reglab/statecodes huggingface dataset:
2023 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 1551.211. Contingency Reserve Fund for Self-Funded Coverage

Sec. 1551.211.  CONTINGENCY RESERVE FUND FOR SELF-FUNDED COVERAGE.  (a)  Before the first day of each state fiscal biennium, the board of trustees shall estimate for an average 60-day period during the biennium the expenditures from the employees life, accident, and health insurance and benefits fund anticipated for self-funded coverage plans, considering projected claims and administrative expenses for those plans.
(b)  The board of trustees shall place the estimated amount in a contingency reserve fund to provide for adverse fluctuations in claims or administrative expenses.
(c)  The board of trustees shall include in each request for legislative appropriations to the group benefits program the amount the board determines to be necessary to maintain the contingency reserve fund at the level required by this section.
(d)  The board of trustees may invest and reinvest any portion of the contingency reserve fund under the standard of care provided by Section 815.307, Government Code, considering the functional need to provide for adverse fluctuations in claims or administrative expenses.
(e)  The interest on, earnings of, and proceeds from the sale of investments of assets in the contingency reserve fund shall be credited to the fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.212. Firms to Administer Self-Funded Coverage

Sec. 1551.212.  FIRMS TO ADMINISTER SELF-FUNDED COVERAGE.  (a)  For those coverage plans that the board of trustees funds from the employees life, accident, and health insurance and benefits fund, the board may contract with one or more qualified and experienced administering firms to administer the plans in the best interest of the participants in the group benefits program.
(b)  The contract may be awarded only after a competitive bid process.  The board of trustees is not required to select the lowest bid but shall take into consideration other relevant criteria, including ability to service large group programs and past experience.
(c)  If the board of trustees selects a firm whose bid was not the lowest or whose bid differs from that specified, the board shall fully justify and explain the reasons for the action in the minutes of the next meeting of the board.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.213. Bids for Purchased Coverage

Sec. 1551.213.  BIDS FOR PURCHASED COVERAGE.  (a)  For those coverage plans for which the board of trustees determines to purchase coverage, the board shall notify eligible carriers:
(1)  that competitive bidding will be conducted;  and
(2)  of the date by which an eligible carrier must submit a bid on the contract to the board.
(b)  The board of trustees shall submit the group coverages provided by the group benefits program for competitive bidding at least every six years.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.214. Selection of Bids for Purchased Coverage

Sec. 1551.214.  SELECTION OF BIDS FOR PURCHASED COVERAGE.  (a)  An actuary selected by the board of trustees shall advise the board as to the actuarial soundness of the bids received under Section 1551.213.
(b)  The board of trustees:
(1)  shall select carriers to provide services that will be in the best interest of participants;  and
(2)  is not required to select the lowest bid but shall take into consideration other relevant criteria, including ability to service contracts, past experience, and financial ability.
(c)  If the board of trustees selects a carrier whose bid differs from that advertised, the board shall record the deviation and shall fully justify and explain the reasons for the deviation in the minutes of the next meeting of the board.
(d)  The board of trustees shall notify the carriers that submitted bids of the results of the bidding.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.215. Accounting by Carrier Providing Purchased Coverage

Sec. 1551.215.  ACCOUNTING BY CARRIER PROVIDING PURCHASED COVERAGE.  (a)  A carrier providing a coverage purchased under this chapter shall provide an accounting to the board of trustees not later than the 90th day after the end of each plan year.
(b)  The accounting must be in a form approved by the board of trustees.
(c)  The accounting must state for the period from the coverage's date of issue to the end of the plan year:
(1)  the amounts of contributions accrued under the coverage;
(2)  the total of mortality and other claims, charges, losses, and expenses incurred;  and
(3)  the amounts of the carrier's allowance for a reasonable profit and contingencies.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.216. Special Contingency Reserve

Sec. 1551.216.  SPECIAL CONTINGENCY RESERVE.  (a)  A carrier issuing a group coverage plan under this chapter shall hold as a special contingency reserve an amount that equals the amount by which the amount described by Section 1551.215(c)(1) exceeds the sum of the amounts described by Sections 1551.215(c)(2) and (3).
(b)  The carrier may use the special contingency reserve only for charges, claims, and expenses under the plan.
(c)  The special contingency reserve earns interest at a rate determined before each plan year by the carrier and approved by the board of trustees as consistent with the rates generally used by the carrier for similar funds held under other group coverage plans.
(d)  On a determination by the board of trustees that the special contingency reserve has attained an amount estimated by the board to make satisfactory provision for adverse fluctuations in future charges, claims, or expenses under the plan, any further excess shall be deposited to the credit of the employees life, accident, and health insurance and benefits fund.
(e)  On discontinuation of a plan, any balance remaining in the special contingency reserve after all charges have been made shall be deposited to the credit of the employees life, accident, and health insurance and benefits fund.  The carrier may make the deposit in equal monthly installments over a period of not more than two years.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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 1551.231. Out-of-Network Emergency Medical Services Provider Payments

Sec. 1551.231.  OUT-OF-NETWORK EMERGENCY MEDICAL SERVICES PROVIDER PAYMENTS.  (a)  In this section, "emergency medical services provider" has the meaning assigned by Section 773.003, Health and Safety Code, except that the term does not include an air ambulance.
(b)  Except as provided by Subsection (c), 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 or covered transport related to that service provided to, a participant by an out-of-network provider who is an emergency medical services provider at:
(1)  if the political subdivision has submitted the rate to the department under Section 38.006, the rate set, controlled, or regulated by the political subdivision in which:
(A)  the service originated; or
(B)  the transport originated if transport is provided; or
(2)  if the political subdivision has not submitted the rate to the department, the lesser of:
(A)  the provider's billed charge; or
(B)  325 percent of the current Medicare rate, including any applicable extenders and modifiers.
(c)  The administrator shall adjust a payment required by Subsection (b)(1) each plan year by increasing the payment by the lesser of the Medicare Inflation Index or 10 percent of the provider's previous calendar year rates.
(d)  The administrator shall make a payment required by this section 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.
(e)  An out-of-network provider who is an emergency medical services 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 or transport 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 is based on:
(1)  the amount initially determined payable by the administrator; or
(2)  if applicable, the modified amount as determined under the administrator's internal appeal process.
(f)  This section expires September 1, 2025.
Added by Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 10, eff. September 1, 2023.
2023 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.
2023 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.
2023 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.
2023 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 1551.254. Accelerated Life Insurance Benefits

Sec. 1551.254.  ACCELERATED LIFE INSURANCE BENEFITS.  (a)  In addition to exercising the authority granted under Subchapter B, Chapter 1111, the board of trustees may adopt rules to provide for payment of accelerated life insurance benefits to a terminally ill, terminally injured, or permanently disabled participant, including an annuitant participating in optional term life insurance coverage, in amounts that benefit the participant without increasing the cost of providing the benefits.
(b)  The amount of any payment of an accelerated benefit under a rule adopted under this section must be deducted from the amount that would otherwise be payable as a death benefit.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.255. Inclusion of Provisions for Viatical Settlements

Sec. 1551.255.  INCLUSION OF PROVISIONS FOR VIATICAL SETTLEMENTS.  (a)  In this section, "viatical settlement" has the meaning assigned to "life settlement contract" by Section 1111A.002.
(b)  The board of trustees shall adopt rules that require a group life insurance coverage plan established under this chapter to allow a participant in the plan to make, in conjunction with receipt of a viatical settlement, an irrevocable designation of beneficiary for part or all of the group life coverage benefits.
(c)  A viatical settlement is not valid for any coverage under the group benefits program unless the participant has a terminal illness or terminal injury, as defined by rules adopted by the board of trustees, at the time application for benefits is made.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1156 (H.B. 2277), Sec. 16, eff. September 1, 2011.
2023 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 1551.256. Optional Term Life Insurance Coverage After Retirement

Sec. 1551.256.  OPTIONAL TERM LIFE INSURANCE COVERAGE AFTER RETIREMENT.  (a)  A participant in the optional group term life insurance coverage plan may maintain optional term life insurance coverage after retirement in addition to basic term life insurance coverage after retirement.
(b)  The board of trustees may adopt rules to implement and administer Subsection (a).
(c)  Under Subsection (a), the participant may maintain an amount of optional term life insurance coverage on the participant's life on the date of retirement, not to exceed two times the participant's annual salary on the last September 1 before retirement and subject to benefit reduction factors based on age as determined by the board of trustees.
(d)  The board of trustees shall determine the premium rate for optional term life insurance coverage for annuitants under Subsection (a).  The rate must be comparable to the premium rate for optional term life insurance coverage for employees of the same age.
(e)  As an alternative to the optional term life insurance coverage plan, an annuitant may choose a minimum optional term life insurance coverage amount not subject to benefit reduction factors based on age, with a coverage amount and premium rate determined by the board of trustees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.257. Eligibility of Annuitant for Extended Insurance Benefits

Sec. 1551.257.  ELIGIBILITY OF ANNUITANT FOR EXTENDED INSURANCE BENEFITS.  An annuitant participating in optional term life insurance coverage is not eligible for premium-waived extended insurance benefits if the total disability begins after the date of retirement.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 1551.258. Termination of Accidental Death and Dismemberment Insurance Coverage on Retirement

Sec. 1551.258.  TERMINATION OF ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE COVERAGE ON RETIREMENT.  Without regard to the employee's age, accidental death and dismemberment insurance coverage ends on the employee's date of retirement.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.301. Funding of Basic Coverage

Sec. 1551.301.  FUNDING OF BASIC COVERAGE.  The board of trustees shall use the amount appropriated for employer contributions in the manner provided by this subchapter to fund the basic coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.3015. Cost Assessment for Certain Participants

Sec. 1551.3015.  COST ASSESSMENT FOR CERTAIN PARTICIPANTS.  Notwithstanding any other provision of law, the board of trustees may impose against an employer whose employees are not paid salaries from amounts appropriated by the General Appropriations Act and whose participation in the group benefits program begins after August 31, 2003, as a condition for participation in the program, a one-time assessment of administrative costs for participation of the employees and annuitants in the program, which may include the actuarial costs of including the group in the program and a participation premium determined by the board.  The board of trustees shall deposit all amounts recovered under this section in the employees life, accident, and health insurance and benefits fund.
Added by Acts 2003, 78th Leg., ch. 366, Sec. 2.08, eff. Sept. 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.302. Allocation of Employer Contributions

Sec. 1551.302.  ALLOCATION OF EMPLOYER CONTRIBUTIONS.  (a)  The board of trustees may equitably allocate to each health benefit plan the employer contributions that would be required to fund basic health coverage for participants in the plans to the extent funds are available.
(b)  In allocating the employer contributions among plans, the board of trustees shall consider the relevant risk characteristics of each plan's enrollment, including:
(1)  demographic variations in the use and cost of health care;  and
(2)  prevailing cost patterns in the area in which the plan operates.
(c)  The allocation must be reasonable and set in a manner that ensures participants a fair choice among health benefit plans providing a basic plan.
(d)  The contribution set for each participant must be within the total amount appropriated in the General Appropriations Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.303. Funding of Optional Coverages

Sec. 1551.303.  FUNDING OF OPTIONAL COVERAGES.  The board of trustees may allocate any employer contributions remaining after the basic coverage has been funded to fund optional coverages in any manner the board determines is appropriate.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.304. Funding of Voluntary Coverages

Sec. 1551.304.  FUNDING OF VOLUNTARY COVERAGES.  The board of trustees may not allocate any employer contributions to fund voluntary coverages.  Voluntary coverages may be funded only by participant contributions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.305. Cost of Basic Coverage Exceeding Employer Contributions

Sec. 1551.305.  COST OF BASIC COVERAGE EXCEEDING EMPLOYER CONTRIBUTIONS.  If the cost of the basic coverage for an individual eligible to participate in the group benefits program under Section 1551.101 or 1551.102 exceeds the amount of employer contributions allocated to fund the basic coverage, the state shall deduct from or reduce the monthly compensation of the participant or deduct from the retirement benefits of the participant, as applicable, an amount sufficient to pay the cost of the basic coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.306. Payment of Excess Cost Over Basic Coverage Contribution

Sec. 1551.306.  PAYMENT OF EXCESS COST OVER BASIC COVERAGE CONTRIBUTION.  (a)  The board of trustees shall apply the amount of any employer contribution for optional coverages to the excess of the cost of the basic and optional coverages for which an individual eligible to participate in the group benefits program under Section 1551.101 or 1551.102 applies over the basic coverage contribution.
(b)  Except as provided by Section 1551.309, if a participant applies for basic and optional coverages for which the cost exceeds the employer contributions for those coverages under this chapter, the participant shall authorize in a form and manner satisfactory to the board of trustees a deduction from the participant's monthly compensation or monthly annuity equal to the difference between:
(1)  the cost of basic and optional coverages for which the participant applies;  and
(2)  the employer contributions for basic and optional coverages.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.307. Payment for Voluntary Coverages

Sec. 1551.307.  PAYMENT FOR VOLUNTARY COVERAGES.  Except as provided by Section 1551.309, if an individual eligible to participate in the group benefits program under Section 1551.101 or 1551.102 applies for voluntary coverages, the participant shall authorize in a form and manner satisfactory to the board of trustees a deduction from the participant's monthly compensation or monthly annuity equal to the cost of the voluntary coverages.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 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 G. Contributions and Costs › Section 1551.3075. Tobacco User Premium Differential

Sec. 1551.3075.  TOBACCO USER PREMIUM DIFFERENTIAL.  (a)  The board of trustees shall assess each participant in a health benefit plan provided under the group benefits program who uses one or more tobacco products a tobacco user premium differential, to be paid in monthly installments.  Except as provided by Subsection (b), the board of trustees shall determine the amount of the monthly installments of the premium differential.
(b)  If the General Appropriations Act for a state fiscal biennium sets the amount of the monthly installments of the tobacco user premium differential for that biennium, the board of trustees shall assess the premium differential during that biennium in the amount prescribed by the General Appropriations Act.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 21, eff. September 1, 2011.
2023 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 G. Contributions and Costs › Section 1551.3076. Employer Enrollment Fee

Sec. 1551.3076.  EMPLOYER ENROLLMENT FEE.  (a)  The board of trustees shall assess each employer whose employees participate in the group benefits program an employer enrollment fee in an amount not to exceed a percentage of the employer's total payroll, as determined by the General Appropriations Act.
(b)  The board of trustees shall deposit the enrollment fees to the credit of the employees life, accident, and health insurance and benefits fund to be used for the purposes specified by Section 1551.401.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 22, eff. September 1, 2011.
2023 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 G. Contributions and Costs › Section 1551.308. No Contribution on Refusal of Coverage

Sec. 1551.308.  NO CONTRIBUTION ON REFUSAL OF COVERAGE.  The state and a state agency may not make any contribution to the cost of any coverages or benefits provided under this chapter for an individual who refuses the coverages or benefits in a form and manner satisfactory to the board of trustees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.