75R10834 CAS-F
By Rangel, et al. H.B. No. 1700
Substitute the following for H.B. No. 1700:
By Telford C.S.H.B. No. 1700
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to group health coverage for school district employees.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 22.004, Education Code, is amended to
1-5 read as follows:
1-6 Sec. 22.004. GROUP HEALTH BENEFITS FOR SCHOOL EMPLOYEES.
1-7 (a) Each district shall make available to its employees group
1-8 health coverage provided by a risk pool established by one or more
1-9 school districts under Chapter 172, Local Government Code, or under
1-10 a policy of insurance or group contract issued by an insurer, a
1-11 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 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). To be considered substantially similar, the coverage must:
2-6 (1) have a value that is equal to 90 percent or more
2-7 of the value of the basic health coverage provided under the Texas
2-8 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
2-9 Vernon's Texas Insurance Code), as determined based on the
2-10 coverage's:
2-11 (A) deductible amount;
2-12 (B) coinsurance payment requirement amount; and
2-13 (C) lifetime maximum benefit amount;
2-14 (2) require the district to pay 90 percent or more of
2-15 the employee-only cost of coverage and 45 percent or more of the
2-16 dependent unit cost of coverage; and
2-17 (3) be issued by a provider licensed to do business in
2-18 this state by the Texas Department of Insurance or be provided
2-19 through district self-insurance.
2-20 (b) The cost of the coverage may be shared by the employees
2-21 and the district to the extent authorized under Subsection (a).
2-22 (c) Each district shall report [certify] the district's
2-23 compliance with this subsection to the executive director of the
2-24 Teacher Retirement System of Texas not later than November 1 of
2-25 each year in the manner required by the board of trustees of the
2-26 Teacher Retirement System of Texas. The report [certification]
2-27 must be based on the district group health coverage plan in effect
3-1 on November 1 and must include:
3-2 (1) appropriate documentation of:
3-3 (A) [a copy of] the district's [current]
3-4 contract for group health coverage with a provider licensed to do
3-5 business in this state by the Texas Department of Insurance; or
3-6 (B) a resolution of the board of trustees of the
3-7 district authorizing a self-insurance plan for district employees
3-8 and of the district's review of district ability to cover the
3-9 liability assumed;
3-10 (2) the schedule of benefits;
3-11 (3) the premium rate sheet, including district and
3-12 employee costs; and
3-13 (4) any other information considered appropriate by
3-14 the executive director of the Teacher Retirement System of Texas.
3-15 (d) Based on the criteria prescribed by Subsection (a), the
3-16 executive director of the Teacher Retirement System of Texas shall
3-17 certify whether a district's coverage is substantially similar to
3-18 the basic health coverage provided under the Texas Employees
3-19 Uniform Group Insurance Benefits Act (Article 3.50-2, Vernon's
3-20 Texas Insurance Code). If the executive director of the Teacher
3-21 Retirement System of Texas determines that the group health
3-22 coverage offered by a district is not substantially similar, the
3-23 executive director shall report that information to the district
3-24 and to the Legislative Budget Board. The executive director shall
3-25 submit a report to the legislature not later than January 1 of each
3-26 odd-numbered year describing the status of each district's group
3-27 health coverage program based on the certification required by this
4-1 section.
4-2 (e) [(b)] A school district may not contract with an
4-3 insurer, a company subject to Chapter 20, Insurance Code, or a
4-4 health maintenance organization to issue a policy or contract under
4-5 this section, or with any person to assist the school district in
4-6 obtaining or managing the policy or contract unless, before the
4-7 contract is entered into, the insurer, company, organization, or
4-8 person provides the district with an audited financial statement
4-9 showing the financial condition of the insurer, company,
4-10 organization, or person.
4-11 (f) [(c)] An insurer, a company subject to Chapter 20,
4-12 Insurance Code, or a health maintenance organization that issues a
4-13 policy or contract under this section and any person that assists
4-14 the school district in obtaining or managing the policy or contract
4-15 for compensation shall provide an annual audited financial
4-16 statement to the school district showing the financial condition of
4-17 the insurer, company, organization, or person.
4-18 (g) [(d)] An audited financial statement provided under this
4-19 section must be made in accordance with rules adopted by the
4-20 commissioner of insurance or state auditor, as applicable.
4-21 SECTION 2. This Act applies beginning with the 1997-1998
4-22 school year.
4-23 SECTION 3. The importance of this legislation and the
4-24 crowded condition of the calendars in both houses create an
4-25 emergency and an imperative public necessity that the
4-26 constitutional rule requiring bills to be read on three several
4-27 days in each house be suspended, and this rule is hereby suspended,
5-1 and that this Act take effect and be in force from and after its
5-2 passage, and it is so enacted.