CHAPTER 1575. TEXAS PUBLIC SCHOOL EMPLOYEES GROUP BENEFITS PROGRAM

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1575-texas-public-school-employees-group-benefits-program

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE H. HEALTH BENEFITS AND OTHER COVERAGES FOR GOVERNMENTAL

EMPLOYEES

CHAPTER 1575. TEXAS PUBLIC SCHOOL EMPLOYEES GROUP BENEFITS

PROGRAM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1575.001. SHORT TITLE. This chapter may be cited as the

Texas Public School Retired Employees Group Benefits Act.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.413(a),

eff. Sept. 1, 2003.

Sec. 1575.002. GENERAL DEFINITIONS. In this chapter:

(1) "Active employee" means a contributing member of the Teacher

Retirement System of Texas who:

(A) is employed by a public school; and

(B) is not entitled to coverage under a plan provided under

Chapter 1551 or 1601.

(2) "Carrier" means an insurance company or hospital service

corporation authorized by the department under this code or

another insurance law of this state to provide any of the

insurance coverages, benefits, or services provided by this

chapter.

(3) "Fund" means the retired school employees group insurance

fund.

(4) "Group program" means the Texas Public School Employees

Group Insurance Program authorized by this chapter.

(5) "Health benefit plan" means a group insurance policy,

contract, or certificate, medical or hospital service agreement,

membership or subscription contract, salary continuation plan, or

similar group arrangement to provide health care services or to

pay or reimburse expenses of health care services.

(6) "Public school" means:

(A) a school district;

(B) another educational district whose employees are members of

the Teacher Retirement System of Texas;

Chapter 8, Education Code; or

(D) an open-enrollment charter school established under

Subchapter D, Chapter 12, Education Code.

(7) "Trustee" means the Teacher Retirement System of Texas.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 47, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 366, Sec. 3.01, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 1, eff. Sept.

1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.414(a), eff.

Sept. 1, 2003.

Sec. 1575.003. DEFINITION OF DEPENDENT AND RELATED TERMS. In

this chapter:

(1) "Dependent" means:

(A) the spouse of a retiree;

(B) an unmarried child of a retiree or deceased active member if

the child is younger than 25 years of age, including:

(i) an adopted child;

(ii) a foster child, stepchild, or other child who is in a

regular parent-child relationship; or

(iii) a recognized natural child;

child, stepchild, or other child who is in a regular parent-child

relationship and who lives with or has his or her care provided

by the retiree or surviving spouse on a regular basis regardless

of the child's age, if the child is mentally retarded or

physically incapacitated to an extent that the child is dependent

on the retiree or surviving spouse for care or support, as

determined by the trustee; or

(D) a deceased active member's recognized natural child, adopted

child, foster child, stepchild, or other child who is in a

regular parent-child relationship, without regard to the age of

the child, if, while the active member was alive, the child:

(i) lived with or had the child's care provided by the active

member on a regular basis; and

(ii) was mentally retarded or physically incapacitated to an

extent that the child was dependent on the active member or

surviving spouse for care or support, as determined by the

trustee.

(2) "Surviving dependent child" means:

(A) the dependent child of a deceased retiree who has survived

the deceased retiree and the deceased retiree's spouse; or

(B) the dependent child of a deceased active member who has

survived the deceased member and the deceased member's spouse if

the deceased member:

(i) had contributions made to the group program at the last

place of employment of the deceased member in public education in

this state;

(ii) had 10 or more years of service credit in the Teacher

Retirement System of Texas; and

(iii) died on or after September 1, 1986.

(3) "Surviving spouse" means:

(A) the surviving spouse of a deceased retiree; or

(B) the surviving spouse of a deceased active member:

(i) for whom contributions have been made to the group program

at the last place of employment of the deceased member in public

education in this state;

(ii) who had 10 or more years of service credit in the Teacher

Retirement System of Texas; and

(iii) who died on or after September 1, 1986.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.414(b),

(c), eff. Sept. 1, 2003.

Sec. 1575.004. DEFINITION OF RETIREE. (a) In this chapter,

"retiree" means:

(1) an individual not eligible for coverage under a plan

provided under Chapter 1551 or 1601 who:

(A) has taken a service retirement under the Teacher Retirement

System of Texas after September 1, 2005, with at least 10 years

of service credit in the system, which may include up to five

years of military service credit, but which may not include any

other service credit purchased for equivalent or special service

credit, and either:

(i) the sum of the retiree's age and years of service credit in

the retirement system equals or exceeds 80 at the time of

retirement, regardless of whether the retiree had a reduction in

the retirement annuity for early age; or

(ii) the retiree has 30 or more years of service credit in the

retirement system at the time of retirement;

(B) has taken a service retirement under the Teacher Retirement

System of Texas after September 1, 2004, but on or before August

31, 2005, and on September 1, 2005, either:

(i) meets the requirements for eligibility for the group program

for coverage as a retiree as those requirements existed on August

31, 2004;

(ii) meets the requirements of Paragraph (A); or

(iii) is enrolled in the group program and was enrolled in the

group program on August 31, 2005; or

System of Texas on or before August 31, 2004, and who is enrolled

in the group program on August 31, 2005;

(2) an individual who:

(A) has taken a disability retirement under the Teacher

Retirement System of Texas; and

(B) is entitled to receive monthly benefits from the Teacher

Retirement System of Texas; or

(3) an individual who:

(A) has taken a disability retirement under the Teacher

Retirement System of Texas;

(B) has at least 10 years of service credit in the Teacher

Retirement System of Texas on the date of disability retirement,

as determined under Section 824.304, Government Code; and

Retirement System of Texas because those benefits have been

suspended in accordance with Section 824.310, Government Code.

(b) In this section, "public school" has the meaning assigned

by Section 821.001, Government Code.

eligibility that existed on August 31, 2004, for a service

retiree, an individual must not have been eligible to be covered

by a plan provided under Chapter 1551 or 1601 and must have taken

a service retirement under the Teacher Retirement System of Texas

with either:

(1) at least 10 years of service credit in the retirement system

for actual service in public schools in this state; or

(2) at least five years of service credit for actual service in

the public schools in this state and five years of out-of-state

service credit in the Teacher Retirement System of Texas.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 48, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 2, eff. Sept.

1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.415, eff. Sept.

1, 2003; Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.05, eff.

Sept. 1, 2004.

Amended by:

Acts 2005, 79th Leg., Ch.

1359, Sec. 38, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

1230, Sec. 15, eff. September 1, 2007.

Sec. 1575.005. ISSUANCE OF CERTIFICATE OF COVERAGE. At the time

and in the circumstances specified by the trustee, a carrier

shall issue to each retiree, surviving spouse, or surviving

dependent child covered under this chapter a certificate of

coverage that:

(1) states the benefits to which the person is entitled;

(2) states to whom the benefits are payable;

(3) states to whom a claim must be submitted; and

(4) summarizes the provisions of the coverage principally

affecting the person.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.416(a),

eff. Sept. 1, 2003.

Sec. 1575.006. EXEMPTION FROM PROCESS. (a) The following are

exempt from execution, attachment, garnishment, or any other

process:

(1) benefit payments, including optional benefits payments,

active employee and state contributions, and retiree, surviving

spouse, and surviving dependent child contributions;

(2) any rights, benefits, or payments accruing to any person

under this chapter; and

(3) any money in the fund.

(b) The items listed in Subsection (a) may not be assigned

except for direct payment to benefit providers as authorized by

the trustee by contract, rule, or otherwise.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.417,

eff. Sept. 1, 2003.

Sec. 1575.007. EXEMPTION FROM STATE TAXES AND FEES. A premium

or contribution on a policy, insurance contract, or agreement

authorized by this chapter is not subject to any state tax,

regulatory fee, or surcharge, including a premium or maintenance

tax or fee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.008. COVERAGE EXEMPT FROM INSURANCE LAW. A coverage

plan provided under this chapter is exempt from any other

insurance law, including common law, that does not expressly

apply to the plan or this chapter.

Added by Acts 2005, 79th Leg., Ch.

1359, Sec. 39, eff. September 1, 2005.

SUBCHAPTER B. ADMINISTRATION

Sec. 1575.051. ADMINISTRATION OF GROUP PROGRAM. The trustee

shall take the actions it considers necessary to devise,

implement, and administer the group program.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.419,

eff. Sept. 1, 2003.

Sec. 1575.052. AUTHORITY TO ADOPT RULES AND PROCEDURES; OTHER

AUTHORITY. (a) The trustee may adopt rules, plans, procedures,

and orders reasonably necessary to implement this chapter,

including:

(1) minimum benefit and financing standards for group coverage

for retirees, dependents, surviving spouses, and surviving

dependent children;

(2) basic and optional group coverage for retirees, dependents,

surviving spouses, and surviving dependent children;

(3) procedures for contributions and deductions;

(4) periods for enrollment and selection of optional coverage

and procedures for enrolling and exercising options under the

group program;

(5) procedures for claims administration;

(6) procedures to administer the fund; and

(7) a timetable for:

(A) developing minimum benefit and financial standards for group

coverage;

(B) establishing group plans; and

(b) The trustee may:

(1) study the operation of all group coverage provided under

this chapter; and

(2) contract for advice and counsel in implementing and

administering the group program with independent and experienced

group insurance consultants and actuaries.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.420(a),

eff. Sept. 1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch.

1359, Sec. 40, eff. September 1, 2005.

Sec. 1575.053. PERSONNEL. (a) The trustee may employ persons

to assist the trustee in implementing this chapter.

(b) The trustee shall prescribe the duties and compensation of

each employee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,

eff. Sept. 1, 2003.

Sec. 1575.054. BUDGET. Expenses incurred in developing and

administering the group program shall be paid as provided by a

budget adopted by the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,

eff. Sept. 1, 2003.

Sec. 1575.055. DEPARTMENT ASSISTANCE. The department shall, as

requested by the trustee, assist the trustee in implementing and

administering this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.421,

eff. Sept. 1, 2003.

Sec. 1575.056. TRANSFER OF RECORDS RELATING TO ACTIVE EMPLOYEE

PROGRAM. The trustee shall transfer from the program all records

relating to active employees participating in the program

established under Chapter 1579 not later than the date on which

the program established under Chapter 1579 is implemented.

Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.422(a), eff.

Sept. 1, 2003.

SUBCHAPTER C. PROVISION OF BENEFITS

Sec. 1575.101. SYSTEM AS GROUP PLAN HOLDER. The Teacher

Retirement System of Texas is the group plan holder of a plan

established under this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,

eff. Sept. 1, 2003.

Sec. 1575.102. SELF-INSURED PLANS. The trustee may self-insure

any plan established under this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,

eff. Sept. 1, 2003.

Sec. 1575.103. PLANS MAY VARY ACCORDING TO MEDICARE COVERAGE.

For retirees and surviving spouses who are covered by Medicare,

the trustee may provide one or more plans that are different from

the plans provided for retirees and surviving spouses who are not

covered by Medicare.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,

eff. Sept. 1, 2003.

Sec. 1575.104. TERMS OF CONTRACT. A contract for group coverage

awarded by the trustee must meet the minimum benefit and

financial standards adopted by the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.423,

eff. Sept. 1, 2003.

Sec. 1575.105. PLAN COVERAGE SECONDARY TO CERTAIN OTHER

COVERAGE. The coverage provided by a plan established under this

chapter:

(1) is secondary to Medicare hospital and medical insurance to

the extent permitted by federal law if the retiree, dependent,

surviving spouse, or surviving dependent child is entitled to

receive Medicare hospital insurance benefits without charge; and

(2) may be made secondary to other coverage to which the

retiree, dependent, surviving spouse, or surviving dependent

child is entitled.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.106. COMPETITIVE BIDDING REQUIREMENTS; RULE. (a) A

contract to provide group benefits under this chapter may be

awarded only through competitive bidding under rules adopted by

the trustee.

(b) The trustee shall submit for competitive bidding at least

every six years each contract for coverage under this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.424(a),

eff. Sept. 1, 2003.

Sec. 1575.107. CONTRACT AWARD; CONSIDERATIONS. (a) In awarding

a contract to provide group benefits under this chapter, the

trustee is not required to select the lowest bid and may consider

any relevant criteria, including the bidder's:

(1) ability to service contracts;

(2) past experiences; and

(3) financial stability.

(b) If the trustee awards a contract to a bidder whose bid

deviates from that advertised, the trustee shall record the

deviation and fully justify the reason for the deviation in the

minutes of the next meeting of the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.424(b),

eff. Sept. 1, 2003.

Sec. 1575.108. USE OF PRIVATE ENTITIES. The trustee may engage

a private entity to collect contributions from or to settle

claims in connection with a plan established by the trustee under

this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,

eff. Sept. 1, 2003.

Sec. 1575.109. USE OF HEALTH CARE PROVIDER. To provide benefits

to participants in the group program, the trustee may contract

directly with a health care provider, including a health

maintenance organization, a preferred provider organization, a

carrier, an administrator, and any other qualified vendor.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,

eff. Sept. 1, 2003.

Sec. 1575.110. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In

awarding a contract to provide pharmacy benefit manager services

under this chapter, the trustee is not required to select the

lowest bid but must select a contract that meets the criteria

established by this section.

(b) The contract must state that:

(1) the trustee is entitled to audit the pharmacy benefit

manager to verify costs and discounts associated with drug

claims, pharmacy benefit manager compliance with contract

requirements, and services provided by subcontractors;

(2) the audit must be conducted by an independent auditor in

accordance with established auditing standards; and

(3) to conduct the audit, the trustee and the independent

auditor are entitled access to information related to the

services and the costs associated with the services performed

under the contract, including access to the pharmacy benefit

manager's facilities, records, contracts, medical records, and

agreements with subcontractors.

benefit manager is required to provide to the trustee concerning

the audit of the retail, independent, and mail order pharmacies

performing services under the contract and describe how the

results of these audits must be reported to the trustee,

including how often the results must be reported. The contract

must state whether the pharmacy benefit manager is required to

return recovered overpayments to the trustee.

(d) The contract must state that any audit of a mail order

pharmacy owned by the pharmacy benefit manager must be conducted

by an independent auditor selected by the trustee in accordance

with established auditing standards.

Added by Acts 2009, 81st Leg., R.S., Ch.

1207, Sec. 6, eff. September 1, 2009.

SUBCHAPTER D. COVERAGES AND PARTICIPATION

Sec. 1575.151. TYPES OF COVERAGES. The trustee may include in a

plan any coverage it considers advisable, including:

(1) life insurance;

(2) accidental death and dismemberment coverage;

(3) coverage for:

(A) hospital care and benefits;

(B) surgical care and treatment;

(D) dental care;

(E) eye care;

(F) obstetrical benefits;

(G) long-term care;

(H) prescribed drugs, medicines, and prosthetic devices; and

(I) supplemental benefits, supplies, and services in accordance

with this chapter; and

(4) protection against loss of salary.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.425,

eff. Sept. 1, 2003.

Sec. 1575.152. BASIC PLAN MUST COVER PREEXISTING CONDITIONS. A

basic plan must cover preexisting conditions.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.153. BASIC COVERAGE. A retiree who applies for

coverage during an enrollment period may not be denied coverage

in a basic plan provided under this chapter unless the trustee

finds under Subchapter K that the retiree defrauded or attempted

to defraud the group program.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 49(a), eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 3(a), eff.

Sept. 1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.426(a),

eff. Sept. 1, 2003.

Sec. 1575.155. COVERAGE FOR DEPENDENTS OF RETIREE. (a) A

retiree participating in the group program is entitled to secure

for the retiree's dependents group coverage provided for the

retiree under this chapter, as determined by the trustee.

(b) The additional contribution payments for the dependent

coverage shall be deducted from the annuity payments to the

retiree in the manner and form determined by the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.427,

eff. Sept. 1, 2003.

Sec. 1575.156. COVERAGE FOR SURVIVING SPOUSE OR DEPENDENTS OF

SURVIVING SPOUSE. (a) A surviving spouse who is entitled to

group coverage under this chapter may elect to retain or obtain

coverage for the surviving spouse or dependents of the surviving

spouse at the applicable rate for the deceased participant.

(b) A surviving spouse must provide payment of applicable

contributions in the manner established by Section 1575.205 and

by the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.428,

eff. Sept. 1, 2003.

Sec. 1575.157. COVERAGE FOR SURVIVING DEPENDENT CHILD. (a) A

surviving dependent child, the guardian of the child's estate, or

the person having custody of the child may elect to retain or

obtain group coverage for the surviving dependent child at the

applicable rate for a dependent.

(b) The applicable contributions must be provided in the manner

established by Section 1575.205 and by the trustee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.429,

eff. Sept. 1, 2003.

Sec. 1575.158. OPTIONAL GROUP HEALTH BENEFIT PLAN. (a) The

trustee may, in addition to providing a basic plan, contract for

and make available an optional group health benefit plan for

retirees, dependents, surviving spouses, or surviving dependent

children.

(b) An optional group health benefit plan may provide for:

(1) a deductible in an amount that is less than the amount for

the basic plan;

(2) coinsurance in an amount that is less than the amount for

the basic plan; or

(3) additional benefits as permitted under Section 1575.151.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.430,

eff. Sept. 1, 2003.

Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN TEST. A

health benefit plan offered under the group program must provide

coverage for a medically accepted prostate-specific antigen test

used for the detection of prostate cancer for each male enrolled

in the plan who:

(1) is at least 50 years of age; or

(2) is at least 40 years of age and:

(A) has a family history of prostate cancer; or

(B) exhibits another cancer risk factor.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.160. GROUP LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT

INSURANCE: PAYMENT OF CLAIM. The amount of group life insurance

or group accidental death and dismemberment insurance covering a

retiree, dependent, surviving spouse, or surviving dependent

child on the date of death shall be paid, on the establishment of

a valid claim, only to:

(1) the beneficiary designated by the person in a signed and

witnessed document received before death in the office of the

trustee; or

(2) a person in the order prescribed by Section 824.103(b),

Government Code, if a beneficiary is not properly designated or a

beneficiary does not exist.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.431(a),

eff. Sept. 1, 2003.

Sec. 1575.161. OPEN ENROLLMENT; ADDITIONAL ENROLLMENT PERIODS.

(a) A retiree eligible for coverage under the group program may

select any coverage provided under this chapter for which the

person is otherwise eligible:

(1) on any date that is on or after the date the person retires

and on or before the 90th day after that date; and

(2) during any other open enrollment periods for retirees set by

the trustee by rule.

(b) In addition to the enrollment periods authorized under

Subsection (a), a retiree who:

(1) is enrolled in the group program as of August 31, 2004, and

who is 65 years of age or older on that date may select coverage

as described by Subsections (c) and (d) on September 1, 2004;

(2) is enrolled in the group program as of August 31, 2004, and

who is 65 years of age after that date may select coverage as

described by Subsections (c) and (d) on the date that the retiree

is 65 years of age; or

(3) enrolls in the group program on or after September 1, 2004,

and who is 65 years of age or older on or after that date may

select coverage as described in Subsections (c) and (d) on the

date that the retiree is 65 years of age.

the Medicare program, the retiree may enroll in the next-higher

coverage tier under the group program and may add dependent

coverage in that same coverage tier.

(d) If a retiree described by Subsection (b) is covered by the

Medicare program, the retiree may enroll in any coverage tier

under the group program and may add dependent coverage in that

same coverage tier.

(e) This section does not affect the right of a retiree enrolled

in a coverage tier under the group program to select a lower

level of coverage at any time.

Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,

2003; Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.

Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.06,

eff. Jan. 11, 2004.

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

354, Sec. 1, eff. September 1, 2009.

Sec. 1575.162. SPECIAL ENROLLMENTS. This chapter does not limit

the ability of an individual to enroll in the group program if

the individual:

(1) experiences a special enrollment event as provided by the

Health Insurance Portability and Accountability Act of 1996 (Pub.

L. No. 104-191, 110 Stat. 1936 (1996)), as amended; and

(2) is otherwise eligible to enroll in the group program.

Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,

2003; Acts 2003, 78th Leg., ch. 1231, Sec. 4, eff. Sept. 1, 2004.

Sec. 1575.163. LIMITATIONS. The Teacher Retirement System of

Texas, as trustee, may not contract for or provide a health

benefit plan that excludes from participation in the network a

general hospital that:

(1) is located in within the geographical service area or areas

of the health coverage plan that includes a county that:

(A) has a population of at least 100,000 and not more than

175,000; and

(B) is located in the Texas-Louisiana border region, as that

term is defined in Section 2056.002(e), Government Code; and

(2) agrees to provide medical and health care services under the

plan subject to the same terms and conditions as other hospital

providers under the plan.

Added by Acts 2003, 78th Leg., ch. 201, Sec. 50, eff. Sept. 1,

2003.

Sec. 1575.164. DISEASE MANAGEMENT SERVICES.

(a) In this section, "disease management services" means

services to assist an individual manage a disease or other

chronic health condition, such as heart disease, diabetes,

respiratory illness, end-stage renal disease, HIV infection, or

AIDS, and with respect to which the Teacher Retirement System of

Texas identifies populations requiring disease management.

(b) A health benefit plan provided under this chapter must

provide disease management services or coverage for disease

management services in the manner required by the Teacher

Retirement System of Texas, including:

(1) patient self-management education;

(2) provider education;

(3) evidence-based models and minimum standards of care;

(4) standardized protocols and participation criteria; and

(5) physician-directed or physician-supervised care.

Added by Acts 2003, 78th Leg., ch. 589, Sec. 4, eff. June 20,

2003.

Renumbered from Insurance Code, Section 1575.162 by Acts 2005,

79th Leg., Ch.

728, Sec. 23.001(62), eff. September 1, 2005.

Sec. 1575.170. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a) In

this section, "drug formulary" means a list of drugs preferred

for use and eligible for coverage under a health benefit plan.

(b) A health benefit plan provided under this chapter that uses

a drug formulary in providing a prescription drug benefit must

require prior authorization for coverage of the following

categories of prescribed drugs if the specific drug prescribed is

not included in the formulary:

(1) a gastrointestinal drug;

(2) a cholesterol-lowering drug;

(3) an anti-inflammatory drug;

(4) an antihistamine; and

(5) an antidepressant drug.

comptroller and Legislative Budget Board a report regarding any

cost savings achieved in the group program through implementation

of the prior authorization requirement of this section. A report

must cover the previous six-month period.

Added by Acts 2003, 78th Leg., ch. 213, Sec. 3, eff. Sept. 1,

2003. Renumbered from Insurance Code Sec. 1575.161 by Acts 2003,

78th Leg., 3rd C.S., ch. 3, Sec. 16.07, eff. Jan. 11, 2004.

SUBCHAPTER E. CONTRIBUTIONS

Sec. 1575.201. ADDITIONAL STATE CONTRIBUTIONS; CERTAIN

CONTRIBUTIONS. (a) The state through the trustee shall

contribute from money in the fund:

(1) the total cost of the basic plan covering each participating

retiree; and

(2) for each participating dependent, surviving spouse, and

surviving dependent child, the amount prescribed by the General

Appropriations Act to cover part of the cost of the basic plan

covering the dependent, surviving spouse, and surviving dependent

child.

(b) The trustee shall collect the amount of premium required for

basic coverage under the group program that exceeds the amount

contributed by the state for those individuals described by

Subsection (a)(2).

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 51, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 5, eff. Sept.

1, 2004; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.432, eff. Sept.

1, 2003.

Sec. 1575.202. STATE CONTRIBUTION BASED ON ACTIVE EMPLOYEE

COMPENSATION. (a) Each state fiscal year, the state shall

contribute to the fund an amount equal to one percent of the

salary of each active employee.

(b) The state may contribute to the fund an amount in addition

to the contribution required by Subsection (a).

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 52, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 6, eff. Sept.

1, 2003.

Sec. 1575.203. ACTIVE EMPLOYEE CONTRIBUTION. (a) Each state

fiscal year, each active employee shall, as a condition of

employment, contribute to the fund an amount equal to 0.65

percent of the employee's salary.

(b) The employer of an active employee shall monthly:

(1) deduct the employee's contribution from the employee's

salary and remit the contribution to the trustee in the manner

required by the trustee; or

(2) assume and pay the total contributions due from its active

employees.

active employee are included in annual compensation for purposes

of the Teacher Retirement System of Texas.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 53, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 366, Sec. 3.02, eff.

Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1231, Sec. 7, eff. Sept.

1, 2003; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.433, eff. Sept.

1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch.

899, Sec. 17.02, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

1359, Sec. 41, eff. September 1, 2005.

Sec. 1575.204. PUBLIC SCHOOL CONTRIBUTION. (a) Each state

fiscal year, each public school shall contribute to the fund the

amount prescribed by the General Appropriations Act, which may

not be less than 0.25 percent or greater than 0.75 percent of the

salary of each active employee of the public school. The public

school shall make the contributions on a monthly basis and as

otherwise prescribed by the trustee.

(b) Each state fiscal year, each employer who reports to the

retirement system under Section 824.6022, Government Code, the

employment of a retiree who is enrolled in the group program

shall contribute to the fund the difference, if any, between the

contribution amount that the reported retiree is required to pay

for the retiree and any enrolled dependents to participate in the

group program and the full cost of the retiree's and enrolled

dependents' participation in the group program, as determined by

the trustee. The amounts required to be paid under this

subsection are not required to be paid by a reporting employer

for a retiree who retired from the retirement system before

September 1, 2005.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 201, Sec. 54, eff.

Sept. 1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch.

1359, Sec. 42, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

1389, Sec. 4, eff. September 1, 2007.

Sec. 1575.205. PARTICIPATION CONTRIBUTION FOR OPTIONAL PLAN.

(a) A retiree, surviving spouse, or surviving dependent child

who elects an optional plan shall pay a monthly contribution to

cover the cost of the plan. The trustee shall adopt rules for the

collection of additional contributions.

(b) As a condition of electing coverage under an optional plan,

a retiree or surviving spouse must, in writing, authorize the

trustee to deduct the amount of the contribution from the

person's monthly annuity payment.

group program to offset a part of the costs for optional coverage

paid by retirees if the expenditure does not reduce the period

the group program is projected to remain financially solvent by

more than one year in a biennium.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.434,

eff. Sept. 1, 2003.

Sec. 1575.206. CONTRIBUTIONS HELD IN TRUST FOR FUND. An

employing school district and its trustees:

(1) hold contributions required by this subchapter in trust for

the fund and its participants; and

(2) may not divert the contributions for any other purpose.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.207. INTEREST ASSESSED ON LATE PAYMENT OF DEPOSITS BY

EMPLOYING SCHOOL DISTRICTS. (a) An employing school district

that does not remit to the trustee all contributions required by

this subchapter before the seventh day after the last day of the

month shall pay to the fund:

(1) the contributions; and

(2) interest on the unpaid amounts at the annual rate of six

percent compounded monthly.

(b) On request, the trustee may grant a waiver of the deadline

imposed by this section based on an employing district's

financial or technological resources.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.435(a),

eff. Sept. 1, 2003.

Sec. 1575.208. CERTIFICATION OF AMOUNT NECESSARY TO PAY STATE

CONTRIBUTIONS. Not later than October 31 preceding each regular

session of the legislature, the trustee shall certify the amount

necessary to pay the state contributions to the fund to:

(1) the Legislative Budget Board; and

(2) the budget division of the governor's office.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436,

eff. Sept. 1, 2003.

Sec. 1575.209. CERTIFICATION OF AMOUNT OF STATE CONTRIBUTIONS.

Not later than August 31 of each year, the trustee shall certify

to the comptroller the estimated amount of state contributions to

be received by the fund for the next fiscal year under the

appropriations authorized by this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.436,

eff. Sept. 1, 2003.

Sec. 1575.210. PAYMENT OF STATE CONTRIBUTIONS; RECONCILIATION.

(a) Contributions allocated and appropriated under this

subchapter for a state fiscal year shall be:

(1) paid from the general revenue fund in equal monthly

installments;

(2) based on the estimated amount certified by the trustee to

the comptroller for that year; and

(3) subject to any express limitations specified in the Act

making the appropriation.

(b) A variation between the certified amount and the actual

amount due for the state fiscal year shall be reconciled at the

end of the fiscal year, and the annual contributions to the fund

shall be adjusted accordingly.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.437,

eff. Sept. 1, 2003.

Sec. 1575.211. COST SHARING. (a) The total costs for the

operation of the group program shall be shared among the state,

the public schools, the active employees, and the retirees in the

manner prescribed by the General Appropriations Act.

(b) In determining the allocation of total costs under this

section, the state shall pay not more than 55 percent of the

total costs, retirees shall pay at least 30 percent of the total

costs, and the balance shall be paid by active employees and

public schools.

eff. September 1, 2005.

Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1,

2003; Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.

Amended by Acts 2003, 78th Leg., 3rd C.S., ch. 3, Sec. 16.08,

eff. Sept. 1, 2004.

Amended by:

Acts 2005, 79th Leg., Ch.

1359, Sec. 55(a)(2), eff. September 1, 2005.

Sec. 1575.212. PAYMENT BY RETIREES; RANGES. (a) The trustee by

rule shall establish ranges for payment of the share of total

costs allocated under Section 1575.211 to retirees, with

different levels for:

(1) retirees who are not eligible to participate in Part A of

the Medicare program;

(2) retirees who are eligible for participation but are not

participating in Part A of the Medicare program; and

(3) retirees who are eligible for participation in the Medicare

program and are participating in Part A of the Medicare program.

(b) In establishing ranges for payment of the share of total

costs allocated under Section 1575.211 to retirees, the trustee

may consider the years of service credit accrued by a retiree and

may reward those retirees with more years of service credit.

Added by Acts 2003, 78th Leg., ch. 201, Sec. 55, eff. Sept. 1,

2003; Acts 2003, 78th Leg., ch. 1231, Sec. 8, eff. Sept. 1, 2004.

Sec. 1575.213. CERTAIN DISABILITY RETIREES. An individual who

is eligible as a retiree under Section 1575.004(a)(3) shall pay

an additional premium in an amount determined by the trustee. The

amount of the premium may not exceed the total cost, as

determined by the trustee, attributable to the participation of

that retiree and the dependents of that retiree during the period

the individual is eligible as a retiree under Section

1575.004(a)(3).

Added by Acts 2007, 80th Leg., R.S., Ch.

1230, Sec. 16, eff. September 1, 2007.

SUBCHAPTER F. FEDERAL OR PRIVATE SOURCE CONTRIBUTIONS

Sec. 1575.251. DEFINITION. In this subchapter, "employer" has

the meaning assigned by Section 821.001, Government Code.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.252. APPLICATION BY EMPLOYER FOR MONEY TO PAY STATE

CONTRIBUTIONS. An employer who applies for money provided by the

United States or a privately sponsored source shall:

(1) if any of the money will pay part or all of an active

employee's salary, also apply for any legally available money to

pay state contributions required by Subchapter E; and

(2) immediately send any money received for state contributions

as a result of the application to the trustee for deposit in the

fund.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,

eff. Sept. 1, 2003.

Amended by:

Acts 2007, 80th Leg., R.S., Ch.

1223, Sec. 3, eff. September 1, 2007.

Sec. 1575.253. MONTHLY CERTIFICATION. An employer shall monthly

certify to the trustee in a form prescribed by the trustee:

(1) the total amount of salary paid from federal funds and

private grants; and

(2) the total amount of state contributions provided by the

funds and grants.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,

eff. Sept. 1, 2003.

Sec. 1575.254. MONTHLY MAINTENANCE OF INFORMATION. An employer

shall monthly maintain:

(1) the name of each employee whose salary is paid wholly or

partly from a grant;

(2) the source of the grant;

(3) the amount of the employee's salary paid from the grant;

(4) the amount of the money provided by the grant for state

contributions for the employee; and

(5) any other information the trustee determines is necessary to

enforce this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,

eff. Sept. 1, 2003.

Sec. 1575.255. PROOF OF COMPLIANCE. The trustee may:

(1) require an employer to report an application for federal or

private money;

(2) require evidence that the application includes a request for

funds available to pay state contributions for active employees;

and

(3) examine the records of an employer to determine compliance

with this subchapter and rules adopted under this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.438,

eff. Sept. 1, 2003.

Sec. 1575.256. CRIMINAL OFFENSE: FAILURE OF ADMINISTRATOR TO

COMPLY. (a) An administrator of an employer commits an offense

if the administrator knowingly fails to comply with this

subchapter.

(b) An offense under this section is a Class C misdemeanor.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.257. CIVIL SANCTIONS FOR FAILURE OF EMPLOYER TO

COMPLY. (a) An employer who fails to comply with this

subchapter may not apply for or spend any money received from a

federal or private grant.

(b) The trustee shall report an alleged noncompliance with this

subchapter to the attorney general, the Legislative Budget Board,

the comptroller, and the governor.

general shall bring a writ of mandamus against the employer to

compel compliance with this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.439,

eff. Sept. 1, 2003.

SUBCHAPTER G. RETIRED SCHOOL EMPLOYEES GROUP INSURANCE FUND

Sec. 1575.301. FUND; ADMINISTRATION. (a) The retired school

employees group insurance fund is a trust fund with the

comptroller, who is custodian of the fund.

(b) The trustee shall administer the fund.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.440(a),

eff. Sept. 1, 2003.

Sec. 1575.302. PAYMENTS INTO FUND. The following shall be paid

into the fund:

(1) contributions from active employees and the state, including

contributions for optional coverages;

(2) investment income;

(3) appropriations for implementation of the group program; and

(4) other money required or authorized to be paid into the fund.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.303. PAYMENTS FROM FUND. (a) The following shall,

without state fiscal year limitation, be paid from the fund:

(1) the appropriate premiums to a carrier providing group

coverage under a plan under this chapter;

(2) claims for benefits under the group coverage; and

(3) money spent by the trustee to administer the group program.

(b) The appropriate portion of the contributions to the fund to

provide for incurred but unreported claim reserves and

contingency reserves, as determined by the trustee, shall be

retained in the fund.

the group program and may not be diverted.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,

eff. Sept. 1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch.

1359, Sec. 43, eff. September 1, 2005.

Sec. 1575.304. TRANSFER OF CERTAIN CONTRIBUTIONS. The trustee

shall transfer into the fund the amounts deducted from annuities

for contributions.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,

eff. Sept. 1, 2003.

Sec. 1575.305. INVESTMENT OF FUND. The trustee may invest money

in the fund in the manner provided by Subchapter D, Chapter 825,

Government Code, for assets of the Teacher Retirement System of

Texas.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,

eff. Sept. 1, 2003.

Sec. 1575.306. EMPLOYEE CONTRIBUTIONS PROPERTY OF FUND ON

RECEIPT; NO REFUND. A contribution from an active employee:

(1) is the property of the fund on receipt by the trustee; and

(2) may not be refunded to the active employee under any

circumstances, including termination of employment.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.441,

eff. Sept. 1, 2003.

SUBCHAPTER H. COORDINATED CARE NETWORK

Sec. 1575.351. DEFINITIONS. In this subchapter:

(1) "Credentialing committee" means a credentialing committee

created by the trustee under Section 1575.354.

(2) "Health care provider" means:

(A) an individual licensed as a health care practitioner; or

(B) a health care facility.

(3) "Network" means the coordinated care network implemented and

administered by the trustee under this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.442,

eff. Sept. 1, 2003.

Sec. 1575.352. IMPLEMENTATION AND ADMINISTRATION. The trustee

may implement and administer a coordinated care network for the

group program.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,

eff. Sept. 1, 2003.

Sec. 1575.353. CONTRACTS WITH HEALTH CARE PROVIDERS AND OTHERS.

As the trustee determines is necessary to implement and

administer the network, the trustee may contract with a health

care provider or other individuals or entities.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,

eff. Sept. 1, 2003.

Sec. 1575.354. CREDENTIALING COMMITTEES. The trustee may

establish credentialing committees to evaluate the qualifications

of health care providers to participate in the network.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.443,

eff. Sept. 1, 2003.

Sec. 1575.355. IMMUNITY FROM LIABILITY ARISING FROM ACTS OR

OMISSIONS OF HEALTH CARE PROVIDER. (a) The following are not

liable for damages arising from an act or omission of a health

care provider participating in the network:

(1) the trustee and its officers and employees, including the

board of trustees of the trustee;

(2) the group program;

(3) the fund; and

(4) a member of an advisory committee to the trustee.

(b) A health care provider participating in the network is an

independent contractor and is responsible for the provider's acts

or omissions.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.444,

eff. Sept. 1, 2003.

Sec. 1575.356. IMMUNITY FROM LIABILITY ARISING FROM EVALUATION

OF QUALIFICATIONS OR CARE. The following are not liable for

damages arising from an act, including a statement,

determination, report of an act, or recommendation, committed

without malice in the course of the evaluation of the

qualifications of a health care provider or of the patient care

provided by a health care provider participating in the network:

(1) the trustee and its officers and employees, including the

board of trustees;

(2) the group program;

(3) the fund;

(4) a member of an advisory committee to the trustee; and

(5) a member of a credentialing committee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.445,

eff. Sept. 1, 2003.

Sec. 1575.357. IMMUNITY FROM LIABILITY ARISING FROM ACTS

RELATING TO CREDENTIALING COMMITTEE. An individual, a health

care provider, or a medical peer review committee is not liable

for damages arising from an act committed without malice that

consists of:

(1) participating in the activity of a credentialing committee;

(2) furnishing records, information, or assistance to a

credentialing committee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.358. OPEN MEETINGS LAW NOT APPLICABLE TO CREDENTIALING

COMMITTEE. The proceedings of a credentialing committee are not

subject to Chapter 551, Government Code.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.359. RECORDS AND PROCEEDINGS OF CREDENTIALING

COMMITTEE NOT SUBJECT TO SUBPOENA. Except to the extent required

by the constitution of this state or the United States, the

records and proceedings of a credentialing committee and a

communication made to a credentialing committee are not subject

to court subpoena.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.360. CONFIDENTIALITY. Except as otherwise provided by

this subchapter:

(1) proceedings and records of a credentialing committee are

confidential; and

(2) a communication made to a credentialing committee is

privileged.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.361. DISCLOSURE TO HEALTH CARE PROVIDER. Disclosure

of confidential credentialing committee information that is

relevant to the matter under review to an affected health care

provider is not a waiver of the confidentiality requirements

under this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.362. DISCLOSURE TO CERTAIN ENTITIES. (a) A written

or oral communication made to a credentialing committee, or a

record or proceeding of the committee, may be disclosed to an

appropriate:

(1) state or federal agency, including a state board of

registration or licensing;

(2) national accreditation body; or

(3) medical peer review committee.

(b) A disclosure under this section is not a waiver of the

confidential and privileged nature of the information.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.363. DISCLOSURE TO DEFENDANTS IN CIVIL ACTIONS. (a)

Any of the following persons named as a defendant in any civil

action filed as a result of participation in the credentialing

process may use, including in the person's own defense, otherwise

confidential information obtained for legitimate internal

business and professional purposes:

(1) the trustee and its officers and employees, including the

board of trustees;

(2) a credentialing committee;

(3) a person participating in a credentialing review;

(4) a health care provider;

(5) the group program; and

(6) a member of an advisory committee.

(b) Use of information under this section is not a waiver of the

confidential and privileged nature of the information.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.446,

eff. Sept. 1, 2003.

SUBCHAPTER I. RETIREES ADVISORY COMMITTEE

Sec. 1575.401. DEFINITION. In this subchapter, "committee"

means the Retirees Advisory Committee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.402. APPOINTMENT OF COMMITTEE MEMBERS. (a) The

Retirees Advisory Committee is composed of the following nine

members appointed by the trustee:

(1) one member who is an active school administrator;

(2) one member who is a retired school administrator;

(3) two members who are active teachers;

(4) three members who are retired teachers;

(5) one member who is an active member of the auxiliary

personnel of a school district; and

(6) one member who is a retired member of the auxiliary

personnel of a school district.

(b) A person is not eligible for appointment as a member of the

committee if the person is required to register as a lobbyist

under Chapter 305, Government Code.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.447,

eff. Sept. 1, 2003.

Sec. 1575.403. TERMS. (a) Members of the committee serve

staggered four-year terms.

(b) Five members' terms, including the terms of the active

school administrator, one active teacher, two retired teachers,

and the retired member of the auxiliary personnel, expire

February 1, 2002, and every fourth year after that date.

every fourth year after that date.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.404. VACANCY. The trustee shall fill a vacancy on the

committee by appointing a person who meets the qualifications

applicable to the vacated position.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.448,

eff. Sept. 1, 2003.

Sec. 1575.405. MEETINGS. (a) The committee shall meet:

(1) at least twice each year; and

(2) at the call of the trustee.

(b) If there is an emergency, the committee may meet at the call

of a majority of the members of the committee.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.449,

eff. Sept. 1, 2003.

Sec. 1575.406. DUTIES. The committee shall:

(1) hold public hearings on group coverage;

(2) recommend to the trustee minimum standards and features of a

plan under the group program that the committee considers

appropriate; and

(3) recommend to the trustee desirable changes in rules and

legislation affecting the group program.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450,

eff. Sept. 1, 2003.

Sec. 1575.407. PROCEDURAL RULES. The trustee shall adopt

procedural rules for the committee to follow in implementing its

powers and duties under this subchapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.450,

eff. Sept. 1, 2003.

Sec. 1575.408. REIMBURSEMENT FOR ACTUAL AND REASONABLE EXPENSES.

A committee member is entitled to reimbursement for actual and

reasonable expenses incurred in performing functions as a

committee member.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

SUBCHAPTER J. ACCOUNTING, REPORTS, AND RECORDS

Sec. 1575.451. ANNUAL ACCOUNTING. (a) In this section, "plan

year" means the period beginning on September 1 and ending on the

following August 31.

(b) Group coverage purchased under this chapter must provide for

an accounting to the trustee by each carrier providing the

coverage.

(1) not later than the 90th day after the last day of each plan

year; and

(2) on a form approved by the trustee.

(d) Each carrier shall prepare any other report that the trustee

considers necessary.

(e) A carrier may not assess an extra charge for an accounting

report.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.451,

eff. Sept. 1, 2003.

Sec. 1575.452. ANNUAL REPORT. Not later than the 180th day

after the last day of each state fiscal year, the trustee shall

submit a written report to the department concerning the group

coverages provided to and the benefits and services being

received by individuals covered under this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,

eff. Sept. 1, 2003.

Sec. 1575.453. STUDY AND REPORT BY TRUSTEE. (a) The trustee

shall study the operation and administration of this chapter,

including:

(1) conducting surveys and preparing reports on financing group

coverages and health benefit plans available to participants; and

(2) studying the experience and projected cost of coverage.

(b) The trustee shall report to the legislature at each regular

session on the operation and administration of this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,

eff. Sept. 1, 2003.

Sec. 1575.454. REPORTS BY AND EXAMINATION OF CARRIER. Each

contract entered into under this chapter between the trustee and

a carrier must require the carrier to:

(1) furnish to the trustee in a timely manner reasonable reports

that the trustee determines are necessary to implement this

chapter; and

(2) permit the trustee and the state auditor to examine records

of the carrier as necessary to implement this chapter.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.452,

eff. Sept. 1, 2003.

Sec. 1575.455. PUBLIC INSPECTION. A report required by this

chapter shall be made available for public inspection in a form

that protects the identity of individual claimants.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1,

2003.

Sec. 1575.456. CONFIDENTIALITY OF RECORDS. (a) Section

825.507, Government Code, concerning confidentiality and

disclosure of records applies to records in the custody of the

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

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