reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter G. Retired School Employees Group Insurance Fund › Section 1575.307. Contingency Reserve Account

Sec. 1575.307.  CONTINGENCY RESERVE ACCOUNT.  (a)  Before the first day of each state fiscal biennium, the trustee shall estimate for an average 60-day period during the biennium the expenditures from the fund anticipated for the group program, considering projected claims and administrative expenses.
(b)  The trustee shall place the estimated amount in a contingency reserve account to provide for adverse fluctuations in claims or administrative expenses.
(c)  The trustee shall include in each request for legislative appropriations to the group program the amount the trustee determines to be necessary to maintain the contingency reserve account at the level required by this section.
(d)  The trustee may invest and reinvest any portion of the contingency reserve account in accordance with Sections 825.103(b) and 825.301, Government Code, considering the functional need to provide for adverse fluctuations in claims or administrative expenses.
(e)  The interest on, earnings of, and proceeds from the sale of investments of assets in the contingency reserve account shall be credited to the account.
(f)  The trustee, from time to time and in amounts the trustee considers appropriate, may transfer unused money for administrative expenses to the contingency reserve account to be used by the trustee only for charges, claims, and expenses under the group program.
Added by Acts 2019, 86th Leg., R.S., Ch. 445 (S.B. 1682), Sec. 1, eff. June 4, 2019.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.351. Definitions

Sec. 1575.351.  DEFINITIONS.  In this subchapter:
(1)  "Credentialing committee" means a credentialing committee created by the trustee under Section 1575.354.
(2)  "Health care provider" means:
(A)  an individual licensed as a health care practitioner;  or
(B)  a health care facility.
(3)  "Network" means the coordinated care network implemented and administered by the trustee under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.442, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.352. Implementation and Administration

Sec. 1575.352.  IMPLEMENTATION AND ADMINISTRATION.  The trustee may implement and administer a coordinated care network for the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.353. Contracts With Health Care Providers and Others

Sec. 1575.353.  CONTRACTS WITH HEALTH CARE PROVIDERS AND OTHERS.  As the trustee determines is necessary to implement and administer the network, the trustee may contract with a health care provider or other individuals or entities.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.354. Credentialing Committees

Sec. 1575.354.  CREDENTIALING COMMITTEES.  The trustee may establish credentialing committees to evaluate the qualifications of health care providers to participate in the network.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.355. Immunity From Liability Arising From Acts or Omissions of Health Care Provider

Sec. 1575.355.  IMMUNITY FROM LIABILITY ARISING FROM ACTS OR OMISSIONS OF HEALTH CARE PROVIDER.  (a)  The following are not liable for damages arising from an act or omission of a health care provider participating in the network:
(1)  the trustee and its officers and employees, including the board of trustees of the trustee;
(2)  the group program;
(3)  the fund;  and
(4)  a member of an advisory committee to the trustee.
(b)  A health care provider participating in the network is an independent contractor and is responsible for the provider's acts or omissions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.444, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.356. Immunity From Liability Arising From Evaluation of Qualifications or Care

Sec. 1575.356.  IMMUNITY FROM LIABILITY ARISING FROM EVALUATION OF QUALIFICATIONS OR CARE.  The following are not liable for damages arising from an act, including a statement, determination, report of an act, or recommendation, committed without malice in the course of the evaluation of the qualifications of a health care provider or of the patient care provided by a health care provider participating in the network:
(1)  the trustee and its officers and employees, including the board of trustees;
(2)  the group program;
(3)  the fund;
(4)  a member of an advisory committee to the trustee;  and
(5)  a member of a credentialing committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.445, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.357. Immunity From Liability Arising From Acts Relating to Credentialing Committee

Sec. 1575.357.  IMMUNITY FROM LIABILITY ARISING FROM ACTS RELATING TO CREDENTIALING COMMITTEE.  An individual, a health care provider, or a medical peer review committee is not liable for damages arising from an act committed without malice that consists of:
(1)  participating in the activity of a credentialing committee;  or
(2)  furnishing records, information, or assistance to a credentialing committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.358. Open Meetings Law Not Applicable to Credentialing Committee

Sec. 1575.358.  OPEN MEETINGS LAW NOT APPLICABLE TO CREDENTIALING COMMITTEE.  The proceedings of a credentialing committee are not subject to Chapter 551, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.359. Records and Proceedings of Credentialing Committee Not Subject to Subpoena

Sec. 1575.359.  RECORDS AND PROCEEDINGS OF CREDENTIALING COMMITTEE NOT SUBJECT TO SUBPOENA.  Except to the extent required by the constitution of this state or the United States, the records and proceedings of a credentialing committee and a communication made to a credentialing committee are not subject to court subpoena.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.360. Confidentiality

Sec. 1575.360.  CONFIDENTIALITY.  Except as otherwise provided by this subchapter:
(1)  proceedings and records of a credentialing committee are confidential;  and
(2)  a communication made to a credentialing committee is privileged.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.361. Disclosure to Health Care Provider

Sec. 1575.361.  DISCLOSURE TO HEALTH CARE PROVIDER.  Disclosure of confidential credentialing committee information that is relevant to the matter under review to an affected health care provider is not a waiver of the confidentiality requirements under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.362. Disclosure to Certain Entities

Sec. 1575.362.  DISCLOSURE TO CERTAIN ENTITIES.  (a)  A written or oral communication made to a credentialing committee, or a record or proceeding of the committee, may be disclosed to an appropriate:
(1)  state or federal agency, including a state board of registration or licensing;
(2)  national accreditation body;  or
(3)  medical peer review committee.
(b)  A disclosure under this section is not a waiver of the confidential and privileged nature of the information.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter H. Coordinated Care Network › Section 1575.363. Disclosure to Defendants in Civil Actions

Sec. 1575.363.  DISCLOSURE TO DEFENDANTS IN CIVIL ACTIONS.  (a)  Any of the following persons named as a defendant in any civil action filed as a result of participation in the credentialing process may use, including in the person's own defense, otherwise confidential information obtained for legitimate internal business and professional purposes:
(1)  the trustee and its officers and employees, including the board of trustees;
(2)  a credentialing committee;
(3)  a person participating in a credentialing review;
(4)  a health care provider;
(5)  the group program;  and
(6)  a member of an advisory committee.
(b)  Use of information under this section is not a waiver of the confidential and privileged nature of the information.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.446, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.401. Definition

Sec. 1575.401.  DEFINITION.  In this subchapter, "committee" means the Retirees Advisory Committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.402. Appointment of Committee Members

Sec. 1575.402.  APPOINTMENT OF COMMITTEE MEMBERS.
(a)  The Retirees Advisory Committee is composed of the following seven members appointed by the trustee:
(1)  one member who is an active school administrator;
(2)  one member who is a retired school administrator;
(3)  two members who are active teachers; and
(4)  three members who are retired teachers.
(b)  A person is not eligible for appointment as a member of the committee if the person is required to register as a lobbyist under Chapter 305, 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.447, eff. Sept. 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 930 (S.B. 1663), Sec. 16, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.403. Terms

Sec. 1575.403.  TERMS.  (a)  Members of the committee serve staggered four-year terms.
(b)  The terms of the active school administrator, one active teacher, and two retired teachers expire February 1, 2002, and every fourth year after that date.
(c)  The remaining members' terms expire February 1, 2004, and every fourth year after that date.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 930 (S.B. 1663), Sec. 17, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.404. Vacancy

Sec. 1575.404.  VACANCY.  The trustee shall fill a vacancy on the committee by appointing a person who meets the qualifications applicable to the vacated position.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.448, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.405. Meetings

Sec. 1575.405.  MEETINGS.  (a)  The committee shall meet:
(1)  at least twice each year;  and
(2)  at the call of the trustee.
(b)  If there is an emergency, the committee may meet at the call of a majority of the members of the committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.449, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.406. Duties

Sec. 1575.406.  DUTIES.  The committee shall:
(1)  hold public hearings on group coverage;
(2)  recommend to the trustee minimum standards and features of a plan under the group program that the committee considers appropriate;  and
(3)  recommend to the trustee desirable changes in rules and legislation affecting the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.407. Procedural Rules

Sec. 1575.407.  PROCEDURAL RULES.  The trustee shall adopt procedural rules for the committee to follow in implementing its powers and duties under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter I. Retirees Advisory Committee › Section 1575.408. Reimbursement for Actual and Reasonable Expenses

Sec. 1575.408.  REIMBURSEMENT FOR ACTUAL AND REASONABLE EXPENSES.  A committee member is entitled to reimbursement for actual and reasonable expenses incurred in performing functions as a committee member.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter J. Accounting, Reports, and Records › Section 1575.451. Annual Accounting

Sec. 1575.451.  ANNUAL ACCOUNTING.  (a)  In this section, "plan year" means the period beginning on September 1 and ending on the following August 31.
(b)  Group coverage purchased under this chapter must provide for an accounting to the trustee by each carrier providing the coverage.
(c)  The accounting must be submitted:
(1)  not later than the 90th day after the last day of each plan year;  and
(2)  on a form approved by the trustee.
(d)  Each carrier shall prepare any other report that the trustee considers necessary.
(e)  A carrier may not assess an extra charge for an accounting report.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.451, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter J. Accounting, Reports, and Records › Section 1575.453. Study and Report by Trustee

Sec. 1575.453.  STUDY AND REPORT BY TRUSTEE.  (a)  The trustee shall study the operation and administration of this chapter, including:
(1)  conducting surveys and preparing reports on financing group coverages and health benefit plans available to participants;
(2)  studying the experience and projected cost of coverage; and
(3)  reviewing the group coverages provided to and the benefits and services being received by individuals covered under this chapter.
(b)  The trustee shall report annually to the legislature and the department on the operation and administration of this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452, eff. Sept. 1, 2003.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 141 (H.B. 1585), Sec. 17, eff. May 26, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter J. Accounting, Reports, and Records › Section 1575.454. Reports by and Examination of Carrier

Sec. 1575.454.  REPORTS BY AND EXAMINATION OF CARRIER.  Each contract entered into under this chapter between the trustee and a carrier must require the carrier to:
(1)  furnish to the trustee in a timely manner reasonable reports that the trustee determines are necessary to implement this chapter;  and
(2)  permit the trustee and the state auditor to examine records of the carrier as necessary to implement this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter J. Accounting, Reports, and Records › Section 1575.455. Public Inspection

Sec. 1575.455.  PUBLIC INSPECTION.  A report required by this chapter shall be made available for public inspection in a form that protects the identity of individual claimants.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter J. Accounting, Reports, and Records › Section 1575.456. Confidentiality of Records

Sec. 1575.456.  CONFIDENTIALITY OF RECORDS.  (a)  Section 825.507, Government Code, concerning confidentiality and disclosure of records applies to records in the custody of the Teacher Retirement System of Texas or in the custody of an administrator, carrier, agent, attorney, consultant, or governmental body acting in cooperation with or on behalf of the system relating to a retiree, active employee, annuitant, or beneficiary under the group program.
(b)  The Teacher Retirement System of Texas may disclose to a health or benefit provider information in the records of an individual that the system determines is necessary to administer the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.453(a), eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.501. Expulsion for Fraud

Sec. 1575.501.  EXPULSION FOR FRAUD.  After notice and hearing as provided by this subchapter, the trustee may expel from participation in the group program a retiree, dependent, surviving spouse, or surviving dependent child who:
(1)  submits a fraudulent claim or application for coverage under the group program;  or
(2)  defrauds or attempts to defraud a health benefit plan offered under the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.454(a), eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.502. Hearing

Sec. 1575.502.  HEARING.  On receipt of a complaint or on its own motion, the trustee may call and hold a hearing to determine whether an individual has acted in the manner described by Section 1575.501.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.455, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.503. Contested Case

Sec. 1575.503.  CONTESTED CASE.  A proceeding under this subchapter is a contested case under Chapter 2001, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.504. Expulsion at Conclusion of Hearing

Sec. 1575.504.  EXPULSION AT CONCLUSION OF HEARING.  At the conclusion of the hearing under Section 1575.502, if the trustee determines that the individual acted in the manner described by Section 1575.501, the trustee shall expel the individual from participation in the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.455, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.505. Effect of Expulsion

Sec. 1575.505.  EFFECT OF EXPULSION.  An individual expelled from participation in the group program may not be covered by a health benefit plan offered under the group program for a period determined by the trustee, not to exceed five years, beginning on the date the expulsion takes effect.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.455, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1575 - Texas Public School Employees Group Benefits Program › Subchapter K. Expulsion for Fraud › Section 1575.506. Appeal

Sec. 1575.506.  APPEAL.  An appeal of a determination by the trustee under this subchapter is under the substantial evidence rule.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.455, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.001. Definitions

Sec. 1576.001.  DEFINITIONS.  In this chapter:
(1)  "Active employee" has the meaning assigned by Section 1575.002.
(2)  "Trustee" means the Teacher Retirement System of Texas.
(3)  "Retiree" has the meaning assigned by Section 1575.004.
(4)  "Surviving spouse" has the meaning assigned by Section 1575.003.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.457, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.002. Establishment of Program

Sec. 1576.002.  ESTABLISHMENT OF PROGRAM.  (a)  The trustee may establish a group long-term care insurance program to provide long-term care insurance coverage for:
(1)  an active employee or retiree;
(2)  the spouse of an active employee or retiree, including a surviving spouse;
(3)  a parent or grandparent of an active employee or retiree;  and
(4)  a parent of the spouse of an employee or retiree, including a parent of a surviving spouse.
(b)  The trustee may not implement a group long-term care insurance program unless any cost or administrative burden associated with the development of, implementation of, or communications about the program is incidental.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.458, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.003. Contracts to Provide Coverages

Sec. 1576.003.  CONTRACTS TO PROVIDE COVERAGES.  The trustee may contract with one or more carriers authorized to provide long-term care insurance to provide that coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.458, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 44, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.004. Premiums

Sec. 1576.004.  PREMIUMS.  (a)  The trustee shall determine the procedures by which each program participant pays premiums and any other program costs.  Each participant is responsible for required payments.
(b)  The trustee may authorize any payment method appropriate for the program, including a payment method under which:
(1)  a participating employee is required to pay premiums by payroll deduction remitted by the employee's employer at the times and in the manner determined by the trustee;
(2)  a participating retiree is required to pay premiums by deduction from the retiree's monthly annuity; or
(3)  a carrier with which the trustee has contracted under Section 1576.003 bills a program participant directly.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 44, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.005. Program Not Part of Other Group Coverages

Sec. 1576.005.  PROGRAM NOT PART OF OTHER GROUP COVERAGES.  (a)  The group long-term care insurance program is not part of the group coverages offered under Chapter 1575 or 1579.
(b)  The state may not contribute any part of the premiums for coverage offered under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 45, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.006. Rules

Sec. 1576.006.  RULES.  The trustee may adopt rules as necessary to administer this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.458, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 46, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.007. Exemption From State Taxes and Fees

Sec. 1576.007.  EXEMPTION FROM STATE TAXES AND FEES.  A premium or contribution on a policy, insurance contract, or agreement authorized under this chapter is not subject to any state tax, regulatory fee, or surcharge, including a premium or maintenance tax or fee.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.459(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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.008. Competitive Bidding Requirements; Rules

Sec. 1576.008.  COMPETITIVE BIDDING REQUIREMENTS; RULES.  (a)  A contract to provide benefits under this chapter may be awarded only through competitive bidding under rules adopted by the trustee.
(b)  The rules may provide criteria for determining whether a carrier is qualified.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.009. Contract Award; Considerations

Sec. 1576.009.  CONTRACT AWARD; CONSIDERATIONS.  (a)  In awarding a contract under this chapter, the trustee is not required to select the lowest bid and may consider any relevant criteria, including a bidder's:
(1)  ability to service contracts;
(2)  past experience; and
(3)  financial stability.
(b)  If the trustee awards a contract to a bidder whose bid deviates from that advertised, the trustee shall record the deviation and fully justify the reason for the deviation in the minutes of the next meeting of the trustee.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.010. Group Long-Term Care Insurance Program Fund

Sec. 1576.010.  GROUP LONG-TERM CARE INSURANCE PROGRAM FUND.  (a)  The group long-term care insurance program fund is a trust fund with the comptroller.
(b)  The trustee shall administer the fund on behalf of the participants in the plan of insurance coverage provided under this chapter.
(c)  The following shall be credited to the fund:
(1)  money recovered under contracts for providing insurance coverage under this chapter; and
(2)  investment and depository income.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.011. Investment of Fund

Sec. 1576.011.  INVESTMENT OF FUND.  The trustee may invest the group long-term care insurance program fund in the manner provided by Section 67(a)(3), Article XVI, Texas Constitution.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.012. Payments From Fund

Sec. 1576.012.  PAYMENTS FROM FUND.  Money in the group long-term care insurance program fund may be used only to cover the cost of administering the program and to provide coverage under this chapter.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1576 - Group Long-Term Care Insurance for Public School Employees › Section 1576.013. Coverage Exempt From Insurance Law

Sec. 1576.013.  COVERAGE EXEMPT FROM INSURANCE LAW.  A coverage plan provided under this chapter is exempt from any other insurance law, including common law, that does not expressly apply to the plan or this chapter.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 47, 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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter A. General Provisions › Section 1578.001. Applicability of Chapter

Sec. 1578.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to a voluntary association that is:
(1)  composed of teachers or school administrators of public or private primary or secondary schools, colleges, or universities;  and
(2)  incorporated under federal law or a law of this state on a nonprofit membership basis.
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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter A. General Provisions › Section 1578.002. Authority to Issue

Sec. 1578.002.  AUTHORITY TO ISSUE.  Notwithstanding any other law, an insurance company authorized to engage in the business of insurance in this state may issue a group policy to a voluntary association in accordance with 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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter B. Purchase of Insurance › Section 1578.051. Authority to Obtain Insurance

Sec. 1578.051.  AUTHORITY TO OBTAIN INSURANCE.  (a)  A voluntary association may obtain for any class of the association's membership and for the class's dependents a group policy of:
(1)  life insurance;
(2)  health insurance;
(3)  accident insurance;
(4)  accidental death or dismemberment insurance;  or
(5)  hospital, surgical, or medical expense insurance.
(b)  The association may obtain a separate policy for each type of insurance listed under Subsection (a).
(c)  The association is the policyholder.
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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter B. Purchase of Insurance › Section 1578.052. Payment of Premium

Sec. 1578.052.  PAYMENT OF PREMIUM.  A voluntary association that obtains a group policy under this chapter shall pay the premium for the policy wholly or partly from money:
(1)  contributed by the association;  or
(2)  contributed by the insured association members for that purpose.
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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter B. Purchase of Insurance › Section 1578.053. Minimum Requirements to Obtain Policy

Sec. 1578.053.  MINIMUM REQUIREMENTS TO OBTAIN POLICY.  (a)  A voluntary association may obtain a group policy under this chapter only if the policy will cover at least 25 association members on the date of issue.
(b)  If the premium for the group policy is paid wholly or partly from money contributed by association members for that purpose, the policy on the date of issue must cover at least the lesser of 75 percent of the eligible members or 400 members, excluding any member whose evidence of individual insurability is not satisfactory to the insurer, who elect to make the required contributions and to be insured under the policy.
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 1578 - Purchase of Insurance by Association of Teachers and School Administrators › Subchapter B. Purchase of Insurance › Section 1578.054. Amount of Insurance

Sec. 1578.054.  AMOUNT OF INSURANCE.  The amount of insurance under a policy issued under this chapter must be based on a plan that precludes individual selection by the voluntary association or an insured association member.
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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.001. Short Title

Sec. 1579.001.  SHORT TITLE.  This chapter may be cited as the Texas School Employees Uniform Group Health Coverage Act.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.002. General Definitions

Sec. 1579.002.  GENERAL DEFINITIONS.  In this chapter:
(1)  "Administering firm" means any entity designated by the trustee to administer any coverages, services, benefits, or requirements under this chapter and the trustee's rules adopted under this chapter.
(2)  "Trustee" means the Teacher Retirement System of Texas.
(3)  "Charter school" means an open-enrollment charter school established under Subchapter D, Chapter 12, Education Code.
(4)  "Health coverage plan" means any group policy or contract, hospital service agreement, health maintenance organization agreement, preferred provider arrangement, or any similar group arrangement or any combination of those policies, contracts, agreements, or arrangements that provides for, pays for, or reimburses expenses for health care services.
(5)  "Participating entity" means an entity participating in the uniform group coverage program established under this chapter.  The term includes:
(A)  a school district;
(B)  another educational district whose employees are members of the Teacher Retirement System of Texas;
(C)  a regional education service center;  and
(D)  a charter school that meets the requirements of Section 1579.154.
(6)  "Program" means the uniform group coverage program established under this chapter.
(7)  "Regional education service center" means a regional education service center established under Chapter 8, Education Code.
(8)  "Usual and customary rate" means the relevant allowable amount as described by the applicable master benefit plan document or policy.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.16, 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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.003. Definition of Employee

Sec. 1579.003.  DEFINITION OF EMPLOYEE.  In this chapter, "employee" means a participating member of the Teacher Retirement System of Texas who is employed by a participating entity and who is not receiving coverage from a program under Chapter 1551, 1575, or 1601.  The term does not include an individual performing personal services as an independent contractor.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.004. Definition of Dependent

Sec. 1579.004.  DEFINITION OF DEPENDENT.  In this chapter, "dependent" means:
(1)  a spouse of a full-time employee or part-time employee;
(2)  a child of a full-time or part-time employee if the child is younger than 26 years of age, including:
(A)  an adopted child or child who is lawfully placed for adoption;
(B)  a foster child, stepchild, or other child who is in a regular parent-child relationship; and
(C)  a natural child;
(3)  a full-time or part-time employee's natural child, adopted child, foster child, stepchild, or other child who is in a regular parent-child relationship and who lives with or has his or her care provided by the employee or the surviving spouse on a regular basis, regardless of the child's age, if the child has a mental disability or is physically incapacitated to an extent that the child is dependent on the employee or surviving spouse for care or support, as determined by the board of trustees; and
(4)  notwithstanding any other provision of this code, any other dependent of a full-time or part-time employee specified by rules adopted by the board of trustees.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 455 (S.B. 1667), Sec. 24, eff. September 1, 2011.
Acts 2013, 83rd Leg., R.S., Ch. 1078 (H.B. 3357), Sec. 20, 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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.005. Confidentiality

Sec. 1579.005.  CONFIDENTIALITY.  (a)  Section 825.507, Government Code, applies to records relating to an employee or dependent under the program and in the custody of the Teacher Retirement System of Texas or in the custody of an administrator, carrier, agent, attorney, consultant, or governmental body acting in cooperation with or on behalf of the system.
(b)  The Teacher Retirement System of Texas may disclose to a health care provider, benefit provider, or claims administrator information in the records of an individual that the system determines is necessary to administer the program.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 48, 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 1579 - Texas School Employees Uniform Group Health Coverage › Subchapter A. General Provisions › Section 1579.006. Exemption From Process

Sec. 1579.006.  EXEMPTION FROM PROCESS.  (a)  The following are exempt from execution, attachment, garnishment, or any other process:
(1)  benefit payments, including optional benefit payments;
(2)  contributions of active employees, the state, and a participating entity, and any other contributions;
(3)  any rights, benefits, or payments accruing to any person under this chapter; and
(4)  any money in the Texas school employees uniform group coverage trust fund.
(b)  The items listed in Subsection (a) may not be assigned except for direct payment to benefit providers as authorized by the trustee by contract, rule, or otherwise.
Added by Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 48, eff. September 1, 2005.