2005 Texas Insurance Code CHAPTER 1579. TEXAS SCHOOL EMPLOYEES UNIFORM GROUP HEALTH COVERAGE

INSURANCE CODE

CHAPTER 1579. TEXAS SCHOOL EMPLOYEES UNIFORM GROUP HEALTH COVERAGE

SUBCHAPTER A. GENERAL PROVISIONS


	§ 1579.001. SHORT TITLE.  This chapter may be cited as the 
Texas School Employees Uniform Group Health Coverage Act.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.002. GENERAL DEFINITIONS.  In this chapter:                          
		(1)  "Administering firm" means any entity designated 
by the trustee to administer any coverages, services, benefits, or 
requirements under this chapter and the trustee's rules adopted 
under this chapter.
		(2)  "Trustee" means the Teacher Retirement System of 
Texas.                
		(3)  "Charter school" means an open-enrollment charter 
school established under Subchapter D, Chapter 12, Education Code.
		(4)  "Health coverage plan" means any group policy or 
contract, hospital service agreement, health maintenance 
organization agreement, preferred provider arrangement, or any 
similar group arrangement or any combination of those policies, 
contracts, agreements, or arrangements that provides for, pays for, 
or reimburses expenses for health care services.
		(5)  "Participating entity" means an entity 
participating in the uniform group coverage program established 
under this chapter.  The term includes:
			(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;  and                               
			(D)  a charter school that meets the requirements 
of Section 1579.154.     
		(6)  "Program" means the uniform group coverage program 
established under this chapter.
		(7)  "Regional education service center" means a 
regional education service center established under Chapter 8, 
Education Code.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.003. DEFINITION OF EMPLOYEE.  In this chapter, " 
employee" means a participating member of the Teacher Retirement 
System of Texas who is employed by a participating entity and who is 
not receiving coverage from a program under Chapter 1551, 1575, or 
1601.  The term does not include an individual performing personal 
services as an independent contractor.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.004. DEFINITION OF DEPENDENT.  In this chapter, 
"dependent" means: 
		(1)  a spouse of a full-time employee or part-time 
employee;                
		(2)  an unmarried child of a full-time or part-time 
employee if the child is younger than 25 years of age, including:
			(A)  an adopted child;                                                       
			(B)  a foster child, stepchild, or other child who 
is in a regular parent-child relationship;  and
			(C)  a recognized natural child;                                             
		(3)  a full-time or part-time employee'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 employee or the 
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 employee or surviving 
spouse for care or support, as determined by the board of trustees;  
and
		(4)  notwithstanding any other provision of this code, 
any other dependent of a full-time or part-time employee specified 
by rules adopted by the board of trustees.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.005. CONFIDENTIALITY.  (a) Section 825.507, 
Government Code, applies to records relating to an employee or 
dependent under the program and in the custody of the Teacher 
Retirement System of Texas or in the custody of an administrator, 
carrier, agent, attorney, consultant, or governmental body acting 
in cooperation with or on behalf of the system.
	(b)  The Teacher Retirement System of Texas may disclose to a 
health care provider, benefit provider, or claims administrator 
information in the records of an individual that the system 
determines is necessary to administer the program.

Added by Acts 2005, 79th Leg., ch. 1359, § 48, eff. Sept. 1, 
2005.       


	§ 1579.006. EXEMPTION FROM PROCESS.  (a) The following 
are exempt from execution, attachment, garnishment, or any other 
process:
		(1)  benefit payments, including optional benefit 
payments;                 
		(2)  contributions of active employees, the state, and 
a participating entity, and any other contributions;
		(3)  any rights, benefits, or payments accruing to any 
person under this chapter;  and
		(4)  any money in the Texas school employees uniform 
group coverage trust 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 2005, 79th Leg., ch. 1359, § 48, eff. Sept. 1, 
2005.       


	§ 1579.007. 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 2005, 79th Leg., ch. 1359, § 48, eff. Sept. 1, 
2005.       


	§ 1579.008. 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, § 48, eff. Sept. 1, 
2005.       

SUBCHAPTER B. ADMINISTRATION


	§ 1579.051. ADMINISTRATION OF GROUP PROGRAM.  The Teacher 
Retirement System of Texas, as trustee, shall implement and 
administer the uniform group coverage program described by this 
chapter.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.052. AUTHORITY TO ADOPT RULES;  OTHER 
AUTHORITY.  (a) The trustee may adopt rules relating to the program 
as considered necessary by the trustee.
	(b)  The trustee may adopt rules to administer the program, 
including rules relating to adjudication of claims and expelling 
participants from the program for cause.
	(c)  The trustee may contract with independent and 
experienced group insurance consultants and actuaries for advice 
and counsel in implementing and administering the program.
	(d)  The trustee may enter into interagency contracts with 
any agency of the state, including the Employees Retirement System 
of Texas and the department, for the purpose of assistance in 
implementing the program.
	(e)  The trustee shall take the actions it considers 
necessary to devise, implement, and administer the program.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.  Amended by Acts 2005, 79th Leg., ch. 1359, § 49, eff. 
Sept. 1, 2005.


	§ 1579.053. PERSONNEL.  The trustee may hire and 
compensate employees as necessary to implement the program.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.054. COMPETITIVE BIDDING REQUIREMENTS;  RULES.  A 
contract to provide group health coverage under this chapter may be 
awarded only through competitive bidding under rules adopted by the 
trustee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.055. 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 also 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 board meeting.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.

SUBCHAPTER C. COVERAGES


	§ 1579.101. PLANS OF GROUP COVERAGES.  (a) The trustee by 
rule shall establish plans of group coverages for employees 
participating in the program and their dependents.
	(b)  The plans must include at least two tiers of group 
coverage, with coverage at different levels in each tier, ranging 
from the catastrophic care coverage plan to the primary care 
coverage plan.  Each tier must contain a health coverage plan.
	(c)  The trustee by rule shall define the requirements of 
each coverage plan and tier of coverage.
	(d)  Comparable coverage plans of each tier of coverage 
established must be offered to employees of all participating 
entities.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.102. CATASTROPHIC CARE COVERAGE PLAN.  The 
coverage provided under the catastrophic care coverage plan shall 
be prescribed by the trustee by rule and must provide coverage at 
least as extensive as the coverage provided under the TRS-Care 1 
plan operated under Chapter 1575.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.  Amended by Acts 2005, 79th Leg., ch. 1359, § 50, eff. 
Sept. 1, 2005.


	§ 1579.103. PRIMARY CARE COVERAGE PLAN.  The coverage 
provided under the primary care coverage plan must be comparable in 
scope and, to the greatest extent possible, in cost to the coverage 
provided under Chapter 1551.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.104. OPTIONAL COVERAGES.  The trustee may not 
offer optional coverages, other than optional permanent life 
insurance, optional long-term care insurance, and optional 
disability insurance, to employees participating in the program.  
This section does not affect the right of a participating entity to 
offer optional coverages to its employees under terms and 
conditions established by the participating entity.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.  Amended by Acts 2005, 79th Leg., ch. 1359, § 51(a), 
eff. Sept. 1, 2005.


	§ 1579.105. PREEXISTING CONDITION LIMITATION.  During 
the initial period of eligibility, coverage provided under the 
program may not be made subject to a preexisting condition 
limitation.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.

SUBCHAPTER D. PARTICIPATING ENTITIES


	§ 1579.151. REQUIRED PARTICIPATION OF SCHOOL DISTRICTS 
WITH 500 OR FEWER EMPLOYEES.  (a) Each school district with 500 or 
fewer employees and each regional education service center is 
required to participate in the program.
	(b)  Notwithstanding Subsection (a), a school district 
otherwise subject to Subsection (a) that, on January 1, 2001, was 
individually self-funded for the provision of health coverage to 
its employees may elect not to participate in the program.
	(c)  An educational district described by Section 
1579.002(5)(B) that, on January 1, 2001, had 500 or fewer employees 
may elect not to participate in the program.
	(d)  Expired.                                                                  

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.152. PARTICIPATION OF OTHER SCHOOL 
DISTRICTS.  Effective September 1, 2005, a school district with 
more than 500 employees may elect to participate in the program.  A 
school district that elects to participate under this section shall 
apply for participation in the manner prescribed by the trustee by 
rule.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.153. PARTICIPATION BY CERTAIN RISK POOLS.  (a) In 
determining the number of employees of a school district for 
purposes of Sections 1579.151 and 1579.152, school districts that, 
on January 1, 2001, were members of a risk pool established under 
the authority of Chapter 172, Local Government Code, as provided by 
Section 22.004, Education Code, may elect to be treated as a single 
unit.  A school district shall elect whether to be considered as a 
member of a risk pool under this section by notifying the trustee 
not later than September 1, 2001.
	(b)  A risk pool in existence on January 1, 2001, that, as of 
that date, provided group health coverage to 500 or fewer school 
district employees may elect to participate in the program.
	(c)  A school district with 500 or fewer employees that is a 
member of a risk pool described by Subsection (a) that provides 
group health coverage to more than 500 school district employees 
must elect, not later than September 1, 2001, whether to be treated 
as a school district with 500 or fewer employees or as part of a unit 
with more than 500 employees.  The school district must notify the 
trustee of the election, in the manner prescribed by the trustee, 
not later than September 1, 2001.
	(d)  For purposes of this section, participation in the 
program by school districts covered by a risk pool is limited to 
school districts covered by the risk pool as of January 1, 2001.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.154. PARTICIPATION BY CHARTER SCHOOLS;  
ELIGIBILITY.  (a) A charter school is eligible to participate in 
the program if the school agrees:
		(1)  that all records of the school relating to 
participation in the program are open to inspection by the trustee, 
the administering firm, the commissioner of education, or a 
designee of any of those entities;  and
		(2)  to have the school's accounts relating to 
participation in the program annually audited by a certified public 
accountant at the school's expense.
	(b)  A charter school must notify the trustee of the school's 
intent to participate in the program in the manner and within the 
time required by rules adopted by the trustee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.

SUBCHAPTER E. PARTICIPATION BY EMPLOYEE


	§ 1579.201. DEFINITION.  In this subchapter, "full-time 
employee" and "part-time employee" have the meanings assigned by 
rules adopted by the trustee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.202. ELIGIBLE EMPLOYEES.  (a) Except as provided 
by Section 1579.204, participation in the program is limited to 
employees of participating entities who are full-time employees and 
to part-time employees who are participating members in the Teacher 
Retirement System of Texas.
	(b)  An employee described by Subsection (a) who applies for 
coverage during an open enrollment period prescribed by the trustee 
is automatically covered by the catastrophic care coverage plan 
unless the employee:
		(1)  specifically waives coverage under this chapter;                         
		(2)  selects a higher tier coverage plan;  or                                 
		(3)  is expelled from the program.                                            

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.203. SELECTION OF COVERAGE.  (a) A participating 
employee may select coverage in any coverage plan offered by the 
trustee.
	(b)  The employee is not required to continue participation 
in the coverage plan initially selected and may select a higher or 
lower tier coverage plan than the plan initially selected by the 
employee in the manner provided by rules adopted by the trustee.
	(c)  If the combined contributions received from the state 
and the employing participating entity under Subchapter F exceed 
the cost of a coverage plan selected by the employee, the employee 
may use the excess amount of contributions to obtain coverage under 
a higher tier coverage plan or to pay all or part of the cost of 
coverage for the employee's dependents.
	(d)  A married couple, both of whom are eligible for coverage 
under the program, may pool the amount of contributions to which the 
couple are entitled under the program to obtain coverage for 
themselves and dependent coverage.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.204. CERTAIN PART-TIME EMPLOYEES.  A part-time 
employee of a participating entity who is not a participating 
member in the Teacher Retirement System of Texas is eligible to 
participate in the program only if the employee pays all of the 
premiums and other costs associated with the health coverage plan 
selected by the employee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.205. PAYMENT BY PARTICIPATING 
ENTITY.  Notwithstanding Section 1579.204, a participating entity 
may pay any portion of what otherwise would be the employee share of 
premiums and other costs associated with the coverage selected by 
the employee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.

SUBCHAPTER F. CONTRIBUTIONS


	§ 1579.251. STATE ASSISTANCE.  (a) The state shall assist 
employees of participating school districts and charter schools in 
the purchase of group health coverage under this chapter by 
providing for each covered employee the amount of $900 each state 
fiscal year or a greater amount as provided by the General 
Appropriations Act.  The state contribution shall be distributed 
through the school finance formulas under Chapters 41 and 42, 
Education Code, and used by school districts and charter schools as 
provided by Sections 42.2514 and 42.260, Education Code.
	(b)  The state shall assist employees of participating 
regional education service centers and educational districts 
described by Section 1579.002(5)(B) in the purchase of group health 
coverage under this chapter by providing to the employing service 
center or educational district, for each covered employee, the 
amount of $900 each state fiscal year or a greater amount as 
provided by the General Appropriations Act.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.252. CONTRIBUTION BY PARTICIPATING ENTITIES.  A 
participating entity shall make contributions for the program as 
provided by Chapter 1581.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.253. CONTRIBUTION BY EMPLOYEE.  (a) An employee 
covered by the program shall pay that portion of the cost of 
coverage selected by the employee that exceeds the amount of the 
state contribution under Section 1579.251 and the participating 
entity contribution under Section 1579.252.
	(b)  The employee may pay the employee's contribution under 
this subsection from the amount distributed to the employee under 
Subchapter D, Chapter 22, Education Code.
	(c)  Notwithstanding Subsection (a), a participating entity 
may pay any portion of what otherwise would be the employee share of 
premiums and other costs associated with the coverage selected by 
the employee.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.  Amended by Acts 2005, 79th Leg., ch. 899, § 18.04, eff. 
Sept. 1, 2005;  Acts 2005, 79th Leg., ch. 1359, § 52, eff. Sept. 
1, 2005.


	§ 1579.254. CONTRIBUTIONS HELD IN TRUST FOR FUND.  A 
participating entity:
		(1)  shall hold contributions required by this 
subchapter in trust for the Texas school employees uniform group 
coverage trust fund and its participants;  and
		(2)  may not divert the contributions for any other 
purpose.                

Added by Acts 2005, 79th Leg., ch. 1359, § 53, eff. Sept. 1, 
2005.       


	§ 1579.255. INTEREST ASSESSED ON LATE PAYMENT OF 
CONTRIBUTIONS BY PARTICIPATING ENTITIES.  (a) A participating 
entity 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 Texas school employees uniform 
group coverage trust 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 a participating entity's 
financial or technological resources.

Added by Acts 2005, 79th Leg., ch. 1359, § 53, eff. Sept. 1, 
2005.       

SUBCHAPTER G. TEXAS SCHOOL EMPLOYEES UNIFORM GROUP COVERAGE TRUST 
FUND


	§ 1579.301. FUND;  ADMINISTRATION.  The Texas school 
employees uniform group coverage trust fund is a trust fund with the 
comptroller.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.302. COMPOSITION OF FUND.  The fund is composed 
of:                
		(1)  all contributions made to the fund under this 
chapter from employees, participating entities, and the state;
		(2)  contributions made by employees or participating 
entities for optional coverages;
		(3)  investment income;                                                       
		(4)  any additional amounts appropriated by the 
legislature for contingency reserves, administrative expenses, or 
other expenses;  and
		(5)  any other money required or authorized to be paid 
into the fund.       

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.303. PAYMENTS FROM FUND.  The trustee may use 
amounts in the fund only to provide group coverages under this 
chapter and to pay the expenses of administering the program.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.


	§ 1579.304. INVESTMENT OF FUND.  The trustee may invest 
assets of the fund in the manner provided by Section 67(a)(3), 
Article XVI, Texas Constitution.

Added by Acts 2003, 78th Leg., ch. 1276, § 10A.471(a), eff. Sept. 
1, 2003.