Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle H - Health Benefits and Other Coverages for Governmental Employees

Section 1550.053. Certain Exclusions and Increased Deductibles Prohibited - Sec. 1550.053. CERTAIN EXCLUSIONS AND INCREASED DEDUCTIBLES PROHIBITED. Except as...

Section 1550.054. Exception for Written Waiver - Sec. 1550.054. EXCEPTION FOR WRITTEN WAIVER. By executing a written...

Chapter 1551 - Texas Employees Group Benefits Act

Subchapter A. General Provisions

Section 1551.001. Short Title - Sec. 1551.001. SHORT TITLE. This chapter may be cited as...

Section 1551.002. Purposes - Sec. 1551.002. PURPOSES. The purposes of this chapter are to:...

Section 1551.003. General Definitions - Sec. 1551.003. GENERAL DEFINITIONS. In this chapter: (1) "Administering firm"...

Section 1551.004. Definition of Dependent - Sec. 1551.004. DEFINITION OF DEPENDENT. (a) In this chapter, "dependent"...

Section 1551.005. Definition of Health Benefit Plan - Sec. 1551.005. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this...

Section 1551.006. Definition of Institution of Higher Education - Sec. 1551.006. DEFINITION OF INSTITUTION OF HIGHER EDUCATION. (a) In...

Section 1551.007. Definition of Carrier - Sec. 1551.007. DEFINITION OF CARRIER. In this chapter, "carrier" means:...

Section 1551.008. Applicability of Definitions - Sec. 1551.008. APPLICABILITY OF DEFINITIONS. The definition of a term...

Section 1551.009. Board of Trustees May Define Other Words - Sec. 1551.009. BOARD OF TRUSTEES MAY DEFINE OTHER WORDS. The...

Section 1551.010. Board of Trustees Approval for Payroll Deductions or Reductions - Sec. 1551.010. BOARD OF TRUSTEES APPROVAL FOR PAYROLL DEDUCTIONS OR...

Section 1551.011. Exemption From Execution - Sec. 1551.011. EXEMPTION FROM EXECUTION. All benefit payments, contributions of...

Section 1551.012. Exemption From State Taxes and Fees - Sec. 1551.012. EXEMPTION FROM STATE TAXES AND FEES. Any coverage...

Section 1551.013. Combining of Carriers Not Restraint of Trade - Sec. 1551.013. COMBINING OF CARRIERS NOT RESTRAINT OF TRADE. Carriers...

Section 1551.014. Exclusive Remedies - Sec. 1551.014. EXCLUSIVE REMEDIES. The remedies provided under this chapter...

Section 1551.015. Balance Billing Prohibition Notice - Sec. 1551.015. BALANCE BILLING PROHIBITION NOTICE. (a) The administrator of...

Subchapter B. Administration and Implementation

Section 1551.051. Administration and Implementation - Sec. 1551.051. ADMINISTRATION AND IMPLEMENTATION. The administration and implementation of...

Section 1551.052. Authority for Rules, Plans, Procedures, and Orders - Sec. 1551.052. AUTHORITY FOR RULES, PLANS, PROCEDURES, AND ORDERS. (a)...

Section 1551.053. Authority to Hire Employees - Sec. 1551.053. AUTHORITY TO HIRE EMPLOYEES. (a) The board of...

Section 1551.055. General Powers of Board of Trustees Regarding Coverage Plans - Sec. 1551.055. GENERAL POWERS OF BOARD OF TRUSTEES REGARDING COVERAGE...

Section 1551.056. Independent Administrator - Sec. 1551.056. INDEPENDENT ADMINISTRATOR. (a) The board of trustees may,...

Section 1551.057. Compensation of Person Employed by Board of Trustees - Sec. 1551.057. COMPENSATION OF PERSON EMPLOYED BY BOARD OF TRUSTEES....

Section 1551.058. Electronic Authorizations - Sec. 1551.058. ELECTRONIC AUTHORIZATIONS. (a) The board of trustees may...

Section 1551.059. Certificate of Coverage - Sec. 1551.059. CERTIFICATE OF COVERAGE. The board of trustees shall...

Section 1551.060. Identification Cards - Sec. 1551.060. IDENTIFICATION CARDS. (a) The board of trustees may...

Section 1551.061. Annual Report - Sec. 1551.061. ANNUAL REPORT. The board of trustees shall submit...

Section 1551.062. Information on Operation and Administration of Chapter - Sec. 1551.062. INFORMATION ON OPERATION AND ADMINISTRATION OF CHAPTER. (a)...

Section 1551.063. Confidentiality of Certain Records - Sec. 1551.063. CONFIDENTIALITY OF CERTAIN RECORDS. (a) The records of...

Section 1551.064. Certain Group Health and Accident Policies or Contracts - Sec. 1551.064. CERTAIN GROUP HEALTH AND ACCIDENT POLICIES OR CONTRACTS....

Section 1551.065. Disclosure of Social Security Number - Sec. 1551.065. DISCLOSURE OF SOCIAL SECURITY NUMBER. The board of...

Section 1551.066. Information Relating to Misconduct - Sec. 1551.066. INFORMATION RELATING TO MISCONDUCT. (a) This section applies...

Section 1551.067. Pharmacy Benefit Manager Contracts - Sec. 1551.067. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In awarding a...

Section 1551.068. Qualification of Group Benefits Program - Sec. 1551.068. QUALIFICATION OF GROUP BENEFITS PROGRAM. Notwithstanding any provision...

Subchapter C. Coverage and Participation

Section 1551.101. Participation Eligibility: State Officers and Employees - Sec. 1551.101. PARTICIPATION ELIGIBILITY: STATE OFFICERS AND EMPLOYEES. (a) An...

Section 1551.102. Participation Eligibility: Annuitants - Sec. 1551.102. PARTICIPATION ELIGIBILITY: ANNUITANTS. (a) An individual who has...

Section 1551.1021. Participation Eligibility: Certain Faculty of Institutions of Higher Education - Sec. 1551.1021. PARTICIPATION ELIGIBILITY: CERTAIN FACULTY OF INSTITUTIONS OF HIGHER...

Section 1551.1022. Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students - Sec. 1551.1022. PARTICIPATION ELIGIBILITY: CERTAIN POSTDOCTORAL FELLOWS AND GRADUATE STUDENTS....

Section 1551.103. Right to Coverage - Sec. 1551.103. RIGHT TO COVERAGE. Subject to Section 1551.351, an...

Section 1551.104. Automatic Coverage - Sec. 1551.104. AUTOMATIC COVERAGE. (a) Subject to Sections 1551.101 and...

Section 1551.1045. Waiver - Sec. 1551.1045. WAIVER. (a) Subject to Subsections (b) and (c),...

Section 1551.105. Date Automatic Coverage Begins - Sec. 1551.105. DATE AUTOMATIC COVERAGE BEGINS. Automatic coverage under this...

Section 1551.1055. Date Eligibility Begins; Waiting Period - Sec. 1551.1055. DATE ELIGIBILITY BEGINS; WAITING PERIOD. (a) Except as...

Section 1551.106. Group Coverage Plan Purchased to Provide for Automatic Coverage - Sec. 1551.106. GROUP COVERAGE PLAN PURCHASED TO PROVIDE FOR AUTOMATIC...

Section 1551.107. Contingent Coverage - Sec. 1551.107. CONTINGENT COVERAGE. (a) Each part-time employee or employee...

Section 1551.108. Continuing Eligibility of Certain Persons With Legislative Service or Employment - Sec. 1551.108. CONTINUING ELIGIBILITY OF CERTAIN PERSONS WITH LEGISLATIVE SERVICE...

Section 1551.109. Continuing Eligibility of Certain Members of Boards, Commissions, and Institutions of Higher Education - Sec. 1551.109. CONTINUING ELIGIBILITY OF CERTAIN MEMBERS OF BOARDS, COMMISSIONS,...

Section 1551.110. Ineligibility of Certain Junior College Employees - Sec. 1551.110. INELIGIBILITY OF CERTAIN JUNIOR COLLEGE EMPLOYEES. (a) Except...

Section 1551.111. Participation by Certain Retirement Systems - Sec. 1551.111. PARTICIPATION BY CERTAIN RETIREMENT SYSTEMS. (a) The Texas...

Section 1551.112. Participation by Texas Turnpike Authority - Sec. 1551.112. PARTICIPATION BY TEXAS TURNPIKE AUTHORITY. (a) An individual...

Section 1551.113. Participation by Certain Employees Whose Positions Are Privatized or Eliminated - Sec. 1551.113. PARTICIPATION BY CERTAIN EMPLOYEES WHOSE POSITIONS ARE PRIVATIZED...

Section 1551.114. Participation by Community Supervision and Corrections Departments - Sec. 1551.114. PARTICIPATION BY COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENTS. (a)...

Section 1551.115. Participation by Wrongfully Imprisoned Persons - Sec. 1551.115. PARTICIPATION BY WRONGFULLY IMPRISONED PERSONS. Subject to Section...

Subchapter D. Coverage for Dependents

Section 1551.151. Entitlement to Coverage - Sec. 1551.151. ENTITLEMENT TO COVERAGE. An individual who is eligible...

Section 1551.152. Eligibility of Foster Child - Sec. 1551.152. ELIGIBILITY OF FOSTER CHILD. A foster child is...

Section 1551.153. Participant Residing Outside of Service Area - Sec. 1551.153. PARTICIPANT RESIDING OUTSIDE OF SERVICE AREA. An individual...

Section 1551.154. Employee Payments - Sec. 1551.154. EMPLOYEE PAYMENTS. In the manner and form the...

Section 1551.155. Coverage Options for Surviving Spouse - Sec. 1551.155. COVERAGE OPTIONS FOR SURVIVING SPOUSE. (a) A surviving...

Section 1551.156. Coverage Options for Surviving Dependent - Sec. 1551.156. COVERAGE OPTIONS FOR SURVIVING DEPENDENT. (a) A surviving...

Section 1551.157. Coverage Options After Expiration of Annuity Option - Sec. 1551.157. COVERAGE OPTIONS AFTER EXPIRATION OF ANNUITY OPTION. The...

Section 1551.158. Reinstatement of Health Benefit Plan Coverage by Certain Dependents - Sec. 1551.158. REINSTATEMENT OF HEALTH BENEFIT PLAN COVERAGE BY CERTAIN...

Subchapter E. Group Coverages

Section 1551.201. Establishment - Sec. 1551.201. ESTABLISHMENT. (a) The board of trustees by rule...

Section 1551.2011. Employee Awareness and Education - Sec. 1551.2011. EMPLOYEE AWARENESS AND EDUCATION. (a) The board of...

Section 1551.202. Authority to Define Basic Coverages - Sec. 1551.202. AUTHORITY TO DEFINE BASIC COVERAGES. (a) The board...

Section 1551.203. Authority to Define Optional Coverages - Sec. 1551.203. AUTHORITY TO DEFINE OPTIONAL COVERAGES. The board of...

Section 1551.204. Authority to Define Voluntary Coverages - Sec. 1551.204. AUTHORITY TO DEFINE VOLUNTARY COVERAGES. Subject to Section...

Section 1551.205. Limitations - Sec. 1551.205. LIMITATIONS. The board of trustees may not contract...

Section 1551.206. Cafeteria Plan - Sec. 1551.206. CAFETERIA PLAN. (a) The board of trustees may...

Section 1551.207. Premium Conversion Benefit Portion of Cafeteria Plan - Sec. 1551.207. PREMIUM CONVERSION BENEFIT PORTION OF CAFETERIA PLAN. Each...

Section 1551.208. Determination to Self-Fund - Sec. 1551.208. DETERMINATION TO SELF-FUND. (a) The board of trustees,...

Section 1551.209. Coverage Exempt From Insurance Law - Sec. 1551.209. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage plan...

Section 1551.210. Actuarial Advice for Self-Funded Coverage - Sec. 1551.210. ACTUARIAL ADVICE FOR SELF-FUNDED COVERAGE. A qualified actuary...

Section 1551.211. Contingency Reserve Fund for Self-Funded Coverage - Sec. 1551.211. CONTINGENCY RESERVE FUND FOR SELF-FUNDED COVERAGE. (a) Before...

Section 1551.212. Firms to Administer Self-Funded Coverage - Sec. 1551.212. FIRMS TO ADMINISTER SELF-FUNDED COVERAGE. (a) For those...

Section 1551.213. Bids for Purchased Coverage - Sec. 1551.213. BIDS FOR PURCHASED COVERAGE. (a) For those coverage...

Section 1551.214. Selection of Bids for Purchased Coverage - Sec. 1551.214. SELECTION OF BIDS FOR PURCHASED COVERAGE. (a) An...

Section 1551.215. Accounting by Carrier Providing Purchased Coverage - Sec. 1551.215. ACCOUNTING BY CARRIER PROVIDING PURCHASED COVERAGE. (a) A...

Section 1551.216. Special Contingency Reserve - Sec. 1551.216. SPECIAL CONTINGENCY RESERVE. (a) A carrier issuing a...

Section 1551.217. Use of Employee's Salary in Computation of Premium or Coverage - Sec. 1551.217. USE OF EMPLOYEE'S SALARY IN COMPUTATION OF PREMIUM...

Section 1551.218. Prior Authorization for Certain Drugs - Sec. 1551.218. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a) In this...

Section 1551.2181. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services - Sec. 1551.2181. EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND HEALTH...

Section 1551.219. Disease Management Services - Sec. 1551.219. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease...

Section 1551.220. Beneficiary Causing Death of Participant or Beneficiary of Participant - Sec. 1551.220. BENEFICIARY CAUSING DEATH OF PARTICIPANT OR BENEFICIARY OF...

Section 1551.222. Incentive Payments - Sec. 1551.222. INCENTIVE PAYMENTS. (a) The board of trustees may...

Section 1551.224. Mail Order Requirement for Prescription Drug Coverage Prohibited - Sec. 1551.224. MAIL ORDER REQUIREMENT FOR PRESCRIPTION DRUG COVERAGE PROHIBITED....

Section 1551.225. Bariatric Surgery Coverage - Sec. 1551.225. BARIATRIC SURGERY COVERAGE. (a) The board of trustees...

Section 1551.226. Tobacco Cessation Coverage - Sec. 1551.226. TOBACCO CESSATION COVERAGE. (a) The board of trustees...

Section 1551.227. Tricare Military Health System Supplemental Plan - Sec. 1551.227. TRICARE MILITARY HEALTH SYSTEM SUPPLEMENTAL PLAN. (a) The...

Section 1551.228. Emergency Care Payments - Sec. 1551.228. EMERGENCY CARE PAYMENTS. (a) In this section, "emergency...

Section 1551.229. Out-of-Network Facility-Based Provider Payments - Sec. 1551.229. OUT-OF-NETWORK FACILITY-BASED PROVIDER PAYMENTS. (a) In this section,...

Section 1551.230. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments - Sec. 1551.230. OUT-OF-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER...

Subchapter F. Group Life and Accidental Death and Dismemberment Insurance Coverage Plan

Section 1551.251. Group Life Insurance Coverage Plan - Sec. 1551.251. GROUP LIFE INSURANCE COVERAGE PLAN. (a) The board...

Section 1551.252. Additional Term Life Insurance - Sec. 1551.252. ADDITIONAL TERM LIFE INSURANCE. Notwithstanding any other provision...

Section 1551.253. Determination of Annual Salary - Sec. 1551.253. DETERMINATION OF ANNUAL SALARY. (a) To implement this...

Section 1551.254. Accelerated Life Insurance Benefits - Sec. 1551.254. ACCELERATED LIFE INSURANCE BENEFITS. (a) In addition to...

Section 1551.255. Inclusion of Provisions for Viatical Settlements - Sec. 1551.255. INCLUSION OF PROVISIONS FOR VIATICAL SETTLEMENTS. (a) In...

Section 1551.256. Optional Term Life Insurance Coverage After Retirement - Sec. 1551.256. OPTIONAL TERM LIFE INSURANCE COVERAGE AFTER RETIREMENT. (a)...

Section 1551.257. Eligibility of Annuitant for Extended Insurance Benefits - Sec. 1551.257. ELIGIBILITY OF ANNUITANT FOR EXTENDED INSURANCE BENEFITS. An...

Section 1551.258. Termination of Accidental Death and Dismemberment Insurance Coverage on Retirement - Sec. 1551.258. TERMINATION OF ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE COVERAGE...

Section 1551.259. Order of Precedence of Payment to Survivors - Sec. 1551.259. ORDER OF PRECEDENCE OF PAYMENT TO SURVIVORS. (a)...

Subchapter G. Contributions and Costs

Section 1551.301. Funding of Basic Coverage - Sec. 1551.301. FUNDING OF BASIC COVERAGE. The board of trustees...

Section 1551.3015. Cost Assessment for Certain Participants - Sec. 1551.3015. COST ASSESSMENT FOR CERTAIN PARTICIPANTS. Notwithstanding any other...

Section 1551.302. Allocation of Employer Contributions - Sec. 1551.302. ALLOCATION OF EMPLOYER CONTRIBUTIONS. (a) The board of...

Section 1551.303. Funding of Optional Coverages - Sec. 1551.303. FUNDING OF OPTIONAL COVERAGES. The board of trustees...

Section 1551.304. Funding of Voluntary Coverages - Sec. 1551.304. FUNDING OF VOLUNTARY COVERAGES. The board of trustees...

Section 1551.305. Cost of Basic Coverage Exceeding Employer Contributions - Sec. 1551.305. COST OF BASIC COVERAGE EXCEEDING EMPLOYER CONTRIBUTIONS. If...

Section 1551.306. Payment of Excess Cost Over Basic Coverage Contribution - Sec. 1551.306. PAYMENT OF EXCESS COST OVER BASIC COVERAGE CONTRIBUTION....

Section 1551.307. Payment for Voluntary Coverages - Sec. 1551.307. PAYMENT FOR VOLUNTARY COVERAGES. Except as provided by...

Section 1551.3075. Tobacco User Premium Differential - Sec. 1551.3075. TOBACCO USER PREMIUM DIFFERENTIAL. (a) The board of...

Section 1551.3076. Employer Enrollment Fee - Sec. 1551.3076. EMPLOYER ENROLLMENT FEE. (a) The board of trustees...

Section 1551.308. No Contribution on Refusal of Coverage - Sec. 1551.308. NO CONTRIBUTION ON REFUSAL OF COVERAGE. The state...

Section 1551.309. Employee Payments for Participation in Cafeteria Plan - Sec. 1551.309. EMPLOYEE PAYMENTS FOR PARTICIPATION IN CAFETERIA PLAN. (a)...

Section 1551.310. State Contribution Required - Sec. 1551.310. STATE CONTRIBUTION REQUIRED. The state shall contribute to...

Section 1551.311. Amount of State Contribution - Sec. 1551.311. AMOUNT OF STATE CONTRIBUTION. (a) Not later than...

Section 1551.3111. Amount of State Contribution for Certain Junior College Employees - Sec. 1551.3111. AMOUNT OF STATE CONTRIBUTION FOR CERTAIN JUNIOR COLLEGE...

Section 1551.313. Amount of State Contribution for Certain Surviving Dependents - Sec. 1551.313. AMOUNT OF STATE CONTRIBUTION FOR CERTAIN SURVIVING DEPENDENTS....

Section 1551.314. Certain State Contributions Prohibited - Sec. 1551.314. CERTAIN STATE CONTRIBUTIONS PROHIBITED. A state contribution may...

Section 1551.315. Required Contributions by State Agencies - Sec. 1551.315. REQUIRED CONTRIBUTIONS BY STATE AGENCIES. (a) The governing...

Section 1551.316. Allocation to Board of Trustees of Employer Contributions - Sec. 1551.316. ALLOCATION TO BOARD OF TRUSTEES OF EMPLOYER CONTRIBUTIONS....

Section 1551.317. Payment of Employer Contributions Allocated by the State - Sec. 1551.317. PAYMENT OF EMPLOYER CONTRIBUTIONS ALLOCATED BY THE STATE....

Section 1551.318. Payment of Employer Contributions Not Allocated by the State - Sec. 1551.318. PAYMENT OF EMPLOYER CONTRIBUTIONS NOT ALLOCATED BY THE...

Section 1551.319. Amount of Contribution for Full-Time and Part-Time Employees - Sec. 1551.319. AMOUNT OF CONTRIBUTION FOR FULL-TIME AND PART-TIME EMPLOYEES....

Section 1551.3195. Amount of Contribution for Annuitants Who Were Part-Time Employees - Sec. 1551.3195. AMOUNT OF CONTRIBUTION FOR ANNUITANTS WHO WERE PART-TIME...

Section 1551.3196. Amount of Contribution for Certain Annuitants - Sec. 1551.3196. AMOUNT OF CONTRIBUTION FOR CERTAIN ANNUITANTS. (a) An...

Section 1551.320. Certain Costs - Sec. 1551.320. CERTAIN COSTS. The Texas Higher Education Coordinating Board...

Section 1551.323. Cost of Certain Annuitants - Sec. 1551.323. COST OF CERTAIN ANNUITANTS. (a) An annuitant eligible...

Section 1551.324. Reduction in Contribution for Certain Active Employees and Annuitants; Incentive Payments - Sec. 1551.324. REDUCTION IN CONTRIBUTION FOR CERTAIN ACTIVE EMPLOYEES AND...

Subchapter H. Sanctions and Adjudication of Claims

Section 1551.351. Administrative Process and Sanctions for Program Violations - Sec. 1551.351. ADMINISTRATIVE PROCESS AND SANCTIONS FOR PROGRAM VIOLATIONS. (a)...

Section 1551.352. Executive Director Determines Questions Relating to Enrollment or Payment of Claims - Sec. 1551.352. EXECUTIVE DIRECTOR DETERMINES QUESTIONS RELATING TO ENROLLMENT OR...

Section 1551.354. Double or Multiple Liability - Sec. 1551.354. DOUBLE OR MULTIPLE LIABILITY. (a) The executive director...

Section 1551.355. Appeal of Executive Director's Determination - Sec. 1551.355. APPEAL OF EXECUTIVE DIRECTOR'S DETERMINATION. (a) Subject to...

Section 1551.356. Standing - Sec. 1551.356. STANDING. (a) A person has standing to appeal...

Section 1551.357. Determination of Appeal by Board of Trustees - Sec. 1551.357. DETERMINATION OF APPEAL BY BOARD OF TRUSTEES. (a)...

Section 1551.358. Negotiation - Sec. 1551.358. NEGOTIATION. (a) Notwithstanding any other provision of this...

Section 1551.359. Judicial Review - Sec. 1551.359. JUDICIAL REVIEW. A person aggrieved by a final...

Section 1551.360. Delegation - Sec. 1551.360. DELEGATION. (a) The board of trustees may delegate...

Section 1551.361. Diligent Prosecution of Suit - Sec. 1551.361. DILIGENT PROSECUTION OF SUIT. The plaintiff shall prosecute...

Section 1551.362. Subpoena - Sec. 1551.362. SUBPOENA. Notwithstanding any other law, the Employees Retirement...

Section 1551.363. Precedent Manual - Sec. 1551.363. PRECEDENT MANUAL. (a) The board of trustees shall...

Subchapter I. Funds

Section 1551.401. Employees Life, Accident, and Health Insurance and Benefits Fund - Sec. 1551.401. EMPLOYEES LIFE, ACCIDENT, AND HEALTH INSURANCE AND BENEFITS...

Section 1551.402. State Employees Cafeteria Plan Trust Fund - Sec. 1551.402. STATE EMPLOYEES CAFETERIA PLAN TRUST FUND. (a) The...

Section 1551.403. Fees for State Employees Cafeteria Plan Trust Fund - Sec. 1551.403. FEES FOR STATE EMPLOYEES CAFETERIA PLAN TRUST FUND....

Section 1551.404. Insufficient Earnings for Employee to Participate in Cafeteria Fund - Sec. 1551.404. INSUFFICIENT EARNINGS FOR EMPLOYEE TO PARTICIPATE IN CAFETERIA...

Section 1551.405. Employees' Health Care Stabilization Trust Fund - Sec. 1551.405. EMPLOYEES' HEALTH CARE STABILIZATION TRUST FUND. (a) The...

Section 1551.406. Investment of Funds - Sec. 1551.406. INVESTMENT OF FUNDS. (a) Under the standard of...

Section 1551.407. Management of Assets - Sec. 1551.407. MANAGEMENT OF ASSETS. The board of trustees may...

Subchapter J. State Consumer-Directed Health Plan

Section 1551.451. Definitions - Sec. 1551.451. DEFINITIONS. In this subchapter: (1) "High deductible health...

Section 1551.452. Establishment of State Consumer-Directed Health Plan - Sec. 1551.452. ESTABLISHMENT OF STATE CONSUMER-DIRECTED HEALTH PLAN. (a) The...

Section 1551.453. Account Administrator - Sec. 1551.453. ACCOUNT ADMINISTRATOR. (a) The account administrator selected to...

Section 1551.454. Participation in Program - Sec. 1551.454. PARTICIPATION IN PROGRAM. (a) Each individual eligible to...

Section 1551.455. Coverage for Dependents; Required Contributions - Sec. 1551.455. COVERAGE FOR DEPENDENTS; REQUIRED CONTRIBUTIONS. (a) A plan...

Section 1551.456. State Contribution - Sec. 1551.456. STATE CONTRIBUTION. (a) For each plan enrollee, from...

Section 1551.457. Plan Enrollee Contributions - Sec. 1551.457. PLAN ENROLLEE CONTRIBUTIONS. (a) Each plan enrollee, in...

Section 1551.458. Coordination With Cafeteria Plan - Sec. 1551.458. COORDINATION WITH CAFETERIA PLAN. (a) The board of...

Section 1551.459. Exemption From Execution; Unassignability - Sec. 1551.459. EXEMPTION FROM EXECUTION; UNASSIGNABILITY. A state contribution to...

Section 1551.460. Single Undivided Risk Pool - Sec. 1551.460. SINGLE UNDIVIDED RISK POOL. In implementing and administering...

Chapter 1552 - Long-Term Care Insurance for State Employees

Section 1552.001. Definitions - Sec. 1552.001. DEFINITIONS. In this chapter, "annuitant," "board of trustees,"...

Section 1552.002. Establishment of Program - Sec. 1552.002. ESTABLISHMENT OF PROGRAM. (a) The board of trustees...

Section 1552.003. Administering Firm - Sec. 1552.003. ADMINISTERING FIRM. The board of trustees may select...

Section 1552.005. Program Not Part of Other Group Coverages - Sec. 1552.005. PROGRAM NOT PART OF OTHER GROUP COVERAGES. (a)...

Section 1552.006. Rules - Sec. 1552.006. RULES. The board of trustees may adopt rules...

Chapter 1560 - Delivery of Prescription Drugs by Mail

Section 1560.001. Definitions - Sec. 1560.001. DEFINITIONS. In this chapter: (1) "Community retail pharmacy"...

Section 1560.002. Applicability of Chapter - Sec. 1560.002. APPLICABILITY OF CHAPTER. This chapter applies only to...

Section 1560.003. Multiple-Month Supply of Prescription Drug - Sec. 1560.003. MULTIPLE-MONTH SUPPLY OF PRESCRIPTION DRUG. (a) In this...

Section 1560.004. Prescription Drug Reimbursement Rates - Sec. 1560.004. PRESCRIPTION DRUG REIMBURSEMENT RATES. (a) An issuer of...

Chapter 1575 - Texas Public School Employees Group Benefits Program

Subchapter A. General Provisions

Section 1575.001. Short Title - Sec. 1575.001. SHORT TITLE. This chapter may be cited as...

Section 1575.002. General Definitions - Sec. 1575.002. GENERAL DEFINITIONS. In this chapter: (1) "Active employee"...

Section 1575.0025. References to Basic Plan - Sec. 1575.0025. REFERENCES TO BASIC PLAN. A reference in this...

Section 1575.003. Definition of Dependent and Related Terms - Sec. 1575.003. DEFINITION OF DEPENDENT AND RELATED TERMS. In this...

Section 1575.004. Definition of Retiree - Sec. 1575.004. DEFINITION OF RETIREE. (a) In this chapter, "retiree"...

Section 1575.005. Issuance of Certificate of Coverage - Sec. 1575.005. ISSUANCE OF CERTIFICATE OF COVERAGE. At the time...

Section 1575.006. Exemption From Process - Sec. 1575.006. EXEMPTION FROM PROCESS. (a) The following are exempt...

Section 1575.007. Exemption From State Taxes and Fees - Sec. 1575.007. EXEMPTION FROM STATE TAXES AND FEES. A premium...

Section 1575.008. Coverage Exempt From Insurance Law - Sec. 1575.008. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage plan...

Section 1575.009. Balance Billing Prohibition Notice - Sec. 1575.009. BALANCE BILLING PROHIBITION NOTICE. (a) The administrator of...

Section 1575.010. Information Regarding Appeals - Sec. 1575.010. INFORMATION REGARDING APPEALS. The trustee shall develop and...

Subchapter B. Administration

Section 1575.051. Administration of Group Program - Sec. 1575.051. ADMINISTRATION OF GROUP PROGRAM. The trustee shall take...

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...

Chapter 1576 - Group Long-Term Care Insurance for Public School Employees

Section 1576.001. Definitions - Sec. 1576.001. DEFINITIONS. In this chapter: (1) "Active employee" has...

Section 1576.002. Establishment of Program - Sec. 1576.002. ESTABLISHMENT OF PROGRAM. (a) The trustee may establish...

Section 1576.003. Contracts to Provide Coverages - Sec. 1576.003. CONTRACTS TO PROVIDE COVERAGES. The trustee may contract...

Section 1576.004. Premiums - Sec. 1576.004. PREMIUMS. (a) The trustee shall determine the procedures...

Section 1576.005. Program Not Part of Other Group Coverages - Sec. 1576.005. PROGRAM NOT PART OF OTHER GROUP COVERAGES. (a)...

Section 1576.006. Rules - Sec. 1576.006. RULES. The trustee may adopt rules as necessary...

Section 1576.007. Exemption From State Taxes and Fees - Sec. 1576.007. EXEMPTION FROM STATE TAXES AND FEES. A premium...

Section 1576.008. Competitive Bidding Requirements; Rules - Sec. 1576.008. COMPETITIVE BIDDING REQUIREMENTS; RULES. (a) A contract to...

Section 1576.009. Contract Award; Considerations - Sec. 1576.009. CONTRACT AWARD; CONSIDERATIONS. (a) In awarding a contract...

Section 1576.010. Group Long-Term Care Insurance Program Fund - Sec. 1576.010. GROUP LONG-TERM CARE INSURANCE PROGRAM FUND. (a) The...

Section 1576.011. Investment of Fund - Sec. 1576.011. INVESTMENT OF FUND. The trustee may invest the...

Section 1576.012. Payments From Fund - Sec. 1576.012. PAYMENTS FROM FUND. Money in the group long-term...

Section 1576.013. Coverage Exempt From Insurance Law - Sec. 1576.013. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage plan...

Chapter 1578 - Purchase of Insurance by Association of Teachers and School Administrators

Subchapter A. General Provisions

Section 1578.001. Applicability of Chapter - Sec. 1578.001. APPLICABILITY OF CHAPTER. This chapter applies only to...

Section 1578.002. Authority to Issue - Sec. 1578.002. AUTHORITY TO ISSUE. Notwithstanding any other law, an...

Subchapter B. Purchase of Insurance

Section 1578.051. Authority to Obtain Insurance - Sec. 1578.051. AUTHORITY TO OBTAIN INSURANCE. (a) A voluntary association...

Section 1578.052. Payment of Premium - Sec. 1578.052. PAYMENT OF PREMIUM. A voluntary association that obtains...

Section 1578.053. Minimum Requirements to Obtain Policy - Sec. 1578.053. MINIMUM REQUIREMENTS TO OBTAIN POLICY. (a) A voluntary...

Section 1578.054. Amount of Insurance - Sec. 1578.054. AMOUNT OF INSURANCE. The amount of insurance under...

Chapter 1579 - Texas School Employees Uniform Group Health Coverage

Subchapter A. General Provisions

Section 1579.001. Short Title - Sec. 1579.001. SHORT TITLE. This chapter may be cited as...

Section 1579.002. General Definitions - Sec. 1579.002. GENERAL DEFINITIONS. In this chapter: (1) "Administering firm"...

Section 1579.003. Definition of Employee - Sec. 1579.003. DEFINITION OF EMPLOYEE. In this chapter, "employee" means...

Section 1579.004. Definition of Dependent - Sec. 1579.004. DEFINITION OF DEPENDENT. In this chapter, "dependent" means:...

Section 1579.005. Confidentiality - Sec. 1579.005. CONFIDENTIALITY. (a) Section 825.507, Government Code, applies to...

Section 1579.006. Exemption From Process - Sec. 1579.006. EXEMPTION FROM PROCESS. (a) The following are exempt...

Section 1579.007. Exemption From State Taxes and Fees - Sec. 1579.007. EXEMPTION FROM STATE TAXES AND FEES. A premium...

Section 1579.008. Coverage Exempt From Insurance Law - Sec. 1579.008. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage plan...

Section 1579.009. Balance Billing Prohibition Notice - Sec. 1579.009. BALANCE BILLING PROHIBITION NOTICE. (a) The administrator of...

Section 1579.010. Information Regarding Appeals - Sec. 1579.010. INFORMATION REGARDING APPEALS. The trustee shall develop and...

Subchapter B. Administration

Section 1579.051. Administration of Group Program - Sec. 1579.051. ADMINISTRATION OF GROUP PROGRAM. The Teacher Retirement System...

Section 1579.052. Authority to Adopt Rules; Other Authority - Sec. 1579.052. AUTHORITY TO ADOPT RULES; OTHER AUTHORITY. (a) The...

Section 1579.053. Personnel - Sec. 1579.053. PERSONNEL. The trustee may hire and compensate employees...

Section 1579.054. Competitive Bidding Requirements; Rules - Sec. 1579.054. COMPETITIVE BIDDING REQUIREMENTS; RULES. A contract to provide...

Section 1579.055. Contract Award; Considerations - Sec. 1579.055. CONTRACT AWARD; CONSIDERATIONS. (a) In awarding a contract...

Section 1579.057. Pharmacy Benefit Manager Contracts - Sec. 1579.057. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In awarding a...

Subchapter C. Coverages

Section 1579.101. Plans of Group Coverages - Sec. 1579.101. PLANS OF GROUP COVERAGES. (a) The trustee by...

Section 1579.102. Catastrophic Care Coverage Plan - Sec. 1579.102. CATASTROPHIC CARE COVERAGE PLAN. The coverage provided under...

Section 1579.104. Optional Coverages - Sec. 1579.104. OPTIONAL COVERAGES. The trustee may not offer optional...

Section 1579.1045. Alternative Group Health Coverage Prohibited - Sec. 1579.1045. ALTERNATIVE GROUP HEALTH COVERAGE PROHIBITED. Notwithstanding any other...

Section 1579.105. Preexisting Condition Limitation - Sec. 1579.105. PREEXISTING CONDITION LIMITATION. During the initial period of...

Section 1579.106. Prior Authorization for Certain Drugs - Sec. 1579.106. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a) In this...

Section 1579.1061. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services - Sec. 1579.1061. EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND HEALTH...

Section 1579.107. Disease Management Services - Sec. 1579.107. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease...

Section 1579.108. Limitations - Sec. 1579.108. LIMITATIONS. The trustee may not contract for or...

Section 1579.109. Emergency Care Payments - Sec. 1579.109. EMERGENCY CARE PAYMENTS. (a) In this section, "emergency...

Section 1579.110. Out-of-Network Facility-Based Provider Payments - Sec. 1579.110. OUT-OF-NETWORK FACILITY-BASED PROVIDER PAYMENTS. (a) In this section,...

Section 1579.111. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments - Sec. 1579.111. OUT-OF-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER...

Subchapter D. Participating Entities

Section 1579.151. Required Participation of School Districts With 500 or Fewer Employees - Sec. 1579.151. REQUIRED PARTICIPATION OF SCHOOL DISTRICTS WITH 500 OR...

Section 1579.152. Participation of Other School Districts - Sec. 1579.152. PARTICIPATION OF OTHER SCHOOL DISTRICTS. Effective September 1,...

Section 1579.153. Participation by Certain Risk Pools - Sec. 1579.153. PARTICIPATION BY CERTAIN RISK POOLS. (a) In determining...

Section 1579.154. Participation by Charter Schools; Eligibility - Sec. 1579.154. PARTICIPATION BY CHARTER SCHOOLS; ELIGIBILITY. (a) A charter...

Section 1579.155. Program Participation: Election - Sec. 1579.155. PROGRAM PARTICIPATION: ELECTION. (a) Effective September 1, 2022,...

Subchapter E. Participation by Employee

Section 1579.201. Definition - Sec. 1579.201. DEFINITION. In this subchapter, "full-time employee" and "part-time...

Section 1579.202. Eligible Employees - Sec. 1579.202. ELIGIBLE EMPLOYEES. (a) Except as provided by Section...

Section 1579.203. Selection of Coverage - Sec. 1579.203. SELECTION OF COVERAGE. (a) A participating employee may...

Section 1579.204. Certain Part-Time Employees - Sec. 1579.204. CERTAIN PART-TIME EMPLOYEES. A part-time employee of a...

Section 1579.205. Payment by Participating Entity - Sec. 1579.205. PAYMENT BY PARTICIPATING ENTITY. Notwithstanding Section 1579.204, a...

Subchapter F. Contributions

Section 1579.251. State Assistance - Sec. 1579.251. STATE ASSISTANCE. (a) The state shall assist employees...

Section 1579.252. Contribution by Participating Entities - Sec. 1579.252. CONTRIBUTION BY PARTICIPATING ENTITIES. A participating entity shall...

Section 1579.253. Contribution by Employee - Sec. 1579.253. CONTRIBUTION BY EMPLOYEE. (a) An employee covered by...

Section 1579.254. Contributions Held in Trust for Fund - Sec. 1579.254. CONTRIBUTIONS HELD IN TRUST FOR FUND. A participating...

Section 1579.255. Interest Assessed on Late Payment of Contributions by Participating Entities - Sec. 1579.255. INTEREST ASSESSED ON LATE PAYMENT OF CONTRIBUTIONS BY...

Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund

Section 1579.301. Fund; Administration - Sec. 1579.301. FUND; ADMINISTRATION. The Texas school employees uniform group...

Section 1579.302. Composition of Fund - Sec. 1579.302. COMPOSITION OF FUND. The fund is composed of:...

Section 1579.303. Payments From Fund - Sec. 1579.303. PAYMENTS FROM FUND. The trustee may use amounts...

Section 1579.304. Investment of Fund - Sec. 1579.304. INVESTMENT OF FUND. The trustee may invest assets...

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...

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)...

Section 1581.052. Required Minimum Effort - Sec. 1581.052. REQUIRED MINIMUM EFFORT. (a) A school district, other...

Section 1581.053. Use of State Funds - Sec. 1581.053. USE OF STATE FUNDS. (a) To comply with...

Section 1581.054. Excess of Maintenance of Effort - Sec. 1581.054. EXCESS OF MAINTENANCE OF EFFORT. If the amount...

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...

Section 1601.002. Purposes - Sec. 1601.002. PURPOSES. The purposes of this chapter are to:...

Section 1601.003. General Definitions - Sec. 1601.003. GENERAL DEFINITIONS. In this chapter: (1) "Administering carrier"...

Section 1601.004. Definition of Dependent - Sec. 1601.004. DEFINITION OF DEPENDENT. (a) In this chapter, "dependent,"...

Section 1601.005. Definition of Carrier - Sec. 1601.005. DEFINITION OF CARRIER. In this chapter, "carrier" means:...

Section 1601.006. Applicability of Definitions - Sec. 1601.006. APPLICABILITY OF DEFINITIONS. The definition of a term...

Section 1601.007. System May Define Other Words - Sec. 1601.007. SYSTEM MAY DEFINE OTHER WORDS. A system may...

Section 1601.008. Exemption From Execution - Sec. 1601.008. EXEMPTION FROM EXECUTION. All insurance benefits and other...

Section 1601.009. Exemption From Taxation and Fees - Sec. 1601.009. EXEMPTION FROM TAXATION AND FEES. Premiums on a...

Section 1601.010. Certain Combining of Carriers Not Restraint of Trade - Sec. 1601.010. CERTAIN COMBINING OF CARRIERS NOT RESTRAINT OF TRADE....

Section 1601.011. Participation of the Texas A&m University System - Sec. 1601.011. PARTICIPATION OF THE TEXAS A&M UNIVERSITY SYSTEM. Notwithstanding...

Subchapter B. Administration and Implementation

Section 1601.051. Administration and Implementation - Sec. 1601.051. ADMINISTRATION AND IMPLEMENTATION. A system shall: (1) implement...

Section 1601.052. Rulemaking Authority - Sec. 1601.052. RULEMAKING AUTHORITY. A system shall adopt rules consistent...

Section 1601.053. General Duties Relating to Coverage - Sec. 1601.053. GENERAL DUTIES RELATING TO COVERAGE. (a) A system...

Section 1601.054. Competitive Bidding Required - Sec. 1601.054. COMPETITIVE BIDDING REQUIRED. A system shall submit the...

Section 1601.055. Identification of Administrative Costs in Bids - Sec. 1601.055. IDENTIFICATION OF ADMINISTRATIVE COSTS IN BIDS. A system...

Section 1601.056. Information on Bidders and Bidding Contracts - Sec. 1601.056. INFORMATION ON BIDDERS AND BIDDING CONTRACTS. (a) The...

Section 1601.057. Selection of Bids - Sec. 1601.057. SELECTION OF BIDS. (a) A system is not...

Section 1601.058. Selection of Health Maintenance Organizations - Sec. 1601.058. SELECTION OF HEALTH MAINTENANCE ORGANIZATIONS. A system shall...

Section 1601.059. Certificate of Coverage - Sec. 1601.059. CERTIFICATE OF COVERAGE. A system shall ensure that...

Section 1601.060. Accounting by Carrier Providing Purchased Coverage - Sec. 1601.060. ACCOUNTING BY CARRIER PROVIDING PURCHASED COVERAGE. (a) A...

Section 1601.061. Special Reserve - Sec. 1601.061. SPECIAL RESERVE. (a) A carrier issuing a group...

Section 1601.062. Reports and Records by Administering Carrier - Sec. 1601.062. REPORTS AND RECORDS BY ADMINISTERING CARRIER. Each contract...

Section 1601.063. Assistance in Requesting Money - Sec. 1601.063. ASSISTANCE IN REQUESTING MONEY. The Legislative Budget Board...

Section 1601.064. Pharmacy Benefit Manager Contracts - Sec. 1601.064. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In awarding a...

Subchapter C. Coverage and Participation

Section 1601.101. Participation Eligibility: Employees - Sec. 1601.101. PARTICIPATION ELIGIBILITY: EMPLOYEES. (a) An individual who is...

Section 1601.102. Participation Eligibility: Retirees - Sec. 1601.102. PARTICIPATION ELIGIBILITY: RETIREES. (a) An individual who retires...

Section 1601.1021. Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students - Sec. 1601.1021. PARTICIPATION ELIGIBILITY: CERTAIN POSTDOCTORAL FELLOWS AND GRADUATE STUDENTS....

Section 1601.103. Right to Coverage - Sec. 1601.103. RIGHT TO COVERAGE. An individual eligible to participate...

Section 1601.104. Automatic Coverage - Sec. 1601.104. AUTOMATIC COVERAGE. (a) A system shall automatically provide...

Section 1601.1045. Date Eligibility Begins; Waiting Period - Sec. 1601.1045. DATE ELIGIBILITY BEGINS; WAITING PERIOD. (a) Except as...

Section 1601.105. Waiver - Sec. 1601.105. WAIVER. An employee or retired employee may waive...

Section 1601.106. Optional Coverage - Sec. 1601.106. OPTIONAL COVERAGE. A system shall provide optional coverage...

Section 1601.1065. Optional Basic Coverage Plan for Graduate Students - Sec. 1601.1065. OPTIONAL BASIC COVERAGE PLAN FOR GRADUATE STUDENTS. The...

Section 1601.107. Coverage for Dependents - Sec. 1601.107. COVERAGE FOR DEPENDENTS. An individual who is eligible...

Section 1601.108. Coverage Options for Certain Surviving Spouses - Sec. 1601.108. COVERAGE OPTIONS FOR CERTAIN SURVIVING SPOUSES. (a) This...

Section 1601.109. Coverage for Aids, Hiv, or Serious Mental Illness - Sec. 1601.109. COVERAGE FOR AIDS, HIV, OR SERIOUS MENTAL ILLNESS....

Section 1601.110. Disease Management Services - Sec. 1601.110. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease...

Section 1601.111. Programs Promoting Disease Prevention, Wellness, and Health - Sec. 1601.111. PROGRAMS PROMOTING DISEASE PREVENTION, WELLNESS, AND HEALTH. A...

Subchapter D. Group Coverages

Section 1601.151. Authority to Self-Insure; Exemption From Other Insurance Laws - Sec. 1601.151. AUTHORITY TO SELF-INSURE; EXEMPTION FROM OTHER INSURANCE LAWS....

Section 1601.152. Cafeteria Plan - Sec. 1601.152. CAFETERIA PLAN. (a) The governing board of a...

Section 1601.153. Systems May Join in Procuring Insurance - Sec. 1601.153. SYSTEMS MAY JOIN IN PROCURING INSURANCE. The systems...

Section 1601.154. Long-Term Care Coverage - Sec. 1601.154. LONG-TERM CARE COVERAGE. (a) A system may join...

Section 1601.155. Reinsurance - Sec. 1601.155. REINSURANCE. A system may arrange with an administering...

Subchapter E. Payments, Contributions, and Costs

Section 1601.201. Payment for Coverage - Sec. 1601.201. PAYMENT FOR COVERAGE. (a) A system may not...

Section 1601.202. Fees for Cafeteria Plan - Sec. 1601.202. FEES FOR CAFETERIA PLAN. (a) The governing board...

Section 1601.203. Payment for Coverage for Dependents - Sec. 1601.203. PAYMENT FOR COVERAGE FOR DEPENDENTS. Contributions for coverages...

Section 1601.204. Authorization of Employee Deduction - Sec. 1601.204. AUTHORIZATION OF EMPLOYEE DEDUCTION. (a) Except for a...

Section 1601.2041. Employee Deduction for Automatic Coverage - Sec. 1601.2041. EMPLOYEE DEDUCTION FOR AUTOMATIC COVERAGE. Each individual automatically...

Section 1601.2042. Compensation Insufficient to Cover Deduction - Sec. 1601.2042. COMPENSATION INSUFFICIENT TO COVER DEDUCTION. If a participant's...

Section 1601.205. Employee Payments for Participation in Cafeteria Plan - Sec. 1601.205. EMPLOYEE PAYMENTS FOR PARTICIPATION IN CAFETERIA PLAN. (a)...

Section 1601.206. Payment by Retired Employee - Sec. 1601.206. PAYMENT BY RETIRED EMPLOYEE. An individual eligible to...

Section 1601.207. System Contributions - Sec. 1601.207. SYSTEM CONTRIBUTIONS. A system shall contribute monthly to...

Section 1601.208. Amount of System Contribution - Sec. 1601.208. AMOUNT OF SYSTEM CONTRIBUTION. Not later than November...

Section 1601.209. Order of Precedence of Payment to Survivors - Sec. 1601.209. ORDER OF PRECEDENCE OF PAYMENT TO SURVIVORS. (a)...

Section 1601.210. Provision of Necessary Information - Sec. 1601.210. PROVISION OF NECESSARY INFORMATION. The Teacher Retirement System...

Section 1601.211. Liability for Back Contributions for Dropped Coverage - Sec. 1601.211. LIABILITY FOR BACK CONTRIBUTIONS FOR DROPPED COVERAGE. (a)...

Subchapter F. Cafeteria Plan Fund

Section 1601.251. System Cafeteria Plan Fund - Sec. 1601.251. SYSTEM CAFETERIA PLAN FUND. (a) The governing board...

Section 1601.252. Use of Fund - Sec. 1601.252. USE OF FUND. The cafeteria plan fund of...

Section 1601.253. Investment of Money in Fund - Sec. 1601.253. INVESTMENT OF MONEY IN FUND. (a) The governing...

Subchapter G. Advisory Committee

Section 1601.301. Advisory Committee - Sec. 1601.301. ADVISORY COMMITTEE. An advisory committee for each system...

Section 1601.302. Election of Members - Sec. 1601.302. ELECTION OF MEMBERS. One member of the advisory...

Section 1601.303. Qualifications of Members - Sec. 1601.303. QUALIFICATIONS OF MEMBERS. (a) A member of a...

Section 1601.304. Terms - Sec. 1601.304. TERMS. A member of the advisory committee is...

Section 1601.305. Officers - Sec. 1601.305. OFFICERS. Annually, the members of a system's advisory...

Section 1601.306. Vacancy - Sec. 1601.306. VACANCY. The chief executive officer of a component,...

Section 1601.307. Duties of Committee - Sec. 1601.307. DUTIES OF COMMITTEE. (a) The advisory committee of...

Section 1601.308. Expenses - Sec. 1601.308. EXPENSES. (a) A member's service on the advisory...

Chapter 1625 - Transfer Between Certain Governmental Programs

Section 1625.001. Definitions - Sec. 1625.001. DEFINITIONS. In this chapter: (1) "Board of trustees"...

Section 1625.002. Inapplicability of Preexisting Conditions Requirement - Sec. 1625.002. INAPPLICABILITY OF PREEXISTING CONDITIONS REQUIREMENT. A person, including...

Section 1625.003. Rules - Sec. 1625.003. RULES. The board of trustees and the governing...

Section 1625.004. Memorandum of Understanding - Sec. 1625.004. MEMORANDUM OF UNDERSTANDING. The board of trustees and...

Section 1625.005. Uniform Procedures - Sec. 1625.005. UNIFORM PROCEDURES. The governing board of an institution...

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Texas Statutes Title 8 - Health Insurance and Other Health Coverages Subtitle H - Health Benefits and Other Coverages for Governmental Employees

Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle H - Health Benefits and Other Coverages for Governmental Employees