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 B. Administration and Implementation › Section 1551.068. Qualification of Group Benefits Program

Sec. 1551.068.  QUALIFICATION OF GROUP BENEFITS PROGRAM.  Notwithstanding any provision of this chapter or any other law, it is intended that the provisions of this chapter be construed and administered in a manner that coverages under the group benefits program will be considered in compliance with applicable federal law.  The board of trustees may adopt rules that modify the coverage provided under the program by adding, deleting, or changing a provision of the program, including rules that modify eligibility and enrollment requirements and the benefits available under the program.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1249 (S.B. 1664), Sec. 18, 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 C. Coverage and Participation › Section 1551.101. Participation Eligibility: State Officers and Employees

Sec. 1551.101.  PARTICIPATION ELIGIBILITY:  STATE OFFICERS AND EMPLOYEES.  (a)  An elected or appointed officer or employee who performs service, other than as an independent contractor, for this state, including an institution of higher education, and who is described by this section is eligible to participate in the group benefits program as an employee on the date specified by Section 1551.1055.
(b)  An individual is eligible to participate in the group benefits program as provided by Subsection (a) if the individual receives compensation for service performed for this state pursuant to a payroll certified by a state agency, other than an institution of higher education, or by an elected or appointed officer of this state, including a payment made from:
(1)  an amount appropriated by the legislature from a state fund;
(2)  a trust fund held by the comptroller;  or
(3)  money paid under the official budget of a state agency, other than money appropriated under a general appropriations act.
(c), (d) Repealed by Acts 2003, 78th Leg., ch. 366, Sec. 2.14.
(e)  An individual is eligible to participate in the group benefits program as provided by Subsection (a) if the individual receives compensation for service performed for an institution of higher education pursuant to a payroll certified by an institution of higher education or by an elected or appointed officer of this state and either:
(1)  is eligible to become a member of the Teacher Retirement System of Texas after any waiting period provided by law before membership in that retirement system; or
(2)  is employed at least 20 hours a week and is not permitted to be a member of the Teacher Retirement System of Texas because the individual is employed by an institution of higher education only in a position that as a condition of employment requires the individual to be enrolled as a student in the institution in graduate-level courses.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.03, 2.14, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 347 (S.B. 1176), Sec. 26, 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 C. Coverage and Participation › Section 1551.1021. Participation Eligibility: Certain Faculty of Institutions of Higher Education

Sec. 1551.1021.  PARTICIPATION ELIGIBILITY:  CERTAIN FACULTY OF INSTITUTIONS OF HIGHER EDUCATION.  (a)  An adjunct faculty member at a public institution of higher education is eligible to participate in the group benefits program as an employee if the faculty member:
(1)  receives compensation for services rendered to a public institution of higher education as an adjunct faculty member;
(2)  was employed as a faculty member by the same public institution of higher education and taught at least one course in the regular fall and spring semester at the public institution of higher education in the preceding academic year; and
(3)  is under contract or is scheduled to teach at least 12 semester credit hours in the academic year of coverage or, if the person is also employed by the public institution of higher education to perform nonteaching duties, is under contract or is scheduled to teach at least six semester credit hours in the academic year of coverage and has been approved by the public institution of higher education to participate in the group benefits program.
(a-1)  Notwithstanding Subsection (a)(3), an adjunct faculty member at a public institution of higher education who is a professional librarian is eligible to participate in the group benefits program as an employee if the faculty member receives compensation for services rendered to a public institution of higher education as an adjunct faculty member.
(b)  From money appropriated from a fund other than the general revenue fund or from money available from local sources, a public institution of higher education may, for an adjunct faculty member eligible to receive benefits under this section, contribute:
(1)  not more than 50 percent of the cost of basic coverage for the employee;  and
(2)  not more than 25 percent of the cost of dependent coverage.
(c)  Subsection (b) does not prohibit a public institution of higher education from contributing, from money other than money appropriated from the general revenue fund, amounts that exceed the amount specified in Subsection (b) to provide coverage for a person employed by a public institution of higher education who meets the criteria for eligibility under Subsection (a).
Added by Acts 2003, 78th Leg., ch. 366, Sec. 4.04, eff. Sept. 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 343 (H.B. 2127), Sec. 1, eff. September 1, 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 C. Coverage and Participation › Section 1551.1022. Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students

Sec. 1551.1022.  PARTICIPATION ELIGIBILITY:  CERTAIN POSTDOCTORAL FELLOWS AND GRADUATE STUDENTS.  (a)  An individual who is not eligible to participate in the group benefits program under Section 1551.101 is eligible to participate in the group benefits program under this section if the individual, at an institution of higher education:
(1)  holds:
(A)  a postdoctoral fellowship; or
(B)  one or more graduate student fellowships awarded to the individual on a competitive basis that, either singly or in combination, are valued at not less than $10,000 per year; and
(2)  is currently receiving a stipend from an applicable fellowship.
(b)  An individual who is eligible to participate in the group benefits program under this section shall pay all contributions required under this chapter for the coverage selected by the individual, except that an institution of higher education may make contributions for the individual from available funds other than money appropriated to the institution from the general revenue fund.
(c)  An institution of higher education shall determine which individuals are eligible to participate in the group benefits program under this section and, at the time of initial eligibility, shall notify each individual of the individual's eligibility to participate in the program.
(d)  An individual who participates in the group benefits program under this section is not considered an employee of an institution of higher education solely as a result of the individual's participation in the program.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1198 (S.B. 29), Sec. 1, 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 C. Coverage and Participation › Section 1551.103. Right to Coverage

Sec. 1551.103.  RIGHT TO COVERAGE.  Subject to Section 1551.351, an individual eligible to participate in the group benefits program under Section 1551.101 or 1551.102 may not be denied any group coverage under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter C. Coverage and Participation › Section 1551.104. Automatic Coverage

Sec. 1551.104.  AUTOMATIC COVERAGE.  (a)  Subject to Sections 1551.101 and 1551.102, each full-time employee is covered automatically by the basic coverage plan for employees and each annuitant is covered by the basic coverage plan for annuitants unless:
(1)  participation is specifically waived as provided by Section 1551.1045;
(2)  the employee or annuitant is expelled from the program under Section 1551.351; or
(3)  eligibility is otherwise limited by this chapter.
(b)  This section does not apply to an employee described by Section 1551.101(e)(2).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.06, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 4.01, 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 C. Coverage and Participation › Section 1551.1045. Waiver

Sec. 1551.1045.  WAIVER.  (a)  Subject to Subsections (b) and (c), an employee or annuitant may waive in writing any coverage provided under this chapter.
(b)  To waive coverage under the basic coverage plan for employees, a full-time employee must demonstrate, in the manner required by the board of trustees, that the employee is:
(1)  covered by another health benefit plan that provides substantially equivalent coverage, as determined by the board of trustees, to the coverage provided to employees by the basic coverage plan; or
(2)  eligible for benefits under the TRICARE Military Health System.
(c)  To waive coverage under the basic coverage plan for annuitants for the purpose of eligibility for an incentive payment under Section 1551.222, an annuitant must demonstrate, in the manner required by the board of trustees, that the annuitant is:
(1)  covered by another health benefit plan that provides substantially equivalent coverage, as determined by the board of trustees, to the coverage provided to annuitants by the basic coverage plan; or
(2)  eligible for benefits under the TRICARE Military Health System.
Added by Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 4.02, 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 C. Coverage and Participation › Section 1551.105. Date Automatic Coverage Begins

Sec. 1551.105.  DATE AUTOMATIC COVERAGE BEGINS.  Automatic coverage under this subchapter begins on the date an employee or annuitant becomes eligible for coverage.
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 C. Coverage and Participation › Section 1551.1055. Date Eligibility Begins; Waiting Period

Sec. 1551.1055.  DATE ELIGIBILITY BEGINS;  WAITING PERIOD.  (a)  Except as provided by Subsection (c), (d), or (e), eligibility under Section 1551.101 begins not later than the 90th day after the date the employee performs services for a state agency or is qualified for and begins to hold elected or appointed office.
(b)  Except as provided by Subsection (c), eligibility under Section 1551.102, for an individual who does not retire at the end of the last month for which the individual is on the payroll of a state agency before retirement, begins not later than the 90th day after the date the individual retires.
(c)  The waiting period established by Subsections (a) and (b) applies only to the determination of initial eligibility to participate in the group benefits program and does not apply to the determination of initial eligibility to participate in optional and voluntary insurance coverages under the group benefits program.
(d)  This subsection applies only to an employee of an institution of higher education or a dependent of the employee.  Notwithstanding Subsection (a), eligibility under Section 1551.101 may not begin earlier than the first day that an employee performs services for an institution of higher education if any amount paid for premium incurred before the date specified under Subsection (a) for the employee and any dependents of the employee is paid from money not appropriated from the general revenue fund, in accordance with policies and procedures established by the governing body of the institution of higher education.
(e)  Eligibility under Section 1551.101 for an employee reemployed under Chapter 613, Government Code, begins on the first day of reemployment on which the employee performs services for a state agency.
Added by Acts 2003, 78th Leg., ch. 366, Sec. 2.07, eff. Sept. 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 618 (S.B. 1459), Sec. 23, eff. September 1, 2014.
Acts 2015, 84th Leg., R.S., Ch. 150 (H.B. 437), 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 C. Coverage and Participation › Section 1551.106. Group Coverage Plan Purchased to Provide for Automatic Coverage

Sec. 1551.106.  GROUP COVERAGE PLAN PURCHASED TO PROVIDE FOR AUTOMATIC COVERAGE.  A group coverage plan purchased by the board of trustees must provide for the automatic coverage described by this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter C. Coverage and Participation › Section 1551.107. Contingent Coverage

Sec. 1551.107.  CONTINGENT COVERAGE.  (a)  Each part-time employee or employee eligible to participate in the group benefits program under Section 1551.101(e)(2) may participate in the program on execution of an appropriate application for coverage unless the employee is:
(1)  ineligible for the group benefits program under Section 1551.110;  or
(2)  expelled from the group benefits program under Section 1551.351.
(b)  An institution of higher education shall, at the time of employment, notify each of the institution's employees eligible to participate in the group benefits program under Section 1551.101(e)(2) of the employee's eligibility to participate.
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 C. Coverage and Participation › Section 1551.108. Continuing Eligibility of Certain Persons With Legislative Service or Employment

Sec. 1551.108.  CONTINUING ELIGIBILITY OF CERTAIN PERSONS WITH LEGISLATIVE SERVICE OR EMPLOYMENT.  Subject to Section 1551.351, on application to the board of trustees and on arrangement for payment of contributions and postage:
(1)  an individual who has at least eight years of service credit in the Employees Retirement System of Texas for service as a member of the legislature, on ending the individual's service in the legislature, remains eligible for participation in the group benefits program;  and
(2)  an individual who has at least 10 years of service credit in the Employees Retirement System of Texas as an employee of the legislature, on ending the individual's service for the legislature, remains eligible for participation in the group benefits 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 C. Coverage and Participation › Section 1551.109. Continuing Eligibility of Certain Members of Boards, Commissions, and Institutions of Higher Education

Sec. 1551.109.  CONTINUING ELIGIBILITY OF CERTAIN MEMBERS OF BOARDS, COMMISSIONS, AND INSTITUTIONS OF HIGHER EDUCATION.  (a)  Subject to Section 1551.351, on application to the board of trustees and arrangement for payment of contributions, an individual participating in the group benefits program on August 31, 2003, as a current or former member of a governing body with administrative responsibility over a state agency created under a statute of this state that has statewide jurisdiction and whose employees are covered by this chapter or as a current or former member of the State Board of Education or the governing body of an institution of higher education remains eligible for participation in a health benefit plan offered under this chapter if a lapse in coverage has not occurred.
(b)  A participant described by this section may not receive a state contribution for premiums.  The governing body of an institution of higher education may pay from local funds part or all of the contributions the state would pay for similar coverage of other participants in the group benefits program.
(c)  The participant's contribution for coverage under a health benefit plan may not be greater than the contribution for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.09, 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 C. Coverage and Participation › Section 1551.110. Ineligibility of Certain Junior College Employees

Sec. 1551.110.  INELIGIBILITY OF CERTAIN JUNIOR COLLEGE EMPLOYEES.  (a)  Except as provided by Subsections (c) and (d), an employee of a public junior college who is employed to perform services outside this state is not eligible to participate in the group benefits program unless the college elects, under procedures adopted by the board of trustees, to permit the employee to participate in the group benefits program.
(b)  For purposes of this section, an employee is employed to perform services outside this state if 75 percent or more of the services performed by the employee are performed outside this state.
(c)  This section does not apply to an individual employed by a public junior college on August 31, 1999.  That individual remains eligible to participate in the group benefits program in the same manner as other employees of the college even if the individual's employment by the college is not continuous.
(d)  An employee of a public junior college who is employed to perform services outside this state and who is employed after June 18, 1999, is eligible to participate in a group coverage provided under this chapter if the coverage is provided under an insurance policy, contract, or other agreement that:
(1)  is in effect on June 18, 1999;  and
(2)  requires that the employee be eligible to participate in the coverage provided under the agreement.
(e)  Eligibility to participate in a coverage under Subsection (d) ends on the date the insurance policy, contract, or other agreement is terminated or renewed.
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 C. Coverage and Participation › Section 1551.111. Participation by Certain Retirement Systems

Sec. 1551.111.  PARTICIPATION BY CERTAIN RETIREMENT SYSTEMS.  (a)  The Texas Municipal Retirement System and the Texas County and District Retirement System shall participate in the group benefits program in the manner described by this section.
(b)  Participation is limited to:
(1)  an officer or employee of either system who has been an officer or employee of either system following completion of the waiting period described by Section 1551.1055;
(2)  an eligible dependent of an officer or employee of either system described by Subdivision (1);
(3)  an individual who:
(A)  was an officer or employee of either system;
(B)  has retired from either system, subject to Section 1551.1055;
(C)  receives or is eligible to receive an annuity from either system or under Chapter 803, Government Code, based on at least 10 years of service credit and is at least 65 years of age;  and
(D)  has at least 10 years of service credit with a state agency whose employees are authorized to participate in the group benefits program;  and
(4)  an eligible dependent of a retired officer or employee described by Subdivision (3).
(c)  Except as provided by Section 1551.114, participation in the group benefits program does not extend to:
(1)  the governing body of either system;
(2)  a municipality or subdivision participating in either system;  or
(3)  a trustee, officer, or employee, or a dependent of a trustee, officer, or employee, of a participating municipality or subdivision.
(d)  A participant described by this section may not receive a state contribution for premiums.
(e)  Subject to Section 1551.323, an individual and the individual's dependents are eligible to participate in the group benefits program as an annuitant and the dependents of an annuitant as described under this section if the individual:
(1)  served as an officer or employee as described by Subsection (b)(1) on or before August 31, 2003;  and
(2)  at the time of retirement meets the requirements for eligibility for participation in the program as an annuitant as those requirements existed on August 31, 2003.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.10, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1030, Sec. 1.02, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.02, 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 C. Coverage and Participation › Section 1551.112. Participation by Texas Turnpike Authority

Sec. 1551.112.  PARTICIPATION BY TEXAS TURNPIKE AUTHORITY.  (a)  An individual may participate in the group benefits program as an annuitant, subject to Section 1551.1055, and may obtain coverage for the individual's dependents as any other participating annuitant if the individual:
(1)  began employment with, or became an officer of, the Texas Turnpike Authority within the three-year period preceding August 31, 1997;
(2)  was an officer or employee of the Texas Turnpike Authority on August 31, 1997;
(3)  became an officer or employee of the North Texas Tollway Authority on September 1, 1997; and
(4)  retires or is eligible to retire with at least 10 years of service credit under the proportionate retirement program established by Chapter 803, Government Code, or under a public retirement system to which Chapter 803 applies and is at least 65 years of age.
(b)  The North Texas Tollway Authority is responsible for payment of the contributions the state would make if the annuitant were a state employee.
(c)  Subject to Section 1551.323, an individual and the individual's dependents are eligible to participate in the group benefits program as an annuitant and the dependents of an annuitant as described under this section if the individual:
(1)  served in a position described by Subsection (a) on or before August 31, 2003; and
(2)  at the time of retirement meets the requirements for eligibility for participation in the program as an annuitant as those requirements existed on August 31, 2003.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.11, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.03, 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 C. Coverage and Participation › Section 1551.113. Participation by Certain Employees Whose Positions Are Privatized or Eliminated

Sec. 1551.113.  PARTICIPATION BY CERTAIN EMPLOYEES WHOSE POSITIONS ARE PRIVATIZED OR ELIMINATED.  (a)  An individual described by Subsection (b) is entitled to receive state contributions required to provide health benefit plan coverage under the group benefits program for two months after the effective date of the individual's separation from state service.
(b)  This section applies only to an individual who separates from state service and receives a cash payment under an incentive program implemented by the Texas Department of Human Services or the Texas Department of Health for certain employees whose positions are eliminated as a result of privatization or other reductions in services provided by those agencies.
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 C. Coverage and Participation › Section 1551.115. Participation by Wrongfully Imprisoned Persons

Sec. 1551.115.  PARTICIPATION BY WRONGFULLY IMPRISONED PERSONS.  Subject to Section 103.001, Civil Practice and Remedies Code, a person who is entitled to compensation under Chapter 103, Civil Practice and Remedies Code, is eligible to obtain health benefit plan coverage under the group benefits program in the manner and to the extent that an employee of the Texas Department of Criminal Justice would be entitled to coverage. The person's spouse and dependents may be included in the person's coverage as if the person were an employee of the Texas Department of Criminal Justice.
Added by Acts 2011, 82nd Leg., R.S., Ch. 698 (H.B. 417), Sec. 9, eff. June 17, 2011.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1107 (S.B. 1686), Sec. 4, eff. September 1, 2011.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 315 (H.B. 1455), Sec. 2, eff. September 1, 2023.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter D. Coverage for Dependents › Section 1551.151. Entitlement to Coverage

Sec. 1551.151.  ENTITLEMENT TO COVERAGE.  An individual who is eligible to participate in the group benefits program under Section 1551.101, 1551.102, or 1551.1022 is entitled to secure for a dependent of the individual any group coverages provided under this chapter, as determined by the board of trustees and subject to the exceptions provided by this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1198 (S.B. 29), Sec. 2, 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 D. Coverage for Dependents › Section 1551.152. Eligibility of Foster Child

Sec. 1551.152.  ELIGIBILITY OF FOSTER CHILD.  A foster child is eligible for health benefit plan coverage only if the child is not covered by another governmental health 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 D. Coverage for Dependents › Section 1551.153. Participant Residing Outside of Service Area

Sec. 1551.153.  PARTICIPANT RESIDING OUTSIDE OF SERVICE AREA.  An individual who is eligible to participate in the group benefits program under Section 1551.101 or 1551.102 and who resides outside of a health maintenance organization service area is entitled to group coverages for a dependent of the individual without evidence of insurability if the individual applies for the coverage for the dependent during the annual enrollment period.
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 D. Coverage for Dependents › Section 1551.154. Employee Payments

Sec. 1551.154.  EMPLOYEE PAYMENTS.  In the manner and form the board of trustees determines, payments required of an employee in excess of employer contributions shall be made by:
(1)  a deduction from the employee's monthly pay or retirement benefits;  or
(2)  a reduction of the employee's salary.
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 D. Coverage for Dependents › Section 1551.155. Coverage Options for Surviving Spouse

Sec. 1551.155.  COVERAGE OPTIONS FOR SURVIVING SPOUSE.  (a)  A surviving spouse of an individual who is eligible to participate in the group benefits program under Section 1551.101 or 1551.102 and who is entitled to monthly benefits paid by a retirement system named in this chapter may, following the death of the individual, elect to retain:
(1)  the spouse's authorized coverages;  and
(2)  authorized coverages for any dependent of the spouse.
(b)  The coverage is at the group rate for other participants if:
(1)  the coverage was previously secured by the deceased participant for the surviving spouse or dependent;  and
(2)  the surviving spouse directs the applicable retirement system to deduct required contributions from the monthly benefits paid to the spouse by the retirement system.
(c)  A person who is the surviving spouse of an individual described by Subsection (a) may secure group health coverage without evidence of the person's insurability if the individual was eligible to participate in the group benefits program under Section 1551.101 or 1551.102 but was not participating at the time of the individual's death.
(d)  A surviving spouse seeking group coverage under Subsection (c):
(1)  must apply for the coverage not later than the 30th day after the date on which the individual who was eligible to participate in the group benefits program dies; and
(2)  shall pay for the coverage at the group rate as provided by Subsection (b).
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. 35, 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 D. Coverage for Dependents › Section 1551.156. Coverage Options for Surviving Dependent

Sec. 1551.156.  COVERAGE OPTIONS FOR SURVIVING DEPENDENT.  (a)  A surviving dependent of an annuitant who was receiving monthly benefits paid by a retirement system named in this chapter may, following the death of the annuitant if there is not a surviving spouse, elect to retain any coverage previously secured by the annuitant until the dependent becomes ineligible for coverage for a reason other than the death of the member of the group.
(b)  The coverage is at the group rate for other participants.
(c)  A dependent who elects to retain coverage under this section and who is entitled to monthly benefits from a retirement system named in this chapter based on the service of the deceased annuitant must direct the retirement system to deduct required contributions for the coverage from the monthly benefits paid the surviving dependent by the retirement system.
(d)  A person who is a surviving dependent of an annuitant may secure group health coverage after the death of the annuitant without evidence of the person's insurability if the annuitant was eligible to participate in the group benefits program of a retirement system named in this chapter but was not participating at the time of the individual's death.
(e)  A surviving dependent seeking group coverage under Subsection (d):
(1)  must apply for the coverage not later than the 30th day after the date on which the individual who was eligible to participate in the group benefits program dies; and
(2)  shall pay for the coverage at the group rate as provided by Subsection (b).
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. 36, eff. September 1, 2009.
Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 37, 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 D. Coverage for Dependents › Section 1551.157. Coverage Options After Expiration of Annuity Option

Sec. 1551.157.  COVERAGE OPTIONS AFTER EXPIRATION OF ANNUITY OPTION.  The surviving spouse or dependent of an employee or annuitant may retain authorized coverages after expiration of a time-certain annuity option selected by the employee or annuitant.  To retain the coverages, the surviving spouse or dependent must make advance payment of contributions to the Employees Retirement System of Texas under rules adopted 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 D. Coverage for Dependents › Section 1551.158. Reinstatement of Health Benefit Plan Coverage by Certain Dependents

Sec. 1551.158.  REINSTATEMENT OF HEALTH BENEFIT PLAN COVERAGE BY CERTAIN DEPENDENTS.  (a)  A dependent child who is unmarried and whose coverage under this chapter ends when the child becomes 26 years of age may, on expiration of continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272), reinstate health benefit plan coverage under this chapter if the child, or the child's participating parent, pays the full cost of the health benefit plan coverage.
(b)  A state contribution is not payable for coverage under this section.
(c)  Coverage under this section terminates at the end of the month in which the child marries.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 618 (S.B. 1459), Sec. 24, eff. September 1, 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 E. Group Coverages › Section 1551.201. Establishment

Sec. 1551.201.  ESTABLISHMENT.  (a)  The board of trustees by rule shall establish group coverage plans for individuals eligible to participate in the group benefits program.
(b)  The group coverage plans may, in the board of trustees' discretion, include:
(1)  life coverage;
(2)  accidental death and dismemberment coverage;
(3)  health benefit coverage, including coverage for:
(A)  hospital care and benefits;
(B)  surgical care and treatment;
(C)  medical care and treatment;
(D)  dental care;
(E)  obstetrical benefits;
(F)  prescribed drugs, medicines, and prosthetic devices;  and
(G)  supplemental benefits, supplies, and services in accordance with this chapter;
(4)  coverage providing protection against either long-term or short-term loss of salary;  and
(5)  any other group coverage that the board of trustees, in consultation with the advisory committee, considers advisable.
(c)  The group coverage plans for annuitants may, at the discretion of the board of trustees, be separate or a part of the group coverage plans for employees.  If the trustee establishes separate group coverage plans for annuitants, the separate group coverage plans must include both full benefits and supplemental coverage options.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.412(b), eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1551 - Texas Employees Group Benefits Act › Subchapter E. Group Coverages › Section 1551.2011. Employee Awareness and Education

Sec. 1551.2011.  EMPLOYEE AWARENESS AND EDUCATION.  (a)  The board of trustees by rule shall ensure that employees receive information about life coverage, accidental death and dismemberment coverage, and long-term and short-term loss of salary coverage, if those coverages are included in a group coverage plan established under Section 1551.201.
(b)  The information must contain descriptions of:
(1)  probabilities of death and disability; and
(2)  policy exclusions and limitations, including:
(A)  limitations based on multiple sources of benefits;
(B)  preexisting condition exclusions; and
(C)  required waiting periods for benefits.
(c)  The board of trustees by rule may provide the information described by Subsections (a) and (b) in printed materials for new employees distributed on the first day of employment.  The board of trustees may consider using printed materials, online presentations, and educational presentations to ensure the information described by Subsections (a) and (b) is provided to employees.
(d)  If applicable, the board of trustees shall annually review the materials and presentations described by Subsection (c) to determine if changes to the contents of the materials or presentations are necessary.  If applicable, the department shall adopt rules necessary for considering and making changes to the materials or presentations.
(e)  The board of trustees shall publish the information described by Subsections (a) and (b) on the Employees Retirement System of Texas website.
Added by Acts 2013, 83rd Leg., R.S., Ch. 296 (H.B. 1265), Sec. 1, 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 E. Group Coverages › Section 1551.202. Authority to Define Basic Coverages

Sec. 1551.202.  AUTHORITY TO DEFINE BASIC COVERAGES.  (a)  The board of trustees may define the basic coverage applicable to each individual for whom coverage is automatic unless participation is specifically waived.
(b)  The board of trustees may define different basic coverage plans for individuals eligible to participate in the uniform program under Section 1551.101 and for individuals eligible to participate in the group benefits program under Section 1551.102.
(c)  Basic coverage must include basic health coverage.  The coverage may be offered through any health benefit 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 E. Group Coverages › Section 1551.203. Authority to Define Optional Coverages

Sec. 1551.203.  AUTHORITY TO DEFINE OPTIONAL COVERAGES.  The board of trustees may define optional coverages for which the board may make available employer contributions under Section 1551.303.
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 E. Group Coverages › Section 1551.204. Authority to Define Voluntary Coverages

Sec. 1551.204.  AUTHORITY TO DEFINE VOLUNTARY COVERAGES.  Subject to Section 1551.304, the board of trustees may define voluntary coverages.
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 E. Group Coverages › Section 1551.205. Limitations

Sec. 1551.205.  LIMITATIONS.  The board of trustees may not contract for or provide a coverage plan that:
(1)  excludes or limits coverage or services for acquired immune deficiency syndrome, as defined by the Centers for Disease Control and Prevention of the United States Public Health Service, or human immunodeficiency virus infection;
(2)  provides coverage for serious mental illness that is less extensive than the coverage provided for any physical illness;  or
(3)  may provide coverage for prescription drugs to assist in stopping smoking at a lower benefit level than is provided for other prescription drugs.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 213, Sec. 1, 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 E. Group Coverages › Section 1551.206. Cafeteria Plan

Sec. 1551.206.  CAFETERIA PLAN.  (a)  The board of trustees may develop, implement, and administer a cafeteria plan if the board determines that establishment of the plan:
(1)  is feasible;
(2)  would be beneficial to the state and to employees who would be eligible to participate in the plan;  and
(3)  would not adversely affect the coverage plans provided under the group benefits program.
(b)  The board of trustees may include in the cafeteria plan any benefit that may be included in a cafeteria plan under federal law.
(c)  The board of trustees may enter into a contract or agreement with an independent and qualified agency, individual, or entity to:
(1)  develop, implement, or administer a cafeteria plan;  or
(2)  assist in those activities.
(d)  The board of trustees may adopt an order terminating the cafeteria plan and providing a procedure for the orderly withdrawal of the state and its employees from the plan if the board determines that a cafeteria plan established under this section is no longer advantageous to the state or its employees.
(e)  The board of trustees may adopt rules for the use of a debit card or other similar technology for claims administration under this section.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.408(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 E. Group Coverages › Section 1551.207. Premium Conversion Benefit Portion of Cafeteria Plan

Sec. 1551.207.  PREMIUM CONVERSION BENEFIT PORTION OF CAFETERIA PLAN.  Each employee must be enrolled in the premium conversion benefit portion of a cafeteria plan established under Section 1551.206.
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 E. Group Coverages › Section 1551.208. Determination to Self-Fund

Sec. 1551.208.  DETERMINATION TO SELF-FUND.  (a)  The board of trustees, in the board's sole discretion, shall determine those coverage plans that the board does not intend to purchase but intends to provide directly from the employees life, accident, and health insurance and benefits fund.
(b)  The board of trustees, in the board's sole discretion and under conditions the board approves, may reinsure any coverage the board determines will be provided directly from the employees life, accident, and health insurance and benefits fund under Subsection (a).
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 E. Group Coverages › Section 1551.209. Coverage Exempt From Insurance Law

Sec. 1551.209.  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 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1111, Sec. 35, 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 E. Group Coverages › Section 1551.210. Actuarial Advice for Self-Funded Coverage

Sec. 1551.210.  ACTUARIAL ADVICE FOR SELF-FUNDED COVERAGE.  A qualified actuary selected by the board of trustees shall advise the board regarding an actuarially sound level of contributions required to provide coverage directly from the employees life, accident, and health insurance and benefits fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.