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 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.158. Group Health Benefit Plans

Sec. 1575.158.  GROUP HEALTH BENEFIT PLANS.  (a)  The trustee shall establish or contract for and make available under the group program a high deductible health plan for retirees, dependents, surviving spouses, or surviving dependent children who are eligible under Section 1575.1582.
(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(3), eff. September 1, 2017.
(c)  The trustee shall establish or contract for and make available under the group program a Medicare Advantage plan and a Medicare prescription drug plan for retirees, dependents, surviving spouses, and surviving dependent children who are eligible under Section 1575.1582.
(d)  Notwithstanding Subsection (c), if the trustee determines that a Medicare Advantage plan or a Medicare prescription drug plan is no longer appropriate for the group program, the trustee may establish or contract for and make available under the group program other health benefit plans to provide medical or pharmacy benefits.
(e)  To the extent the group program has available funds, the trustee shall consider implementing a plan design for non-Medicare eligible enrollees in the high deductible health plan established or made available under Subsection (a) that provides assistance in the payment of preventive care, including generic preventive maintenance medications, in a manner that is consistent with federal law.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.430, eff. Sept. 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 1214 (S.B. 1458), Sec. 9, eff. September 1, 2014.
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 10, eff. September 1, 2017.
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 11, eff. September 1, 2017.
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 24(3), eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.1582. Eligibility for Group Health Benefit Plans

Sec. 1575.1582.  ELIGIBILITY FOR GROUP HEALTH BENEFIT PLANS.  (a)  A retiree, dependent, surviving spouse, or surviving dependent child who is not eligible to enroll in Medicare is eligible to enroll in a high deductible health plan offered under the group program, subject to any other applicable eligibility requirements, including requirements established by the trustee, but is not eligible to enroll in another health benefit plan offered under the group program.
(b)  A retiree, dependent, surviving spouse, or surviving dependent child who is eligible to enroll in Medicare is eligible to enroll in a Medicare Advantage plan or a Medicare prescription drug plan offered under the group program, subject to any other applicable eligibility requirements, including requirements established by the trustee, but is not eligible to enroll in another health benefit plan offered under the group program unless authorized by Subsection (c).
(c)  If the trustee makes another health benefit plan available under Section 1575.158(d), any individual otherwise eligible under this section to enroll in a Medicare Advantage plan or Medicare prescription drug plan is eligible to enroll in that health benefit plan.
Added by Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 12, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.159. Coverage for Prostate-Specific Antigen Test

Sec. 1575.159.  COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN TEST.  A health benefit plan offered under the group program, other than a Medicare Advantage plan or a Medicare prescription drug plan, must provide coverage for a medically accepted prostate-specific antigen test used for the detection of prostate cancer for each male enrolled in the health benefit plan who:
(1)  is at least 50 years of age; or
(2)  is at least 40 years of age and:
(A)  has a family history of prostate cancer; or
(B)  exhibits another cancer risk factor.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 13, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.160. Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim

Sec. 1575.160.  GROUP LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE:  PAYMENT OF CLAIM.  The amount of group life insurance or group accidental death and dismemberment insurance covering a retiree, dependent, surviving spouse, or surviving dependent child on the date of death shall be paid, on the establishment of a valid claim, only to:
(1)  the beneficiary designated by the person in a signed and witnessed document received before death in the office of the trustee;  or
(2)  a person in the order prescribed by Section 824.103(b), Government Code, if a beneficiary is not properly designated or a beneficiary does not exist.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.431(a), eff. Sept. 1, 2003.
2023 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 1575.1601. Group Benefits for Dental and Vision Care

Sec. 1575.1601.  GROUP BENEFITS FOR DENTAL AND VISION CARE.  The trustee shall establish or contract for and make available under the group program the following plans for retirees, dependents, surviving spouses, and surviving dependent children:
(1)  an optional plan that provides coverage for dental care; and
(2)  an optional plan that provides coverage for vision care.
Added by Acts 2023, 88th Leg., R.S., Ch. 955 (S.B. 1854), Sec. 1, eff. September 1, 2023.
For expiration of Subsections (b) and (c), see Subsection (c).
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.161. Enrollment Periods

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

Sec. 1575.162.  SPECIAL ENROLLMENTS.  This chapter does not limit the ability of an individual to enroll in the group program if the individual:
(1)  experiences a special enrollment event as provided by the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)), as amended;  and
(2)  is otherwise eligible to enroll in the group program.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.163. Limitations

Sec. 1575.163.  LIMITATIONS.  The Teacher Retirement System of Texas, as trustee, may not contract for or provide a health benefit plan that excludes from participation in the network a general hospital that:
(1)  is located in the geographical service area or areas of the health coverage plan that includes a county that:
(A)  has a population of at least 100,000 and not more than 233,500; and
(B)  is located in the Texas-Louisiana border region, as that term is defined in Section 2056.002(e), Government Code; and
(2)  agrees to provide medical and health care services under the plan subject to the same terms and conditions as other hospital providers under the plan.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1163 (H.B. 2702), Sec. 57, eff. September 1, 2011.
Acts 2023, 88th Leg., R.S., Ch. 644 (H.B. 4559), Sec. 117, 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.164. Disease Management Services

Sec. 1575.164.  DISEASE MANAGEMENT SERVICES.  (a)  In this section, "disease management services" means services to assist an individual manage a disease or other chronic health condition, such as heart disease, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS, and with respect to which the Teacher Retirement System of Texas identifies populations requiring disease management.
(b)  A health benefit plan provided under this chapter, other than a Medicare Advantage plan or a Medicare prescription drug plan, must provide disease management services or coverage for disease management services in the manner required by the Teacher Retirement System of Texas, including:
(1)  patient self-management education;
(2)  provider education;
(3)  evidence-based models and minimum standards of care;
(4)  standardized protocols and participation criteria; and
(5)  physician-directed or physician-supervised care.
Added by Acts 2003, 78th Leg., ch. 589, Sec. 4, eff. June 20, 2003.
Renumbered from Insurance Code, Section 1575.162 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(62), eff. September 1, 2005.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 16, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.170. Prior Authorization for Certain Drugs

Sec. 1575.170.  PRIOR AUTHORIZATION FOR CERTAIN DRUGS.  (a)  In this section, "drug formulary" means a list of drugs preferred for use and eligible for coverage under a health benefit plan.
(b)  A health benefit plan provided under this chapter, other than a Medicare Advantage plan or a Medicare prescription drug plan, that uses a drug formulary in providing a prescription drug benefit must require prior authorization for coverage of the following categories of prescribed drugs if the specific drug prescribed is not included in the formulary:
(1)  a gastrointestinal drug;
(2)  a cholesterol-lowering drug;
(3)  an anti-inflammatory drug;
(4)  an antihistamine; and
(5)  an antidepressant drug.
(c)  Repealed by Acts 2013, 83rd Leg., R.S., Ch. 1312, Sec. 99(27), eff. September 1, 2013.
Added by Acts 2003, 78th Leg., ch. 213, Sec. 3, eff. Sept. 1, 2003.  Renumbered from Insurance Code Sec. 1575.161 by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.07, eff. Jan. 11, 2004.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 99(27), eff. September 1, 2013.
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 17, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.1701. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services

Sec. 1575.1701.  EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND HEALTH CARE PROVIDERS PROVIDING CERTAIN HEALTH CARE SERVICES.  A preauthorization process used by a health benefit plan provided under this chapter is subject to the same limitations and requirements provided by Subchapter N, Chapter 4201, for a preauthorization process used by an insurer.
Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 2, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter D. Coverages and Participation › Section 1575.171. Emergency Care Payments

Sec. 1575.171.  EMERGENCY CARE PAYMENTS.  (a)  In this section, "emergency care" has the meaning assigned by Section 1301.155.
(b)  The administrator of a managed care plan provided under the group program shall pay for covered emergency care performed by or a covered supply related to that care provided by an out-of-network provider at the usual and customary rate or at an agreed rate.  The administrator shall make a payment required by this subsection directly to the provider not later than, as applicable:
(1)  the 30th day after the date the administrator receives an electronic claim for those services that includes all information necessary for the administrator to pay the claim; or
(2)  the 45th day after the date the administrator receives a nonelectronic claim for those services that includes all information necessary for the administrator to pay the claim.
(c)  For emergency care subject to this section or a supply related to that care, an out-of-network provider or a person asserting a claim as an agent or assignee of the provider may not bill an enrollee in, and the enrollee does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the enrollee's managed care plan that:
(1)  is based on:
(A)  the amount initially determined payable by the administrator; or
(B)  if applicable, a modified amount as determined under the administrator's internal appeal process; and
(2)  is not based on any additional amount determined to be owed to the provider under Chapter 1467.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.15, eff. September 1, 2019.
2023 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.
2023 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 1575.174. Out-of-Network Emergency Medical Services Provider Payments

Sec. 1575.174.  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 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, an enrollee 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 an enrollee receiving a health care or medical service or supply or transport 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 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. 12, 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 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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 1575.255. Proof of Compliance

Sec. 1575.255.  PROOF OF COMPLIANCE.  The trustee may:
(1)  require an employer to report an application for federal or private money;
(2)  require evidence that the application includes a request for funds available to pay state contributions for active employees;  and
(3)  examine the records of an employer to determine compliance with this subchapter and rules adopted under 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.
2023 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 1575.256. Criminal Offense: Failure of Administrator to Comply

Sec. 1575.256.  CRIMINAL OFFENSE:  FAILURE OF ADMINISTRATOR TO COMPLY.  (a)  An administrator of an employer commits an offense if the administrator knowingly fails to comply with this subchapter.
(b)  An offense under this section is a Class C misdemeanor.
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 1575 - Texas Public School Employees Group Benefits Program › Subchapter F. Federal or Private Source Contributions › Section 1575.257. Civil Sanctions for Failure of Employer to Comply

Sec. 1575.257.  CIVIL SANCTIONS FOR FAILURE OF EMPLOYER TO COMPLY.  (a)  An employer who fails to comply with this subchapter may not apply for or spend any money received from a federal or private grant.
(b)  The trustee shall report an alleged noncompliance with this subchapter to the attorney general, the Legislative Budget Board, the comptroller, and the governor.
(c)  On receipt of a report under Subsection (b), the attorney general shall bring a writ of mandamus against the employer to compel compliance with 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.439, 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.301. Fund; Administration

Sec. 1575.301.  FUND;  ADMINISTRATION.  (a)  The retired school employees group insurance fund is a trust fund with the comptroller, who is custodian of the fund.
(b)  The trustee shall administer 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.440(a), 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.302. Payments Into Fund

Sec. 1575.302.  PAYMENTS INTO FUND.  The following shall be paid into the fund:
(1)  contributions from active employees and the state;
(2)  investment income;
(3)  appropriations for implementation of the group program; and
(4)  other money required or authorized to be paid into the fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 712 (H.B. 3976), Sec. 23, eff. September 1, 2017.
2023 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 G. Retired School Employees Group Insurance Fund › Section 1575.303. Payments From Fund

Sec. 1575.303.  PAYMENTS FROM FUND.  (a)  The following shall, without state fiscal year limitation, be paid from the fund:
(1)  the appropriate premiums to a carrier providing group coverage under a plan under this chapter;
(2)  claims for benefits under the group coverage;  and
(3)  money spent by the trustee to administer the group program.
(b)  The appropriate portion of the contributions to the fund to provide for incurred but unreported claim reserves and contingency reserves, as determined by the trustee, shall be retained in the fund.
(c)  The fund is held in trust for the benefit of participants of the group program and may not be diverted.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 43, eff. September 1, 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.304. Transfer of Certain Contributions

Sec. 1575.304.  TRANSFER OF CERTAIN CONTRIBUTIONS.  The trustee shall transfer into the fund the amounts deducted from annuities for contributions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441, 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.305. Investment of Fund

Sec. 1575.305.  INVESTMENT OF FUND.  The trustee may invest money in the fund in the manner provided by Subchapter D, Chapter 825, Government Code, for assets 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. 1276, Sec. 10A.441, 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 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.306. Employee Contributions Property of Fund on Receipt; No Refund

Sec. 1575.306.  EMPLOYEE CONTRIBUTIONS PROPERTY OF FUND ON RECEIPT;  NO REFUND.  A contribution from an active employee:
(1)  is the property of the fund on receipt by the trustee;  and
(2)  may not be refunded to the active employee under any circumstances, including termination of employment.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441, eff. Sept. 1, 2003.