By Johnson H.B. No. 2710
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the Texas Public School Retired Employees Group
1-3 Insurance Program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 2 of Article 3.50-4, Texas Insurance
1-6 Code, is amended to read as follows:
1-7 Sec. 2. In this article:
1-8 (a) <(1)> "Active employee" means an employee as
1-9 defined by Subdivision (6), Section 821.001, Government Code, who
1-10 is a member of the Teacher Retirement System of Texas and who is
1-11 not entitled to coverage under a plan provided under the Texas
1-12 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
1-13 Vernon's Texas Insurance Code), or under the Texas State College
1-14 and University Employees Uniform Insurance Benefits Act (Article
1-15 3.50-3, Vernon's Texas Insurance Code).
1-16 (b) <(2)> "Carrier" means any insurance company or
1-17 hospital service corporation authorized by the State Board of
1-18 Insurance to provide any of the insurance coverages, benefits, or
1-19 services provided by this article under the insurance laws of this
1-20 state.
1-21 (c) <(3)> "Dependent" means:
1-22 (1) <(A)> a spouse of a retiree;
1-23 (2) <(B)> a retiree's or a deceased active
2-1 member's unmarried child who is younger than 25 years of age
2-2 including:
2-3 (A) <(i)> an adopted child;
2-4 (B) <(ii)> a foster child, a stepchild, or
2-5 other child who is in a regular parent-child relationship; and
2-6 (C) <(iii)> a recognized natural child;
2-7 and
2-8 (3) <(C)> a retiree's recognized natural child,
2-9 adopted child, foster child, stepchild, or other child who is in a
2-10 regular parent-child relationship and who lives with or whose care
2-11 is provided by the retiree or surviving spouse on a regular basis,
2-12 regardless of the child's age, if the child is mentally retarded or
2-13 physically incapacitated to such an extent as to be trustee, or in
2-14 the case of a deceased active member, a recognized natural child,
2-15 adopted child, foster child, stepchild, or other child who was in a
2-16 regular parent-child relationship and who lived with or whose care
2-17 was provided by the deceased active member or surviving spouse for
2-18 care or support, as determined by the trustee.
2-19 (d) <(4)> "Fund" means the Texas public school retired
2-20 employees group insurance fund.
2-21 (e) <(5)> "Health benefit plan" or "plan" means a
2-22 group insurance policy, contract, or certificate, medical or
2-23 hospital service agreement, membership or subscription contract,
2-24 salary continuation plan, or similar group arrangement to provide,
2-25 pay for, or reimburse expenses for health care services.
3-1 (f) <(6)> "Medicare" means the health insurance
3-2 program for the aged and disabled that is provided by the United
3-3 States government.
3-4 (g) <(7)> "Minimum premium contract" means a contract
3-5 entered into with the carrier by the trustee that provides that:
3-6 (1) <(A)> an appropriate amount will be paid to
3-7 the carrier to cover its cost of direct claims administration, cost
3-8 of other administration, risk charges with stop loss provisions,
3-9 and profit; and
3-10 (2) <(B)> the remainder of the funds under the
3-11 program will be used by the fund to reimburse the carrier to cover
3-12 claims as they are paid, to pay the administrative expenses of the
3-13 program, and to provide within the fund the assets to cover all
3-14 reserves necessary for the trustee to operate on a financially
3-15 sound basis.
3-16 (h) <(8)> "Policy year" or "year" means the period
3-17 beginning on September 1 of one year and ending on August 31 of the
3-18 following year.
3-19 (i) <(9)> "Program" means the group insurance program
3-20 authorized by this article.
3-21 (j) <(10)> "Retiree" means:
3-22 (1) <(A)> a person who has retired under the
3-23 Teacher Retirement System of Texas, as provided by Subtitle C,
3-24 Title 8, Government Code, with at least 10 <or more> years of
3-25 service credit in the retirement system for actual service in Texas
4-1 public schools and who is not eligible to be covered by a plan
4-2 provided under the Texas Employees Uniform Group Insurance Benefits
4-3 Act (Article 3.50-2, Texas Insurance Code), or under the Texas
4-4 State College and University Employees Uniform Insurance Benefits
4-5 Act (Article 3.50-3, Texas Insurance Code); or
4-6 (2) <(B)> a person who has retired as a
4-7 disability retiree under Subtitle C, Title 8, Government Code, and
4-8 is entitled to receive monthly benefits from the retirement system.
4-9 (k) <(11)> "Surviving spouse" means:
4-10 (1) <(A)> the surviving spouse of a deceased
4-11 retiree;
4-12 (2) <(B)> the surviving spouse of a deceased
4-13 active member of the Teacher Retirement System of Texas:
4-14 (A) <(i)> for whom contributions have been
4-15 made to the Texas Public School Retired Employees Group Insurance
4-16 Program at the last place of employment of the deceased active
4-17 member in public education in this state:
4-18 (B) <(ii)> who died on or after September
4-19 1, 1986.
4-20 (l) <(12)> "Trustee" means the Teacher Retirement
4-21 System of Texas.
4-22 (m) <(13)> "Surviving dependent child" means:
4-23 (1) <(A)> the dependent child of a deceased
4-24 retiree who has survived the deceased retiree and the deceased
4-25 retiree's spouse; or
5-1 (2) <(B)> the dependent child of a deceased
5-2 active member of the Teacher Retirement System of Texas who has
5-3 survived the deceased active member and the deceased member's
5-4 spouse if the deceased active member;
5-5 (A) <(i)> had contributions to the Texas
5-6 Public School Retired Employees Group Insurance Program at his last
5-7 place of employment within public education;
5-8 (B) <(ii)> had 10 or more years of service
5-9 credit in the Teacher Retirement System of Texas; and
5-10 (C) <(iii)> died on or after September 1,
5-11 1986.
5-12 SECTION 2. Section 8 of Article 3.50-4, Texas Insurance
5-13 Code, is amended to read as follows:
5-14 Sec. 8 (a) The trustee shall be designated as the group
5-15 policyholder for any plan or plans established in this article.
5-16 (b) The group insurance coverages provided under the plan or
5-17 plans may include but are not limited to life insurance, accidental
5-18 death and dismemberment, hospital care and benefits, surgical care
5-19 and treatment, medical care and treatment, dental care, eye care,
5-20 obstetrical benefits, prescribed drugs, medicines, and prosthetic
5-21 devices, and other supplemental benefits, supplies, and services as
5-22 provided by this article, protection against loss of salary, and
5-23 other coverages considered advisable.
5-24 (c) The trustee may provide different plans for retirees and
5-25 surviving spouses covered by Medicare than the plans provided for
6-1 retirees and surviving spouses who are not covered by Medicare.
6-2 (d) Each basic plan must cover preexisting conditions.
6-3 (e) The trustee may contract for and make available to all
6-4 retirees, dependents, surviving spouses, and surviving dependent
6-5 children optional group health insurance benefit plans in addition
6-6 to the basic plans. The optional coverage may include a smaller
6-7 deductible, lower coinsurance, or additional categories of benefits
6-8 permitted under Subsection (b) of this section to provide
6-9 additional levels of coverages and benefits. Any additional
6-10 contributions for these optional plans shall be paid for by the
6-11 retiree, surviving spouse, or surviving dependent children.
6-12 (f) The trustee shall enter into a contract or contracts
6-13 with a carrier or carriers for the plan or plans that will provide
6-14 that the method of paying expenses, paying claims, and establishing
6-15 reserves shall be under the minimum premium approach to financing;
6-16 and the contract shall be referred to as a minimum premium
6-17 contract.
6-18 (g) New contracts for coverages under this program shall be
6-19 submitted for competitive bidding at least every six years.
6-20 Contracts between the trustee and carriers for the group insurance
6-21 pool may provide for renegotiation.
6-22 (h) Each contract shall be based on the terms and conditions
6-23 agreed on between the trustee and the carrier or carriers selected
6-24 to provide the insurance coverage and benefits. Any contract for
6-25 group insurance awarded by the trustee must meet the minimum
7-1 benefit and financial standards adopted by the trustee.
7-2 (i) The coverage provided by the plan or plans may be
7-3 secondary to all other benefit coverage to which the retiree,
7-4 surviving spouse, dependent, or surviving dependent child is
7-5 entitled. In the event the retiree, surviving spouse, dependent,
7-6 or surviving dependent child is entitled to receive medicare
7-7 hospital insurance benefits at no charge, then the coverage
7-8 provided by the plan or plans shall be secondary to medicare
7-9 hospital and medical insurance to the extent permitted by federal
7-10 law.
7-11 (j) In contracting for any insurance under this article,
7-12 competitive bidding shall be required under rules adopted by the
7-13 trustee. The trustee is not required to select the lowest bid but
7-14 may consider also ability to service contracts, past experiences,
7-15 financial stability, and other relevant criteria. If the trustee
7-16 awards a contract to a carrier whose bid deviates from that
7-17 advertised, the deviation shall be recorded and the reasons for the
7-18 deviation shall be fully justified in the minutes of the next
7-19 meeting of the trustee.
7-20 (k) Notwithstanding any other provisions of this article,
7-21 the trustee providing programs of benefits under this article is
7-22 authorized to self-insure any and all programs available under this
7-23 article and may, at its discretion, engage private entities to
7-24 collect contributions from or to settle claims in connection with
7-25 plans established by the trustee under Section 8 of this article.
8-1 (l) The Trustee may contract directly with certain benefit
8-2 providers in order to provide benefits to participants in the
8-3 program. Such benefits may include but are not limited to dental
8-4 care, eye care, hospital care and benefits, surgical care and
8-5 treatment, medicare care and treatment, obstetrical benefits,
8-6 prescribed drugs, medicines, and prosthetic devices.
8-7 SECTION 3. Article 3.50-4, Texas Insurance Code, is amended
8-8 by adding Section 18C to read as follows:
8-9 Sec. 18C (a) The trustee is authorized to contract with
8-10 various health care providers in order to implement and administer
8-11 a coordinated care network for the program.
8-12 (b) The trustee is authorized to contract with additional
8-13 individuals and/or entities which the trustee determines are needed
8-14 to implement and administer the network.
8-15 (c) The Teacher Retirement System of Texas, the Texas Public
8-16 School Retired Employees Group Insurance Program, the Retired
8-17 School Employees Group Insurance Fund and the trustees, officers,
8-18 advisory committee members and employees of the Teacher Retirement
8-19 System of Texas are immune from any civil liability arising from
8-20 the acts or omissions of health care providers who are
8-21 participating health care providers in the Texas Public School
8-22 Retired Employees Group Insurance Fund coordinated care network.
8-23 Such health care providers are independent contractors and as such
8-24 are responsible for their own acts and omissions.
8-25 (d) A cause of action does not accrue against The Teacher
9-1 Retirement System of Texas, the Texas Public School Retired
9-2 Employees Group Insurance Program, the Retired School Employees
9-3 Group Insurance Fund, members of the credentialing committees or
9-4 the trustees, officers, advisory committee members or employees of
9-5 the Teacher Retirement System of Texas from any act, statement,
9-6 determination or recommendation made, or act reported, without
9-7 malice, in the course of the evaluation of the qualifications of
9-8 professional health-care practitioners and/or entities and of the
9-9 patient care rendered by those practitioners and/or entities.
9-10 (e) Except as otherwise provided by this Act, all
9-11 proceedings and records of a credentialing committees are
9-12 confidential, and all communications made to a credentialing
9-13 committee are privileged. The proceedings of a credentialing
9-14 committee are not subject to the open meetings act (Article 6252-17
9-15 Texas Civil Statutes). The records and proceedings of a
9-16 credentialing committee and communication made to a credentialing
9-17 committee are not subject to court subpoena.
9-18 (f) A person, health-care entity, or a medical peer review
9-19 committee, that, without malice, participates in a credentialing
9-20 committee activity or furnishes records, information or assistance
9-21 to a credentialing committee is immune from any civil liability
9-22 from such an act.
9-23 (g) Disclosure of confidential credentialing committee
9-24 information to the affected health care provider pertinent to the
9-25 matter being reviewed shall not constitute waiver of the
10-1 confidentiality provisions provided in this Act.
10-2 (h) Written or oral communications made to a credentialing
10-3 committee and the records and proceedings of such a committee may
10-4 be disclosed to appropriate state or federal agencies, national
10-5 accreditation bodies, state boards of registration or licensures,
10-6 or to medical peer review committees. Such a disclosure shall not
10-7 constitute a waiver of the confidentiality or privileged nature of
10-8 the information.
10-9 (i) A credentialing committee, a person participating in a
10-10 credentialing review, a health care entity, the Teacher Retirement
10-11 System of Texas, the Texas Public School Retired Employees Group
10-12 Insurance Program or the trustees, officers, advisory committee
10-13 members or employees of the Teacher Retirement System of Texas that
10-14 are named as a defendant in any civil action filed as a result of
10-15 participation in the credentialing process, may use otherwise
10-16 confidential information obtained for legitimate internal business
10-17 and professional purposes, including use in its or his own defense.
10-18 Such a use does not constitute a waiver of the confidential and
10-19 privileged nature of the information.
10-20 SECTION 4. This Act takes effect September 1, 1993, except
10-21 that Section 3 takes effect immediately on passage of this Act.
10-22 SECTION 5. The importance of this legislation and the
10-23 crowded condition of the calendars in both houses create an
10-24 emergency and an imperative public necessity that the
10-25 constitutional rule requiring bills to be read on three several
11-1 days in each house be suspended, and this rule is hereby suspended,
11-2 and that this Act take effect and be in force according to its
11-3 terms, and it is so enacted.