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 1581 - Employer Expenditures for School Employee Health Coverage Plans › Subchapter A. General Provisions › Section 1581.001. Definitions

Sec. 1581.001.  DEFINITIONS.  In this chapter:
(1)  "Participating employee" means an employee of a school district, other educational district whose employees are members of the Teacher Retirement System of Texas, participating charter school, or regional education service center who participates in a group health coverage plan provided by or through the district, school, or service center.
(2)  "Participating charter school" means an open-enrollment charter school established under Subchapter D, Chapter 12, Education Code, that participates in the uniform group coverage program established under Chapter 1579.
(3)  "Regional education service center" means a regional education service center established under Chapter 8, Education Code.
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 1581 - Employer Expenditures for School Employee Health Coverage Plans › Subchapter B. Maintenance of Effort; Minimum Effort › Section 1581.051. Maintenance of Effort for 2000-2001 School Year

Sec. 1581.051.  MAINTENANCE OF EFFORT FOR 2000-2001 SCHOOL YEAR.  (a)  Subject to Sections 1581.052 and 1581.053, and except as provided by Section 1581.054, a school district, other educational district whose employees are members of the Teacher Retirement System of Texas, participating charter school, or regional education service center that, for the 2000-2001 school year, paid amounts to share with employees the cost of coverage under a group health coverage plan shall, for each fiscal year, use to provide health coverage an amount for each participating employee at least equal to the amount computed as provided by this section.
(b)  The school district, other educational district, participating charter school, or regional education service center shall divide the amount that the district, school, or service center paid during the 2000-2001 school year for the prior group health coverage plan by the total number of full-time employees of the district, school, or service center in the 2000-2001 school year and multiply the result by the number of full-time employees of the district, school, or service center in the fiscal year for which the computation is made.  If, for the 2000-2001 school year, a school district, other educational district, participating charter school, or regional education service center provided group health coverage to its employees through a self-funded insurance plan, the amount the district, school, or service center paid during that school year for the plan includes only the amount of regular contributions made by the district, school, or service center to the plan.
(c)  Amounts used as required by this section shall be deposited, as applicable, in a fund described by Section 1581.052(b).
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 1581 - Employer Expenditures for School Employee Health Coverage Plans › Subchapter B. Maintenance of Effort; Minimum Effort › Section 1581.052. Required Minimum Effort

Sec. 1581.052.  REQUIRED MINIMUM EFFORT.  (a)  A school district, other educational district, participating charter school, or regional education service center shall, for each fiscal year, use to provide health coverage an amount equal to the number of participating employees of the district, school, or service center multiplied by $1,800.
(b)  Amounts used as required by this section shall be deposited, as applicable, in:
(1)  the Texas school employees uniform group coverage trust fund established under Subchapter G, Chapter 1579;  or
(2)  another fund established for the payment of employee health coverage that meets requirements for those funds prescribed by the Texas Education Agency.
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 1581 - Employer Expenditures for School Employee Health Coverage Plans › Subchapter B. Maintenance of Effort; Minimum Effort › Section 1581.053. Use of State Funds

Sec. 1581.053.  USE OF STATE FUNDS.  (a)  To comply with Section 1581.052, a school district or participating charter school may use state funds received under Chapter 48, Education Code, other than funds that may be used under that chapter only for a specific purpose.
(b)  Notwithstanding Subsection (a), amounts a district or school is required to use to pay contributions under a group health coverage plan for district or school employees under Section 48.275, Education Code, other than amounts described by Section 48.275(c)(2), are not used in computing whether the district or school complies with Section 1581.052.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1328 (H.B. 3646), Sec. 84, eff. September 1, 2009.
Acts 2019, 86th Leg., R.S., Ch. 943 (H.B. 3), Sec. 3.086, 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 1581 - Employer Expenditures for School Employee Health Coverage Plans › Subchapter B. Maintenance of Effort; Minimum Effort › Section 1581.054. Excess of Maintenance of Effort

Sec. 1581.054.  EXCESS OF MAINTENANCE OF EFFORT.  If the amount a school district, other educational district, or participating charter school is required to use to provide health coverage under Section 1581.051 for a fiscal year exceeds the amount necessary for the district or school to comply with Section 1581.052(a) for that year, the district or school may use the excess only to provide employee compensation at a rate greater than the rate of compensation that the district or school paid an employee in the 2000-2001 school year, benefits, or both.
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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.001. Short Title

Sec. 1601.001.  SHORT TITLE.  This chapter may be cited as the State University Employees Uniform Insurance Benefits Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.002. Purposes

Sec. 1601.002.  PURPOSES.  The purposes of this chapter are to:
(1)  provide uniformity in the basic group life, accident, and health benefit coverages for all system employees;
(2)  enable the systems to attract and retain competent and able employees by providing employees with basic life, accident, and health benefit coverages comparable to those commonly provided in private industry and to employees of a state agency other than a system, including a public college or university whose employees are covered under Chapter 1551;
(3)  foster, promote, and encourage employment by and service to the systems as a career profession for individuals of high standards of competence and ability;
(4)  recognize and protect the investment of the systems in each employee by promoting and preserving economic security and good health among employees;
(5)  foster and develop high standards of employer-employee relationships between the systems and their employees;  and
(6)  recognize the long and faithful service and dedication of employees and encourage them to remain in service until eligible for retirement by providing health benefits and other group benefits for them.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.003. General Definitions

Sec. 1601.003.  GENERAL DEFINITIONS.  In this chapter:
(1)  "Administering carrier" means a carrier or organization that is:
(A)  qualified to engage in business in this state;  and
(B)  designated by a system to administer services, benefits, insurance coverages, or requirements in accordance with this chapter.
(2)  "Basic coverage" means coverage, including health benefit coverage, that meets the basic coverage standards required under Section 1601.053(a)(1).
(3)  "Cafeteria plan" means a plan defined and authorized by Section 125, Internal Revenue Code of 1986.
(4)  "Group life, accident, or health benefit plan" means a group agreement, policy, contract, or arrangement provided by an administering carrier, including:
(A)  a group insurance policy or contract;
(B)  a life, accident, medical, dental, or hospital service agreement;
(C)  a membership or subscription contract;  or
(D)  any other similar group arrangement.
(5)  "Optional coverage" means group coverage other than the basic coverage.
(6)  "Service" means personal service to a system for which an employee is credited in accordance with rules adopted by the system.
(7)  "System" means The University of Texas System or The Texas A&M University System.
(8)  "The Texas A&M University System" means the entities governed under Chapters 85 through 88, Education Code, including the Texas Veterinary Diagnostic Laboratory.
(9)  "The University of Texas System" means the entities listed or described by Section 65.02, Education Code.
(10)  "Uniform program" means an employees uniform insurance benefits program provided under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.004. Definition of Dependent

Sec. 1601.004.  DEFINITION OF DEPENDENT.  (a)  In this chapter, "dependent," with respect to an individual eligible to participate in the uniform program under Section 1601.101 or 1601.102, means the individual's:
(1)  spouse;
(2)  unmarried child younger than 25 years of age; and
(3)  child of any age who lives with or has the child's care provided by the individual on a regular basis if the child is a person with an intellectual disability or is physically incapacitated to the extent that the child is dependent on the individual for care or support, as determined by the system.
(b)  In this section:
(1)  "Child" includes:
(A)  an adopted child;  and
(B)  a stepchild, foster child, or other child who is in a parent-child relationship with an individual who is eligible to participate in the uniform program under Section 1601.101 or 1601.102.
(2)  "Spouse" has the meaning assigned by the Family Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 30 (H.B. 446), Sec. 8.08, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.005. Definition of Carrier

Sec. 1601.005.  DEFINITION OF CARRIER.  In this chapter, "carrier" means:
(1)  an insurance company that is authorized by the department to provide under this code any of the types of insurance coverages, benefits, or services provided for in this chapter, and that:
(A)  has an adequate surplus;
(B)  has a successful operating history;  and
(C)  has had successful experience, as determined by the department, in providing and servicing any of the types of group coverage provided for in this chapter;
(2)  a corporation operating under Chapter 842 that provides any of the types of coverage, benefits, or services provided for in this chapter and that:
(A)  has a successful operating history;  and
(B)  has had successful experience, as determined by the department, in providing and servicing any of the types of group coverage provided for in this chapter;  or
(3)  any combination of carriers described by Subdivisions (1) and (2) on terms the system prescribes.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.006. Applicability of Definitions

Sec. 1601.006.  APPLICABILITY OF DEFINITIONS.  The definition of a term defined by this subchapter and the use of the terms "employee" and "retired employee" as described by Sections 1601.101 and 1601.102 apply to this chapter unless a different meaning is plainly required by the context in which the term appears.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.007. System May Define Other Words

Sec. 1601.007.  SYSTEM MAY DEFINE OTHER WORDS.  A system may define by rule a word or term necessary in the administration of this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.008. Exemption From Execution

Sec. 1601.008.  EXEMPTION FROM EXECUTION.  All insurance benefits and other payments and transactions made under this chapter to a participant under this chapter are exempt from execution, attachment, garnishment, or any other process.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.009. Exemption From Taxation and Fees

Sec. 1601.009.  EXEMPTION FROM TAXATION AND FEES.  Premiums on a policy, an insurance contract, or an agreement established under this chapter with a health maintenance organization are not subject to any state tax, regulatory fee, or surcharge, including a premium or maintenance tax or fee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.010. Certain Combining of Carriers Not Restraint of Trade

Sec. 1601.010.  CERTAIN COMBINING OF CARRIERS NOT RESTRAINT OF TRADE.  Carriers combining to bid, underwrite, or both bid and underwrite, a group life, accident, or health benefit plan for the uniform program are not in violation of Chapter 15, Business & Commerce Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter A. General Provisions › Section 1601.011. Participation of the Texas A&m University System

Sec. 1601.011.  PARTICIPATION OF THE TEXAS A&M UNIVERSITY SYSTEM.  Notwithstanding any other provision of this chapter, if The Texas A&M University System elects to participate in the group benefits program under Section 1551.006(c), that system, including the Texas Veterinary Medical Diagnostic Laboratory, does not participate in a uniform program established under this chapter, effective on the date participation in the group benefits program under Chapter 1551 begins.
Added by Acts 2003, 78th Leg., ch. 366, Sec. 4.01, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.051. Administration and Implementation

Sec. 1601.051.  ADMINISTRATION AND IMPLEMENTATION.  A system shall:
(1)  implement a uniform program for the benefit of its employees and retired employees;  and
(2)  determine basic procedural and administrative practices for insurance coverage provided under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.052. Rulemaking Authority

Sec. 1601.052.  RULEMAKING AUTHORITY.  A system shall adopt rules consistent with this chapter as it considers necessary to implement this chapter and its purposes.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.053. General Duties Relating to Coverage

Sec. 1601.053.  GENERAL DUTIES RELATING TO COVERAGE.  (a)  A system shall:
(1)  determine basic coverage standards that must be comparable to those commonly provided:
(A)  in private industry;  and
(B)  to employees of another agency or an institution of higher education in this state under Chapter 1551;  and
(2)  establish procedures to allow each covered employee and retired employee to obtain prompt action regarding claims pertaining to coverages provided under this chapter.
(b)  In designing a coverage plan, a system may consider existing local conditions.
(c)  Notwithstanding any other provision of this chapter, a system may adjust a plan and coverage standards as necessary to comply with applicable state and federal law and to provide consistent eligibility for all plans under the program, including eligibility for optional coverages.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 1106 (H.B. 4035), Sec. 3, eff. June 15, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.054. Competitive Bidding Required

Sec. 1601.054.  COMPETITIVE BIDDING REQUIRED.  A system shall submit the uniform program, including any agreement under which a carrier is engaged to administer a self-insured program, for competitive bidding at least every six years.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.055. Identification of Administrative Costs in Bids

Sec. 1601.055.  IDENTIFICATION OF ADMINISTRATIVE COSTS IN BIDS.  A system shall include in its respective bid documents for the various coverages a provision calling for each bidder to identify the system's administrative costs as a distinguishable figure and to enumerate the services the bidder will render in exchange for the administrative costs.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.056. Information on Bidders and Bidding Contracts

Sec. 1601.056.  INFORMATION ON BIDDERS AND BIDDING CONTRACTS.  (a)  The department shall, on request by a system, provide a list of all carriers:
(1)  authorized to engage in business in this state;  and
(2)  eligible to bid on insurance coverage provided under this chapter.
(b)  The department shall, on request by a system, examine and evaluate a bidding contract and certify the contract's actuarial soundness to the system not later than the 15th day after the date of the request.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.057. Selection of Bids

Sec. 1601.057.  SELECTION OF BIDS.  (a)  A system is not required to select the lowest bid under Section 1601.054 but shall take into consideration other relevant criteria, such as ability to service contracts, past experience, and financial stability.
(b)  If a system selects a carrier whose bid differs from that advertised, the governing board of the system shall fully justify and record the reasons for the deviation in the minutes of the next meeting of the governing board.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.058. Selection of Health Maintenance Organizations

Sec. 1601.058.  SELECTION OF HEALTH MAINTENANCE ORGANIZATIONS.  A system shall select and contract for services performed by health maintenance organizations that are approved by this state to offer health care services in specific areas of the state to eligible employees and retired employees.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.059. Certificate of Coverage

Sec. 1601.059.  CERTIFICATE OF COVERAGE.  A system shall ensure that each employee and retired employee participating under this chapter is issued a certificate of coverage that states:
(1)  the benefits to which the participant is entitled;
(2)  to whom the benefits are payable;
(3)  to whom a claim must be submitted;  and
(4)  the provisions of the plan document, in summary form, that principally affect the participant.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.060. Accounting by Carrier Providing Purchased Coverage

Sec. 1601.060.  ACCOUNTING BY CARRIER PROVIDING PURCHASED COVERAGE.  (a)  A carrier providing coverage purchased under this chapter to a system shall provide an accounting for each line of coverage to the system not later than the 120th day after the end of each plan year.
(b)  The accounting must be in a form acceptable to the system.
(c)  The accounting for each line of coverage must state:
(1)  the cumulative amount of contributions remitted to the carrier under the coverage;
(2)  the total of all mortality and other claims, charges, losses, costs, contingency reserve for pending and unreported claims, and expenses incurred;  and
(3)  the amounts of the allowance for a reasonable profit, contingency reserve, and all other administrative charges.
(d)  Information provided under Subsection (c) must be provided:
(1)  for the period from the coverage's date of issue to the end of the plan year;  and
(2)  for the plan year covered by the report.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.061. Special Reserve

Sec. 1601.061.  SPECIAL RESERVE.  (a)  A carrier issuing a group coverage plan under this chapter may hold as a special reserve for a system an amount that equals the amount by which the total amount described by Section 1601.060(c)(1) exceeds the sum of the corresponding amounts described by Sections 1601.060(c)(2) and (3).
(b)  The system may use money in the special reserve at its discretion, including for:
(1)  providing additional coverage for participating employees or retired employees;
(2)  offsetting necessary rate increases;  or
(3)  reducing contributions to the coverage by participating employees or retired employees.
(c)  A special reserve held by a carrier for a system earns interest at a rate determined each plan year by the carrier and approved by the system as consistent with the rate generally used by the carrier for similar funds held under other group 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.062. Reports and Records by Administering Carrier

Sec. 1601.062.  REPORTS AND RECORDS BY ADMINISTERING CARRIER.  Each contract entered into under this chapter between a system and an administering carrier must:
(1)  require the administering carrier to provide reasonable reports that the system determines are necessary for the system to perform its functions under this chapter;  and
(2)  permit the system and representatives of the state auditor to examine records of the administering carrier as necessary to accomplish the purposes of this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.063. Assistance in Requesting Money

Sec. 1601.063.  ASSISTANCE IN REQUESTING MONEY.  The Legislative Budget Board and the Governor's Budget and Planning Office shall:
(1)  establish procedures to ensure that each system requests appropriate money to support its uniform program;  and
(2)  present appropriate budget recommendations to the legislature.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter B. Administration and Implementation › Section 1601.064. Pharmacy Benefit Manager Contracts

Sec. 1601.064.  PHARMACY BENEFIT MANAGER CONTRACTS.  (a)  In awarding a contract to provide pharmacy benefit manager services under this chapter, a system is not required to select the lowest bid but must select a contract that meets the criteria established by this section.
(b)  The contract must state that:
(1)  the system is entitled to audit the pharmacy benefit manager to verify costs and discounts associated with drug claims, pharmacy benefit manager compliance with contract requirements, and services provided by subcontractors;
(2)  the audit must be conducted by an independent auditor in accordance with established auditing standards; and
(3)  to conduct the audit, the system and the independent auditor are entitled access to information related to the services and the costs associated with the services performed under the contract, including access to the pharmacy benefit manager's facilities, records, contracts, medical records, and agreements with subcontractors.
(c)  The contract must define the information that the pharmacy benefit manager is required to provide to the system concerning the audit of the retail, independent, and mail order pharmacies performing services under the contract and describe how the results of these audits must be reported to the system, including how often the results must be reported.  The contract must state whether the pharmacy benefit manager is required to return recovered overpayments to the system.
(d)  The contract must state that any audit of a mail order pharmacy owned by the pharmacy benefit manager must be conducted by an independent auditor selected by the system in accordance with established auditing standards.
Added by Acts 2009, 81st Leg., R.S., Ch. 1207 (S.B. 704), Sec. 8, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.101. Participation Eligibility: Employees

Sec. 1601.101.  PARTICIPATION ELIGIBILITY:  EMPLOYEES.  (a)  An individual who is employed by the governing board of a system, who performs service, other than as an independent contractor, for the system, and who is described by this section is eligible to participate as an employee in the uniform program on the date specified by Section 1601.1045.
(b)  An individual is eligible to participate in the uniform program as provided by Subsection (a) if the individual receives compensation for services performed for the system, is eligible to be a member of the Teacher Retirement System of Texas, and either:
(1)  is expected to work at least 20 hours per week and to continue in the employment for a term of at least 4-1/2 months;  or
(2)  is appointed for at least 50 percent of a standard full-time appointment.
(c)  An individual is eligible to participate in the uniform program as provided by Subsection (a) if the individual:
(1)  receives compensation for services performed for the system;
(2)  is employed at least 20 hours a week; and
(3)  is not permitted to be a member of the Teacher Retirement System of Texas because the individual is solely employed by the system in a position that as a condition of employment requires the individual to be enrolled as a student in the system in graduate-level courses.
(d)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1198, Sec. 5, eff. January 1, 2012.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 366, Sec. 4.02, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1266, Sec. 2.11, eff. Sept. 1, 2003.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 91 (S.B. 1303), Sec. 14.002, eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1198 (S.B. 29), Sec. 5, eff. January 1, 2012.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.1021. Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students

Sec. 1601.1021.  PARTICIPATION ELIGIBILITY:  CERTAIN POSTDOCTORAL FELLOWS AND GRADUATE STUDENTS.  (a)  An individual who is not eligible to participate in the uniform program under Section 1601.101 is eligible to participate in the uniform program under this section if the individual, at an institution in a system:
(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 uniform 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 uniform 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 uniform 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. 3, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.103. Right to Coverage

Sec. 1601.103.  RIGHT TO COVERAGE.  An individual eligible to participate in the uniform program under Section 1601.101 or 1601.102 may not be denied enrollment in any coverage provided under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.104. Automatic Coverage

Sec. 1601.104.  AUTOMATIC COVERAGE.  (a)  A system shall automatically provide the basic coverage to each full-time employee unless the employee has:
(1)  waived participation in the basic coverage;  or
(2)  selected an optional coverage plan.
(b)  An employee or retired employee who is automatically covered under this section may subsequently:
(1)  retain the basic coverage or waive participation in the basic coverage;  and
(2)  apply for any other coverage provided under this chapter within applicable standards.
(c)  Automatic coverage as described under this section begins on the first date of employment.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.1045. Date Eligibility Begins; Waiting Period

Sec. 1601.1045.  DATE ELIGIBILITY BEGINS;  WAITING PERIOD.  (a)  Except as provided by Subsection (c), (d), or (e), eligibility under Section 1601.101 begins on the first day of the calendar month that begins after the 90th day after the date the employee performs services for a system.
(b)  Except as provided by Subsection (c), eligibility under Section 1601.102, for an individual who does not retire at the end of the last month for which the individual is on the payroll of a system before retirement, begins on the first day of the calendar month that begins after 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 health benefits program and does not apply to the determination of initial eligibility to participate in optional coverages under the uniform program.
(d)  Notwithstanding Subsection (a), eligibility under Section 1601.101 may not begin earlier than the first day that an employee performs services for a system 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 system.
(e)  Eligibility under Section 1601.101 for an employee reemployed under Chapter 613, Government Code, begins on the first day of reemployment on which the employee performs services for a system.
Added by Acts 2003, 78th Leg., ch. 366, Sec. 4.05, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 150 (H.B. 437), Sec. 2, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.105. Waiver

Sec. 1601.105.  WAIVER.  An employee or retired employee may waive in writing any coverage provided under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.106. Optional Coverage

Sec. 1601.106.  OPTIONAL COVERAGE.  A system shall provide optional coverage in accordance with Section 1601.201.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.1065. Optional Basic Coverage Plan for Graduate Students

Sec. 1601.1065.  OPTIONAL BASIC COVERAGE PLAN FOR GRADUATE STUDENTS.  The system may design and offer a separate optional basic coverage plan for employees who are graduate students.  The system shall determine the participation eligibility, coverage, payments, contributions, and costs of a plan offered under this section.
Added by Acts 2017, 85th Leg., R.S., Ch. 1106 (H.B. 4035), Sec. 7, eff. June 15, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.107. Coverage for Dependents

Sec. 1601.107.  COVERAGE FOR DEPENDENTS.  An individual who is eligible to participate in the uniform program under Section 1601.101, 1601.102, or 1601.1021 is entitled to secure for a dependent of the individual any group coverages provided under this chapter for dependents under rules adopted by the applicable system.
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. 4, 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 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.108. Coverage Options for Certain Surviving Spouses

Sec. 1601.108.  COVERAGE OPTIONS FOR CERTAIN SURVIVING SPOUSES.  (a)  This section applies only to the surviving spouse of:
(1)  an individual eligible to participate in the uniform program under Section 1601.101 who had at least five years of service on the date of the individual's death, including at least three years of service as an eligible employee with the employing system;  or
(2)  an individual eligible to participate in the uniform program under Section 1601.102.
(b)  A surviving spouse to whom this section applies may elect to retain any of the following coverages in effect on the date of the participant's death:
(1)  the surviving spouse's authorized coverages;  and
(2)  authorized coverages for any eligible dependent of the deceased participant.
(c)  The coverage is at the group rate for other participants.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.109. Coverage for Aids, Hiv, or Serious Mental Illness

Sec. 1601.109.  COVERAGE FOR AIDS, HIV, OR SERIOUS MENTAL ILLNESS.  (a)  In this section, "serious mental illness" has the meaning assigned by Section 1355.001.
(b)  A system may not contract for or provide for group insurance or HMO coverage or provide self-insured coverage, 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;  or
(2)  provides coverage for serious mental illness that is less extensive than the coverage provided for any other physical illness.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.020, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.110. Disease Management Services

Sec. 1601.110.  DISEASE MANAGEMENT SERVICES.  (a)  In this section, "disease management services" means services to assist an individual manage a disease or other chronic health condition, such as heart disease, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS, and with respect to which the governing board of a system identifies populations requiring disease management.
(b)  A health benefit plan provided under this chapter must provide disease management services or coverage for disease management services in the manner required by the governing board of a system, including:
(1)  patient self-management education;
(2)  provider education;
(3)  evidence-based models and minimum standards of care;
(4)  standardized protocols and participation criteria;  and
(5)  physician-directed or physician-supervised care.
Added by Acts 2003, 78th Leg., ch. 589, Sec. 5, eff. June 20, 2003.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle H - Health Benefits and Other Coverages for Governmental Employees › Chapter 1601 - Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System › Subchapter C. Coverage and Participation › Section 1601.111. Programs Promoting Disease Prevention, Wellness, and Health

Sec. 1601.111.  PROGRAMS PROMOTING DISEASE PREVENTION, WELLNESS, AND HEALTH.  A system may establish premium discounts, surcharges, rebates, or a revision in otherwise applicable copayments, coinsurance, or deductibles, or any combination of those incentives, for an individual who participates in system-approved programs promoting disease prevention, wellness, and health.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1049 (S.B. 5), Sec. 3.02, eff. June 17, 2011.