Texas Statutes
Subtitle H - Health Benefits and Other Coverages for Governmental Employees
Chapter 1575 - Texas Public School Employees Group Benefits Program

Section 1575.052. Authority to Adopt Rules and Procedures; Other Authority - Sec. 1575.052. AUTHORITY TO ADOPT RULES AND PROCEDURES; OTHER AUTHORITY....

Section 1575.053. Personnel - Sec. 1575.053. PERSONNEL. (a) The trustee may employ persons to...

Section 1575.054. Budget - Sec. 1575.054. BUDGET. Expenses incurred in developing and administering the...

Section 1575.055. Department Assistance - Sec. 1575.055. DEPARTMENT ASSISTANCE. The department shall, as requested by...

Section 1575.056. Transfer of Records Relating to Active Employee Program - Sec. 1575.056. TRANSFER OF RECORDS RELATING TO ACTIVE EMPLOYEE PROGRAM....

Subchapter C. Provision of Benefits

Section 1575.101. System as Group Plan Holder - Sec. 1575.101. SYSTEM AS GROUP PLAN HOLDER. The Teacher Retirement...

Section 1575.102. Self-Insured Plans - Sec. 1575.102. SELF-INSURED PLANS. The trustee may self-insure any plan...

Section 1575.104. Terms of Contract - Sec. 1575.104. TERMS OF CONTRACT. A contract for group coverage...

Section 1575.105. Plan Coverage Secondary to Certain Other Coverage - Sec. 1575.105. PLAN COVERAGE SECONDARY TO CERTAIN OTHER COVERAGE. The...

Section 1575.106. Competitive Bidding Requirements; Rule - Sec. 1575.106. COMPETITIVE BIDDING REQUIREMENTS; RULE. (a) A contract to...

Section 1575.107. Contract Award; Considerations - Sec. 1575.107. CONTRACT AWARD; CONSIDERATIONS. (a) In awarding a contract...

Section 1575.108. Use of Private Entities - Sec. 1575.108. USE OF PRIVATE ENTITIES. The trustee may engage...

Section 1575.109. Use of Health Care Provider - Sec. 1575.109. USE OF HEALTH CARE PROVIDER. To provide benefits...

Section 1575.110. Pharmacy Benefit Manager Contracts - Sec. 1575.110. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In awarding a...

Subchapter D. Coverages and Participation

Section 1575.151. Types of Coverages - Sec. 1575.151. TYPES OF COVERAGES. The trustee may include in...

Section 1575.152. Health Benefit Plan Must Cover Preexisting Conditions - Sec. 1575.152. HEALTH BENEFIT PLAN MUST COVER PREEXISTING CONDITIONS. A...

Section 1575.153. Health Benefit Plan Coverage for Retirees - Sec. 1575.153. HEALTH BENEFIT PLAN COVERAGE FOR RETIREES. (a) A...

Section 1575.155. Coverage for Dependents of Retiree - Sec. 1575.155. COVERAGE FOR DEPENDENTS OF RETIREE. (a) A retiree...

Section 1575.156. Coverage for Surviving Spouse or Dependents of Surviving Spouse - Sec. 1575.156. COVERAGE FOR SURVIVING SPOUSE OR DEPENDENTS OF SURVIVING...

Section 1575.157. Coverage for Surviving Dependent Child - Sec. 1575.157. COVERAGE FOR SURVIVING DEPENDENT CHILD. (a) A surviving...

Section 1575.158. Group Health Benefit Plans - Sec. 1575.158. GROUP HEALTH BENEFIT PLANS. (a) The trustee shall...

Section 1575.1582. Eligibility for Group Health Benefit Plans - Sec. 1575.1582. ELIGIBILITY FOR GROUP HEALTH BENEFIT PLANS. (a) A...

Section 1575.159. Coverage for Prostate-Specific Antigen Test - Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN TEST. A health benefit...

Section 1575.160. Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim - Sec. 1575.160. GROUP LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE:...

Section 1575.161. Enrollment Periods - Sec. 1575.161. ENROLLMENT PERIODS. (a) A retiree eligible for coverage...

Section 1575.162. Special Enrollments - Sec. 1575.162. SPECIAL ENROLLMENTS. This chapter does not limit the...

Section 1575.163. Limitations - Sec. 1575.163. LIMITATIONS. The Teacher Retirement System of Texas, as...

Section 1575.164. Disease Management Services - Sec. 1575.164. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease...

Section 1575.170. Prior Authorization for Certain Drugs - Sec. 1575.170. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a) In this...

Section 1575.1701. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services - Sec. 1575.1701. EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND HEALTH...

Section 1575.171. Emergency Care Payments - Sec. 1575.171. EMERGENCY CARE PAYMENTS. (a) In this section, "emergency...

Section 1575.172. Out-of-Network Facility-Based Provider Payments - Sec. 1575.172. OUT-OF-NETWORK FACILITY-BASED PROVIDER PAYMENTS. (a) In this section,...

Section 1575.173. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments - Sec. 1575.173. OUT-OF-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER...

Subchapter E. Contributions

Section 1575.201. Additional State Contributions; Certain Contributions - Sec. 1575.201. ADDITIONAL STATE CONTRIBUTIONS; CERTAIN CONTRIBUTIONS. (a) The state...

Section 1575.202. State Contribution Based on Active Employee Compensation - Sec. 1575.202. STATE CONTRIBUTION BASED ON ACTIVE EMPLOYEE COMPENSATION. (a)...

Section 1575.203. Active Employee Contribution - Sec. 1575.203. ACTIVE EMPLOYEE CONTRIBUTION. (a) Each state fiscal year,...

Section 1575.204. Public School Contribution - Sec. 1575.204. PUBLIC SCHOOL CONTRIBUTION. (a) Each state fiscal year,...

Section 1575.206. Contributions Held in Trust for Fund - Sec. 1575.206. CONTRIBUTIONS HELD IN TRUST FOR FUND. An employing...

Section 1575.207. Interest Assessed on Late Payment of Deposits by Employing Public Schools - Sec. 1575.207. INTEREST ASSESSED ON LATE PAYMENT OF DEPOSITS BY...

Section 1575.208. Certification of Amount Necessary to Pay State Contributions - Sec. 1575.208. CERTIFICATION OF AMOUNT NECESSARY TO PAY STATE CONTRIBUTIONS....

Section 1575.209. Certification of Amount of State Contributions - Sec. 1575.209. CERTIFICATION OF AMOUNT OF STATE CONTRIBUTIONS. Not later...

Section 1575.210. Payment of State Contributions; Reconciliation - Sec. 1575.210. PAYMENT OF STATE CONTRIBUTIONS; RECONCILIATION. (a) Contributions allocated...

Section 1575.211. Cost Sharing - Sec. 1575.211. COST SHARING. (a) The total costs for the...

Section 1575.212. Payment by Retirees; Ranges - Sec. 1575.212. PAYMENT BY RETIREES; RANGES. (a) Repealed by Acts...

Section 1575.213. Certain Disability Retirees - Sec. 1575.213. CERTAIN DISABILITY RETIREES. An individual who is eligible...

Subchapter F. Federal or Private Source Contributions

Section 1575.251. Definition - Sec. 1575.251. DEFINITION. In this subchapter, "employer" has the meaning...

Section 1575.252. Application by Employer for Money to Pay State Contributions - Sec. 1575.252. APPLICATION BY EMPLOYER FOR MONEY TO PAY STATE...

Section 1575.253. Monthly Certification - Sec. 1575.253. MONTHLY CERTIFICATION. An employer shall monthly certify to...

Section 1575.254. Monthly Maintenance of Information - Sec. 1575.254. MONTHLY MAINTENANCE OF INFORMATION. An employer shall monthly...

Section 1575.255. Proof of Compliance - Sec. 1575.255. PROOF OF COMPLIANCE. The trustee may: (1) require...

Section 1575.256. Criminal Offense: Failure of Administrator to Comply - Sec. 1575.256. CRIMINAL OFFENSE: FAILURE OF ADMINISTRATOR TO COMPLY. (a)...

Section 1575.257. Civil Sanctions for Failure of Employer to Comply - Sec. 1575.257. CIVIL SANCTIONS FOR FAILURE OF EMPLOYER TO COMPLY....

Subchapter G. Retired School Employees Group Insurance Fund

Section 1575.301. Fund; Administration - Sec. 1575.301. FUND; ADMINISTRATION. (a) The retired school employees group...

Section 1575.302. Payments Into Fund - Sec. 1575.302. PAYMENTS INTO FUND. The following shall be paid...

Section 1575.303. Payments From Fund - Sec. 1575.303. PAYMENTS FROM FUND. (a) The following shall, without...

Section 1575.304. Transfer of Certain Contributions - Sec. 1575.304. TRANSFER OF CERTAIN CONTRIBUTIONS. The trustee shall transfer...

Section 1575.305. Investment of Fund - Sec. 1575.305. INVESTMENT OF FUND. The trustee may invest money...

Section 1575.306. Employee Contributions Property of Fund on Receipt; No Refund - Sec. 1575.306. EMPLOYEE CONTRIBUTIONS PROPERTY OF FUND ON RECEIPT; NO...

Section 1575.307. Contingency Reserve Account - Sec. 1575.307. CONTINGENCY RESERVE ACCOUNT. (a) Before the first day...

Subchapter H. Coordinated Care Network

Section 1575.351. Definitions - Sec. 1575.351. DEFINITIONS. In this subchapter: (1) "Credentialing committee" means...

Section 1575.352. Implementation and Administration - Sec. 1575.352. IMPLEMENTATION AND ADMINISTRATION. The trustee may implement and...

Section 1575.353. Contracts With Health Care Providers and Others - Sec. 1575.353. CONTRACTS WITH HEALTH CARE PROVIDERS AND OTHERS. As...

Section 1575.354. Credentialing Committees - Sec. 1575.354. CREDENTIALING COMMITTEES. The trustee may establish credentialing committees...

Section 1575.355. Immunity From Liability Arising From Acts or Omissions of Health Care Provider - Sec. 1575.355. IMMUNITY FROM LIABILITY ARISING FROM ACTS OR OMISSIONS...

Section 1575.356. Immunity From Liability Arising From Evaluation of Qualifications or Care - Sec. 1575.356. IMMUNITY FROM LIABILITY ARISING FROM EVALUATION OF QUALIFICATIONS...

Section 1575.357. Immunity From Liability Arising From Acts Relating to Credentialing Committee - Sec. 1575.357. IMMUNITY FROM LIABILITY ARISING FROM ACTS RELATING TO...

Section 1575.358. Open Meetings Law Not Applicable to Credentialing Committee - Sec. 1575.358. OPEN MEETINGS LAW NOT APPLICABLE TO CREDENTIALING COMMITTEE....

Section 1575.359. Records and Proceedings of Credentialing Committee Not Subject to Subpoena - Sec. 1575.359. RECORDS AND PROCEEDINGS OF CREDENTIALING COMMITTEE NOT SUBJECT...

Section 1575.360. Confidentiality - Sec. 1575.360. CONFIDENTIALITY. Except as otherwise provided by this subchapter:...

Section 1575.361. Disclosure to Health Care Provider - Sec. 1575.361. DISCLOSURE TO HEALTH CARE PROVIDER. Disclosure of confidential...

Section 1575.362. Disclosure to Certain Entities - Sec. 1575.362. DISCLOSURE TO CERTAIN ENTITIES. (a) A written or...

Section 1575.363. Disclosure to Defendants in Civil Actions - Sec. 1575.363. DISCLOSURE TO DEFENDANTS IN CIVIL ACTIONS. (a) Any...

Subchapter I. Retirees Advisory Committee

Section 1575.401. Definition - Sec. 1575.401. DEFINITION. In this subchapter, "committee" means the Retirees...

Section 1575.402. Appointment of Committee Members - Sec. 1575.402. APPOINTMENT OF COMMITTEE MEMBERS. (a) The Retirees Advisory...

Section 1575.403. Terms - Sec. 1575.403. TERMS. (a) Members of the committee serve staggered...

Section 1575.404. Vacancy - Sec. 1575.404. VACANCY. The trustee shall fill a vacancy on...

Section 1575.405. Meetings - Sec. 1575.405. MEETINGS. (a) The committee shall meet: (1) at...

Section 1575.406. Duties - Sec. 1575.406. DUTIES. The committee shall: (1) hold public hearings...

Section 1575.407. Procedural Rules - Sec. 1575.407. PROCEDURAL RULES. The trustee shall adopt procedural rules...

Section 1575.408. Reimbursement for Actual and Reasonable Expenses - Sec. 1575.408. REIMBURSEMENT FOR ACTUAL AND REASONABLE EXPENSES. A committee...

Subchapter J. Accounting, Reports, and Records

Section 1575.451. Annual Accounting - Sec. 1575.451. ANNUAL ACCOUNTING. (a) In this section, "plan year"...

Section 1575.453. Study and Report by Trustee - Sec. 1575.453. STUDY AND REPORT BY TRUSTEE. (a) The trustee...

Section 1575.454. Reports by and Examination of Carrier - Sec. 1575.454. REPORTS BY AND EXAMINATION OF CARRIER. Each contract...

Section 1575.455. Public Inspection - Sec. 1575.455. PUBLIC INSPECTION. A report required by this chapter...

Section 1575.456. Confidentiality of Records - Sec. 1575.456. CONFIDENTIALITY OF RECORDS. (a) Section 825.507, Government Code,...

Subchapter K. Expulsion for Fraud

Section 1575.501. Expulsion for Fraud - Sec. 1575.501. EXPULSION FOR FRAUD. After notice and hearing as...

Section 1575.502. Hearing - Sec. 1575.502. HEARING. On receipt of a complaint or on...

Section 1575.503. Contested Case - Sec. 1575.503. CONTESTED CASE. A proceeding under this subchapter is...

Section 1575.504. Expulsion at Conclusion of Hearing - Sec. 1575.504. EXPULSION AT CONCLUSION OF HEARING. At the conclusion...

Section 1575.505. Effect of Expulsion - Sec. 1575.505. EFFECT OF EXPULSION. An individual expelled from participation...

Section 1575.506. Appeal - Sec. 1575.506. APPEAL. An appeal of a determination by the...

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Texas Statutes Subtitle H - Health Benefits and Other Coverages for Governmental Employees Chapter 1575 - Texas Public School Employees Group Benefits Program

Texas Statutes
Subtitle H - Health Benefits and Other Coverages for Governmental Employees
Chapter 1575 - Texas Public School Employees Group Benefits Program