By Wise                                         H.B. No. 1590

      75R6479 CAS-F                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to group health insurance coverage for school district

 1-3     employees.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  Section 22.004(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

1-15     Article 3.51-6, Insurance Code, and any other law applicable to

1-16     group health insurance policies or contracts issued in this state.

1-17     The 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 substantially similar [comparable] to the basic

 2-3     health coverage provided under the Texas Employees Uniform Group

 2-4     Insurance Benefits Act  (Article 3.50-2, Vernon's Texas Insurance

 2-5     Code).  The cost of the coverage may be shared by the employees and

 2-6     the district.  Each district shall certify the district's

 2-7     compliance with this subsection to the executive director of the

 2-8     Teacher Retirement System of Texas not later than February 1 of

 2-9     each year in the manner required by the board of trustees of the

2-10     Teacher  Retirement System of Texas.  The certification must

2-11     include a copy of the district's current contract for group health

2-12     coverage.  The executive director of the Teacher Retirement System

2-13     of Texas shall review the group health coverage offered by each

2-14     district and shall determine whether that coverage is substantially

2-15     similar to the basic health coverage provided under the Texas

2-16     Employees Uniform Group Insurance Benefits Act (Article 3.50-2,

2-17     Vernon's Texas Insurance Code).  If the executive director

2-18     determines that the group health coverage offered by a district is

2-19     not substantially similar, the executive director shall report that

2-20     information to the district and to the commissioner.

2-21           SECTION 2.  This Act takes effect September 1, 1997.

2-22           SECTION 3.  The importance of this legislation and the

2-23     crowded condition of the calendars in both houses create an

2-24     emergency and an imperative public necessity that the

2-25     constitutional rule requiring bills to be read on three several

2-26     days in each house be suspended, and this rule is hereby suspended.