reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.309. Employee Payments for Participation in Cafeteria Plan

Sec. 1551.309.  EMPLOYEE PAYMENTS FOR PARTICIPATION IN CAFETERIA PLAN.  (a)  If an employee elects to participate in the 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 employer contributions for basic and optional coverages;  and
(2)  the cost of the cafeteria plan coverages the board of trustees identifies as comparable to the basic and optional coverages for which the employee is eligible.
(b)  The salary reduction agreement must also provide for an additional reduction in the employee's compensation equal to the cost of voluntary coverages for which the employee has applied.
(c)  An employee who executes a salary reduction agreement for a group coverage plan included in the cafeteria plan elects to participate in the cafeteria plan and agrees to a salary reduction for the coverages for subsequent plan years unless the employee, during an annual enrollment period specified by the board of trustees, elects in a form and manner satisfactory to the board not to participate for the next plan year in the coverages.
(d)  An employee who elects not to participate in the cafeteria plan group coverage plans may reenroll by executing a new salary reduction agreement during a subsequent annual enrollment period.
(e)  A salary reduction agreement for cafeteria plan benefits, other than a group coverage plan, must be executed annually during the annual enrollment period.
(f)  The employee shall pay any remaining portion of the cost of benefits that is not covered by the contributions for basic and optional coverages and the salary reduction under the cafeteria plan by executing a payroll deduction agreement.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.310. State Contribution Required

Sec. 1551.310.  STATE CONTRIBUTION REQUIRED.  The state shall contribute to the cost of each participant's group coverages, including dependents' group coverages, the amounts appropriated for the coverages in the General Appropriations Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.311. Amount of State Contribution

Sec. 1551.311.  AMOUNT OF STATE CONTRIBUTION.  (a)  Not later than November 1 preceding each regular session of the legislature, the board of trustees, in coordination with the Legislative Budget Board, shall certify to the budget division of the governor's office for information and review the amount necessary to pay the contributions of the state to the board for the coverages provided under this chapter during the following biennium.
(b)  The governor shall include the amount in the budget that the governor submits to the legislature.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 812 (S.B. 1812), Sec. 4, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.3111. Amount of State Contribution for Certain Junior College Employees

Sec. 1551.3111.  AMOUNT OF STATE CONTRIBUTION FOR CERTAIN JUNIOR COLLEGE EMPLOYEES.  (a)  In computing the amount to be certified under Section 1551.311, for participants who are employed by public junior colleges or public junior college districts, the board of trustees shall include:
(1)  50 percent of the cost associated with eligible employees who:
(A)  otherwise are eligible to participate in the group benefits program; and
(B)  are instructional or administrative employees whose salaries may be fully paid from funds appropriated under the General Appropriations Act, regardless of whether such salaries are actually paid from appropriated funds; and
(2)  none of the cost associated with employees who:
(A)  do not meet the requirements of Subdivision (1)(B) but are otherwise eligible to participate in the group benefits program; or
(B)  cannot be included as a qualifying employee under Subdivision (1) by application of Subsection (c).
(b)  For qualifying employees under Subsection (a)(1), the board of trustees shall include only the amount payable by the state under Subsection (a)(1) in determining the amount to be certified under Section 1551.311.
(c)  In determining the amount described by Subsection (b), the number of qualifying employees under Subsection (a)(1) whose group benefits program costs may be included for each public junior college or public junior college district in each biennium may not be adjusted in a proportion greater than the change in student enrollment at each college during the reporting period except that a college that experiences a decline in student enrollment may petition the Legislative Budget Board to maintain the number of eligible employees up to 98 percent of the level of the prior biennium.
Added by Acts 2013, 83rd Leg., R.S., Ch. 812 (S.B. 1812), Sec. 5, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.313. Amount of State Contribution for Certain Surviving Dependents

Sec. 1551.313.  AMOUNT OF STATE CONTRIBUTION FOR CERTAIN SURVIVING DEPENDENTS.  If funds are specifically appropriated for the purpose, this state shall pay the same portion of the cost of the required contributions for a deceased annuitant's surviving spouse or other surviving dependent who elects to retain coverage under Section 1551.156 as this state pays for similar dependent coverage for an employee or annuitant participating in the program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.314. Certain State Contributions Prohibited

Sec. 1551.314.  CERTAIN STATE CONTRIBUTIONS PROHIBITED.  A state contribution may not be:
(1)  made for coverages under this chapter selected by an individual who receives a state contribution for coverages under a group benefits program provided by another state health plan or by an institution of higher education, as defined by Section 61.003, Education Code; or
(2)  made for or used to pay a tobacco user premium differential assessed under Section 1551.3075.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 23, eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.315. Required Contributions by State Agencies

Sec. 1551.315.  REQUIRED CONTRIBUTIONS BY STATE AGENCIES.  (a)  The governing board of each state agency participating in the group benefits program shall pay to the board of trustees an amount equal to the amount appropriated by the legislature for each employee's individual group coverages or dependents' group coverages for the agency's employees who are, and annuitants who were, compensated from funds not appropriated in the General Appropriations Act.
(b)  The state agency shall:
(1)  include the required contributions from funds not appropriated in the General Appropriations Act in its annual operating budget;
(2)  ensure current participant coverages based on the records of the board of trustees;
(3)  make timely payments of amounts due the board of trustees from all fund sources under the state agency's control;  and
(4)  each month reconcile board of trustees and state agency records of coverages and payments.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.316. Allocation to Board of Trustees of Employer Contributions

Sec. 1551.316.  ALLOCATION TO BOARD OF TRUSTEES OF EMPLOYER CONTRIBUTIONS.  From the several funds from which employees receive their respective salaries, all employer contributions computed in accordance with this chapter and rules adopted under this chapter are allocated to the board of trustees as 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 G. Contributions and Costs › Section 1551.317. Payment of Employer Contributions Allocated by the State

Sec. 1551.317.  PAYMENT OF EMPLOYER CONTRIBUTIONS ALLOCATED BY THE STATE.  (a)  All money allocated by this state, including by institutions of higher education, to the board of trustees under this chapter shall be paid to the board in monthly installments based on the annual estimate by the board of the contributions to be received for all employees during the year.
(b)  At the end of each fiscal year, the board of trustees shall make any adjustments required to cover the difference between:
(1)  the annual estimate;  and
(2)  the actual amount of the employer contributions during the year.
(c)  Each monthly installment shall be paid to the appropriate fund created by this chapter in the amount certified by the board of trustees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.318. Payment of Employer Contributions Not Allocated by the State

Sec. 1551.318.  PAYMENT OF EMPLOYER CONTRIBUTIONS NOT ALLOCATED BY THE STATE.  (a)  The board of trustees shall certify to the governing board of each state agency participating in the group benefits program that provides contributions for its employees' group coverages and dependents' group coverages from operating budgets provided from sources other than the General Appropriations Act the proportionate amounts required to pay its contributions.
(b)  The board of trustees shall make the certification not later than the 30th day before the date of the meeting at which the governing board of the state agency adopts its operating budget.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.319. Amount of Contribution for Full-Time and Part-Time Employees

Sec. 1551.319.  AMOUNT OF CONTRIBUTION FOR FULL-TIME AND PART-TIME EMPLOYEES.  (a)  A full-time employee receives the benefits of a full state contribution for coverage under this chapter.
(b)  A part-time employee receives the benefits of one-half of the amount of the state contribution received by a full-time employee.
(c)  The superintendent of the Texas School for the Deaf and the superintendent of the Texas School for the Blind and Visually Impaired shall determine whether an educational professional employee under contract with the school under Section 30.024 or 30.055, Education Code, as applicable, is a full-time employee for purposes of this chapter.
(d)  The executive head of the Windham School District shall determine whether an educational professional employee of the school is a full-time employee for purposes of this chapter.
(e)  This section does not prohibit an institution of higher education from contributing, from money not appropriated from the general revenue fund, amounts in excess of the state contribution for a part-time employee described by Section 1551.101(e)(2).
(f)  Notwithstanding any other provision of this section, if the board of trustees establishes a supplemental health coverage program under Section 1551.221, the amount of the contribution made for an individual who elects to receive supplemental health coverage under the program may be reduced, as provided in the General Appropriations Act, to reflect the reduced cost of the supplemental health coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.12, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 178 (H.B. 417), Sec. 2, eff. May 27, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.3195. Amount of Contribution for Annuitants Who Were Part-Time Employees

Sec. 1551.3195.  AMOUNT OF CONTRIBUTION FOR ANNUITANTS WHO WERE PART-TIME EMPLOYEES.  An annuitant who as an employee received the benefits of a state contribution under Section 1551.319(b) for coverage during any portion of the annuitant's last employment by a state agency is not eligible to receive more than the state contribution provided under Section 1551.319(b) unless the annuitant was designated by the annuitant's employer as a full-time employee during the three-consecutive-month period before retirement.
Added by Acts 2005, 79th Leg., Ch. 347 (S.B. 1176), Sec. 29, eff. January 1, 2006.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.3196. Amount of Contribution for Certain Annuitants

Sec. 1551.3196.  AMOUNT OF CONTRIBUTION FOR CERTAIN ANNUITANTS.  (a)  An annuitant receives the benefits of a state contribution for coverage under this chapter based on the annuitant's eligible service credit, as follows:
(1)  for an annuitant with 20 years or more of eligible service credit, a full state contribution;
(2)  for an annuitant with at least 15 years but less than 20 years of eligible service credit, 75 percent of a full state contribution; and
(3)  for an annuitant with less than 15 years of eligible service credit, 50 percent of a full state contribution.
(b)  An annuitant receiving a reduced state contribution under Subsection (a) shall have any state contribution for dependent coverage reduced in an amount proportional to the reduction under Subsection (a).
(c)  This section does not apply to an individual who:
(1)  receives or is eligible to receive an annuity that is based on eligibility under Section 814.002, 814.102, 834.101, 839.101, or 840A.052, Government Code; or
(2)  is eligible to participate in the group benefits program under:
(A)  Section 1551.102(d) because of a disability; or
(B)  Section 1551.102(f).
Added by Acts 2013, 83rd Leg., R.S., Ch. 618 (S.B. 1459), Sec. 25, eff. September 1, 2014.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 1092 (S.B. 1245), Sec. 18, eff. June 18, 2023.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.320. Certain Costs

Sec. 1551.320.  CERTAIN COSTS.  The Texas Higher Education Coordinating Board shall pay all costs incurred in determining whether an individual is disabled if:
(1)  the individual is an annuitant under the optional retirement program established by Chapter 830, Government Code;  and
(2)  the individual's last state employment was as an officer or employee of the coordinating board.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.323. Cost of Certain Annuitants

Sec. 1551.323.  COST OF CERTAIN ANNUITANTS.  (a)  An annuitant eligible to participate under Section 1551.102(i), 1551.111(e), or 1551.112(c) is, except as provided by this subsection, required to pay the total cost, as determined by the board, attributable to the participation of that individual and the dependents of that individual until the date the individual is 65 years of age.  If the General Appropriations Act or other similar legislation addresses the payment of those costs, those costs shall be paid in the manner specified by that legislation.
(b)  This section applies only to an individual who is eligible to participate as an annuitant under Section 1551.102(i), 1551.111(e), or 1551.112(c) and who is not eligible to participate under another provision of Section 1551.102, 1551.111, or 1551.112.
Added by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.04, eff. Jan. 11, 2004.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter G. Contributions and Costs › Section 1551.324. Reduction in Contribution for Certain Active Employees and Annuitants; Incentive Payments

Sec. 1551.324.  REDUCTION IN CONTRIBUTION FOR CERTAIN ACTIVE EMPLOYEES AND ANNUITANTS; INCENTIVE PAYMENTS.  (a)  Notwithstanding any other provision of this subchapter, the state contribution for an employee's coverage or an annuitant's coverage under this chapter may be reduced, as provided in the General Appropriations Act, to reflect the reduced cost of coverage for an employee or annuitant who elects to waive basic coverage as provided by Section 1551.1045(b) or (c).
(b)  Instead of the full state contribution for an employee or annuitant who makes an election described by Subsection (a), the state may contribute, as specified by the General Appropriations Act, an amount for the incentive payment authorized by Section 1551.222.
Added by Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 4.04, eff. August 29, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter H. Sanctions and Adjudication of Claims › Section 1551.352. Executive Director Determines Questions Relating to Enrollment or Payment of Claims

Sec. 1551.352.  EXECUTIVE DIRECTOR DETERMINES QUESTIONS RELATING TO ENROLLMENT OR PAYMENT OF CLAIMS.  The executive director has exclusive authority to determine all questions relating to enrollment in or payment of a claim arising from group coverages or benefits provided under this chapter other than questions relating to payment of a claim by a health maintenance organization.
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 H. Sanctions and Adjudication of Claims › Section 1551.354. Double or Multiple Liability

Sec. 1551.354.  DOUBLE OR MULTIPLE LIABILITY.  (a)  The executive director may determine that a claim arising under any group coverage plan administered by the board of trustees may expose the plan to double or multiple liability.
(b)  The executive director may cause the filing of an action for interpleader concerning the claim in a district court in Travis County on behalf of the Employees Retirement System of Texas to protect the group coverage plan from double or multiple liability.
(c)  A person may not pursue a counterclaim or other cause of action against the Employees Retirement System of Texas, a trustee, officer, or employee of the retirement system, or a carrier or administering firm for the retirement system in connection with a transaction or occurrence related to the interpleader action.
(d)  A person who violates Subsection (c) is liable for the costs and attorney's fees incurred by the Employees Retirement System of Texas, a trustee, officer, or employee of the retirement system, or a carrier or administering firm for the retirement system as a result of the violation.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 38, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter H. Sanctions and Adjudication of Claims › Section 1551.355. Appeal of Executive Director's Determination

Sec. 1551.355.  APPEAL OF EXECUTIVE DIRECTOR'S DETERMINATION.  (a)  Subject to Subsection (b), an appeal of a determination of the executive director under this subchapter is only to the board of trustees.
(b)  On behalf of the board of trustees and notwithstanding any other law, including Section 2003.021, Government Code, the executive director may:
(1)  refer an appeal to the State Office of Administrative Hearings for a hearing;  or
(2)  employ, select, or contract for the services of an administrative law judge or other hearing examiner not affiliated with the State Office of Administrative Hearings to conduct the hearing of an appeal.
(c)  The appeal is a contested case under Chapter 2001, Government Code.
(d)  The board of trustees shall develop and implement a process to allow an employee, participant, annuitant, or covered dependent affected by a determination described by Section 1551.352 to participate directly in the process of appealing the determination.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1111, Sec. 37, eff. Sept. 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 530 (S.B. 301), Sec. 11, 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 H. Sanctions and Adjudication of Claims › Section 1551.356. Standing

Sec. 1551.356.  STANDING.  (a)  A person has standing to appeal a determination of the executive director under this subchapter only if the person is:
(1)  an employee, participant, annuitant, or covered dependent participating in the group benefits program;  or
(2)  after the death of an employee, participant, annuitant, or covered dependent, the person's estate, personal representative, heir at law, or designated beneficiary.
(b)  A person has no standing to appeal a determination of the executive director under this subchapter or to pursue a private cause of action against the state, the board of trustees, the retirement system, the executive director, an administering firm, or an employee of any of those persons based on a determination or the implementation by the board or executive director of the type or scope of plan design features under the group benefits program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1111, Sec. 38, eff. Sept. 1. 2003;  Acts 2003, 78th Leg., ch. 1276, Sec. 10A.411(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 H. Sanctions and Adjudication of Claims › Section 1551.357. Determination of Appeal by Board of Trustees

Sec. 1551.357.  DETERMINATION OF APPEAL BY BOARD OF TRUSTEES.  (a)  Notwithstanding any other law, in a proceeding considered to be a contested case under Chapter 2001, Government Code, the board of trustees in its sole discretion may modify, refuse to accept, or delete any proposed finding of fact or conclusion of law contained in a proposal for decision submitted by an administrative law judge or other hearing examiner, or make alternative findings of fact and conclusions of law.
(b)  The board of trustees shall state in writing the specific reason for the board's determination.
(c)  The board of trustees may adopt rules to implement this section.
(d)  The appellant in a contested case under this subchapter has the burden of proof on all issues, including issues in the nature of an affirmative defense.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1111, Sec. 39, 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 H. Sanctions and Adjudication of Claims › Section 1551.358. Negotiation

Sec. 1551.358.  NEGOTIATION.  (a)  Notwithstanding any other provision of this subchapter, the board of trustees and a person who has standing to pursue an administrative appeal under this subchapter may at any time informally negotiate an award of benefits.
(b)  Negotiated benefits may not exceed the maximum benefits otherwise available or required by law.
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 H. Sanctions and Adjudication of Claims › Section 1551.359. Judicial Review

Sec. 1551.359.  JUDICIAL REVIEW.  A person aggrieved by a final decision of the Employees Retirement System of Texas in a contested case under this subchapter is entitled to judicial review of the decision.  Venue of an appeal under this subchapter is only in a district court in Travis County.  The standard of review for the appeal of a determination made by the board of trustees under this subchapter is by substantial evidence.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1111, Sec. 40, 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 H. Sanctions and Adjudication of Claims › Section 1551.360. Delegation

Sec. 1551.360.  DELEGATION.  (a)  The board of trustees may delegate its duty to hear an appeal to the executive director.
(b)  The executive director may delegate the director's duty under this subchapter to another employee of the Employees Retirement System of Texas.
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 H. Sanctions and Adjudication of Claims › Section 1551.361. Diligent Prosecution of Suit

Sec. 1551.361.  DILIGENT PROSECUTION OF SUIT.  The plaintiff shall prosecute with reasonable diligence any suit brought under Section 1551.359.  If the plaintiff does not secure proper service of process or does not prosecute the suit within one year after it is filed, the court shall presume that the suit has been abandoned.  The court shall dismiss the suit on a motion for dismissal made on or behalf of the Employees Retirement System of Texas, unless the plaintiff, after receiving appropriate notice, shows good cause for the delay.
Added by Acts 2005, 79th Leg., Ch. 347 (S.B. 1176), Sec. 31, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter H. Sanctions and Adjudication of Claims › Section 1551.362. Subpoena

Sec. 1551.362.  SUBPOENA.  Notwithstanding any other law, the Employees Retirement System of Texas may issue a subpoena that conforms to Rule 176, Texas Rules of Civil Procedure, including a preappeal investigative subpoena or any subpoena otherwise authorized by the Texas Rules of Civil Procedure, that the retirement system determines necessary to protect the interests of a program or system administered by the retirement system.
Added by Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 39, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter H. Sanctions and Adjudication of Claims › Section 1551.363. Precedent Manual

Sec. 1551.363.  PRECEDENT MANUAL.  (a)  The board of trustees shall develop and maintain a precedent manual relating to the enrollment and claims determinations under Section 1551.352 and appeals of those determinations.  The precedent manual:
(1)  must be composed of precedent-establishing determinations made by the board, executive director, or other staff, initially and on appeal, and include examples of previous determinations that are consistent with the identified precedent; and
(2)  may include other information identified by the board.
(b)  The board of trustees shall make the precedent manual available to appropriate staff and to employees, participants, annuitants, and covered dependents.
(c)  The board of trustees and staff involved in the claims appeal process are not bound by a decision in the manual.
Added by Acts 2017, 85th Leg., R.S., Ch. 530 (S.B. 301), Sec. 12, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter I. Funds › Section 1551.401. Employees Life, Accident, and Health Insurance and Benefits Fund

Sec. 1551.401.  EMPLOYEES LIFE, ACCIDENT, AND HEALTH INSURANCE AND BENEFITS FUND.  (a)  The employees life, accident, and health insurance and benefits fund is in the state treasury.
(b)  The board of trustees shall administer the fund.
(c)  Contributions of participants and the state provided for under this chapter shall be credited to the fund.
(d)  The fund is available:
(1)  without fiscal year limitation for all payments for any coverages provided for under this chapter;  and
(2)  for payment of expenses of administering this chapter within the limitations that may be specified annually by the legislature.
(e)  The board of trustees shall regularly set aside in the fund an amount equal to a percentage of the contributions made by participants and the state that the board determines is reasonably adequate to pay the expenses of administering this chapter.
(f)  The board of trustees, from time to time and in amounts it considers appropriate, may transfer unused funds for administrative expenses to the contingency reserves to be used by the board only for charges, claims, and expenses under the group benefits program.
(g)  Except as provided by Section 1551.259(d), the retirement system may deposit to the credit of the fund any unclaimed money on a finding that a good faith effort has been made to locate the person entitled to the money.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 40, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter I. Funds › Section 1551.402. State Employees Cafeteria Plan Trust Fund

Sec. 1551.402.  STATE EMPLOYEES CAFETERIA PLAN TRUST FUND.  (a)  The state employees cafeteria plan trust fund is in the state treasury.
(b)  The board of trustees shall administer the fund.
(c)  The following shall be credited to the fund:
(1)  salary reduction payments for benefits included in a cafeteria plan other than group coverage plans under the group benefits program;  and
(2)  appropriations by the state for the administration of a cafeteria plan.
(d)  The trust fund is available without fiscal year limitation:
(1)  for all payments for any benefits included in a cafeteria plan other than group coverage plans under the group benefits program;  and
(2)  for payment of expenses of administering a cafeteria plan.
(e)  The board of trustees may establish accounts for money in the fund as the board considers necessary, including accounts for the administration of a cafeteria plan.  The board of trustees may transfer assets from one account to another:
(1)  to pay benefits if:
(A)  the transfer is necessary for financial management purposes;  and
(B)  adequate arrangements are made to reimburse the account from which the transfer was made;  and
(2)  to pay administrative expenses.
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 I. Funds › Section 1551.403. Fees for State Employees Cafeteria Plan Trust Fund

Sec. 1551.403.  FEES FOR STATE EMPLOYEES CAFETERIA PLAN TRUST FUND.  (a)  Subject to Subsection (e), the board of trustees may establish a monthly fee 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)  The board of trustees shall establish the amount of the monthly fee and may establish a separate fee for each benefit included in a cafeteria plan.
(c)  If the board of trustees 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 the salary reduction agreement, as determined by the board.
(d)  The monthly fee shall be paid into the state employees cafeteria plan trust fund.
(e)  The board of trustees may not establish a fee for administering the premium conversion benefit portion of a 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 1551 - Texas Employees Group Benefits Act › Subchapter I. Funds › Section 1551.404. Insufficient Earnings for Employee to Participate in Cafeteria Fund

Sec. 1551.404.  INSUFFICIENT EARNINGS FOR EMPLOYEE TO PARTICIPATE IN CAFETERIA FUND.  (a)  If the earnings of an employee who elects to participate in a cafeteria plan are insufficient to pay the cost of the coverages and benefits selected by the employee, the employee is liable to the board of trustees for an amount equal to the difference between:
(1)  the amount received by the board;  and
(2)  the cost of the coverages and benefits.
(b)  If the employee does not pay the difference within the time specified by the board of trustees, the board may:
(1)  cancel the coverages and benefits retroactive to the last month for which full payment was made;  or
(2)  pursue any other available legal remedy.
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 I. Funds › Section 1551.405. Employees' Health Care Stabilization Trust Fund

Sec. 1551.405.  EMPLOYEES' HEALTH CARE STABILIZATION TRUST FUND.  (a)  The employees' health care stabilization trust fund is a fund in the state treasury.
(b)  The board of trustees shall administer the fund.
(c)  The following shall be credited to the fund:
(1)  money transferred to the fund at the direction of the legislature;  and
(2)  gifts and grants contributed to the fund.
(d)  In administering the fund, the board of trustees shall make investments in a manner that preserves the purchasing power of the fund's assets.
(e)  Money in the fund may not be spent for any purpose, except that the interest and investment returns of the fund may be appropriated only to stabilize the cost of state and participant contributions for health benefit coverage under this chapter by minimizing to the greatest extent possible increases in those contributions.
(f)  The fund is exempt from the application of Section 403.095, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter I. Funds › Section 1551.406. Investment of Funds

Sec. 1551.406.  INVESTMENT OF FUNDS.  (a)  Under the standard of care provided by Section 815.307, Government Code, the board of trustees may manage and has full power to invest and reinvest the money in:
(1)  the employees life, accident, and health insurance and benefits fund;
(2)  the state employees cafeteria plan trust fund;  and
(3)  the employees' health care stabilization trust fund.
(b)  The earnings, including interest on money in the fund and proceeds from the sale of any 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 1551 - Texas Employees Group Benefits Act › Subchapter I. Funds › Section 1551.407. Management of Assets

Sec. 1551.407.  MANAGEMENT OF ASSETS.  The board of trustees may commingle for investment purposes the assets of a fund created under this chapter with another fund created under this chapter or any other trust fund administered by the board if the board maintains and credits proportionate ownership records.
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 J. State Consumer-Directed Health Plan › Section 1551.451. Definitions

Sec. 1551.451.  DEFINITIONS.  In this subchapter:
(1)  "High deductible health plan" means a health benefit plan that complies with Section 223(c), Internal Revenue Code of 1986, and other federal law.
(2)  "Plan enrollee" means an employee or annuitant who is enrolled in the plan established under this subchapter.
(3)  "Qualified medical expense" means an expense paid by a plan enrollee for medical care, as defined by Section 213(d), Internal Revenue Code of 1986, for the plan enrollee or the enrollee's dependents as defined by Section 152, Internal Revenue Code of 1986.
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter J. State Consumer-Directed Health Plan › Section 1551.452. Establishment of State Consumer-Directed Health Plan

Sec. 1551.452.  ESTABLISHMENT OF STATE CONSUMER-DIRECTED HEALTH PLAN.  (a)  The state consumer-directed health plan is established for the benefit of individuals eligible to participate in the group benefits program and those individuals' eligible dependents.
(b)  The board of trustees may adopt rules necessary to administer this subchapter.  In implementing this subchapter the board shall:
(1)  establish health savings accounts under this subchapter and administer or select an administrator in accordance with Section 1551.453 for the accounts;
(2)  finance a self-funded high deductible health plan that:
(A)  is an integral part of the state consumer-directed health plan; and
(B)  provides health benefit coverage, including preventive health care, to a plan enrollee in the state consumer-directed health plan and to the dependents of a plan enrollee in accordance with Section 1551.455; and
(3)  provide to individuals eligible to participate in the group benefits program information regarding the operation of and option to participate in the state consumer-directed health plan established under this subchapter.
(c)  In adopting rules and administering health savings accounts or selecting administrators for health savings accounts under this subchapter, the board of trustees shall ensure that the health savings accounts are qualified for appropriate federal tax exemptions.
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter J. State Consumer-Directed Health Plan › Section 1551.453. Account Administrator

Sec. 1551.453.  ACCOUNT ADMINISTRATOR.  (a)  The account administrator selected to administer a health savings account established under this subchapter must be a person:
(1)  qualified to serve as trustee under Section 223(d)(1)(B), Internal Revenue Code of 1986, and the rules adopted under that section; and
(2)  experienced in administering health savings accounts or other similar trust accounts.
(b)  An account administrator is the fiduciary of a plan enrollee who has a health savings account established under this subchapter.
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter J. State Consumer-Directed Health Plan › Section 1551.454. Participation in Program

Sec. 1551.454.  PARTICIPATION IN PROGRAM.  (a)  Each individual eligible to participate in the basic coverage may choose instead to participate in the state consumer-directed health plan if the plan enrollee is an eligible individual under Section 223(c)(1), Internal Revenue Code of 1986.  The dependents of a plan enrollee may participate in the state consumer-directed health plan in accordance with Section 1551.455.
(b)  Participation in the state consumer-directed health plan qualifies a plan enrollee to receive a contribution to a health savings account under Section 1551.456.  An individual who elects not to participate in the plan is not eligible to receive a contribution under that section.
(c)  Under this section, the board of trustees has exclusive authority to determine an individual's eligibility to participate in the state consumer-directed health plan and may adopt rules regarding eligibility to participate in the plan.
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter J. State Consumer-Directed Health Plan › Section 1551.455. Coverage for Dependents; Required Contributions

Sec. 1551.455.  COVERAGE FOR DEPENDENTS; REQUIRED CONTRIBUTIONS.  (a)  A plan enrollee may obtain for the enrollee's dependents coverage in the state consumer-directed health plan in the manner determined by the board of trustees.
(b)  If the plan enrollee elects to obtain dependent coverage under Subsection (a), the plan enrollee shall pay any required contribution for the dependent coverage in the state consumer-directed health plan in the manner prescribed by the board of trustees.
(c)  Amounts contributed by a plan enrollee under this section may be:
(1)  used to pay the cost of coverage in the high deductible health plan not paid by the state under Section 1551.456(b); or
(2)  allocated by the board of trustees to an enrollee's health savings account in the manner described by Section 1551.456(c).
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter J. State Consumer-Directed Health Plan › Section 1551.456. State Contribution

Sec. 1551.456.  STATE CONTRIBUTION.  (a)  For each plan enrollee, from the state contribution that would otherwise be made for basic coverage for the enrollee, the state shall contribute annually to a high deductible health plan under this subchapter the amount that is necessary to pay the cost of coverage under the high deductible health plan and does not exceed the amount the state annually contributes for a full-time or part-time employee, as applicable, who is covered by the basic coverage.
(b)  For each plan enrollee's dependent covered under this subchapter, from the state contribution that would otherwise be made for basic coverage for the dependent, the state shall contribute annually to the high deductible health plan under this subchapter the same percentage of the cost of coverage under the high deductible health plan as the state annually contributes for dependent coverage in the basic coverage.
(c)  Before each plan year, the board of trustees may determine the amount of allocation of the state's contribution, if any, to an enrollee's health savings account that would otherwise be made for basic coverage for the enrollee and that remains after payment for coverage under Subsection (a) or (b).
(d)  For a calendar year, the amount of any allocations made under Subsection (c) and Section 1551.455(c)(2), in the aggregate, may not exceed the sum of the monthly limitations imposed by federal law for health savings accounts.
Added by Acts 2015, 84th Leg., R.S., Ch. 1015 (H.B. 966), Sec. 1, eff. September 1, 2015.