By Berlanga H.B. No. 3055
75R6649 CAS-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to group insurance coverage for certain employees of
1-3 public schools.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 2, Texas Employees Uniform Group
1-6 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
1-7 Code), is amended to read as follows:
1-8 Sec. 2. PURPOSES. It is hereby declared that the purposes
1-9 of this Act are:
1-10 (a) to provide uniformity in life, accident, and
1-11 health benefits coverages for [on] all employees of the State of
1-12 Texas and of public schools in this state, and their dependents;
1-13 (b) to enable the State of Texas and public schools in
1-14 this state to attract and retain competent and able employees by
1-15 providing them and their dependents with life, accident, and health
1-16 benefits coverages at least equal to those commonly provided in
1-17 private industry;
1-18 (c) to foster, promote, and encourage employment by
1-19 and service to the State of Texas and public schools in this state
1-20 as a career profession for persons of high standards of competence
1-21 and ability;
1-22 (d) to recognize and protect the [state's] investment
1-23 of the state and public schools in each permanent employee by
1-24 promoting and preserving economic security and good health among
2-1 [state] employees and their dependents;
2-2 (e) to foster and develop high standards of
2-3 employer-employee relationships between the State of Texas or
2-4 public schools in this state, as applicable, and [its] employees;
2-5 (f) to recognize the service to the state by elected
2-6 state officials by extending to them and their dependents the same
2-7 life, accident, and health benefits coverages as are provided
2-8 herein for state and public school employees and their dependents;
2-9 and
2-10 (g) to recognize the long and faithful service and
2-11 dedication of employees of the State of Texas and of public schools
2-12 in this state and to encourage them to remain in state or public
2-13 school service until eligible for retirement by providing health
2-14 benefits for such employees and their dependents.
2-15 SECTION 2. Sections 3(a)(5), (6), (14), and (15), Texas
2-16 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
2-17 Vernon's Texas Insurance Code), are amended to read as follows:
2-18 (5)(A) "Employee" shall mean any appointive or
2-19 elective officer or employee in the service of the State of Texas,
2-20 including an employee of an institution of higher education:
2-21 (i) who is retired or retires and is an
2-22 annuitant under the jurisdiction of the Employees Retirement System
2-23 of Texas, pursuant to Subtitle B, D, or E;
2-24 (ii) who is retired or retires and is an
2-25 annuitant under the jurisdiction of the Teacher Retirement System
2-26 of Texas, pursuant to Subtitle C, Title 8, Government Code, or
2-27 pursuant to Chapter 803, Government Code, and whose last employment
3-1 with the state prior to retirement, including employment by a
3-2 public community/junior college, was as an employee of a department
3-3 whose employees are authorized to participate in the Texas
3-4 employees uniform group insurance program;
3-5 (iii) who is retired or retires and is an
3-6 annuitant under the optional retirement program established by
3-7 Chapter 830, Government Code, if the person's last state employment
3-8 before retirement, including employment by a public
3-9 community/junior college, was as an employee of a department whose
3-10 employees are authorized to participate in the Texas employees
3-11 uniform group insurance program, and if the person either:
3-12 (a) would have been
3-13 eligible to retire and receive a service retirement annuity from
3-14 the Teacher Retirement System of Texas or the Employees Retirement
3-15 System of Texas had the person not elected to participate in the
3-16 optional retirement program; or
3-17 (b) is disabled as
3-18 determined by the Employees Retirement System of Texas;
3-19 (iv) who receives compensation for
3-20 services rendered to the State of Texas, other than an employee of
3-21 an institution of higher education described by this subdivision,
3-22 on a warrant issued pursuant to a payroll certified by a department
3-23 or by an elected or duly appointed officer of this state;
3-24 (v) who receives payment for the
3-25 performance of personal services on a warrant issued pursuant to a
3-26 payroll certified by a department and drawn by the State
3-27 Comptroller of Public Accounts upon the State Treasury [Treasurer]
4-1 against appropriations made by the Texas Legislature from any state
4-2 funds or against any trust funds held by the Comptroller [State
4-3 Treasurer] or who is paid from funds of an official budget of a
4-4 state department, rather than from funds of the General
4-5 Appropriations Act;
4-6 (vi) who is appointed, subject to
4-7 confirmation of the senate, as a member of a board or commission
4-8 with administrative responsibility over a statutory agency having
4-9 statewide jurisdiction whose employees are covered by this Act;
4-10 (vii) who is a member of the governing
4-11 body of an institution of higher education, as that term is defined
4-12 by this Act;
4-13 (viii) who is a member of the State Board
4-14 of Education;
4-15 (ix) who receives compensation for
4-16 services rendered to an institution of higher education on a
4-17 warrant or check issued pursuant to a payroll certified by an
4-18 institution of higher education or by an elected or duly appointed
4-19 officer of this state, and who is eligible for participation in the
4-20 Teacher Retirement System of Texas; or
4-21 (x) who receives compensation for services
4-22 rendered to an institution of higher education as provided by this
4-23 subdivision but is not permitted to be a member of the Teacher
4-24 Retirement System of Texas because the person is solely employed by
4-25 an institution of higher education that as a condition of
4-26 employment requires the person to be enrolled as a student in an
4-27 institution of higher education in graduate-level courses and who
5-1 is employed by the institution at least 20 hours a week.
5-2 (B) "Employee" also means a person who is
5-3 employed, as determined by the Teacher Retirement System of Texas,
5-4 on other than a temporary basis, by an employer described under
5-5 Subdivision (6)(B) of this subsection at a regular rate of pay
5-6 comparable to that of other persons employed in similar positions.
5-7 (C) Persons performing personal services for the
5-8 State of Texas as independent contractors shall never be considered
5-9 employees of the state for purposes of this Act.
5-10 (6) "Employer" shall mean:
5-11 (A) the State of Texas and all its departments;
5-12 or
5-13 (B) an employer as defined by Section
5-14 821.001(7), Government Code, other than the board of regents of a
5-15 college or university not included in the meaning of "institution
5-16 of higher education" under Subdivision (18) of this subsection.
5-17 (14) "Part-time employee" shall mean, for purposes of
5-18 this Act, an employee designated by his employing agency as working
5-19 less than 20 hours per week. A part-time employee shall receive
5-20 the benefits of one-half the amount of the [state's] contribution
5-21 from the state or an employer described under Subdivision (6)(B) of
5-22 this subsection, as applicable, received by full-time employees.
5-23 (15) "Full-time employee" shall mean, for purposes of
5-24 this Act, an employee designated by his employing agency as working
5-25 20 or more hours per week. A full-time employee shall receive the
5-26 benefits of a full [state] contribution from the state or an
5-27 employer described under Subdivision (6)(B) of this subsection, as
6-1 applicable, for coverage under this Act.
6-2 SECTION 3. Section 5(a), Texas Employees Uniform Group
6-3 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
6-4 Code), is amended to read as follows:
6-5 (a) The trustee is authorized, empowered, and directed to
6-6 establish plans of group coverages for active employees and retired
6-7 employees which in the trustee's discretion may include but are not
6-8 necessarily limited to the following: group life coverages,
6-9 accidental death and dismemberment, health benefits plans,
6-10 including but not limited to hospital care and benefits, surgical
6-11 care and treatment, medical care and treatment, dental care,
6-12 obstetrical benefits, prescribed drugs, medicines, and prosthetic
6-13 devices and supplemental benefits, supplies, and services in
6-14 conformity with the provisions of this Act, protection against
6-15 either long or short term loss of salary and any other group
6-16 coverages which in the discretion of the trustee with consultation
6-17 from the advisory committee shall be deemed advisable. All rules
6-18 and regulations shall be promulgated pursuant thereto. The trustee
6-19 shall determine the coverages desired for [state] employees and
6-20 will submit this information to the Texas Department [State Board]
6-21 of Insurance for any recommendations as to the types and
6-22 sufficiency of such coverages. The Texas Department [State Board]
6-23 of Insurance will notify the board of trustees within 30 days as to
6-24 any such recommendations and will furnish the board of trustees
6-25 with a list of all carriers authorized to do business in the State
6-26 of Texas who would be eligible to bid on the coverages that are to
6-27 be insured by a carrier. The trustee will notify those carriers
7-1 that competitive bidding will be conducted and that they are to
7-2 submit their bids to the Texas Department [State Board] of
7-3 Insurance by a specified date if they wish to bid on the contract.
7-4 The Texas Department [State Board] of Insurance will, after the
7-5 designated closing date of receiving bids, examine and evaluate the
7-6 bidding contracts and certify their actuarial soundness to the
7-7 trustee within 15 days from the closing date. The trustee shall
7-8 select the desired carrier or carriers and will notify the bidding
7-9 eligible carriers as to the results of the bidding. The trustee
7-10 shall select the desired carrier or carriers to provide services
7-11 which shall be in the best interest of the employees covered by
7-12 this Act. The trustee is not required to select the lowest bid but
7-13 shall take into consideration other factors such as ability to
7-14 service contracts, past experience, financial ability, and other
7-15 relevant criteria. Should the trustee select a carrier whose bid
7-16 differs from that advertised, such deviation shall be recorded and
7-17 the reasons for such deviation shall be fully justified and
7-18 explained in the minutes of the next meeting of the trustee.
7-19 SECTION 4. Section 11(a), Texas Employees Uniform Group
7-20 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
7-21 Code), is amended to read as follows:
7-22 (a) The trustee is authorized and directed to establish a
7-23 group life program for all employees, including retired employees,
7-24 [of this state] as herein provided, which, subject to the
7-25 conditions and limitations contained in this Act and the trustee's
7-26 rules and regulations promulgated pursuant thereto, will provide
7-27 for each employee group life coverages in such an amount as shall
8-1 be determined by the trustee. In addition to the benefits
8-2 hereinabove provided and subject to the conditions and limitations
8-3 of the policy or policies purchased by the trustee, such policy or
8-4 policies shall provide such payments and benefits for employees and
8-5 retired employees as shall be determined by the trustee. The
8-6 trustee is also authorized to include the dependents of employees
8-7 in the life program.
8-8 SECTION 5. Section 13(a), Texas Employees Uniform Group
8-9 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
8-10 Code), is amended to read as follows:
8-11 (a) Except as provided by Section 13A of this Act, no
8-12 employee [of the State of Texas] shall be denied any of the group
8-13 coverage provided under this Act.
8-14 SECTION 6. Section 13B(c), Texas Employees Uniform Group
8-15 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
8-16 Code), is amended to read as follows:
8-17 (c) If the trustee determines that a cafeteria plan adopted
8-18 under this section is no longer advantageous to the state or
8-19 [state] employees, the trustee may adopt an order terminating the
8-20 cafeteria plan and providing a procedure for the orderly withdrawal
8-21 of the state and [its] employees from that plan.
8-22 SECTION 7. Sections 14(d)-(h), Texas Employees Uniform Group
8-23 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
8-24 Code), are amended to read as follows:
8-25 (d) If the cost of the basic coverage for an [a state]
8-26 employee or annuitant exceeds the amount of [employer]
8-27 contributions from the state or an employer described under Section
9-1 3(a)(6)(B) of this Act, as applicable, allocated to fund the basic
9-2 coverage, the employer [state] shall deduct from or reduce the
9-3 monthly compensation of the [state] employee, and the state shall
9-4 deduct from the retirement benefits of the annuitant an amount
9-5 sufficient to pay the cost of the basic coverage. The payroll
9-6 officer for an employer described under Section 3(a)(6)(B) of this
9-7 Act shall pay the amounts deducted under this subsection to the
9-8 trustee at the time and in the manner prescribed by the trustee.
9-9 (e) The trustee shall apply the amount of any employer
9-10 contribution allocated to fund optional coverages to the excess of
9-11 the cost of the basic and optional coverages for which the employee
9-12 or annuitant has applied over the basic coverage contribution.
9-13 Except as provided by Subsection (h) of this section, if an
9-14 employee or annuitant applies for basic and optional coverages for
9-15 which the cost exceeds the contributions for those coverages under
9-16 this Act, the employee or annuitant shall authorize in a form and
9-17 manner satisfactory to the trustee a deduction from the employee's
9-18 or annuitant's monthly compensation or annuity equal to the
9-19 difference between the cost of basic and optional coverages for
9-20 which the employee or annuitant has applied and the employer
9-21 contributions for basic and optional coverage. The payroll officer
9-22 for an employer described under Section 3(a)(6)(B) of this Act
9-23 shall pay the amounts deducted under this subsection to the trustee
9-24 at the time and in the manner prescribed by the trustee.
9-25 (f) Except as provided by Subsection (h) of this section, if
9-26 an employee or annuitant applies for voluntary coverages, the
9-27 employee shall authorize in a form and manner satisfactory to the
10-1 trustee a deduction from the employee's monthly compensation or
10-2 annuity equal to the cost of the voluntary coverages. The payroll
10-3 officer for an employer described under Section 3(a)(6)(B) of this
10-4 Act shall pay the amounts deducted under this subsection to the
10-5 trustee at the time and in the manner prescribed by the trustee.
10-6 (g) If an employee or annuitant refuses the coverages or
10-7 benefits provided under this Act in a form and manner satisfactory
10-8 to the trustee, the employer, state, or [and the] employee's
10-9 department, as applicable, may not make any contribution to the
10-10 cost of any coverages or benefits for the employee or annuitant.
10-11 (h) If an employee elects to participate in the cafeteria
10-12 plan, the employee must execute a salary reduction agreement under
10-13 which the employee's monthly compensation will be reduced in an
10-14 amount that is equal to the difference between the employer
10-15 contributions for basic and optional coverages and the cost of the
10-16 cafeteria plan coverages identified by the trustee as comparable to
10-17 the basic and optional coverages for which the employee is
10-18 eligible. The salary reduction agreement must also provide for an
10-19 additional reduction in the employee's compensation equal to the
10-20 cost of voluntary coverages for which the employee has applied. An
10-21 employee who executes a salary reduction agreement for insurance
10-22 coverage included in the cafeteria plan has elected to participate
10-23 in the cafeteria plan and agreed to a salary reduction for the
10-24 insurance coverages for subsequent plan years unless the
10-25 participant, during an annual enrollment period specified by the
10-26 trustee, elects in a form and manner satisfactory to the trustee
10-27 not to participate for the next plan year in the insurance
11-1 coverages. An employee who has elected not to participate in the
11-2 cafeteria plan insurance coverages may re-enroll by executing a new
11-3 salary reduction agreement during a subsequent annual enrollment
11-4 period. A salary reduction agreement for cafeteria plan benefits
11-5 other than insurance coverages must be executed annually, during
11-6 the annual enrollment period. The employee shall pay any remaining
11-7 portion of the cost of benefits that is not covered by the
11-8 contributions for basic and optional coverages and the salary
11-9 reduction under the cafeteria plan by executing a payroll deduction
11-10 agreement. The payroll officer for an employer described under
11-11 Section 3(a)(6)(B) of this Act shall pay the amounts withheld from
11-12 salary under this subsection to the trustee at the time and in the
11-13 manner prescribed by the trustee.
11-14 SECTION 8. Section 15, Texas Employees Uniform Group
11-15 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
11-16 Code), is amended by amending Subsections (b)-(d) and adding
11-17 Subsection (e) to read as follows:
11-18 (b) From and after the effective date of this Act, the state
11-19 shall appropriate [there is hereby allocated and appropriated] to
11-20 the trustee, in accordance with the provisions of this Act, from
11-21 the several funds from which state employees receive their
11-22 respective salaries, a sum equal to the total of all employer
11-23 contributions for state employees computed in accordance with the
11-24 provisions of this Act and the rules and regulations of the trustee
11-25 promulgated pursuant thereto. The amount the state is required to
11-26 contribute on behalf of employees described under Section
11-27 3(a)(5)(B) of this Act, as provided by Subsection (e) of this
12-1 section, shall be appropriated to the trustee from the general
12-2 revenue fund.
12-3 (c) All money [hereby allocated and] appropriated by the
12-4 state to the trustee [under this Act] shall be paid to the trustee
12-5 in monthly installments based on the annual estimate by the trustee
12-6 of the contributions to be received from the state for all [state]
12-7 employees during said year; provided, however, that in the event
12-8 said estimate of the contributions from [of] the state [employees]
12-9 shall vary from the actual amount of [the employer] contributions
12-10 during the year, such adjustments shall be made at the close of
12-11 each fiscal year as may be required. Each of said monthly
12-12 installments shall be paid into the appropriate fund created by
12-13 this Act in the amount certified by the trustee.
12-14 (d) The trustee shall certify to the governing boards of
12-15 those state departments who provide contributions for their
12-16 employees from operating budgets provided from sources other than
12-17 the General Appropriations Act the proportionate amounts needed to
12-18 pay their respective contributions. The trustee shall certify to
12-19 each employer described under Section 3(a)(6)(B) of this Act the
12-20 proportionate amounts needed to pay their respective contributions.
12-21 Such certifications shall be made at least 30 days prior to the
12-22 meeting at which the governing board adopts its operating budget.
12-23 (e) Each employer described under Section 3(a)(6)(B) of this
12-24 Act shall pay contributions for coverage under this Act for each of
12-25 the employer's employees and annuitants described under Section
12-26 3(a)(5)(B) of this Act in an amount equal to or greater than the
12-27 amount the employer contributed for the health insurance coverage
13-1 of an employee or annuitant for the preceding school year. For
13-2 each employee described under Section 3(a)(5)(B) of this Act or
13-3 annuitant who retired as an employee described by that paragraph,
13-4 the state shall pay an amount equal to the difference between the
13-5 contribution of the employer described under Section 3(a)(6)(B) of
13-6 this Act for an employee or annuitant during the preceding school
13-7 year and the amount the state contributes for basic coverage for a
13-8 state employee under this Act. The contributions required under
13-9 this subsection from an employer described under Section 3(a)(6)(B)
13-10 of this Act shall be paid to the trustee at the time and in the
13-11 manner prescribed by the trustee.
13-12 SECTION 9. Sections 16(a) and (b), Texas Employees Uniform
13-13 Group Insurance Benefits Act (Article 3.50-2, Vernon's Texas
13-14 Insurance Code), are amended to read as follows:
13-15 (a) There is hereby created with the treasury of the State
13-16 of Texas an Employees Life, Accident, and Health Insurance and
13-17 Benefits Fund which shall be administered by the trustee. The
13-18 contributions of employees, annuitants, [and] the state, and
13-19 employers described under Section 3(a)(6)(B) of this Act provided
13-20 for under this Act shall be paid into the fund. The fund is
13-21 available:
13-22 (1) without fiscal year limitation for all payments
13-23 for any coverages provided for under this Act; and
13-24 (2) to pay expenses for administering this Act within
13-25 the limitations that may be specified annually by the legislature.
13-26 (b) Portions of the contributions made by employees,
13-27 annuitants, [and] the state, and employers described under Section
14-1 3(a)(6)(B) of this Act shall be regularly set aside in the fund as
14-2 follows: a percentage determined by the trustee to be reasonably
14-3 adequate to pay the administrative expenses made available by
14-4 Subsection (a) of this section. The trustee, from time to time and
14-5 in amounts it considers appropriate, may transfer unused funds for
14-6 administrative expenses to the contingency reserves to be used by
14-7 the trustee only for charges, claims, costs, and expenses under the
14-8 program.
14-9 SECTION 10. Sections 16B(a)-(c), and (e), Texas Employees
14-10 Uniform Group Insurance Benefits Act (Article 3.50-2, Vernon's
14-11 Texas Insurance Code), are amended to read as follows:
14-12 (a) The State and Public School Employees Cafeteria Plan
14-13 Trust Fund is created in the State Treasury. The trust shall be
14-14 administered by the trustee. Salary reduction payments for
14-15 benefits included in a cafeteria plan adopted under this Act other
14-16 than coverages under the Texas Employees Uniform Group Insurance
14-17 Program and appropriations by the state for the administration of a
14-18 cafeteria plan adopted under this Act shall be paid into the trust
14-19 fund. The trust fund is available without fiscal year limitation:
14-20 (1) for all payments for any benefits included in a
14-21 cafeteria plan adopted under this Act other than coverages under
14-22 the Texas Employees Uniform Group Insurance Program; and
14-23 (2) to pay expenses for administering the cafeteria
14-24 plan adopted under this Act.
14-25 (b) The trustee may establish a monthly charge or charges to
14-26 be paid by each employee who elects to participate in a cafeteria
14-27 plan adopted under this Act for the purpose of paying the expenses
15-1 of administering the cafeteria plan. The trustee shall establish
15-2 the amount of the monthly charge or charges and may establish a
15-3 separate charge for each benefit included in a cafeteria plan
15-4 adopted under this Act. If the trustee establishes a monthly
15-5 charge or charges, each employee who participates in the cafeteria
15-6 plan shall authorize payment of the charge or charges by executing
15-7 a payroll deduction agreement or as part of the salary reduction
15-8 agreement, as determined by the trustee. The monthly charge or
15-9 charges shall be paid into the State and Public School Employees
15-10 Cafeteria Plan Trust Fund. The payroll officer for an employer
15-11 described under Section 3(a)(6)(B) of this Act shall pay the
15-12 amounts deducted under this subsection to the trustee at the time
15-13 and in the manner prescribed by the trustee.
15-14 (c) The trustee may establish the accounts for money in the
15-15 State and Public School Employees Cafeteria Plan Trust Fund as the
15-16 trustee considers necessary, including any accounts the trustee
15-17 considers necessary for the administration of a cafeteria plan
15-18 adopted under this Act. The trustee may transfer assets from one
15-19 account to another to pay benefits if the transfer is necessary for
15-20 financial management purposes and if adequate arrangements are made
15-21 to reimburse the account out of which the transfer was made, and to
15-22 pay administrative expenses.
15-23 (e) The trustee may, under the standard of care provided by
15-24 Section 815.307, Government Code, invest and reinvest any of the
15-25 money in the State and Public School Employees Cafeteria Plan Trust
15-26 Fund. The interest on, earnings of, and the proceeds from the sale
15-27 of the investments become a part of the trust fund.
16-1 SECTION 11. Section 1, Article 3.50-4, Insurance Code, is
16-2 amended to read as follows:
16-3 Sec. 1. SHORT TITLE. This article may be cited as the Texas
16-4 Public School Retired Employees Group Insurance Act.
16-5 SECTION 12. Sections 2(3) and (4), Article 3.50-4, Insurance
16-6 Code, are amended to read as follows:
16-7 (3) "Dependent" means:
16-8 (A) a spouse of a retiree [or active member];
16-9 (B) a retiree's[, an active member's,] or a
16-10 deceased active member's unmarried child who is younger than 25
16-11 years of age including:
16-12 (i) an adopted child;
16-13 (ii) a foster child, a stepchild, or other
16-14 child who is in a regular parent-child relationship; and
16-15 (iii) a recognized natural child; and
16-16 (C) a retiree's [or active member's] recognized
16-17 natural child, adopted child, foster child, stepchild, or other
16-18 child who is in a regular parent-child relationship and who lives
16-19 with or whose care is provided by the retiree[, active member,] or
16-20 surviving spouse on a regular basis, regardless of the child's age,
16-21 if the child is mentally retarded or physically incapacitated to
16-22 such an extent as to be dependent on the retiree[, active member,]
16-23 or surviving spouse for care or support, as determined by the
16-24 trustee, or in the case of a deceased active member, a recognized
16-25 natural child, adopted child, foster child, stepchild, or other
16-26 child who was in a regular parent-child relationship and who lived
16-27 with or whose care was provided by the deceased active member on a
17-1 regular basis, regardless of the child's age, if the child is
17-2 mentally retarded or physically incapacitated to such an extent as
17-3 to have been dependent on the deceased active member or surviving
17-4 spouse for care or support, as determined by the trustee.
17-5 (4) "Fund" means the Texas public school retired
17-6 employees group insurance fund.
17-7 SECTION 13. Section 3(a), Article 3.50-4, Insurance Code, is
17-8 amended to read as follows:
17-9 (a) The Texas Public School Retired Employees Group
17-10 Insurance Program is established to provide for an insurance plan
17-11 or plans under this article.
17-12 SECTION 14. Section 5(a), Article 3.50-4, Insurance Code, is
17-13 amended to read as follows:
17-14 (a) The trustee may adopt rules, plans, procedures, and
17-15 orders reasonably necessary to implement this article, including:
17-16 (1) establishment of minimum benefit and financing
17-17 standards for group insurance coverage to be provided to all
17-18 retirees, [active employees,] dependents, surviving spouses, and
17-19 surviving dependent children;
17-20 (2) establishment of basic and optional group coverage
17-21 to be provided to retirees, [active employees,] dependents,
17-22 surviving spouses, and surviving dependent children;
17-23 (3) establishment of the procedures for contributions
17-24 and deductions;
17-25 (4) establishment of periods for enrollment and
17-26 selection of optional coverage and procedures for enrolling and
17-27 exercising options under the plan;
18-1 (5) determination of methods and procedures for claims
18-2 administration;
18-3 (6) study of the operation of all insurance coverage
18-4 provided under this article;
18-5 (7) administration of the fund;
18-6 (8) adoption of a timetable for the development of
18-7 minimum benefit and financial standards for group insurance
18-8 coverage, establishment of group insurance plans, and the taking of
18-9 bids for and awarding of contracts for insurance plans; and
18-10 (9) contracting with an independent and experienced
18-11 group insurance consultant or actuary, who does not receive
18-12 insurance commissions from any insurance company, for advice and
18-13 counsel in implementing and administering this program.
18-14 SECTION 15. Section 9, Article 3.50-4, Insurance Code, is
18-15 amended to read as follows:
18-16 Sec. 9. BENEFIT CERTIFICATES. At such times, or upon such
18-17 events, as designated by the trustee, each insurance carrier shall
18-18 issue to each retiree, [active employee,] surviving spouse, or
18-19 surviving dependent child insured under this article a certificate
18-20 of insurance that:
18-21 (1) states the benefits to which the person is
18-22 entitled;
18-23 (2) states to whom the benefits are payable;
18-24 (3) states to whom the claims must be submitted; and
18-25 (4) summarizes the provisions of the policy
18-26 principally affecting the person.
18-27 SECTION 16. Sections 12 and 13, Article 3.50-4, Insurance
19-1 Code, are amended to read as follows:
19-2 Sec. 12. DEATH CLAIMS: BENEFICIARIES. The amount of group
19-3 life insurance and group accidental death and dismemberment
19-4 insurance covering a retiree, [active employee,] surviving spouse,
19-5 dependent, or surviving dependent child at the date of death shall
19-6 be paid, on the establishment of a valid claim, only:
19-7 (1) to the beneficiary or beneficiaries designated by
19-8 the person in a signed and witnessed written document received
19-9 before death in the trustee's office; or
19-10 (2) if no beneficiary is properly designated or in
19-11 existence, to persons in accordance with the trustee's death
19-12 benefit provisions in Subsection (b), Section 824.103, Government
19-13 Code.
19-14 Sec. 13. AUTOMATIC COVERAGE. A retiree [or active employee]
19-15 who applies during an enrollment period may not be denied any of
19-16 the group insurance basic coverage provided under this article
19-17 unless the retiree [person] has been found under Section 18A of
19-18 this article to have defrauded or attempted to defraud the Texas
19-19 Public School Retired Employees Group Insurance Program.
19-20 SECTION 17. The heading to Section 15, Article 3.50-4,
19-21 Insurance Code, is amended to read as follows:
19-22 Sec. 15. RETIRED SCHOOL EMPLOYEES GROUP INSURANCE FUND.
19-23 SECTION 18. Section 15(a), Article 3.50-4, Insurance Code,
19-24 is amended to read as follows:
19-25 (a) The retired school employees group insurance fund is
19-26 created. The comptroller [State Treasurer] is the custodian of the
19-27 fund, and the trustee shall administer the fund. All contributions
20-1 from active employees, retirees, and the state, contributions for
20-2 optional coverages, investment income, appropriations for
20-3 implementation of this program, and other money required or
20-4 authorized to be paid into the fund shall be paid into the fund.
20-5 From the fund shall be paid, without state fiscal year limitation,
20-6 the appropriate premiums to the carrier or carriers providing group
20-7 coverage under the plan or plans under this article, claims for
20-8 benefits under the group coverage, and the amounts expended by the
20-9 trustee for administration of the program. The appropriate portion
20-10 of the contributions to the fund to provide for incurred but
20-11 unreported claim reserves and contingency reserves, as determined
20-12 by the trustee, shall be retained in the fund.
20-13 SECTION 19. Section 18A(a), Article 3.50-4, Insurance Code,
20-14 is amended to read as follows:
20-15 (a) After notice and hearing as provided by this section,
20-16 the trustee may expel from participation in the Texas Public School
20-17 Retired Employees Group Insurance Program any retiree, [active
20-18 employee,] surviving spouse, dependent, or surviving dependent
20-19 child who submits a fraudulent claim under, or has defrauded or
20-20 attempted to defraud, any health benefits plan offered under the
20-21 program.
20-22 SECTION 20. Section 18B(a), Article 3.50-4, Insurance Code,
20-23 is amended to read as follows:
20-24 (a) Section 825.507, Government Code, concerning the
20-25 confidentiality of information in records that are in the custody
20-26 of the Teacher Retirement System of Texas, applies to information
20-27 in records that are in the custody of the retirement system
21-1 regarding retirees, [active employees,] annuitants, or
21-2 beneficiaries under the Texas Public School Retired Employees Group
21-3 Insurance Program.
21-4 SECTION 21. Sections 18C(c), (d), and (i), Article 3.50-4,
21-5 Insurance Code, are amended to read as follows:
21-6 (c) The trustee, the Texas public school retired employees
21-7 group insurance program, the retired school employees group
21-8 insurance fund, and the board of trustees, officers, advisory
21-9 committee members, and employees of the trustee are not liable for
21-10 damages arising from the acts or omissions of health care providers
21-11 who are participating health care providers in the coordinated care
21-12 network established by the trustee. Those health care providers
21-13 are independent contractors and are responsible for their own acts
21-14 and omissions.
21-15 (d) The trustee, the Texas public school retired employees
21-16 group insurance program, the retired school employees group
21-17 insurance fund, or a member of a credentialing committee, or the
21-18 board of trustees, officers, advisory committee members, or
21-19 employees of the trustee are not liable for damages arising from
21-20 any act, statement, determination, recommendation made, or act
21-21 reported, without malice, in the course of the evaluation of the
21-22 qualifications of health care providers or of the patient care
21-23 rendered by those providers.
21-24 (i) A credentialing committee, a person participating in a
21-25 credentialing review, a health care provider, the trustee, the
21-26 Texas public school retired employees group insurance program, or
21-27 the board of trustees, officers, advisory committee members, or
22-1 employees of the trustee that are named as defendants in any civil
22-2 action filed as a result of participation in the credentialing
22-3 process may use otherwise confidential information obtained for
22-4 legitimate internal business and professional purposes, including
22-5 use in their own defense. Use of information under this subsection
22-6 does not constitute a waiver of the confidential and privileged
22-7 nature of the information.
22-8 SECTION 22. Section 7A, Article 3.50-4, Insurance Code, is
22-9 repealed.
22-10 SECTION 23. This Act takes effect September 1, 1997.
22-11 SECTION 24. The importance of this legislation and the
22-12 crowded condition of the calendars in both houses create an
22-13 emergency and an imperative public necessity that the
22-14 constitutional rule requiring bills to be read on three several
22-15 days in each house be suspended, and this rule is hereby suspended.