CHAPTER 1575. TEXAS PUBLIC SCHOOL EMPLOYEES GROUP BENEFITS PROGRAM
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE H. HEALTH BENEFITS AND OTHER COVERAGES FOR GOVERNMENTAL
EMPLOYEES
CHAPTER 1575. TEXAS PUBLIC SCHOOL EMPLOYEES GROUP BENEFITS
PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1575.001. SHORT TITLE. This chapter may be cited as the
Texas Public School Retired Employees Group Benefits Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.413(a),
eff. Sept. 1, 2003.
Sec. 1575.002. GENERAL DEFINITIONS. In this chapter:
(1) "Active employee" means a contributing member of the Teacher
Retirement System of Texas who:
(A) is employed by a public school; and
(B) is not entitled to coverage under a plan provided under
Chapter 1551 or 1601.
(2) "Carrier" means an insurance company or hospital service
corporation authorized by the department under this code or
another insurance law of this state to provide any of the
insurance coverages, benefits, or services provided by this
chapter.
(3) "Fund" means the retired school employees group insurance
fund.
(4) "Group program" means the Texas Public School Employees
Group Insurance Program authorized by this chapter.
(5) "Health benefit plan" means a group insurance policy,
contract, or certificate, medical or hospital service agreement,
membership or subscription contract, salary continuation plan, or
similar group arrangement to provide health care services or to
pay or reimburse expenses of health care services.
(6) "Public school" means:
(A) a school district;
(B) another educational district whose employees are members of
the Teacher Retirement System of Texas;
(C) a regional education service center established under
Chapter 8, Education Code; or
(D) an open-enrollment charter school established under
Subchapter D, Chapter 12, Education Code.
(7) "Trustee" means the Teacher Retirement System of Texas.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 47, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 366, Sec. 3.01, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 1, eff. Sept.
1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.414(a), eff.
Sept. 1, 2003.
Sec. 1575.003. DEFINITION OF DEPENDENT AND RELATED TERMS. In
this chapter:
(1) "Dependent" means:
(A) the spouse of a retiree;
(B) an unmarried child of a retiree or deceased active member if
the child is younger than 25 years of age, including:
(i) an adopted child;
(ii) a foster child, stepchild, or other child who is in a
regular parent-child relationship; or
(iii) a recognized natural child;
(C) a retiree's recognized natural child, adopted child, foster
child, stepchild, or other child who is in a regular parent-child
relationship and who lives with or has his or her care provided
by the retiree or surviving spouse on a regular basis regardless
of the child's age, if the child is mentally retarded or
physically incapacitated to an extent that the child is dependent
on the retiree or surviving spouse for care or support, as
determined by the trustee; or
(D) a deceased active member's recognized natural child, adopted
child, foster child, stepchild, or other child who is in a
regular parent-child relationship, without regard to the age of
the child, if, while the active member was alive, the child:
(i) lived with or had the child's care provided by the active
member on a regular basis; and
(ii) was mentally retarded or physically incapacitated to an
extent that the child was dependent on the active member or
surviving spouse for care or support, as determined by the
trustee.
(2) "Surviving dependent child" means:
(A) the dependent child of a deceased retiree who has survived
the deceased retiree and the deceased retiree's spouse; or
(B) the dependent child of a deceased active member who has
survived the deceased member and the deceased member's spouse if
the deceased member:
(i) had contributions made to the group program at the last
place of employment of the deceased member in public education in
this state;
(ii) had 10 or more years of service credit in the Teacher
Retirement System of Texas; and
(iii) died on or after September 1, 1986.
(3) "Surviving spouse" means:
(A) the surviving spouse of a deceased retiree; or
(B) the surviving spouse of a deceased active member:
(i) for whom contributions have been made to the group program
at the last place of employment of the deceased member in public
education in this state;
(ii) who had 10 or more years of service credit in the Teacher
Retirement System of Texas; and
(iii) who died on or after September 1, 1986.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.414(b),
(c), eff. Sept. 1, 2003.
Sec. 1575.004. DEFINITION OF RETIREE. (a) In this chapter,
"retiree" means:
(1) an individual not eligible for coverage under a plan
provided under Chapter 1551 or 1601 who:
(A) has taken a service retirement under the Teacher Retirement
System of Texas after September 1, 2005, with at least 10 years
of service credit in the system, which may include up to five
years of military service credit, but which may not include any
other service credit purchased for equivalent or special service
credit, and either:
(i) the sum of the retiree's age and years of service credit in
the retirement system equals or exceeds 80 at the time of
retirement, regardless of whether the retiree had a reduction in
the retirement annuity for early age; or
(ii) the retiree has 30 or more years of service credit in the
retirement system at the time of retirement;
(B) has taken a service retirement under the Teacher Retirement
System of Texas after September 1, 2004, but on or before August
31, 2005, and on September 1, 2005, either:
(i) meets the requirements for eligibility for the group program
for coverage as a retiree as those requirements existed on August
31, 2004;
(ii) meets the requirements of Paragraph (A); or
(iii) is enrolled in the group program and was enrolled in the
group program on August 31, 2005; or
(C) has taken a service retirement under the Teacher Retirement
System of Texas on or before August 31, 2004, and who is enrolled
in the group program on August 31, 2005;
(2) an individual who:
(A) has taken a disability retirement under the Teacher
Retirement System of Texas; and
(B) is entitled to receive monthly benefits from the Teacher
Retirement System of Texas; or
(3) an individual who:
(A) has taken a disability retirement under the Teacher
Retirement System of Texas;
(B) has at least 10 years of service credit in the Teacher
Retirement System of Texas on the date of disability retirement,
as determined under Section 824.304, Government Code; and
(C) is not entitled to receive monthly benefits from the Teacher
Retirement System of Texas because those benefits have been
suspended in accordance with Section 824.310, Government Code.
(b) In this section, "public school" has the meaning assigned
by Section 821.001, Government Code.
(c) For purposes of this section, to meet the requirements for
eligibility that existed on August 31, 2004, for a service
retiree, an individual must not have been eligible to be covered
by a plan provided under Chapter 1551 or 1601 and must have taken
a service retirement under the Teacher Retirement System of Texas
with either:
(1) at least 10 years of service credit in the retirement system
for actual service in public schools in this state; or
(2) at least five years of service credit for actual service in
the public schools in this state and five years of out-of-state
service credit in the Teacher Retirement System of Texas.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 48, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 2, eff. Sept.
1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.415, eff. Sept.
1, 2003; Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.05, eff.
Sept. 1, 2004.
Amended by:
Acts 2005, 79th Leg., Ch.
1359, Sec. 38, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1230, Sec. 15, eff. September 1, 2007.
Sec. 1575.005. ISSUANCE OF CERTIFICATE OF COVERAGE. At the time
and in the circumstances specified by the trustee, a carrier
shall issue to each retiree, surviving spouse, or surviving
dependent child covered under this chapter a certificate of
coverage that:
(1) states the benefits to which the person is entitled;
(2) states to whom the benefits are payable;
(3) states to whom a claim must be submitted; and
(4) summarizes the provisions of the coverage principally
affecting the person.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.416(a),
eff. Sept. 1, 2003.
Sec. 1575.006. EXEMPTION FROM PROCESS. (a) The following are
exempt from execution, attachment, garnishment, or any other
process:
(1) benefit payments, including optional benefits payments,
active employee and state contributions, and retiree, surviving
spouse, and surviving dependent child contributions;
(2) any rights, benefits, or payments accruing to any person
under this chapter; and
(3) any money in the fund.
(b) The items listed in Subsection (a) may not be assigned
except for direct payment to benefit providers as authorized by
the trustee by contract, rule, or otherwise.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.417,
eff. Sept. 1, 2003.
Sec. 1575.007. EXEMPTION FROM STATE TAXES AND FEES. A premium
or contribution on a policy, insurance contract, or agreement
authorized by this chapter is not subject to any state tax,
regulatory fee, or surcharge, including a premium or maintenance
tax or fee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.008. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage
plan provided under this chapter is exempt from any other
insurance law, including common law, that does not expressly
apply to the plan or this chapter.
Added by Acts 2005, 79th Leg., Ch.
1359, Sec. 39, eff. September 1, 2005.
SUBCHAPTER B. ADMINISTRATION
Sec. 1575.051. ADMINISTRATION OF GROUP PROGRAM. The trustee
shall take the actions it considers necessary to devise,
implement, and administer the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.419,
eff. Sept. 1, 2003.
Sec. 1575.052. AUTHORITY TO ADOPT RULES AND PROCEDURES; OTHER
AUTHORITY. (a) The trustee may adopt rules, plans, procedures,
and orders reasonably necessary to implement this chapter,
including:
(1) minimum benefit and financing standards for group coverage
for retirees, dependents, surviving spouses, and surviving
dependent children;
(2) basic and optional group coverage for retirees, dependents,
surviving spouses, and surviving dependent children;
(3) procedures for contributions and deductions;
(4) periods for enrollment and selection of optional coverage
and procedures for enrolling and exercising options under the
group program;
(5) procedures for claims administration;
(6) procedures to administer the fund; and
(7) a timetable for:
(A) developing minimum benefit and financial standards for group
coverage;
(B) establishing group plans; and
(C) taking bids and awarding contracts for group plans.
(b) The trustee may:
(1) study the operation of all group coverage provided under
this chapter; and
(2) contract for advice and counsel in implementing and
administering the group program with independent and experienced
group insurance consultants and actuaries.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.420(a),
eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
1359, Sec. 40, eff. September 1, 2005.
Sec. 1575.053. PERSONNEL. (a) The trustee may employ persons
to assist the trustee in implementing this chapter.
(b) The trustee shall prescribe the duties and compensation of
each employee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,
eff. Sept. 1, 2003.
Sec. 1575.054. BUDGET. Expenses incurred in developing and
administering the group program shall be paid as provided by a
budget adopted by the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,
eff. Sept. 1, 2003.
Sec. 1575.055. DEPARTMENT ASSISTANCE. The department shall, as
requested by the trustee, assist the trustee in implementing and
administering this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,
eff. Sept. 1, 2003.
Sec. 1575.056. TRANSFER OF RECORDS RELATING TO ACTIVE EMPLOYEE
PROGRAM. The trustee shall transfer from the program all records
relating to active employees participating in the program
established under Chapter 1579 not later than the date on which
the program established under Chapter 1579 is implemented.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.422(a), eff.
Sept. 1, 2003.
SUBCHAPTER C. PROVISION OF BENEFITS
Sec. 1575.101. SYSTEM AS GROUP PLAN HOLDER. The Teacher
Retirement System of Texas is the group plan holder of a plan
established under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,
eff. Sept. 1, 2003.
Sec. 1575.102. SELF-INSURED PLANS. The trustee may self-insure
any plan established under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,
eff. Sept. 1, 2003.
Sec. 1575.103. PLANS MAY VARY ACCORDING TO MEDICARE COVERAGE.
For retirees and surviving spouses who are covered by Medicare,
the trustee may provide one or more plans that are different from
the plans provided for retirees and surviving spouses who are not
covered by Medicare.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,
eff. Sept. 1, 2003.
Sec. 1575.104. TERMS OF CONTRACT. A contract for group coverage
awarded by the trustee must meet the minimum benefit and
financial standards adopted by the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,
eff. Sept. 1, 2003.
Sec. 1575.105. PLAN COVERAGE SECONDARY TO CERTAIN OTHER
COVERAGE. The coverage provided by a plan established under this
chapter:
(1) is secondary to Medicare hospital and medical insurance to
the extent permitted by federal law if the retiree, dependent,
surviving spouse, or surviving dependent child is entitled to
receive Medicare hospital insurance benefits without charge; and
(2) may be made secondary to other coverage to which the
retiree, dependent, surviving spouse, or surviving dependent
child is entitled.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.106. COMPETITIVE BIDDING REQUIREMENTS; RULE. (a) A
contract to provide group benefits under this chapter may be
awarded only through competitive bidding under rules adopted by
the trustee.
(b) The trustee shall submit for competitive bidding at least
every six years each contract for coverage under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.424(a),
eff. Sept. 1, 2003.
Sec. 1575.107. CONTRACT AWARD; CONSIDERATIONS. (a) In awarding
a contract to provide group benefits under this chapter, the
trustee is not required to select the lowest bid and may consider
any relevant criteria, including the bidder's:
(1) ability to service contracts;
(2) past experiences; and
(3) financial stability.
(b) If the trustee awards a contract to a bidder whose bid
deviates from that advertised, the trustee shall record the
deviation and fully justify the reason for the deviation in the
minutes of the next meeting of the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.424(b),
eff. Sept. 1, 2003.
Sec. 1575.108. USE OF PRIVATE ENTITIES. The trustee may engage
a private entity to collect contributions from or to settle
claims in connection with a plan established by the trustee under
this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,
eff. Sept. 1, 2003.
Sec. 1575.109. USE OF HEALTH CARE PROVIDER. To provide benefits
to participants in the group program, the trustee may contract
directly with a health care provider, including a health
maintenance organization, a preferred provider organization, a
carrier, an administrator, and any other qualified vendor.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,
eff. Sept. 1, 2003.
Sec. 1575.110. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In
awarding a contract to provide pharmacy benefit manager services
under this chapter, the trustee 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 trustee 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 trustee 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 trustee 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 trustee,
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 trustee.
(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 trustee in accordance
with established auditing standards.
Added by Acts 2009, 81st Leg., R.S., Ch.
1207, Sec. 6, eff. September 1, 2009.
SUBCHAPTER D. COVERAGES AND PARTICIPATION
Sec. 1575.151. TYPES OF COVERAGES. The trustee may include in a
plan any coverage it considers advisable, including:
(1) life insurance;
(2) accidental death and dismemberment coverage;
(3) coverage for:
(A) hospital care and benefits;
(B) surgical care and treatment;
(C) medical care and treatment;
(D) dental care;
(E) eye care;
(F) obstetrical benefits;
(G) long-term care;
(H) prescribed drugs, medicines, and prosthetic devices; and
(I) supplemental benefits, supplies, and services in accordance
with this chapter; and
(4) protection against loss of salary.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,
eff. Sept. 1, 2003.
Sec. 1575.152. BASIC PLAN MUST COVER PREEXISTING CONDITIONS. A
basic plan must cover preexisting conditions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.153. BASIC COVERAGE. A retiree who applies for
coverage during an enrollment period may not be denied coverage
in a basic plan provided under this chapter unless the trustee
finds under Subchapter K that the retiree defrauded or attempted
to defraud the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 49(a), eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 3(a), eff.
Sept. 1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.426(a),
eff. Sept. 1, 2003.
Sec. 1575.155. COVERAGE FOR DEPENDENTS OF RETIREE. (a) A
retiree participating in the group program is entitled to secure
for the retiree's dependents group coverage provided for the
retiree under this chapter, as determined by the trustee.
(b) The additional contribution payments for the dependent
coverage shall be deducted from the annuity payments to the
retiree in the manner and form determined by the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.427,
eff. Sept. 1, 2003.
Sec. 1575.156. COVERAGE FOR SURVIVING SPOUSE OR DEPENDENTS OF
SURVIVING SPOUSE. (a) A surviving spouse who is entitled to
group coverage under this chapter may elect to retain or obtain
coverage for the surviving spouse or dependents of the surviving
spouse at the applicable rate for the deceased participant.
(b) A surviving spouse must provide payment of applicable
contributions in the manner established by Section 1575.205 and
by the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.428,
eff. Sept. 1, 2003.
Sec. 1575.157. COVERAGE FOR SURVIVING DEPENDENT CHILD. (a) A
surviving dependent child, the guardian of the child's estate, or
the person having custody of the child may elect to retain or
obtain group coverage for the surviving dependent child at the
applicable rate for a dependent.
(b) The applicable contributions must be provided in the manner
established by Section 1575.205 and by the trustee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.429,
eff. Sept. 1, 2003.
Sec. 1575.158. OPTIONAL GROUP HEALTH BENEFIT PLAN. (a) The
trustee may, in addition to providing a basic plan, contract for
and make available an optional group health benefit plan for
retirees, dependents, surviving spouses, or surviving dependent
children.
(b) An optional group health benefit plan may provide for:
(1) a deductible in an amount that is less than the amount for
the basic plan;
(2) coinsurance in an amount that is less than the amount for
the basic plan; or
(3) additional benefits as permitted under Section 1575.151.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.430,
eff. Sept. 1, 2003.
Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN TEST. A
health benefit plan offered under the group program must provide
coverage for a medically accepted prostate-specific antigen test
used for the detection of prostate cancer for each male enrolled
in the plan who:
(1) is at least 50 years of age; or
(2) is at least 40 years of age and:
(A) has a family history of prostate cancer; or
(B) exhibits another cancer risk factor.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.160. GROUP LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT
INSURANCE: PAYMENT OF CLAIM. The amount of group life insurance
or group accidental death and dismemberment insurance covering a
retiree, dependent, surviving spouse, or surviving dependent
child on the date of death shall be paid, on the establishment of
a valid claim, only to:
(1) the beneficiary designated by the person in a signed and
witnessed document received before death in the office of the
trustee; or
(2) a person in the order prescribed by Section 824.103(b),
Government Code, if a beneficiary is not properly designated or a
beneficiary does not exist.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.431(a),
eff. Sept. 1, 2003.
Sec. 1575.161. OPEN ENROLLMENT; ADDITIONAL ENROLLMENT PERIODS.
(a) A retiree eligible for coverage under the group program may
select any coverage provided under this chapter for which the
person is otherwise eligible:
(1) on any date that is on or after the date the person retires
and on or before the 90th day after that date; and
(2) during any other open enrollment periods for retirees set by
the trustee by rule.
(b) In addition to the enrollment periods authorized under
Subsection (a), a retiree who:
(1) is enrolled in the group program as of August 31, 2004, and
who is 65 years of age or older on that date may select coverage
as described by Subsections (c) and (d) on September 1, 2004;
(2) is enrolled in the group program as of August 31, 2004, and
who is 65 years of age after that date may select coverage as
described by Subsections (c) and (d) on the date that the retiree
is 65 years of age; or
(3) enrolls in the group program on or after September 1, 2004,
and who is 65 years of age or older on or after that date may
select coverage as described in Subsections (c) and (d) on the
date that the retiree is 65 years of age.
(c) If a retiree described by Subsection (b) is not covered by
the Medicare program, the retiree may enroll in the next-higher
coverage tier under the group program and may add dependent
coverage in that same coverage tier.
(d) If a retiree described by Subsection (b) is covered by the
Medicare program, the retiree may enroll in any coverage tier
under the group program and may add dependent coverage in that
same coverage tier.
(e) This section does not affect the right of a retiree enrolled
in a coverage tier under the group program to select a lower
level of coverage at any time.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,
2003; Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.
Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.06,
eff. Jan. 11, 2004.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
354, Sec. 1, eff. September 1, 2009.
Sec. 1575.162. SPECIAL ENROLLMENTS. This chapter does not limit
the ability of an individual to enroll in the group program if
the individual:
(1) experiences a special enrollment event as provided by the
Health Insurance Portability and Accountability Act of 1996 (Pub.
L. No. 104-191, 110 Stat. 1936 (1996)), as amended; and
(2) is otherwise eligible to enroll in the group program.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,
2003; Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.
Sec. 1575.163. LIMITATIONS. The Teacher Retirement System of
Texas, as trustee, may not contract for or provide a health
benefit plan that excludes from participation in the network a
general hospital that:
(1) is located in within the geographical service area or areas
of the health coverage plan that includes a county that:
(A) has a population of at least 100,000 and not more than
175,000; and
(B) is located in the Texas-Louisiana border region, as that
term is defined in Section 2056.002(e), Government Code; and
(2) agrees to provide medical and health care services under the
plan subject to the same terms and conditions as other hospital
providers under the plan.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,
2003.
Sec. 1575.164. 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 Teacher Retirement System of
Texas 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 Teacher
Retirement System of Texas, 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. 4, eff. June 20,
2003.
Renumbered from Insurance Code, Section 1575.162 by Acts 2005,
79th Leg., Ch.
728, Sec. 23.001(62), eff. September 1, 2005.
Sec. 1575.170. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a) In
this section, "drug formulary" means a list of drugs preferred
for use and eligible for coverage under a health benefit plan.
(b) A health benefit plan provided under this chapter that uses
a drug formulary in providing a prescription drug benefit must
require prior authorization for coverage of the following
categories of prescribed drugs if the specific drug prescribed is
not included in the formulary:
(1) a gastrointestinal drug;
(2) a cholesterol-lowering drug;
(3) an anti-inflammatory drug;
(4) an antihistamine; and
(5) an antidepressant drug.
(c) Every six months the board of trustees shall submit to the
comptroller and Legislative Budget Board a report regarding any
cost savings achieved in the group program through implementation
of the prior authorization requirement of this section. A report
must cover the previous six-month period.
Added by Acts 2003, 78th Leg., ch. 213, Sec. 3, eff. Sept. 1,
2003. Renumbered from Insurance Code Sec. 1575.161 by Acts 2003,
78th Leg., 3rd C.S., ch. 3, Sec. 16.07, eff. Jan. 11, 2004.
SUBCHAPTER E. CONTRIBUTIONS
Sec. 1575.201. ADDITIONAL STATE CONTRIBUTIONS; CERTAIN
CONTRIBUTIONS. (a) The state through the trustee shall
contribute from money in the fund:
(1) the total cost of the basic plan covering each participating
retiree; and
(2) for each participating dependent, surviving spouse, and
surviving dependent child, the amount prescribed by the General
Appropriations Act to cover part of the cost of the basic plan
covering the dependent, surviving spouse, and surviving dependent
child.
(b) The trustee shall collect the amount of premium required for
basic coverage under the group program that exceeds the amount
contributed by the state for those individuals described by
Subsection (a)(2).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 51, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 5, eff. Sept.
1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.432, eff. Sept.
1, 2003.
Sec. 1575.202. STATE CONTRIBUTION BASED ON ACTIVE EMPLOYEE
COMPENSATION. (a) Each state fiscal year, the state shall
contribute to the fund an amount equal to one percent of the
salary of each active employee.
(b) The state may contribute to the fund an amount in addition
to the contribution required by Subsection (a).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 52, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 6, eff. Sept.
1, 2003.
Sec. 1575.203. ACTIVE EMPLOYEE CONTRIBUTION. (a) Each state
fiscal year, each active employee shall, as a condition of
employment, contribute to the fund an amount equal to 0.65
percent of the employee's salary.
(b) The employer of an active employee shall monthly:
(1) deduct the employee's contribution from the employee's
salary and remit the contribution to the trustee in the manner
required by the trustee; or
(2) assume and pay the total contributions due from its active
employees.
(c) Contributions to the fund deducted from the salary of an
active employee are included in annual compensation for purposes
of the Teacher Retirement System of Texas.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 53, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 366, Sec. 3.02, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 7, eff. Sept.
1, 2003; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.433, eff. Sept.
1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
899, Sec. 17.02, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
1359, Sec. 41, eff. September 1, 2005.
Sec. 1575.204. PUBLIC SCHOOL CONTRIBUTION. (a) Each state
fiscal year, each public school shall contribute to the fund the
amount prescribed by the General Appropriations Act, which may
not be less than 0.25 percent or greater than 0.75 percent of the
salary of each active employee of the public school. The public
school shall make the contributions on a monthly basis and as
otherwise prescribed by the trustee.
(b) Each state fiscal year, each employer who reports to the
retirement system under Section 824.6022, Government Code, the
employment of a retiree who is enrolled in the group program
shall contribute to the fund the difference, if any, between the
contribution amount that the reported retiree is required to pay
for the retiree and any enrolled dependents to participate in the
group program and the full cost of the retiree's and enrolled
dependents' participation in the group program, as determined by
the trustee. The amounts required to be paid under this
subsection are not required to be paid by a reporting employer
for a retiree who retired from the retirement system before
September 1, 2005.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 54, eff.
Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
1359, Sec. 42, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1389, Sec. 4, eff. September 1, 2007.
Sec. 1575.205. PARTICIPATION CONTRIBUTION FOR OPTIONAL PLAN.
(a) A retiree, surviving spouse, or surviving dependent child
who elects an optional plan shall pay a monthly contribution to
cover the cost of the plan. The trustee shall adopt rules for the
collection of additional contributions.
(b) As a condition of electing coverage under an optional plan,
a retiree or surviving spouse must, in writing, authorize the
trustee to deduct the amount of the contribution from the
person's monthly annuity payment.
(c) The trustee may spend a part of the money received for the
group program to offset a part of the costs for optional coverage
paid by retirees if the expenditure does not reduce the period
the group program is projected to remain financially solvent by
more than one year in a biennium.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.434,
eff. Sept. 1, 2003.
Sec. 1575.206. CONTRIBUTIONS HELD IN TRUST FOR FUND. An
employing school district and its trustees:
(1) hold contributions required by this subchapter in trust for
the fund and its participants; and
(2) may not divert the contributions for any other purpose.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.207. INTEREST ASSESSED ON LATE PAYMENT OF DEPOSITS BY
EMPLOYING SCHOOL DISTRICTS. (a) An employing school district
that does not remit to the trustee all contributions required by
this subchapter before the seventh day after the last day of the
month shall pay to the fund:
(1) the contributions; and
(2) interest on the unpaid amounts at the annual rate of six
percent compounded monthly.
(b) On request, the trustee may grant a waiver of the deadline
imposed by this section based on an employing district's
financial or technological resources.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.435(a),
eff. Sept. 1, 2003.
Sec. 1575.208. CERTIFICATION OF AMOUNT NECESSARY TO PAY STATE
CONTRIBUTIONS. Not later than October 31 preceding each regular
session of the legislature, the trustee shall certify the amount
necessary to pay the state contributions to the fund to:
(1) the Legislative Budget Board; and
(2) the budget division of the governor's office.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436,
eff. Sept. 1, 2003.
Sec. 1575.209. CERTIFICATION OF AMOUNT OF STATE CONTRIBUTIONS.
Not later than August 31 of each year, the trustee shall certify
to the comptroller the estimated amount of state contributions to
be received by the fund for the next fiscal year under the
appropriations authorized by this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436,
eff. Sept. 1, 2003.
Sec. 1575.210. PAYMENT OF STATE CONTRIBUTIONS; RECONCILIATION.
(a) Contributions allocated and appropriated under this
subchapter for a state fiscal year shall be:
(1) paid from the general revenue fund in equal monthly
installments;
(2) based on the estimated amount certified by the trustee to
the comptroller for that year; and
(3) subject to any express limitations specified in the Act
making the appropriation.
(b) A variation between the certified amount and the actual
amount due for the state fiscal year shall be reconciled at the
end of the fiscal year, and the annual contributions to the fund
shall be adjusted accordingly.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.437,
eff. Sept. 1, 2003.
Sec. 1575.211. COST SHARING. (a) The total costs for the
operation of the group program shall be shared among the state,
the public schools, the active employees, and the retirees in the
manner prescribed by the General Appropriations Act.
(b) In determining the allocation of total costs under this
section, the state shall pay not more than 55 percent of the
total costs, retirees shall pay at least 30 percent of the total
costs, and the balance shall be paid by active employees and
public schools.
(c) Repealed by Acts 2005, 79th Leg., Ch. 1359, Sec. 55(a)(2),
eff. September 1, 2005.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1,
2003; Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.
Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.08,
eff. Sept. 1, 2004.
Amended by:
Acts 2005, 79th Leg., Ch.
1359, Sec. 55(a)(2), eff. September 1, 2005.
Sec. 1575.212. PAYMENT BY RETIREES; RANGES. (a) The trustee by
rule shall establish ranges for payment of the share of total
costs allocated under Section 1575.211 to retirees, with
different levels for:
(1) retirees who are not eligible to participate in Part A of
the Medicare program;
(2) retirees who are eligible for participation but are not
participating in Part A of the Medicare program; and
(3) retirees who are eligible for participation in the Medicare
program and are participating in Part A of the Medicare program.
(b) In establishing ranges for payment of the share of total
costs allocated under Section 1575.211 to retirees, the trustee
may consider the years of service credit accrued by a retiree and
may reward those retirees with more years of service credit.
Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1,
2003; Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.
Sec. 1575.213. CERTAIN DISABILITY RETIREES. An individual who
is eligible as a retiree under Section 1575.004(a)(3) shall pay
an additional premium in an amount determined by the trustee. The
amount of the premium may not exceed the total cost, as
determined by the trustee, attributable to the participation of
that retiree and the dependents of that retiree during the period
the individual is eligible as a retiree under Section
1575.004(a)(3).
Added by Acts 2007, 80th Leg., R.S., Ch.
1230, Sec. 16, eff. September 1, 2007.
SUBCHAPTER F. FEDERAL OR PRIVATE SOURCE CONTRIBUTIONS
Sec. 1575.251. DEFINITION. In this subchapter, "employer" has
the meaning assigned by Section 821.001, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.252. APPLICATION BY EMPLOYER FOR MONEY TO PAY STATE
CONTRIBUTIONS. An employer who applies for money provided by the
United States or a privately sponsored source shall:
(1) if any of the money will pay part or all of an active
employee's salary, also apply for any legally available money to
pay state contributions required by Subchapter E; and
(2) immediately send any money received for state contributions
as a result of the application to the trustee for deposit in the
fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,
eff. Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
1223, Sec. 3, eff. September 1, 2007.
Sec. 1575.253. MONTHLY CERTIFICATION. An employer shall monthly
certify to the trustee in a form prescribed by the trustee:
(1) the total amount of salary paid from federal funds and
private grants; and
(2) the total amount of state contributions provided by the
funds and grants.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,
eff. Sept. 1, 2003.
Sec. 1575.254. MONTHLY MAINTENANCE OF INFORMATION. An employer
shall monthly maintain:
(1) the name of each employee whose salary is paid wholly or
partly from a grant;
(2) the source of the grant;
(3) the amount of the employee's salary paid from the grant;
(4) the amount of the money provided by the grant for state
contributions for the employee; and
(5) any other information the trustee determines is necessary to
enforce this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,
eff. Sept. 1, 2003.
Sec. 1575.255. PROOF OF COMPLIANCE. The trustee may:
(1) require an employer to report an application for federal or
private money;
(2) require evidence that the application includes a request for
funds available to pay state contributions for active employees;
and
(3) examine the records of an employer to determine compliance
with this subchapter and rules adopted under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,
eff. Sept. 1, 2003.
Sec. 1575.256. CRIMINAL OFFENSE: FAILURE OF ADMINISTRATOR TO
COMPLY. (a) An administrator of an employer commits an offense
if the administrator knowingly fails to comply with this
subchapter.
(b) An offense under this section is a Class C misdemeanor.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.257. CIVIL SANCTIONS FOR FAILURE OF EMPLOYER TO
COMPLY. (a) An employer who fails to comply with this
subchapter may not apply for or spend any money received from a
federal or private grant.
(b) The trustee shall report an alleged noncompliance with this
subchapter to the attorney general, the Legislative Budget Board,
the comptroller, and the governor.
(c) On receipt of a report under Subsection (b), the attorney
general shall bring a writ of mandamus against the employer to
compel compliance with this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.439,
eff. Sept. 1, 2003.
SUBCHAPTER G. RETIRED SCHOOL EMPLOYEES GROUP INSURANCE FUND
Sec. 1575.301. FUND; ADMINISTRATION. (a) The retired school
employees group insurance fund is a trust fund with the
comptroller, who is custodian of the fund.
(b) The trustee shall administer the fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.440(a),
eff. Sept. 1, 2003.
Sec. 1575.302. PAYMENTS INTO FUND. The following shall be paid
into the fund:
(1) contributions from active employees and the state, including
contributions for optional coverages;
(2) investment income;
(3) appropriations for implementation of the group program; and
(4) other money required or authorized to be paid into the fund.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.303. PAYMENTS FROM FUND. (a) The following shall,
without state fiscal year limitation, be paid from the fund:
(1) the appropriate premiums to a carrier providing group
coverage under a plan under this chapter;
(2) claims for benefits under the group coverage; and
(3) money spent by the trustee to administer the group program.
(b) The appropriate portion of the contributions to the fund to
provide for incurred but unreported claim reserves and
contingency reserves, as determined by the trustee, shall be
retained in the fund.
(c) The fund is held in trust for the benefit of participants of
the group program and may not be diverted.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,
eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
1359, Sec. 43, eff. September 1, 2005.
Sec. 1575.304. TRANSFER OF CERTAIN CONTRIBUTIONS. The trustee
shall transfer into the fund the amounts deducted from annuities
for contributions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,
eff. Sept. 1, 2003.
Sec. 1575.305. INVESTMENT OF FUND. The trustee may invest money
in the fund in the manner provided by Subchapter D, Chapter 825,
Government Code, for assets of the Teacher Retirement System of
Texas.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,
eff. Sept. 1, 2003.
Sec. 1575.306. EMPLOYEE CONTRIBUTIONS PROPERTY OF FUND ON
RECEIPT; NO REFUND. A contribution from an active employee:
(1) is the property of the fund on receipt by the trustee; and
(2) may not be refunded to the active employee under any
circumstances, including termination of employment.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,
eff. Sept. 1, 2003.
SUBCHAPTER H. COORDINATED CARE NETWORK
Sec. 1575.351. DEFINITIONS. In this subchapter:
(1) "Credentialing committee" means a credentialing committee
created by the trustee under Section 1575.354.
(2) "Health care provider" means:
(A) an individual licensed as a health care practitioner; or
(B) a health care facility.
(3) "Network" means the coordinated care network implemented and
administered by the trustee under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.442,
eff. Sept. 1, 2003.
Sec. 1575.352. IMPLEMENTATION AND ADMINISTRATION. The trustee
may implement and administer a coordinated care network for the
group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,
eff. Sept. 1, 2003.
Sec. 1575.353. CONTRACTS WITH HEALTH CARE PROVIDERS AND OTHERS.
As the trustee determines is necessary to implement and
administer the network, the trustee may contract with a health
care provider or other individuals or entities.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,
eff. Sept. 1, 2003.
Sec. 1575.354. CREDENTIALING COMMITTEES. The trustee may
establish credentialing committees to evaluate the qualifications
of health care providers to participate in the network.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,
eff. Sept. 1, 2003.
Sec. 1575.355. IMMUNITY FROM LIABILITY ARISING FROM ACTS OR
OMISSIONS OF HEALTH CARE PROVIDER. (a) The following are not
liable for damages arising from an act or omission of a health
care provider participating in the network:
(1) the trustee and its officers and employees, including the
board of trustees of the trustee;
(2) the group program;
(3) the fund; and
(4) a member of an advisory committee to the trustee.
(b) A health care provider participating in the network is an
independent contractor and is responsible for the provider's acts
or omissions.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.444,
eff. Sept. 1, 2003.
Sec. 1575.356. IMMUNITY FROM LIABILITY ARISING FROM EVALUATION
OF QUALIFICATIONS OR CARE. The following are not liable for
damages arising from an act, including a statement,
determination, report of an act, or recommendation, committed
without malice in the course of the evaluation of the
qualifications of a health care provider or of the patient care
provided by a health care provider participating in the network:
(1) the trustee and its officers and employees, including the
board of trustees;
(2) the group program;
(3) the fund;
(4) a member of an advisory committee to the trustee; and
(5) a member of a credentialing committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.445,
eff. Sept. 1, 2003.
Sec. 1575.357. IMMUNITY FROM LIABILITY ARISING FROM ACTS
RELATING TO CREDENTIALING COMMITTEE. An individual, a health
care provider, or a medical peer review committee is not liable
for damages arising from an act committed without malice that
consists of:
(1) participating in the activity of a credentialing committee;
or
(2) furnishing records, information, or assistance to a
credentialing committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.358. OPEN MEETINGS LAW NOT APPLICABLE TO CREDENTIALING
COMMITTEE. The proceedings of a credentialing committee are not
subject to Chapter 551, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.359. RECORDS AND PROCEEDINGS OF CREDENTIALING
COMMITTEE NOT SUBJECT TO SUBPOENA. Except to the extent required
by the constitution of this state or the United States, the
records and proceedings of a credentialing committee and a
communication made to a credentialing committee are not subject
to court subpoena.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.360. CONFIDENTIALITY. Except as otherwise provided by
this subchapter:
(1) proceedings and records of a credentialing committee are
confidential; and
(2) a communication made to a credentialing committee is
privileged.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.361. DISCLOSURE TO HEALTH CARE PROVIDER. Disclosure
of confidential credentialing committee information that is
relevant to the matter under review to an affected health care
provider is not a waiver of the confidentiality requirements
under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.362. DISCLOSURE TO CERTAIN ENTITIES. (a) A written
or oral communication made to a credentialing committee, or a
record or proceeding of the committee, may be disclosed to an
appropriate:
(1) state or federal agency, including a state board of
registration or licensing;
(2) national accreditation body; or
(3) medical peer review committee.
(b) A disclosure under this section is not a waiver of the
confidential and privileged nature of the information.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.363. DISCLOSURE TO DEFENDANTS IN CIVIL ACTIONS. (a)
Any of the following persons named as a defendant in any civil
action filed as a result of participation in the credentialing
process may use, including in the person's own defense, otherwise
confidential information obtained for legitimate internal
business and professional purposes:
(1) the trustee and its officers and employees, including the
board of trustees;
(2) a credentialing committee;
(3) a person participating in a credentialing review;
(4) a health care provider;
(5) the group program; and
(6) a member of an advisory committee.
(b) Use of information under this section is not a waiver of the
confidential and privileged nature of the information.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.446,
eff. Sept. 1, 2003.
SUBCHAPTER I. RETIREES ADVISORY COMMITTEE
Sec. 1575.401. DEFINITION. In this subchapter, "committee"
means the Retirees Advisory Committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.402. APPOINTMENT OF COMMITTEE MEMBERS. (a) The
Retirees Advisory Committee is composed of the following nine
members appointed by the trustee:
(1) one member who is an active school administrator;
(2) one member who is a retired school administrator;
(3) two members who are active teachers;
(4) three members who are retired teachers;
(5) one member who is an active member of the auxiliary
personnel of a school district; and
(6) one member who is a retired member of the auxiliary
personnel of a school district.
(b) A person is not eligible for appointment as a member of the
committee if the person is required to register as a lobbyist
under Chapter 305, Government Code.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.447,
eff. Sept. 1, 2003.
Sec. 1575.403. TERMS. (a) Members of the committee serve
staggered four-year terms.
(b) Five members' terms, including the terms of the active
school administrator, one active teacher, two retired teachers,
and the retired member of the auxiliary personnel, expire
February 1, 2002, and every fourth year after that date.
(c) The remaining members' terms expire February 1, 2004, and
every fourth year after that date.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.404. VACANCY. The trustee shall fill a vacancy on the
committee by appointing a person who meets the qualifications
applicable to the vacated position.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.448,
eff. Sept. 1, 2003.
Sec. 1575.405. MEETINGS. (a) The committee shall meet:
(1) at least twice each year; and
(2) at the call of the trustee.
(b) If there is an emergency, the committee may meet at the call
of a majority of the members of the committee.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.449,
eff. Sept. 1, 2003.
Sec. 1575.406. DUTIES. The committee shall:
(1) hold public hearings on group coverage;
(2) recommend to the trustee minimum standards and features of a
plan under the group program that the committee considers
appropriate; and
(3) recommend to the trustee desirable changes in rules and
legislation affecting the group program.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450,
eff. Sept. 1, 2003.
Sec. 1575.407. PROCEDURAL RULES. The trustee shall adopt
procedural rules for the committee to follow in implementing its
powers and duties under this subchapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450,
eff. Sept. 1, 2003.
Sec. 1575.408. REIMBURSEMENT FOR ACTUAL AND REASONABLE EXPENSES.
A committee member is entitled to reimbursement for actual and
reasonable expenses incurred in performing functions as a
committee member.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
SUBCHAPTER J. ACCOUNTING, REPORTS, AND RECORDS
Sec. 1575.451. ANNUAL ACCOUNTING. (a) In this section, "plan
year" means the period beginning on September 1 and ending on the
following August 31.
(b) Group coverage purchased under this chapter must provide for
an accounting to the trustee by each carrier providing the
coverage.
(c) The accounting must be submitted:
(1) not later than the 90th day after the last day of each plan
year; and
(2) on a form approved by the trustee.
(d) Each carrier shall prepare any other report that the trustee
considers necessary.
(e) A carrier may not assess an extra charge for an accounting
report.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.451,
eff. Sept. 1, 2003.
Sec. 1575.452. ANNUAL REPORT. Not later than the 180th day
after the last day of each state fiscal year, the trustee shall
submit a written report to the department concerning the group
coverages provided to and the benefits and services being
received by individuals covered under this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,
eff. Sept. 1, 2003.
Sec. 1575.453. STUDY AND REPORT BY TRUSTEE. (a) The trustee
shall study the operation and administration of this chapter,
including:
(1) conducting surveys and preparing reports on financing group
coverages and health benefit plans available to participants; and
(2) studying the experience and projected cost of coverage.
(b) The trustee shall report to the legislature at each regular
session on the operation and administration of this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,
eff. Sept. 1, 2003.
Sec. 1575.454. REPORTS BY AND EXAMINATION OF CARRIER. Each
contract entered into under this chapter between the trustee and
a carrier must require the carrier to:
(1) furnish to the trustee in a timely manner reasonable reports
that the trustee determines are necessary to implement this
chapter; and
(2) permit the trustee and the state auditor to examine records
of the carrier as necessary to implement this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,
eff. Sept. 1, 2003.
Sec. 1575.455. PUBLIC INSPECTION. A report required by this
chapter shall be made available for public inspection in a form
that protects the identity of individual claimants.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,
2003.
Sec. 1575.456. CONFIDENTIALITY OF RECORDS. (a) Section
825.507, Government Code, concerning confidentiality and
disclosure of records applies to records in the custody of the