this subchapter in trust for the Texas school employees uniform group coverage trust fund and its participants; and(2)  may not divert the contributions for any other purpose.|Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 53, eff. September 1, 2005.|
TX Ins Code § 1579.255 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter F. Contributions|Section 1579.255. Interest Assessed on Late Payment of Contributions by Participating Entities

Sec. 1579.255.  INTEREST ASSESSED ON LATE PAYMENT OF CONTRIBUTIONS BY PARTICIPATING ENTITIES.  (a)  A participating entity that does not remit to the trustee all contributions required by this subchapter before the seventh day after the last day of the month shall pay to the Texas school employees uniform group coverage trust fund:(1)  the contributions; and(2)  interest on the unpaid amounts at the annual rate of six percent compounded monthly.(b)  On request, the trustee may grant a waiver of the deadline imposed by this section based on a participating entity's financial or technological resources.|Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 53, eff. September 1, 2005.|
TX Ins Code § 1579.301 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund|Section 1579.301. Fund; Administration

Sec. 1579.301.  FUND;  ADMINISTRATION.  The Texas school employees uniform group coverage trust fund is a trust fund with the comptroller.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.302 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund|Section 1579.302. Composition of Fund

Sec. 1579.302.  COMPOSITION OF FUND.  The fund is composed of:(1)  all contributions made to the fund under this chapter from employees, participating entities, and the state;(2)  contributions made by employees or participating entities for optional coverages;(3)  investment income;(4)  any additional amounts appropriated by the legislature for contingency reserves, administrative expenses, or other expenses;  and(5)  any other money required or authorized to be paid into the fund.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.303 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund|Section 1579.303. Payments From Fund

Sec. 1579.303.  PAYMENTS FROM FUND.  The trustee may use amounts in the fund only to provide group coverages under this chapter and to pay the expenses of administering the program.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1579.304 (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 1579 - Texas School Employees Uniform Group Health Coverage|Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund|Section 1579.304. Investment of Fund

Sec. 1579.304.  INVESTMENT OF FUND.  The trustee may invest assets of the fund in the manner provided by Section 67(a)(3), Article XVI, Texas Constitution.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|
TX Ins Code § 1581.001 (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 1581 - Employer Expenditures for School Employee Health Coverage Plans|Subchapter A. General Provisions|Section 1581.001. Definitions

Sec. 1581.001.  DEFINITIONS.  In this chapter:(1)  "Participating employee" means an employee of a school district, other educational district whose employees are members of the Teacher Retirement System of Texas, participating charter school, or regional education service center who participates in a group health coverage plan provided by or through the district, school, or service center.(2)  "Participating charter school" means an open-enrollment charter school established under Subchapter D, Chapter 12, Education Code, that participates in the uniform group coverage program established under Chapter 1579.(3)  "Regional education service center" means a regional education service center established under Chapter 8, Education Code.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.|