reglab/housing_qa huggingface dataset:
TX Ins Code § 1575.172 (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 1575.172. Out-of-Network Facility-Based Provider Payments

Sec. 1575.172.  OUT-OF-NETWORK FACILITY-BASED PROVIDER PAYMENTS.  (a)  In this section, "facility-based provider" means a physician or health care provider who provides health care or medical services to patients of a health care facility.(b)  Except as provided by Subsection (d), the administrator of a managed care plan provided under the group program 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 facility-based provider at the usual and customary rate or at an agreed rate if the provider performed the service at a health care facility that is 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 facility-based 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. 1.15, eff. September 1, 2019.|
TX Ins Code § 1575.173 (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 1575.173. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments

Sec. 1575.173.  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 the group program 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, the 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. 1.15, eff. September 1, 2019.|
TX Ins Code § 1575.201 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter E. Contributions|Section 1575.201. Additional State Contributions; Certain Contributions

Sec. 1575.201.  ADDITIONAL STATE CONTRIBUTIONS;  CERTAIN CONTRIBUTIONS.(a)  The state through the trustee shall contribute from money in the fund an amount prescribed by the General Appropriations Act to cover all or part of the cost for each retiree, surviving spouse, and surviving dependent child enrolled in a health benefit plan offered under the group program.(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(6), eff. September 1, 2017.(c)  The trustee may spend a part of the money received for the group program to offset a part of the costs for dependent coverage if the group program is projected to remain financially solvent during the currently funded biennium.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 201, Sec. 51, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 5, eff. Sept. 1, 2004;  Acts 2003, 78th Leg., ch. 1276, Sec. 10A.432, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 18, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(6), eff. September 1, 2017.|
TX Ins Code § 1575.202 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter E. Contributions|Section 1575.202. State Contribution Based on Active Employee Compensation

Sec. 1575.202.  STATE CONTRIBUTION BASED ON ACTIVE EMPLOYEE COMPENSATION.  (a)  Each state fiscal year, the state shall contribute to the fund an amount equal to 1.25 percent of the salary of each active employee.(b)  The state may contribute to the fund an amount in addition to the contribution required by Subsection (a).|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 201, Sec. 52, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 6, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 19, eff. September 1, 2017.|
TX Ins Code § 1575.203 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter E. Contributions|Section 1575.203. Active Employee Contribution

Sec. 1575.203.  ACTIVE EMPLOYEE CONTRIBUTION.  (a)  Each state fiscal year, each active employee shall, as a condition of employment, contribute to the fund an amount equal to 0.65 percent of the employee's salary.(b)  The employer of an active employee shall monthly:(1)  deduct the employee's contribution from the employee's salary and remit the contribution to the trustee in the manner required by the trustee;  or(2)  assume and pay the total contributions due from its active employees.(c)  Contributions to the fund deducted from the salary of an active employee are included in annual compensation for purposes of the Teacher Retirement System of Texas.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 201, Sec. 53, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 366, Sec. 3.02, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 7, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1276, Sec. 10A.433, eff. Sept. 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 17.02, eff. September 1, 2005.Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 41, eff. September 1, 2005.|
TX Ins Code § 1575.204 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter E. Contributions|Section 1575.204. Public School Contribution

Sec. 1575.204.  PUBLIC SCHOOL CONTRIBUTION.  (a)  Each state fiscal year, each public school shall contribute to the fund the amount prescribed by the General Appropriations Act, which may not be less than 0.25 percent or greater than 0.75 percent of the salary of each active employee of the public school.  The public school shall make the contributions on a monthly basis and as otherwise prescribed by the trustee.(b)  Each state fiscal year, each employer who reports to the retirement system under Section 824.6022, Government Code, the employment of a retiree who is enrolled in and receiving coverage under the group program shall contribute to the fund an amount established by the trustee.  In determining the amount to be contributed by the employer under this subsection, the trustee shall consider the amount a retiree is required to pay for the retiree and any enrolled dependents to participate in the group program and the cost of all retirees' and enrolled dependents' participation in the group program.  If more than one employer reports the retiree to the retirement system during a month, the amount of the contribution required by this subsection shall be prorated among the employers.  The amounts required to be paid under this subsection are not required to be paid by a reporting employer for a retiree who retired from the retirement system before September 1, 2005.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 201, Sec. 54, eff. Sept. 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 42, eff. September 1, 2005.Acts 2007, 80th Leg., R.S., Ch. 1389 (S.B. 1846), Sec. 4, eff. September 1, 2007.Acts 2015, 84th Leg., R.S., Ch. 1102 (H.B. 2974), Sec. 8, eff. September 1, 2015.|
TX Ins Code § 1575.206 (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 E. Contributions|Section 1575.206. Contributions Held in Trust for Fund

Sec. 1575.206.  CONTRIBUTIONS HELD IN TRUST FOR FUND.  An employing public school and its governing body:(1)  hold contributions required by this subchapter in trust for the fund and its participants; and(2)  may not divert the contributions for any other purpose.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 455 (S.B. 1667), Sec. 22, eff. September 1, 2011.|
TX Ins Code § 1575.207 (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 E. Contributions|Section 1575.207. Interest Assessed on Late Payment of Deposits by Employing Public Schools

Sec. 1575.207.  INTEREST ASSESSED ON LATE PAYMENT OF DEPOSITS BY EMPLOYING PUBLIC SCHOOLS.  (a)  An employing public school 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 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 an employing public school's financial or technological resources.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.435(a), eff. Sept. 1, 2003.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 455 (S.B. 1667), Sec. 23, eff. September 1, 2011.|
TX Ins Code § 1575.208 (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 E. Contributions|Section 1575.208. Certification of Amount Necessary to Pay State Contributions

Sec. 1575.208.  CERTIFICATION OF AMOUNT NECESSARY TO PAY STATE CONTRIBUTIONS.  Not later than October 31 preceding each regular session of the legislature, the trustee shall certify the amount necessary to pay the state contributions to the fund to:(1)  the Legislative Budget Board;  and(2)  the budget division of the governor's office.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436, eff. Sept. 1, 2003.|
TX Ins Code § 1575.209 (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 E. Contributions|Section 1575.209. Certification of Amount of State Contributions

Sec. 1575.209.  CERTIFICATION OF AMOUNT OF STATE CONTRIBUTIONS.  Not later than August 31 of each year, the trustee shall certify to the comptroller the estimated amount of state contributions to be received by the fund for the next fiscal year under the appropriations authorized by this chapter.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436, eff. Sept. 1, 2003.|
TX Ins Code § 1575.210 (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 E. Contributions|Section 1575.210. Payment of State Contributions; Reconciliation

Sec. 1575.210.  PAYMENT OF STATE CONTRIBUTIONS;  RECONCILIATION.  (a)  Contributions allocated and appropriated under this subchapter for a state fiscal year shall be:(1)  paid in equal monthly installments;(2)  based on the estimated amount certified by the trustee to the comptroller for that year; and(3)  subject to any express limitations specified in the Act making the appropriation.(b)  A variation between the certified amount and the actual amount due for the state fiscal year shall be reconciled at the end of the fiscal year, and the annual contributions to the fund shall be adjusted accordingly.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.437, eff. Sept. 1, 2003.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 20, eff. September 1, 2017.|
TX Ins Code § 1575.211 (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 E. Contributions|Section 1575.211. Cost Sharing

Sec. 1575.211.  COST SHARING.  (a)  The total costs for the operation of the group program shall be shared among the state, the public schools, the active employees, the retirees, the surviving spouses, and the surviving dependent children in the manner prescribed by the General Appropriations Act.(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(8), eff. September 1, 2017.(c)  Repealed by Acts 2005, 79th Leg., Ch. 1359, Sec. 55(a)(2), eff. September 1, 2005.|Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.  Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.08, eff. Sept. 1, 2004.Amended by: Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 55(a)(2), eff. September 1, 2005.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 21, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(8), eff. September 1, 2017.|
TX Ins Code § 1575.212 (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 E. Contributions|Section 1575.212. Payment by Retirees; Ranges

Sec. 1575.212.  PAYMENT BY RETIREES;  RANGES.(a)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(9), eff. September 1, 2017.(a-1)  The trustee shall establish and collect payments for the share of total costs allocated under Section 1575.211 to retirees, surviving spouses, and surviving dependent children.(b)  In establishing the payments under Subsection (a-1), the trustee may consider various factors, including an enrollee's Medicare status, health benefit plan election, and dependent coverage.|Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.Amended by: Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 22, eff. September 1, 2017.Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(9), eff. September 1, 2017.|
TX Ins Code § 1575.213 (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 E. Contributions|Section 1575.213. Certain Disability Retirees

Sec. 1575.213.  CERTAIN DISABILITY RETIREES.  An individual who is eligible as a retiree under Section 1575.004(a)(3) shall pay an additional premium in an amount determined by the trustee. The amount of the premium may not exceed the total cost, as determined by the trustee, attributable to the participation of that retiree and the dependents of that retiree during the period the individual is eligible as a retiree under Section 1575.004(a)(3).|Added by Acts 2007, 80th Leg., R.S., Ch. 1230 (H.B. 2427), Sec. 16, eff. September 1, 2007.|
TX Ins Code § 1575.251 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter F. Federal or Private Source Contributions|Section 1575.251. Definition

Sec. 1575.251.  DEFINITION.  In this subchapter, "employer" has the meaning assigned by Section 821.001, Government Code.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.|
TX Ins Code § 1575.252 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter F. Federal or Private Source Contributions|Section 1575.252. Application by Employer for Money to Pay State Contributions

Sec. 1575.252.  APPLICATION BY EMPLOYER FOR MONEY TO PAY STATE CONTRIBUTIONS.  An employer who applies for money provided by the United States or a privately sponsored source shall:(1)  if any of the money will pay part or all of an active employee's salary, also apply for any legally available money to pay state contributions required by Subchapter E;  and(2)  immediately send any money received for state contributions as a result of the application to the trustee for deposit in the fund.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438, eff. Sept. 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1223 (H.B. 2358), Sec. 3, eff. September 1, 2007.|
TX Ins Code § 1575.253 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter F. Federal or Private Source Contributions|Section 1575.253. Monthly Certification

Sec. 1575.253.  MONTHLY CERTIFICATION.  An employer shall monthly certify to the trustee in a form prescribed by the trustee:(1)  the total amount of salary paid from federal funds and private grants;  and(2)  the total amount of state contributions provided by the funds and grants.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438, eff. Sept. 1, 2003.|
TX Ins Code § 1575.254 (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 1575 - Texas Public School Employees Group Benefits Program|Subchapter F. Federal or Private Source Contributions|Section 1575.254. Monthly Maintenance of Information

Sec. 1575.254.  MONTHLY MAINTENANCE OF INFORMATION.  An employer shall monthly maintain:(1)  the name of each employee whose salary is paid wholly or partly from a grant;(2)  the source of the grant;(3)  the amount of the employee's salary paid from the grant;(4)  the amount of the money provided by the grant for state contributions for the employee;  and(5)  any other information the trustee determines is necessary to enforce this subchapter.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438, eff. Sept. 1, 2003.|