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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter D. Group Coverages › Section 1601.151. Authority to Self-Insure; Exemption From Other Insurance Laws

Sec. 1601.151.  AUTHORITY TO SELF-INSURE;  EXEMPTION FROM OTHER INSURANCE LAWS.  (a)  Notwithstanding any other provisions of this chapter, the governing board of a system may:
(1)  self-insure a plan provided under this chapter;  and
(2)  hire a carrier to administer the system's uniform program.
(b)  A plan for which a system provides coverage on a self-insured basis is exempt from any other insurance law of this state that does not expressly apply to that plan or this chapter.
(c)  Expenses for the administration of a self-insured plan may come from the contributions of employees and the state after payments for any coverage provided under this chapter have been made.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter D. Group Coverages › Section 1601.152. Cafeteria Plan

Sec. 1601.152.  CAFETERIA PLAN.  (a)  The governing board of a system may develop, implement, and administer a cafeteria plan.
(b)  The governing board may include in the cafeteria plan any benefit that may be included in a cafeteria plan under federal law.
(c)  The governing board may cooperate and work with and enter into a necessary contract or agreement with an independent and qualified agency, person, or entity to:
(1)  develop, implement, or administer a cafeteria plan;  or
(2)  assist in those activities.
(d)  The governing board may adopt an order terminating the cafeteria plan and providing a procedure for the orderly withdrawal of the system and its employees from the cafeteria plan if the governing board determines that a cafeteria plan adopted under this section is no longer advantageous to the system and its employees.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter D. Group Coverages › Section 1601.153. Systems May Join in Procuring Insurance

Sec. 1601.153.  SYSTEMS MAY JOIN IN PROCURING INSURANCE.  The systems may join together to procure one or more group contracts with an insurance company authorized to engage in business in this state to insure the employees and retired employees of each participating system.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter D. Group Coverages › Section 1601.154. Long-Term Care Coverage

Sec. 1601.154.  LONG-TERM CARE COVERAGE.  (a)  A system may join with a board of trustees that administers the uniform program established under Chapter 1551 or the group program established under Chapter 1575 to provide long-term care insurance coverage.
(b)  Each participating board of trustees and the governing board of the system must mutually agree to join together for this purpose, subject to terms that are beneficial to all participants.
(c)  A system may not participate in an agreement under this section unless any cost or administrative burden associated with the development or implementation of or communications about the long-term care coverage plan is incidental.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter D. Group Coverages › Section 1601.155. Reinsurance

Sec. 1601.155.  REINSURANCE.  A system may arrange with an administering carrier issuing a policy under this chapter for the reinsurance of portions of the total amount of insurance under the policy with other carriers that elect to participate in the reinsurance.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.201. Payment for Coverage

Sec. 1601.201.  PAYMENT FOR COVERAGE.  (a)  A system may not contribute more than the amounts specified by this section for coverages provided under the uniform program.
(b)  For an employee designated by the system as working 40 or more hours a week, the system may contribute:
(1)  the full cost of basic coverage for the employee;  and
(2)  not more than 50 percent of the cost of dependent coverage.
(c)  For an employee designated by the system as working less than 40 hours a week, including an individual employed by the system in a position that as a condition of employment requires the individual to be enrolled as a student in the system in graduate-level courses, the system, from money appropriated from the general revenue fund, may contribute:
(1)  not more than 50 percent of the cost of basic coverage for the employee;  and
(2)  not more than 25 percent of the cost of dependent coverage.
(d)  Subsection (c) does not prohibit a system from contributing, from money not appropriated from the general revenue fund, amounts in excess of the amount specified by that subsection for:
(1)  an individual employed by the system in a position that as a condition of employment requires the individual to be enrolled as a student in the system in graduate level courses; or
(2)  an individual who is a tenured faculty member with whom the system has entered into a phased retirement agreement under which the individual will work less than 40 hours a week for a specified period of time at the end of which the individual will retire.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 4.06, eff. Sept. 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1049 (S.B. 5), Sec. 3.03, eff. June 17, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.202. Fees for Cafeteria Plan

Sec. 1601.202.  FEES FOR CAFETERIA PLAN.  (a)  The governing board of a system may establish a monthly fee in an amount set by the board to be paid by each employee who elects to participate in a cafeteria plan for the purpose of paying the expenses of administering the cafeteria plan.
(b)  If the governing board establishes a monthly fee, each employee who participates in the cafeteria plan must authorize payment of the fee by executing a separate payroll deduction agreement or as part of a salary reduction agreement, as determined by the governing 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.203. Payment for Coverage for Dependents

Sec. 1601.203.  PAYMENT FOR COVERAGE FOR DEPENDENTS.  Contributions for coverages for a dependent of an individual eligible to participate in the uniform program under Section 1601.101 or 1601.102 required of the participant that exceed the amount of system contributions shall be paid:
(1)  by a deduction from the monthly compensation of the participant;
(2)  by a reduction of the monthly compensation of the participant in the appropriate amount;  or
(3)  in the form and manner the system determines.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.204. Authorization of Employee Deduction

Sec. 1601.204.  AUTHORIZATION OF EMPLOYEE DEDUCTION.  (a)  Except for a participant who participates in a cafeteria plan, each individual eligible to participate in the uniform program under Section 1601.101 must authorize a deduction from the participant's monthly compensation in an amount equal to the difference between:
(1)  the total cost for coverages for which the participant applies;  and
(2)  the amount contributed by the system.
(b)  The authorization must be:
(1)  in writing or performed electronically;  and
(2)  in a form satisfactory to the system.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.2041. Employee Deduction for Automatic Coverage

Sec. 1601.2041.  EMPLOYEE DEDUCTION FOR AUTOMATIC COVERAGE.  Each individual automatically enrolled in a uniform program under Section 1601.104 is considered to have authorized a deduction from the participant's monthly compensation in an amount equal to the difference between:
(1)  the total cost of the employee's basic coverage; and
(2)  the amount contributed by the system for the employee's basic coverage.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1049 (S.B. 5), Sec. 3.04, eff. June 17, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.2042. Compensation Insufficient to Cover Deduction

Sec. 1601.2042.  COMPENSATION INSUFFICIENT TO COVER DEDUCTION.  If a participant's monthly compensation from which the participant's contribution is deducted is insufficient to pay the participant's contribution for coverage, the system may adopt rules under which the system considers the coverage to have terminated after the last full month for which the contribution was paid in full, as determined by the system.
Added by Acts 2017, 85th Leg., R.S., Ch. 1106 (H.B. 4035), Sec. 8, eff. June 15, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.205. Employee Payments for Participation in Cafeteria Plan

Sec. 1601.205.  EMPLOYEE PAYMENTS FOR PARTICIPATION IN CAFETERIA PLAN.  (a)  If an employee elects to participate in a cafeteria plan, the employee must execute a salary reduction agreement under which the employee's monthly compensation will be reduced in an amount equal to the difference between:
(1)  the amount appropriated for that purpose in the General Appropriations Act or the system's budget;  and
(2)  the cost of the employee's selected coverages for which the employee is eligible to pay under the cafeteria plan.
(b)  The employee must execute a salary reduction agreement for any portion of the cost that is not covered by state or system appropriations and cafeteria plan 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.206. Payment by Retired Employee

Sec. 1601.206.  PAYMENT BY RETIRED EMPLOYEE.  An individual eligible to participate in the uniform program under Section 1601.102 must execute an agreement and make appropriate contributions in a manner analogous to the requirements adopted under Sections 1601.204 and 1601.205 for an individual eligible to participate in the uniform program under Section 1601.101.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.207. System Contributions

Sec. 1601.207.  SYSTEM CONTRIBUTIONS.  A system shall contribute monthly to the cost of each participant's coverage provided under this chapter an amount:
(1)  if the participants are compensated from amounts appropriated in the General Appropriations Act, equal to or greater than the amount appropriated for that purpose in the Act;  or
(2)  if the participants are compensated from amounts appropriated by the governing board of the system in its official operating budget, an amount equal to the amount appropriated for a participant under 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.208. Amount of System Contribution

Sec. 1601.208.  AMOUNT OF SYSTEM CONTRIBUTION.  Not later than November 1 preceding each regular session of the legislature, each system shall certify to the Legislative Budget Board and the budget division of the Governor's Budget and Planning Office the amount necessary to pay the contributions of the system for the coverages provided under this chapter to each employee and retired employee of the system.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.209. Order of Precedence of Payment to Survivors

Sec. 1601.209.  ORDER OF PRECEDENCE OF PAYMENT TO SURVIVORS.  (a)  The amount of group life coverages and group accidental death and dismemberment coverages in force for a participant on the date the participant dies shall be paid, on the establishment of a valid claim, to a person surviving the death in the following order of precedence:
(1)  to the beneficiary designated by the participant in a signed and witnessed writing received before death by the appropriate office of the applicable system;  or
(2)  if a beneficiary is not designated under Subdivision (1), in accordance with the death benefit provisions of Subtitle C, Title 8, Government Code.
(b)  For purposes of Subsection (a)(1), a designation, change, or cancellation of a beneficiary in a document, including a will, that is not executed and filed in the manner described by that subsection is not valid.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.210. Provision of Necessary Information

Sec. 1601.210.  PROVISION OF NECESSARY INFORMATION.  The Teacher Retirement System of Texas, Optional Retirement Program carriers, and Employees Retirement System of Texas shall provide to each system information the system considers necessary to provide retired employees with the coverages and system contributions provided under this chapter.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter E. Payments, Contributions, and Costs › Section 1601.211. Liability for Back Contributions for Dropped Coverage

Sec. 1601.211.  LIABILITY FOR BACK CONTRIBUTIONS FOR DROPPED COVERAGE.  (a)  This section applies to a participant in the uniform program for whom appropriate contributions were not made during the entire plan year because of nonpayment of premiums.
(b)  As a condition of enrollment in the same coverage for a subsequent plan year, the participant must make a contribution equal to the contributions not made for the plan year for which appropriate contributions were not made during the entire plan year, unless the nonpayment of premiums was related to a qualified change in status, as determined by the system. The payment shall be made in the form and manner determined by the system.
Added by Acts 2017, 85th Leg., R.S., Ch. 1106 (H.B. 4035), Sec. 8, eff. June 15, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter F. Cafeteria Plan Fund › Section 1601.251. System Cafeteria Plan Fund

Sec. 1601.251.  SYSTEM CAFETERIA PLAN FUND.  (a)  The governing board of each system may establish and administer a cafeteria plan fund.
(b)  The following shall be credited to the cafeteria plan fund of a system:
(1)  salary reduction payments for benefits included in a cafeteria plan adopted under this chapter, other than group coverage plans under the uniform program;
(2)  appropriations by the state for the administration of a cafeteria plan;  and
(3)  a monthly fee established under Section 1601.202.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter F. Cafeteria Plan Fund › Section 1601.252. Use of Fund

Sec. 1601.252.  USE OF FUND.  The cafeteria plan fund of a system is available without fiscal year limitation:
(1)  for all payments for any benefits included in a cafeteria plan adopted by the system under this chapter other than group coverage plans under the uniform program;  and
(2)  for payment of expenses of administering the cafeteria 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter F. Cafeteria Plan Fund › Section 1601.253. Investment of Money in Fund

Sec. 1601.253.  INVESTMENT OF MONEY IN FUND.  (a)  The governing board of a system may invest the money in the system's cafeteria plan fund.
(b)  The earnings, including interest, and the proceeds from the sale of the investments become a part of 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.301. Advisory Committee

Sec. 1601.301.  ADVISORY COMMITTEE.  An advisory committee for each system shall be selected, serve, and perform duties as provided by this subchapter.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.302. Election of Members

Sec. 1601.302.  ELECTION OF MEMBERS.  One member of the advisory committee shall be elected from each of the components, units, or agencies of the system:
(1)  at times designated by the system;  and
(2)  in accordance with general guidelines for the election provided by the system.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.303. Qualifications of Members

Sec. 1601.303.  QUALIFICATIONS OF MEMBERS.  (a)  A member of a system's advisory committee must be an employee of the system.
(b)  A member must:
(1)  demonstrate mature judgment, special abilities, and sincere interest in employee coverage plans;  and
(2)  be able to represent the needs of all employees of the component, unit, or agency the member represents with respect to an action of the advisory committee.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.304. Terms

Sec. 1601.304.  TERMS.  A member of the advisory committee is elected for a two-year term, subject to reelection.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.305. Officers

Sec. 1601.305.  OFFICERS.  Annually, the members of a system's advisory committee shall elect a presiding officer and other necessary officers.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.306. Vacancy

Sec. 1601.306.  VACANCY.  The chief executive officer of a component, unit, or agency of a system shall appoint to the system's advisory committee an employee of the component, unit, or agency to fill the remainder of a vacated term of a member who is an employee of the component, unit, or agency.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.307. Duties of Committee

Sec. 1601.307.  DUTIES OF COMMITTEE.  (a)  The advisory committee of a system shall cooperate and work with the governing board of the system in coordinating and correlating the administration of the uniform program among the various components, units, and agencies of the system.
(b)  Members of the advisory committee shall cooperate and work with the governing board of the system as advisors in the development, implementation, coordination, and administration of the uniform program among the various components, units, and agencies of the system.
(c)  The advisory committee shall provide a channel for open communication of ideas and suggestions regarding coverages, eligibility, claims, procedures, bidding, administration, and any other aspect of employee plan benefits.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter G. Advisory Committee › Section 1601.308. Expenses

Sec. 1601.308.  EXPENSES.  (a)  A member's service on the advisory committee of a system is in addition to the duties of the member's state office or employment.
(b)  An expense incurred by an advisory committee member in performing a duty as a member of the committee shall be paid from money made available for that purpose to the system of which the member is an employee or officer.
(c) Employees may not be required to pay from the amount of employer contributions due the employees or from the amount of additional contributions due for selected coverages under this chapter the expenses of an advisory committee established under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 14.017(a), 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 1625 - Transfer Between Certain Governmental Programs › Section 1625.001. Definitions

Sec. 1625.001.  DEFINITIONS.  In this chapter:
(1)  "Board of trustees" has the meaning assigned by Section 1551.003.
(2)  "Institution of higher education" means a senior college or university, medical or dental unit, technical institute, or agency of higher education under the policy direction of a single governing board.  The term does not include a public junior college.
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 1625 - Transfer Between Certain Governmental Programs › Section 1625.002. Inapplicability of Preexisting Conditions Requirement

Sec. 1625.002.  INAPPLICABILITY OF PREEXISTING CONDITIONS REQUIREMENT.  A person, including a covered dependent, who obtains insurance, benefits, or any type of health care services coverage under Chapter 1551 or 1601 may transfer from an institution of higher education or other state agency to which either law applies to another institution of higher education or state agency to which either law applies without being required to comply with any preexisting conditions requirement.
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 1625 - Transfer Between Certain Governmental Programs › Section 1625.003. Rules

Sec. 1625.003.  RULES.  The board of trustees and the governing boards of institutions of higher education may adopt rules necessary to implement this chapter.
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 1625 - Transfer Between Certain Governmental Programs › Section 1625.004. Memorandum of Understanding

Sec. 1625.004.  MEMORANDUM OF UNDERSTANDING.  The board of trustees and the governing boards of institutions of higher education may enter into memoranda of understanding with one another to implement this chapter.
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 1625 - Transfer Between Certain Governmental Programs › Section 1625.005. Uniform Procedures

Sec. 1625.005.  UNIFORM PROCEDURES.  The governing board of an institution of higher education and the board of trustees may:
(1)  adopt uniform procedures to implement a transfer under this chapter;  and
(2)  impose conditions necessary to ensure the efficient operation of the programs over which each has jurisdiction.
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 I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.001. Applicability of Chapter

Sec. 1651.001.  APPLICABILITY OF CHAPTER.  (a)  Notwithstanding Section 101.053(b)(5) and subject to Subsection (b), this chapter applies only to:
(1)  an individual long-term care benefit plan that is delivered or issued for delivery in this state;
(2)  a group long-term care benefit plan that is:
(A)  delivered or issued for delivery in this state;  and
(B)  issued to an eligible group as described by Subchapter B, Chapter 1251;
(3)  a certificate issued under a group long-term care benefit plan issued to an eligible group as described by Subchapter B, Chapter 1251, if the certificate is delivered or issued for delivery in this state, regardless of the place where the plan is delivered or issued for delivery;  and
(4)  an evidence of coverage delivered or issued for delivery in this state for long-term care.
(b)  This chapter applies only to a policy, certificate, or evidence of coverage that is issued by:
(1)  a capital stock insurance company, including a life, health and accident, or general casualty insurance company;
(2)  a mutual life insurance company;
(3)  a mutual assessment life insurance company, including a statewide mutual assessment corporation, local mutual aid association, and burial association;
(4)  a mutual or mutual assessment association, including an association subject to Section 887.101;
(5)  a mutual insurance company other than a life insurance company;
(6)  a mutual or natural premium life or casualty insurance company;
(7)  a fraternal benefit society;
(8)  a Lloyd's plan insurer;
(9)  a reciprocal or interinsurance exchange;
(10)  a nonprofit medical, hospital, or dental service corporation, including a company subject to Chapter 842;
(11)  a stipulated premium company;
(12)  a health maintenance organization under Chapter 843;  or
(13)  another insurer required to be licensed by the department.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.002. Exemptions

Sec. 1651.002.  EXEMPTIONS.  This chapter does not apply to:
(1)  a certificate that is delivered or issued for delivery in this state under a single employer or labor union group policy that is delivered or issued for delivery outside this state;  or
(2)  a benefit plan that is not advertised, marketed, or offered as a long-term care benefit plan or nursing home benefit plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.003. Long-Term Care Benefit Plan Defined

Sec. 1651.003.  LONG-TERM CARE BENEFIT PLAN DEFINED.  (a)  In this chapter, "long-term care benefit plan" means an insurance policy or group certificate, or rider to the policy or certificate, or evidence of coverage issued by a health maintenance organization subject to Chapter 843, that is advertised or marketed as providing, or offered or designed to provide, coverage for not less than 12 consecutive months for each covered individual on an expense-incurred, indemnity, prepaid, or other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital.
(b)  The term includes a plan or rider, other than a group or individual annuity or life insurance policy, that provides for payment of benefits based on cognitive impairment or the loss of functional capacity.
(c)  The term does not include an insurance policy, group certificate, or evidence of coverage that is offered primarily to provide:
(1)  basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident-only coverage, specified disease or specified accident coverage, or limited benefit health coverage;  or
(2)  basic or single health care services.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.004. Rules

Sec. 1651.004.  RULES.  (a)  In addition to other rules required or authorized by this chapter, the department may adopt reasonable rules that are necessary and proper to carry out this chapter.
(b)  Rules adopted under this section must include requirements no less favorable than the minimum standards for long-term care benefit plans adopted in any model laws or regulations relating to minimum standards for benefits for long-term care benefit plans and in accordance with all applicable federal law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.005. Construction of Chapter

Sec. 1651.005.  CONSTRUCTION OF CHAPTER.  This chapter may not be construed to enlarge the powers of an entity listed in Section 1651.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter A. General Provisions › Section 1651.006. Conflicts With Other Provisions

Sec. 1651.006.  CONFLICTS WITH OTHER PROVISIONS.  This chapter prevails to the extent of any conflict with another provision of this code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.051. Minimum Standards

Sec. 1651.051.  MINIMUM STANDARDS.  (a)  The commissioner by rule shall establish:
(1)  specific standards for provisions of long-term care benefit plans;  and
(2)  standards for full and fair disclosure setting forth the manner, content, and required disclosures for the marketing and sale of those benefit plans.
(b)  The standards are in addition to and must be in accordance with:
(1)  applicable laws of this state, including Chapter 1201;
(2)  applicable federal law;  and
(3)  any rules, regulations, and standards required by federal law.
(c)  The standards must address:
(1)  terms of renewability;
(2)  initial and subsequent conditions of eligibility;
(3)  nonduplication of coverage;
(4)  coverage of dependents;
(5)  coverage of parents of the insured or enrollee and parents of the spouse of the insured or enrollee;
(6)  preexisting conditions;
(7)  termination of insurance;
(8)  continuation or conversion;
(9)  probationary periods;
(10)  benefit limitations, exceptions, and reductions;
(11)  elimination periods;
(12)  requirements for replacement;
(13)  recurrent conditions;
(14)  definitions of terms;  and
(15)  inflation protection.
(d)  The standards may:
(1)  establish standard claim forms;
(2)  establish standard benefits for:
(A)  skilled nursing care;
(B)  intermediate nursing care;
(C)  custodial care;  and
(D)  home health care;
(3)  require coverage for skilled nursing care, intermediate nursing care, and custodial care to facilitate comparison among long-term care products;
(4)  require long-term care benefit plan issuers to offer coverage for home health care benefits;
(5)  require that rates may not be increased for a covered individual unless:
(A)  the covered individual requests and receives a change of benefits;  or
(B)  the increase applies to all members of the class to which the individual has been assigned by the benefit plan issuer;  or
(6)  require a benefit plan issuer to pay for a service covered by the benefit plan that is provided by an institution licensed to provide that service under Chapter 242, Health and Safety Code.
(e)  Rules adopted under this section must include requirements no less favorable than the minimum standards of benefits for long-term care benefit plans adopted in any model laws or regulations relating to minimum standards for benefits for long-term care benefit plans and required by federal law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.052. Preexisting Conditions

Sec. 1651.052.  PREEXISTING CONDITIONS.  (a)  A long-term care benefit plan may not contain a provision that denies coverage for a claim for losses incurred more than six months after the effective date of coverage for a preexisting condition.
(b)  A long-term care benefit plan may not define a preexisting condition more restrictively than as a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
(c)  The commissioner by rule may:
(1)  establish additional reasonable regulation of preexisting conditions consistent with this section and Section 1651.051;  and
(2)  extend a limitation period specified in this section as to a specific age group category in a specific benefit plan form if the commissioner finds that the extension is in the best interest of the public.
(d)  Rules adopted under this section must comply with Section 1651.051(e).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.053. Loss Ratio Standards

Sec. 1651.053.  LOSS RATIO STANDARDS.  (a)  A long-term care benefit plan must provide a benefit plan holder with benefits that are reasonable in relation to the rates charged.
(b)  The commissioner shall adopt reasonable rules to establish minimum standards for loss ratios of long-term care benefit plans on the basis of:
(1)  incurred claims experience;
(2)  earned premiums;
(3)  the period for which rates are computed to provide coverage;
(4)  experienced and projected trends;
(5)  concentration of experience within early benefit plan duration;
(6)  expected claim fluctuations;
(7)  experience refunds;
(8)  adjustments;
(9)  dividends;
(10)  renewability features;
(11)  all relevant expense factors;
(12)  interest;
(13)  reserves;
(14)  mix of business by risk classification;  and
(15)  product features otherwise affecting claims experience.
(c)  Annually, each entity providing a long-term care benefit plan in this state shall:
(1)  file its rates, rating schedule, and supporting documentation to demonstrate compliance with the applicable loss ratio standards of this state;  and
(2)  comply with any other filing requirement adopted by the commissioner relating to loss ratios.
(d)  Rules adopted under this section shall be no less favorable to the holders of long-term care benefit plans than any model laws, rules, and regulations adopted in connection with minimum standards for benefits for long-term care benefit plans.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.054. Notice of Right to Refund

Sec. 1651.054.  NOTICE OF RIGHT TO REFUND.  (a)  In this section, "applicant" means:
(1)  in the case of an individual long-term care benefit plan, the individual who seeks to contract for insurance or other health benefits;  and
(2)  in the case of a group long-term care benefit plan, the proposed certificate holder.
(b)  A long-term care benefit plan must have a notice prominently printed on the first page of or attached to the benefit plan document.
(c)  The notice must state in substance that, if the applicant is not satisfied for any reason after examining the benefit plan document, the applicant is entitled to:
(1)  return the document not later than the 30th day after the date of its delivery;  and
(2)  have any premium refunded.
(d)  The long-term care benefit plan issuer shall pay in a timely manner the refund directly to the individual or entity that paid the premium.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.055. Rate Stabilization

Sec. 1651.055.  RATE STABILIZATION.  (a)  The commissioner shall adopt rules to stabilize long-term care premium rates by:
(1)  ensuring that:
(A)  initial rates for long-term care benefit plan forms are adequate;  and
(B)  any rate schedule increases for long-term care benefit plans made after issuance of the plans are justified, adequate, and reasonable in relation to benefits provided to plan holders;
(2)  requiring any appropriate plan terms;
(3)  imposing penalties on insurers or other entities subject to this chapter that violate a rule adopted under this section;  and
(4)  protecting plan holders affected by a rate schedule increase.
(b)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 432 (S.B. 1492), Sec. 1, eff. September 1, 2017.
(c)  In adopting rules under this section, the commissioner may exempt long-term care benefit plans from the requirements of Sections 1651.053(a), (b), and (d).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 432 (S.B. 1492), Sec. 1, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter B. Benefit Plan Standards › Section 1651.056. Review; Approval or Disapproval of Premium Rates

Sec. 1651.056.  REVIEW; APPROVAL OR DISAPPROVAL OF PREMIUM RATES.  (a)  A long-term care premium rate may not be used until the rate has been filed with the department and approved by the commissioner.
(b)  The commissioner may disapprove a long-term care premium rate that is not actuarially justified or does not comply with standards established under this chapter or adopted by rule by the commissioner.
(c)  An insurer who obtains the commissioner's approval of an increase of a long-term care premium rate under Subsection (a) shall:
(1)  notify policyholders of the scheduled rate increase at least 45 days prior to the date that the policyholder is required to make a premium payment at the increased rate; and
(2)  provide contingent nonforfeiture benefits consistent with nationally recognized models and rules adopted by the commissioner.
Added by Acts 2009, 81st Leg., R.S., Ch. 1374 (S.B. 963), Sec. 1, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.101. Definitions

Sec. 1651.101.  DEFINITIONS.  In this subchapter:
(1)  "Approved plan" means a long-term care benefit plan that is approved by the department under this subchapter.
(2)  "Dollar-for-dollar asset disregard" and "asset protection" have the meanings assigned by Section 32.251, Human Resources Code.
(3)  "Medical assistance program" means the medical assistance program established under Chapter 32, Human Resources Code.
(4)  "Partnership for long-term care program" means the program established under Subchapter F, Chapter 32, Human Resources Code, and this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.002(13), eff. September 1, 2009.