reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1508 - Healthy Texas Program › Subchapter F. Healthy Texas Small Employer Premium Stabilization Fund › Section 1508.260. Fund Administrator

Sec. 1508.260.  FUND ADMINISTRATOR.  (a)  The commissioner may obtain the services of an independent organization to administer the fund.
(b)  The commissioner shall establish guidelines for the submission of proposals by organizations for the purposes of administering the fund and may approve, disapprove, or recommend modification to the proposal of an applicant to administer the fund.
(c)  An organization approved to administer the fund shall submit reports to the commissioner, in the form and at the times required by the commissioner, as necessary to facilitate evaluation and ensure orderly operation of the fund, including an annual report of the affairs and operations of the fund.  The annual report must also be delivered to the governor, the lieutenant governor, and the speaker of the house of representatives.
(d)  An organization approved to administer the fund shall maintain records in the form prescribed by the commissioner and make those records available for inspection by or at the request of the commissioner.
(e)  The commissioner shall determine the amount of compensation to be allocated to an approved organization as payment for fund administration.  Compensation is payable only from the fund.
(f)  The commissioner may remove an organization approved to administer the fund from fund administration.  An organization removed from fund administration under this subsection must cooperate in the orderly transition of services to another approved organization or to the commissioner.
Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1508 - Healthy Texas Program › Subchapter F. Healthy Texas Small Employer Premium Stabilization Fund › Section 1508.261. Stop-Loss Insurance; Reinsurance

Sec. 1508.261.  STOP-LOSS INSURANCE; REINSURANCE.  (a)  The administrator of the fund, on behalf of and with the prior approval of the commissioner, may purchase stop-loss insurance or reinsurance from an insurance company licensed to write that coverage in this state.
(b)  Stop-loss insurance or reinsurance may be purchased to the extent that the commissioner determines funds are available for the purchase of that insurance.
Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1508 - Healthy Texas Program › Subchapter F. Healthy Texas Small Employer Premium Stabilization Fund › Section 1508.262. Public Education and Outreach

Sec. 1508.262.  PUBLIC EDUCATION AND OUTREACH.  (a)  The commissioner may use an amount of the fund, not to exceed eight percent of the annual amount of the fund, for purposes of developing and implementing public education, outreach, and facilitated enrollment strategies targeted to small employers who do not provide health insurance.
(b)  The commissioner shall solicit and accept recommendations concerning the development and implementation of education, outreach, and enrollment strategies under Subsection (a) from agents licensed under Title 13 to write health benefit plans in this state.
(c)  The commissioner may contract with marketing organizations to perform or provide assistance with education, outreach, and enrollment strategies described by Subsection (a).
Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1509 - Short-Term Limited-Duration Insurance › Section 1509.001. Definition

Sec. 1509.001.  DEFINITION.  In this chapter, "short-term limited-duration insurance" has the meaning assigned by 26 C.F.R. Section 54.9801-2.
Added by Acts 2019, 86th Leg., R.S., Ch. 657 (S.B. 1852), Sec. 3, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1509 - Short-Term Limited-Duration Insurance › Section 1509.002. Policy Disclosure Form

Sec. 1509.002.  POLICY DISCLOSURE FORM.  (a)  The commissioner by rule shall prescribe a disclosure form to be provided with a short-term limited-duration insurance policy and application.
(b)  The disclosure form must be in an easily readable font at least 14-point in size and include:
(1)  the duration of coverage;
(2)  a statement:
(A)  of the number of times the policy may be renewed or that the policy may not be renewed, as applicable;
(B)  that the expiration of short-term coverage is not a qualifying life event that would make a person eligible for a special enrollment period; and
(C)  that the policy may expire outside of the open enrollment period;
(3)  to the extent the information is available, the dates of the next three open enrollment periods under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) following the date the policy expires;
(4)  whether the policy contains any limitations or exclusions to preexisting conditions;
(5)  the maximum dollar amount payable under the policy;
(6)  the deductibles under the policy and the health care services to which the deductibles apply;
(7)  whether the following health care services are covered, including:
(A)  prescription drug coverage;
(B)  mental health services;
(C)  substance abuse treatment;
(D)  maternity care;
(E)  hospitalization;
(F)  surgery;
(G)  emergency health care; and
(H)  preventive health care; and
(8)  any other information the commissioner determines is important for a purchaser of a short-term limited-duration insurance policy.
(c)  An insurer issuing a short-term limited-duration insurance policy shall adopt procedures in accordance with commissioner rule to obtain a signed form from the insured acknowledging receipt of the disclosure form described by this section.  The rule must allow for electronic acknowledgment.  The insurer shall retain an acknowledgment form until the fifth anniversary of the date the insurer receives the form, and the insurer shall make the form available to the department on request.
Added by Acts 2019, 86th Leg., R.S., Ch. 657 (S.B. 1852), Sec. 3, 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 1550 - Certain Requirements for Insurers Contracting With Governmental Entities › Subchapter B. Certain Contracts › Section 1550.051. Definition of Insurer

Sec. 1550.051.  DEFINITION OF INSURER.  In this subchapter, "insurer" means:
(1)  an insurance company, including a company providing stop-loss or excess loss insurance;
(2)  a health maintenance organization operating under Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843, Chapter 1271, and Chapter 1272;
(3)  an approved nonprofit health corporation that holds a certificate of authority issued under Chapter 844; or
(4)  a third-party administrator that holds a certificate of authority under Chapter 4151.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.002, eff. April 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 1550 - Certain Requirements for Insurers Contracting With Governmental Entities › Subchapter B. Certain Contracts › Section 1550.052. Bid Requirements

Sec. 1550.052.  BID REQUIREMENTS.  (a)  Except as provided by Section 1550.054, an insurer that bids on a contract subject to the competitive bidding and competitive proposal requirements adopted under Section 252.021, Local Government Code, may not submit a bid for a contract to provide stop-loss or other insurance coverage that is subject to any qualification imposed by the insurer that permits the insurer to modify or limit the terms of insurance coverage to be provided after the contract has been made.
(b)  An insurer's bid submitted under Section 252.021, Local Government Code, must contain the insurer's entire offer.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.002, eff. April 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 1550 - Certain Requirements for Insurers Contracting With Governmental Entities › Subchapter B. Certain Contracts › Section 1550.053. Certain Exclusions and Increased Deductibles Prohibited

Sec. 1550.053.  CERTAIN EXCLUSIONS AND INCREASED DEDUCTIBLES PROHIBITED.  Except as provided by Section 1550.054, an insurer that provides stop-loss or other insurance coverage for health benefits under a contract subject to this subchapter may not, based on an individual's prior medical history:
(1)  exclude from coverage an individual who is otherwise eligible for the health benefits coverage; or
(2)  assign a higher deductible to the individual.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.002, eff. April 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 1550 - Certain Requirements for Insurers Contracting With Governmental Entities › Subchapter B. Certain Contracts › Section 1550.054. Exception for Written Waiver

Sec. 1550.054.  EXCEPTION FOR WRITTEN WAIVER.  By executing a written waiver in favor of the insurer, a municipality as defined by Section 1.005, Local Government Code, may waive a requirement of Section 1550.052 or 1550.053(2).
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.002, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.001. Short Title

Sec. 1551.001.  SHORT TITLE.  This chapter may be cited as the Texas Employees Group Benefits Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.002. Purposes

Sec. 1551.002.  PURPOSES.  The purposes of this chapter are to:
(1)  provide uniformity in life, accident, and health benefit coverages for all state officers and employees and their dependents;
(2)  enable the state to attract and retain competent and able employees by providing employees and their dependents with life, accident, and health benefit coverages at least equal to those commonly provided in private industry;
(3)  foster, promote, and encourage employment by and service to the state as a career profession for individuals of high standards of competence and ability;
(4)  recognize and protect the state's investment in each permanent employee by promoting and preserving economic security and good health among employees and their dependents;
(5)  foster and develop high standards of employer-employee relationships between the state and its employees;
(6)  recognize the long and faithful service and dedication of state officers and employees and encourage them to remain in state service until eligible for retirement by providing health benefits for them and their dependents;  and
(7)  recognize the service to the state by employees and retired employees of community supervision and corrections departments by extending to them and their dependents the same life, accident, and health benefit coverages as those provided under this chapter to state employees, retired state employees, and their dependents.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1030, Sec. 1.01, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.004. Definition of Dependent

Sec. 1551.004.  DEFINITION OF DEPENDENT.  (a)  In this chapter, "dependent" with respect to an individual eligible to participate in the group benefits program means the individual's:
(1)  spouse;
(2)  unmarried child younger than 26 years of age;
(3)  child of any age who the board of trustees determines lives with or has the child's care provided by the individual on a regular basis if  the child is mentally or physically incapacitated to the extent that the child is dependent on the individual for care or support, as determined by the board of trustees;
(4)  child of any age who is unmarried, for purposes of health benefit coverage under this chapter, on expiration of the child's continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272) and its subsequent amendments; and
(5)  ward, as that term is defined by Chapter 1002, Estates Code, who is 26 years of age or younger.
(b)  In this section, "child" includes:
(1)  a natural child, adopted child, stepchild, foster child, or child in the possession of a participant who is designated as managing conservator of the child under an irrevocable or unrevoked affidavit of relinquishment under Chapter 161, Family Code; or
(2)  a child who is related by blood or marriage and was claimed as a dependent on the federal income tax return of an individual who is eligible to participate in the group benefits program under Section 1551.101 or 1551.102 for the calendar year preceding the plan year in which the child is first enrolled as a dependent under Subchapter D, and for each subsequent year in which the child is enrolled as a dependent.
(c)  The requirement in Subsection (b)(2) that a child must be claimed as a dependent on a federal income tax return in the calendar year preceding the child's enrollment does not apply if:
(1)  the child is born in the year in which the child is first enrolled; or
(2)  the participant can demonstrate good cause for not claiming the child as a dependent in the preceding calendar year.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.401(a), eff. Sept. 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 32, eff. September 1, 2009.
Acts 2011, 82nd Leg., R.S., Ch. 109 (H.B. 755), Sec. 1, eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 17, eff. September 1, 2011.
Acts 2013, 83rd Leg., R.S., Ch. 618 (S.B. 1459), Sec. 22, eff. September 1, 2013.
Acts 2013, 83rd Leg., R.S., Ch. 1285 (H.B. 2155), Sec. 1, eff. June 14, 2013.
Acts 2017, 85th Leg., R.S., Ch. 324 (S.B. 1488), Sec. 22.049, 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 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.005. Definition of Health Benefit Plan

Sec. 1551.005.  DEFINITION OF HEALTH BENEFIT PLAN.  (a)  In this chapter, "health benefit plan" means a plan that provides, pays for, or reimburses expenses for health care services, including comparable health care services for participants who rely solely on spiritual means through prayer for healing in accordance with the teaching of a well-recognized church or denomination.
(b)  A health benefit plan shall be provided on a group basis through:
(1)  a policy or contract;
(2)  a medical, dental, or hospital service agreement;
(3)  a membership or subscription contract;
(4)  a salary continuation plan;
(5)  a health maintenance organization agreement;
(6)  a preferred provider arrangement;  or
(7)  any other similar group arrangement or a combination of policies, plans, contracts, agreements, or arrangements described by this subsection.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.006. Definition of Institution of Higher Education

Sec. 1551.006.  DEFINITION OF INSTITUTION OF HIGHER EDUCATION.  (a)  In this chapter, except as provided by Subsection (b), "institution of higher education" means a public junior college, a senior college or university, or any other agency of higher education within the meaning and jurisdiction of Chapter 61, Education Code.
(b)  In this chapter, "institution of higher education" does not include:
(1)  an entity in The University of Texas System, as described by Section 65.02, Education Code;  and
(2)  an entity in The Texas A&M University System, as described by Subtitle D, Title 3, Education Code, including the Texas Veterinary Medical Diagnostic Laboratory.
(c)  Notwithstanding Subsection (b), The Texas A&M University System, including the Texas Veterinary Medical Diagnostic Laboratory, participates in the group benefits program if, not later than November 1, 2004, the system notifies the board of trustees of the system's election to participate.  If notice is provided as required by this subsection, the employees and annuitants of the system, including the veterinary medical laboratory, and the dependents of those employees and annuitants, participate in the group benefits program effective not later than September 1, 2005.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.02, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.007. Definition of Carrier

Sec. 1551.007.  DEFINITION OF CARRIER.  In this chapter, "carrier" means:
(1)  an insurance company that is authorized by the department under this code or another insurance law of this state to provide any of the types of insurance coverages, benefits, or services provided for in this chapter and that:
(A)  has a surplus of $1 million;
(B)  has a successful operating history;  and
(C)  has had successful experience, as determined by the department, in providing and servicing any of the types of group coverage provided for in this chapter;
(2)  a corporation operating under Chapter 842 or 843 that provides any of the types of coverage, benefits, or services provided for in this chapter and that:
(A)  has a successful operating history;  and
(B)  has had successful experience, as determined by the department, in providing and servicing any of the types of group coverage provided for in this chapter;  or
(3)  any combination of carriers described by Subdivisions (1) and (2) on terms the board of trustees prescribes.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.402, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.008. Applicability of Definitions

Sec. 1551.008.  APPLICABILITY OF DEFINITIONS.  The definition of a term defined by this subchapter and the use of the terms "employee" and "annuitant" to refer to individuals eligible to participate in the group benefits program under Sections 1551.101 and 1551.102 apply to this chapter unless a different meaning is plainly required by the context in which the term appears.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.009. Board of Trustees May Define Other Words

Sec. 1551.009.  BOARD OF TRUSTEES MAY DEFINE OTHER WORDS.  The board of trustees may define by rule a word in terms necessary in the administration of 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 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.010. Board of Trustees Approval for Payroll Deductions or Reductions

Sec. 1551.010.  BOARD OF TRUSTEES APPROVAL FOR PAYROLL DEDUCTIONS OR REDUCTIONS.  A state agency may not establish, continue, or authorize payroll deductions or reductions for any benefit or coverage as provided by this chapter without the express approval of the board of trustees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.011. Exemption From Execution

Sec. 1551.011.  EXEMPTION FROM EXECUTION.  All benefit payments, contributions of employees and annuitants, and optional benefit payments, any rights, benefits, or payments accruing to a person under this chapter, and all money in a fund created by this chapter:
(1)  are exempt from execution, attachment, garnishment, or any other process;  and
(2)  may not be assigned, except:
(A)  for direct payment that a participant may assign to a provider of health care services;  and
(B)  as specifically provided by 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 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.012. Exemption From State Taxes and Fees

Sec. 1551.012.  EXEMPTION FROM STATE TAXES AND FEES.  Any coverage established under this chapter, including a policy, an insurance contract, a certificate of coverage, an evidence of coverage, and an agreement with a health maintenance organization or a plan administrator, is not subject to any state tax, regulatory fee, or surcharge, including a premium or maintenance tax or fee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.013. Combining of Carriers Not Restraint of Trade

Sec. 1551.013.  COMBINING OF CARRIERS NOT RESTRAINT OF TRADE.  Carriers combining to bid, underwrite, or both bid and underwrite for the group benefits program are not in violation of Chapter 15, Business & Commerce 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 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.014. Exclusive Remedies

Sec. 1551.014.  EXCLUSIVE REMEDIES.  The remedies provided under this chapter are the exclusive remedies available to an employee, participant, annuitant, or dependent.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.403(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 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.015. Balance Billing Prohibition Notice

Text of section effective until September 01, 2025
Sec. 1551.015.  BALANCE BILLING PROHIBITION NOTICE.  (a)  The administrator of a managed care plan provided under the group benefits program shall provide written notice in accordance with this section in an explanation of benefits provided to the participant and the physician or health care provider in connection with a health care or medical service or supply or transport provided by an out-of-network provider.  The notice must include:
(1)  a statement of the billing prohibition under Section 1551.228, 1551.229, 1551.230, or 1551.231, as applicable;
(2)  the total amount the physician or provider may bill the participant under the participant's managed care plan and an itemization of copayments, coinsurance, deductibles, and other amounts included in that total; and
(3)  for an explanation of benefits provided to the physician or provider, information required by commissioner rule advising the physician or provider of the availability of mediation or arbitration, as applicable, under Chapter 1467.
(b)  The administrator shall provide the explanation of benefits with the notice required by this section to a physician or health care provider not later than the date the administrator makes a payment under Section 1551.228, 1551.229, 1551.230, or 1551.231, as applicable.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.11, eff. September 1, 2019.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 9(a), eff. September 1, 2023.
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 9(b), eff. September 1, 2025.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter A. General Provisions › Section 1551.015. Balance Billing Prohibition Notice

Text of section effective on September 01, 2025
Sec. 1551.015.  BALANCE BILLING PROHIBITION NOTICE.  (a)  The administrator of a managed care plan provided under the group benefits program shall provide written notice in accordance with this section in an explanation of benefits provided to the participant and the physician or health care provider in connection with a health care or medical service or supply provided by an out-of-network provider.  The notice must include:
(1)  a statement of the billing prohibition under Section 1551.228, 1551.229, or 1551.230, as applicable;
(2)  the total amount the physician or provider may bill the participant under the participant's managed care plan and an itemization of copayments, coinsurance, deductibles, and other amounts included in that total; and
(3)  for an explanation of benefits provided to the physician or provider, information required by commissioner rule advising the physician or provider of the availability of mediation or arbitration, as applicable, under Chapter 1467.
(b)  The administrator shall provide the explanation of benefits with the notice required by this section to a physician or health care provider not later than the date the administrator makes a payment under Section 1551.228, 1551.229, or 1551.230, as applicable.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.11, eff. September 1, 2019.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 9(a), eff. September 1, 2023.
Acts 2023, 88th Leg., R.S., Ch. 981 (S.B. 2476), Sec. 9(b), eff. September 1, 2025.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.051. Administration and Implementation

Sec. 1551.051.  ADMINISTRATION AND IMPLEMENTATION.  The administration and implementation of this chapter are vested solely in the board of trustees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.052. Authority for Rules, Plans, Procedures, and Orders

Sec. 1551.052.  AUTHORITY FOR RULES, PLANS, PROCEDURES, AND ORDERS.  (a)  The board of trustees may adopt rules consistent with this chapter as it considers necessary to implement this chapter and its purposes, including rules that provide standards for determining eligibility for participation in the group benefits program, including standards for determining disability.
(b)  The board of trustees may adopt a plan, procedure, or order reasonably necessary to implement this chapter and its purposes.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.053. Authority to Hire Employees

Sec. 1551.053.  AUTHORITY TO HIRE EMPLOYEES.  (a)  The board of trustees may hire employees as the board considers necessary to ensure the proper administration of this chapter and the coverages, services, and benefits provided for or authorized by this chapter.
(b)  The board of trustees shall determine and assign the compensation and duties of the 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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.055. General Powers of Board of Trustees Regarding Coverage Plans

Sec. 1551.055.  GENERAL POWERS OF BOARD OF TRUSTEES REGARDING COVERAGE PLANS.  The board of trustees may:
(1)  prepare specifications for a coverage provided under this chapter;
(2)  prescribe the time and conditions under which an employee, annuitant, or dependent is eligible for a coverage provided under this chapter;
(3)  determine the methods and procedures of claims administration;
(4)  determine the amount of payroll deductions and reductions applicable to employees and annuitants and establish procedures to implement those deductions and reductions;
(5)  establish procedures for the board of trustees to decide contested cases arising from a coverage provided under this chapter;
(6)  study, on an ongoing basis, the operation of all coverages provided under this chapter, including gross and net costs, administration costs, benefits, utilization of benefits, and claims administration;
(7)  administer the employees life, accident, and health insurance and benefits fund;
(8)  provide the beginning and ending dates of coverages of participants under all benefit plans;
(9)  develop basic group coverage plans applicable to all individuals eligible to participate in the group benefits program under Sections 1551.101 and 1551.102;
(10)  provide for optional group coverage plans in addition to the basic group coverage plans;
(11)  provide, as the board of trustees determines is appropriate, either additional statewide optional coverage plans or individual agency coverage plans;
(12)  develop health benefit plans that permit access to high-quality, cost-effective health care;
(13)  design, implement, and monitor health benefit plan features intended to discourage excessive utilization, promote efficiency, and contain costs;
(14)  develop and refine, on an ongoing basis, a health benefit strategy consistent with evolving benefit delivery systems;
(15)  develop a funding strategy that efficiently uses employer contributions to achieve the purposes of this chapter and that is reasonable and ensures participants a fair choice among health benefit plans as provided by Section 1551.302;  and
(16)  appoint an advisory committee for the group benefits program under the terms provided by Section 815.509, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.406(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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.056. Independent Administrator

Sec. 1551.056.  INDEPENDENT ADMINISTRATOR.  (a)  The board of trustees may, on a competitive bid basis, contract with an entity to act for the board as an independent administrator or manager of the coverages, services, and benefits authorized under this chapter.
(b)  The entity must be a qualified, experienced firm of group insurance specialists or an administering firm and shall assist the board of trustees in ensuring the proper administration of this chapter and the coverages, services, and benefits provided for or authorized by this chapter.
(c)  The board of trustees shall pay an independent administrator selected under this section.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.057. Compensation of Person Employed by Board of Trustees

Sec. 1551.057.  COMPENSATION OF PERSON EMPLOYED BY BOARD OF TRUSTEES.  The board of trustees shall pay the compensation and expenses of a person employed by the board at the rate or in the amount approved by the board.  The rate or amount may not exceed the rate or amount paid for similar services.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.058. Electronic Authorizations

Sec. 1551.058.  ELECTRONIC AUTHORIZATIONS.  (a)  The board of trustees may develop a system for a participant to electronically authorize:
(1)  enrollment in a coverage or benefit;
(2)  contributions to a coverage or benefit;  and
(3)  deductions or reductions to the participant's compensation or annuity for participation in a coverage or benefit.
(b)  Notwithstanding any other law, the board of trustees may permit or require an authorization covered by Subsection (a) to be made electronically.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.059. Certificate of Coverage

Sec. 1551.059.  CERTIFICATE OF COVERAGE.  The board of trustees shall provide for issuance to each employee or annuitant participating in the group benefits program a certificate of coverage that states:
(1)  the benefits to which the participant is entitled;
(2)  to whom the benefits are payable;
(3)  to whom a claim must be submitted;  and
(4)  the provisions of the plan document, in summary form, that principally affect the participant.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.060. Identification Cards

Sec. 1551.060.  IDENTIFICATION CARDS.  (a)  The board of trustees may issue a single identification card to a participant in a health benefit plan and separately administered coverage under this chapter that offers pharmacy benefits.
(b)  The card may contain information regarding both health and pharmacy 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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.061. Annual Report

Sec. 1551.061.  ANNUAL REPORT.  The board of trustees shall submit a written report not later than February 1 of each year to the governor, lieutenant governor, speaker of the house of representatives, and Legislative Budget Board concerning the coverages provided and the benefits and services being received by all participants under this chapter.  The report must include:
(1)  information about the effectiveness and efficiency of:
(A)  managed care cost containment practices; and
(B)  fraud detection and prevention procedures;
(2)  basic information about each group coverage plan provided under this chapter, including the number of participants in each plan and the claims amounts and administrative expenses incurred under each plan;
(3)  a summary of recent changes to the benefits provided under this chapter that highlights any key benefits the board of trustees evaluated but did not implement;
(4)  a discussion of trends in claims under group coverage plans as well as other areas of interest identified by the board of trustees;
(5)  recommendations for any statutory changes the board of trustees determines necessary to achieve its goals for the group benefits program; and
(6)  any other information the board of trustees determines appropriate.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 530 (S.B. 301), Sec. 10, 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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.062. Information on Operation and Administration of Chapter

Sec. 1551.062.  INFORMATION ON OPERATION AND ADMINISTRATION OF CHAPTER.  (a)  The board of trustees shall:
(1)  conduct a continuing study of the operation and administration of this chapter, including:
(A)  conducting surveys and preparing reports on group coverages and benefits available to participants;  and
(B)  studying experience relating to group coverages and benefits available to participants;  and
(2)  maintain statistics on the number, type, and disposition of fraudulent claims for benefits under this chapter.
(b)  A contract entered into under this chapter must require a carrier to:
(1)  furnish any reasonable report the board of trustees determines is necessary to enable the board to perform its functions under this chapter;  and
(2)  permit the board and a representative of the state auditor to examine records of the carrier as necessary to accomplish the purposes of this chapter.
(c)  Each state agency shall keep records, make certifications, and furnish the board of trustees with information and reports necessary to enable the board to perform its functions 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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.064. Certain Group Health and Accident Policies or Contracts

Sec. 1551.064.  CERTAIN GROUP HEALTH AND ACCIDENT POLICIES OR CONTRACTS.  (a)  This section applies only to a group policy or contract described by Section 1251.301.  A policy or contract executed under this chapter must provide that:
(1)  premium payments must be:
(A)  paid directly to the Employees Retirement System of Texas; and
(B)  postmarked or received not later than the 10th day of the month for which the premium is due;
(2)  the premium for group continuation coverage under Subchapter G, Chapter 1251, may not exceed the level established for other surviving dependents of deceased employees and annuitants;
(3)  at the time the group policy or contract is delivered, issued for delivery, renewed, amended, or extended, the Employees Retirement System of Texas shall give notice of the continuation option to each state agency covered by the group benefits program; and
(4)  each state agency shall give written notice of the continuation option to each employee and dependent of an employee who is covered by the group benefits program.
(b)  A group policy or contract executed under this chapter must provide that, not later than the 15th day after the date of any severance of the family relationship that might activate the continuation option under Subchapter G, Chapter 1251, the group member shall give written notice of the severance to the employing state agency.
(c)  On receipt of notice under Subsection (b) or on the death of an employee, the employing state agency shall give written notice of the continuation option to each affected dependent.  The notice must state the amount of the premium to be charged and must be accompanied by any necessary enrollment forms.
(d)  A covered dependent must exercise the continuation option not later than the 45th day after the date of:
(1)  the severance of the family relationship;  or
(2)  the retirement or death of the group member.
(e)  A covered dependent must provide written notice of the exercise of the continuation option to the employing state agency within the time prescribed by Subsection (d).  Coverage under the policy or contract remains in effect during the period prescribed by Subsection (d) if the premiums are paid.
(f)  Any period of previous coverage under the policy or contract must be used in full or partial satisfaction of any required probationary or waiting periods provided in the policy or contract for dependent coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.019, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.065. Disclosure of Social Security Number

Sec. 1551.065.  DISCLOSURE OF SOCIAL SECURITY NUMBER.  The board of trustees may require an individual to disclose the individual's social security number as the board considers necessary to properly administer this chapter and any coverage, service, or benefit authorized by this chapter or as otherwise required by state or federal law.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.404(b), eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.066. Information Relating to Misconduct

Sec. 1551.066.  INFORMATION RELATING TO MISCONDUCT.  (a)  This section applies to:
(1)  the Employees Retirement System of Texas;
(2)  a carrier or other insurance company or health maintenance organization;
(3)  an administering firm or other insurance support organization that provides information or services to the group benefits program or the Employees Retirement System of Texas;
(4)  an agent or third-party administrator authorized under this chapter or licensed under this code;
(5)  a regulatory authority or department;  and
(6)  a board member, executive director, employee, auditor, or actuary of an entity described by this section.
(b)  A person may collect from, furnish to, or exchange with another person information, including medical records or other confidential information, to the extent the person considers necessary to detect or to impose a sanction for a criminal act, a misrepresentation, or nondisclosure that is related to an attempt to obtain coverage, payment, reimbursement, or a benefit under this chapter.
(c)  A person who acts under Subsection (b) is immune from suit and criminal or civil liability unless the person acts with malice or intent to defraud.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.405(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 1551 - Texas Employees Group Benefits Act › Subchapter B. Administration and Implementation › Section 1551.067. Pharmacy Benefit Manager Contracts

Sec. 1551.067.  PHARMACY BENEFIT MANAGER CONTRACTS.  (a)  In awarding a contract to provide pharmacy benefit manager services under this chapter, the board of trustees is not required to select the lowest bid but must select a contract that meets the criteria established by this section.
(b)  The contract must state that:
(1)  the board of trustees is entitled to audit the pharmacy benefit manager to verify costs and discounts associated with drug claims, pharmacy benefit manager compliance with contract requirements, and services provided by subcontractors;
(2)  the audit must be conducted by an independent auditor in accordance with established auditing standards; and
(3)  to conduct the audit, the board of trustees and the independent auditor are entitled access to information related to the services and the costs associated with the services performed under the contract, including access to the pharmacy benefit manager's facilities, records, contracts, medical records, and agreements with subcontractors.
(c)  The contract must define the information that the pharmacy benefit manager is required to provide to the board of trustees concerning the audit of the retail, independent, and mail order pharmacies performing services under the contract and describe how the results of these audits must be reported to the board of trustees, including how often the results must be reported.  The contract must state whether the pharmacy benefit manager is required to return recovered overpayments to the board of trustees.
(d)  The contract must state that any audit of a mail order pharmacy owned by the pharmacy benefit manager must be conducted by an independent auditor selected by the board of trustees in accordance with established auditing standards.
Added by Acts 2009, 81st Leg., R.S., Ch. 1207 (S.B. 704), Sec. 3, eff. September 1, 2009.