By Hernandez, Pitts H.B. No. 2379
74R6445 GCH-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to comparable health insurance coverage for employees of
1-3 public school districts.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 13.913(a), Education Code, is amended to
1-6 read as follows:
1-7 (a) Each district shall make available to its employees
1-8 group health coverage provided by a risk pool established by one or
1-9 more school districts under Chapter 172, Local Government Code, or
1-10 under a policy of insurance or group contract issued by an insurer,
1-11 a company subject to Chapter 20, Insurance Code, or a health
1-12 maintenance organization under the Texas Health Maintenance
1-13 Organization Act (Chapter 20A, Vernon's Texas Insurance Code). The
1-14 coverage must meet the substantive coverage requirements of Article
1-15 3.51-6, Insurance Code, and any other law applicable to group
1-16 health insurance policies or contracts issued in this state. The
1-17 coverage must include major medical treatment but may exclude
1-18 experimental procedures. In this subsection, "major medical
1-19 treatment" means a medical, surgical, or diagnostic procedure or
1-20 intervention that has a significant recovery period, presents a
1-21 significant risk, employs a general anesthetic, or, in the opinion
1-22 of the primary physician, involves a significant invasion of bodily
1-23 integrity that requires the extraction of bodily fluids or an
1-24 incision or that produces substantial pain, discomfort, or
2-1 debilitation. The coverage may include managed care or preventive
2-2 care and must be comparable to the basic health coverage provided
2-3 under the Texas Employees Uniform Group Insurance Benefits Act
2-4 (Article 3.50-2, Vernon's Texas Insurance Code). For purposes of
2-5 this subsection, coverage is comparable only if it is substantially
2-6 similar to the basic health coverage provided under the Texas
2-7 Employees Uniform Group Insurance Benefits Act. The cost of the
2-8 coverage may be shared by the employees and the district. Each
2-9 district shall certify the district's compliance with this
2-10 subsection to the executive director of the Teacher Retirement
2-11 System of Texas by February 1 of each year in the manner required
2-12 by the board of trustees of the Teacher Retirement System of Texas.
2-13 The certification must include a copy of the district's current
2-14 contract for group health coverage. The executive director of the
2-15 Teacher Retirement System of Texas shall determine whether a
2-16 district's coverage is comparable to the basic health coverage
2-17 provided under the Texas Employees Uniform Group Insurance Benefits
2-18 Act. The executive director shall make the determination from
2-19 factors that must include an examination of the entity underwriting
2-20 the district's plan, an accounting of all uninsured costs to or
2-21 copayments by the employee, district costs by employee and
2-22 category, the schedule of benefits including percentage of costs
2-23 paid by the insurer, and the length of service offered by the
2-24 insurance provider in the district. The Teacher Retirement System
2-25 of Texas shall report to the applicable school district and the
2-26 Legislative Budget Board those districts in which the executive
2-27 directors determine that the basic health coverage is not
3-1 comparable.
3-2 SECTION 2. This Act applies beginning with the 1995-1996
3-3 school year.
3-4 SECTION 3. The importance of this legislation and the
3-5 crowded condition of the calendars in both houses create an
3-6 emergency and an imperative public necessity that the
3-7 constitutional rule requiring bills to be read on three several
3-8 days in each house be suspended, and this rule is hereby suspended,
3-9 and that this Act take effect and be in force from and after its
3-10 passage, and it is so enacted.