SUBCHAPTER A GENERAL PROVISIONS
- Texas Section 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,...
- Texas Section 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;...
- Texas Section 1575.003 - Definition Of Dependent And Related Terms
In this chapter: (1) "Dependent" means: (A) the spouse of a retiree; (B) a child of a retiree or deceased active member if the child...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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...
SUBCHAPTER B ADMINISTRATION
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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,...
SUBCHAPTER C PROVISION OF BENEFITS
- Texas Section 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...
- Texas Section 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....
- Texas Section 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...
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER D COVERAGES AND PARTICIPATION
- Texas Section 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...
- Texas Section 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:...
- Texas Section 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.
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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...
- Texas Section 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...
- Texas Section 1575.158 - Optional Group Health Benefit Plan
(a) Subject to Section 1575.1581, the trustee may, in addition to providing a basic plan, contract for and make available an optional group health benefit...
- Texas Section 1575.1581 - Limitation On Enrollment In Optional Group Health Benefit Plan
(a) A service retiree and any dependent of a service retiree are not eligible to participate in an optional group health benefit plan made available...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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:...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER E CONTRIBUTIONS
- Texas Section 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...
- Texas Section 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;...
- Texas Section 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....
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 1575.206 - Contributions Held In Trust For Fund
An employing public school and its governing body: (1) hold contributions required by this subchapter in trust for the fund and its participants; and (2)...
- Texas Section 1575.207 - Interest Assessed On Late Payment Of Deposits By Employing Public Schools
(a) An employing public school that does not remit to the trustee all contributions required by this subchapter before the seventh day after the last...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER F FEDERAL OR PRIVATE SOURCE CONTRIBUTIONS
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER G RETIRED SCHOOL EMPLOYEES GROUP INSURANCE FUND
- Texas Section 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....
- Texas Section 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...
- Texas Section 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)...
- Texas Section 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...
- Texas Section 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....
- Texas Section 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...
SUBCHAPTER H COORDINATED CARE NETWORK
- Texas Section 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...
- Texas Section 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...
- Texas Section 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....
- Texas Section 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...
- Texas Section 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.,...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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....
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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:...
SUBCHAPTER I RETIREES ADVISORY COMMITTEE
- Texas Section 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...
- Texas Section 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.
- Texas Section 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;...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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,...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER J ACCOUNTING, REPORTS, AND RECORDS
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
SUBCHAPTER K EXPULSION FOR FRAUD
- Texas Section 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 Teacher Retirement System of Texas or...
- Texas Section 1575.501 - Expulsion For Fraud
After notice and hearing as provided by this subchapter, the trustee may expel from participation in the group program a retiree, dependent, surviving spouse, or...
- Texas Section 1575.502 - Hearing
On receipt of a complaint or on its own motion, the trustee may call and hold a hearing to determine whether an individual has acted...
- Texas Section 1575.503 - Contested Case
A proceeding under this subchapter is a contested case under Chapter 2001, Government Code. Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff....
- Texas Section 1575.504 - Expulsion At Conclusion Of Hearing
At the conclusion of the hearing under Section 1575.502, if the trustee determines that the individual acted in the manner described by Section 1575.501, the...
- Texas Section 1575.505 - Effect Of Expulsion
An individual expelled from participation in the group program may not be covered by a health benefit plan offered under the group program for a...
- Texas Section 1575.506 - Appeal
An appeal of a determination by the trustee under this subchapter is under the substantial evidence rule. Added by Acts 2001, 77th Leg., ch. 1419,...