reglab/housing_qa huggingface dataset:
TX Ins Code § 1551.217 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.217. Use of Employee's Salary in Computation of Premium or Coverage

Sec. 1551.217.  USE OF EMPLOYEE'S SALARY IN COMPUTATION OF PREMIUM OR COVERAGE.  (a)  If the board of trustees establishes a group coverage plan that protects against either long-term or short-term loss of salary, the board may use an employee's annual salary in computing the amount of the employee's premium or coverage, or both, under the plan.(b)  In this section, an employee's annual salary includes benefit replacement pay under Subchapter H, Chapter 659, Government Code, as added by Chapter 417, Acts of the 74th Legislature, Regular Session, 1995.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.|
TX Ins Code § 1551.218 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.218. Prior Authorization for Certain Drugs

Sec. 1551.218.  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 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drug;(3)  an anti-inflammatory drug;(4)  an antihistamine drug;  and(5)  an antidepressant drug.(c)  Repealed by Acts 2009, 81st Leg., R.S., Ch. 1308, Sec. 41(8), eff. September 1, 2009.|Added by Acts 2003, 78th Leg., ch. 213, Sec. 2, eff. Sept. 1, 2003.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 41(8), eff. September 1, 2009.|
TX Ins Code § 1551.2181 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.2181. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services

Sec. 1551.2181.  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. 1, eff. September 1, 2021.|
TX Ins Code § 1551.219 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.219. Disease Management Services

Sec. 1551.219.  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 board of trustees identifies populations requiring disease management.(b)  A group health benefit plan offered under the group benefits program must provide disease management services or coverage for disease management services in the manner required by the board of trustees, 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. 3, eff. June 20, 2003.|
TX Ins Code § 1551.220 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.220. Beneficiary Causing Death of Participant or Beneficiary of Participant

Sec. 1551.220.  BENEFICIARY CAUSING DEATH OF PARTICIPANT OR BENEFICIARY OF PARTICIPANT.  (a)  Any benefits, funds, or account balances payable on the death of a participant or the beneficiary of a participant in the group benefits program may not be paid to a person convicted of or adjudicated as having caused that death but instead are payable as if the convicted person had predeceased the decedent.(b)  The Employees Retirement System of Texas is not required to change the recipient of any benefits, funds, or account balances under this section unless it receives actual notice of the conviction or adjudication of a beneficiary.  However, the retirement system may delay payment of any benefits, funds, or account balances payable on the death of a participant or beneficiary of a participant pending the results of a criminal investigation or civil proceeding and other legal proceedings relating to the cause of death.(c)  For the purposes of this section, a person has been convicted of or adjudicated as having caused the death of a participant or beneficiary of a participant if the person:(1)  pleads guilty or nolo contendere to, or is found guilty by a court or jury in a criminal proceeding of, causing the death of the participant or beneficiary of a participant, regardless of whether sentence is imposed or probated, and no appeal of the conviction is pending and the time provided for appeal has expired; or(2)  is found liable by a court or jury in a civil proceeding for causing the death of the member or annuitant and no appeal of the judgment is pending and the time provided for appeal has expired.|Added by Acts 2005, 79th Leg., Ch. 347 (S.B. 1176), Sec. 27, eff. September 1, 2005.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 19, eff. September 1, 2011.|
TX Ins Code § 1551.222 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.222. Incentive Payments

Sec. 1551.222.  INCENTIVE PAYMENTS.  (a)  The board of trustees may allow an incentive payment under this section to an employee or annuitant who elects to waive coverage under the basic coverage plan for employees or annuitants as provided by Section 1551.1045(b) or (c).(b)  The incentive payment authorized by this section is in the amount authorized by the General Appropriations Act and may be used by the employee or annuitant, in the manner prescribed by the board of trustees, only to pay for other group coverage plans provided under the group benefits program, including the supplemental health coverage offered under Section 1551.221.(c)  The board of trustees, at the time of initial enrollment in the group benefits program and during subsequent open-enrollment periods, shall inform employees and annuitants that they may make an election described by Subsection (a), if eligible, and receive any authorized incentive payment.|Added by Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 4.03, eff. August 29, 2005.|
TX Ins Code § 1551.224 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.224. Mail Order Requirement for Prescription Drug Coverage Prohibited

Sec. 1551.224.  MAIL ORDER REQUIREMENT FOR PRESCRIPTION DRUG COVERAGE PROHIBITED.  (a)  The board of trustees or a health benefit plan under this chapter that provides benefits for prescription drugs may not require a participant in the group benefits program to purchase a prescription drug through a mail order program.(b)  Except as provided by Subsection (c), the board of trustees or a health benefit plan shall require that a participant who chooses to obtain a prescription drug through a retail pharmacy or other method other than by mail order pay a deductible, copayment, coinsurance, or other cost-sharing obligation to cover the additional cost of obtaining a prescription drug through that method rather than by mail order.(c)  The board of trustees or a health benefit plan may not require a participant who obtains a multiple-month supply of a prescription drug from a retail pharmacy under Section 1560.003 to pay a deductible, copayment, coinsurance, or other cost-sharing obligation that differs from the amount the participant pays for a multiple-month supply of that drug through a mail order program.|Added by Acts 2003, 78th Leg., ch. 213, Sec. 2, eff. Sept. 1, 2003.Renumbered from Insurance Code, Section 1551.219 by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 17.001(52), eff. September 1, 2007.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1207 (S.B. 704), Sec. 4, eff. September 1, 2009.|
TX Ins Code § 1551.225 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.225. Bariatric Surgery Coverage

Sec. 1551.225.  BARIATRIC SURGERY COVERAGE.  (a)  The board of trustees shall develop a cost-neutral or cost-positive plan for providing under the group benefits program bariatric surgery coverage for employees eligible to participate in the program under Section 1551.101.(b)  The board of trustees may adopt rules as necessary to implement this section.|Added by Acts 2009, 81st Leg., R.S., Ch. 1270 (H.B. 1290), Sec. 2, eff. September 1, 2009.Added by Acts 2009, 81st Leg., R.S., Ch. 1399 (S.B. 2577), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1551.226 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.226. Tobacco Cessation Coverage

Sec. 1551.226.  TOBACCO CESSATION COVERAGE.  (a)  The board of trustees shall develop a plan for providing under any health benefit plan provided under the group benefits program tobacco cessation coverage for participants.(b)  The plan developed under Subsection (a) must include coverage for prescription drugs that aid participants in ceasing the use of tobacco products.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 20, eff. September 1, 2011.|
TX Ins Code § 1551.227 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.227. Tricare Military Health System Supplemental Plan

Sec. 1551.227.  TRICARE MILITARY HEALTH SYSTEM SUPPLEMENTAL PLAN.  (a)  The board of trustees shall make available a TRICARE Military Health System supplemental plan to an employee or annuitant who waives coverage under the basic coverage plan under Section 1551.1045 and is eligible for benefits under the TRICARE Military Health System.  The board of trustees may not contribute to the cost of the supplemental plan, including the premium cost.(b)  A plan offered under this section must be considered a permissible offering to TRICARE participants and beneficiaries under 10 U.S.C. Section 1097c.(c)  The board of trustees may adopt rules necessary to implement this section, including rules regarding eligibility for the plan, available insurance products, and enrollment in the plan.|Added by Acts 2015, 84th Leg., R.S., Ch. 807 (H.B. 3307), Sec. 1, eff. June 17, 2015.|
TX Ins Code § 1551.228 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.228. Emergency Care Payments

Sec. 1551.228.  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 benefits 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 a participant in, and the participant does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the participant'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. 1.12, eff. September 1, 2019.|
TX Ins Code § 1551.229 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.229. Out-of-Network Facility-Based Provider Payments

Sec. 1551.229.  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 benefits program shall pay for a covered health care or medical service performed for or a covered supply related to that service provided to a participant 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 a participant receiving a health care or medical service or supply described by Subsection (b) in, and the participant does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the participant'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 a participant 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 participant that:(A)  explains that the provider does not have a contract with the participant's managed care plan;(B)  discloses projected amounts for which the participant may be responsible; and(C)  discloses the circumstances under which the participant would be responsible for those amounts.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.12, eff. September 1, 2019.|
TX Ins Code § 1551.230 (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 1551 - Texas Employees Group Benefits Act|Subchapter E. Group Coverages|Section 1551.230. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments

Sec. 1551.230.  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 benefits program shall pay for a covered health care or medical service performed for or a covered supply related to that service provided to a participant 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 a participant receiving a health care or medical service or supply described by Subsection (b) in, and the participant does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the participant'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 a participant 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 participant that:(A)  explains that the provider does not have a contract with the participant's managed care plan;(B)  discloses projected amounts for which the participant may be responsible; and(C)  discloses the circumstances under which the participant would be responsible for those amounts.|Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.12, eff. September 1, 2019.|
TX Ins Code § 1551.251 (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 1551 - Texas Employees Group Benefits Act|Subchapter F. Group Life and Accidental Death and Dismemberment Insurance Coverage Plan|Section 1551.251. Group Life Insurance Coverage Plan

Sec. 1551.251.  GROUP LIFE INSURANCE COVERAGE PLAN.  (a)  The board of trustees shall administer a group life insurance coverage plan to provide each individual eligible to participate in the group benefits program under Section 1551.101 or 1551.102 group life coverages that provide payments and benefits in an amount and manner the board determines.(b)  The group life insurance coverage plan is subject to the conditions and limitations of:(1)  this chapter and rules adopted under this chapter;  and(2)  the policy or policies purchased by the board of trustees.(c)  The board of trustees may include the dependents of individuals eligible to participate in the group benefits program under Section 1551.101 or 1551.102 in the group life insurance coverage plan.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.|
TX Ins Code § 1551.252 (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 1551 - Texas Employees Group Benefits Act|Subchapter F. Group Life and Accidental Death and Dismemberment Insurance Coverage Plan|Section 1551.252. Additional Term Life Insurance

Sec. 1551.252.  ADDITIONAL TERM LIFE INSURANCE.  Notwithstanding any other provision of this code, the board of trustees may authorize:(1)  dependent term life insurance in an amount equal to the term life insurance provided under the basic coverage;  and(2)  optional term life insurance in an amount equal to four times the employee's annual salary plus the amount of term life insurance provided under the basic coverage.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.|
TX Ins Code § 1551.253 (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 1551 - Texas Employees Group Benefits Act|Subchapter F. Group Life and Accidental Death and Dismemberment Insurance Coverage Plan|Section 1551.253. Determination of Annual Salary

Sec. 1551.253.  DETERMINATION OF ANNUAL SALARY.  (a)  To implement this subchapter, the board of trustees shall:(1)  adopt rules for the conversion of other than annual rates of salary;  and(2)  specify the types of pay included in annual salary and any other matter necessary to implement this subchapter.(b)  For the purpose of determining the amount of an employee's optional term life insurance coverage, an employee's annual salary includes benefit replacement pay under Subchapter H, Chapter 659, Government Code, as added by Chapter 417, Acts of the 74th Legislature, Regular Session, 1995.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.|