By Armbrister S.B. No. 1021
77R3389 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a prescription drug benefit plan for active school
1-3 employees.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 ARTICLE 1. PRESCRIPTION DRUG BENEFIT PLAN FOR
1-6 ACTIVE SCHOOL DISTRICT EMPLOYEES
1-7 SECTION 1.01. Article 3.50-4, Insurance Code, is amended by
1-8 adding Section 7B to read as follows:
1-9 Sec. 7B. PRESCRIPTION DRUG BENEFIT PLAN FOR ACTIVE
1-10 EMPLOYEES. (a) As part of the group coverages offered under the
1-11 program, the trustee shall develop and implement a prescription
1-12 drug benefit plan to provide prescription drug benefits for active
1-13 employees. The plan benefits must be at least equivalent to the
1-14 comparable benefits provided under the basic coverage offered as
1-15 part of the uniform group insurance program for state employees
1-16 under the Texas Employees Uniform Group Insurance Benefits Act
1-17 (Article 3.50-2, Vernon's Texas Insurance Code).
1-18 (b) Coverage under the prescription drug benefit plan is
1-19 limited to active employees.
1-20 (c) For each active employee covered by the prescription
1-21 drug benefit plan, the state shall contribute in the manner
1-22 described by Section 16 of this article an amount equal to the cost
1-23 of the plan premium. An employee covered by the plan is responsible
1-24 for any copayment, coinsurance, or similar charge imposed under the
2-1 plan.
2-2 ARTICLE 2. CONFORMING AMENDMENTS
2-3 SECTION 2.01. Section 7A, Article 3.50-4, Insurance Code, is
2-4 amended by adding Subsection (j) to read as follows:
2-5 (j) Prescription drug benefits for an active employee shall
2-6 be provided under the prescription drug benefit plan established
2-7 under Section 7B of this article.
2-8 SECTION 2.02. Section 13, Article 3.50-4, Insurance Code, is
2-9 amended to read as follows:
2-10 Sec. 13. AUTOMATIC COVERAGE. Unless the person has been
2-11 found under Section 18A of this article to have defrauded or
2-12 attempted to defraud the Texas Public School Employees Group
2-13 Insurance Program:
2-14 (1) a [A] retiree or active employee who applies
2-15 during an enrollment period may not be denied any of the group
2-16 insurance basic coverage provided under this article; and
2-17 (2) an active employee who applies during an
2-18 enrollment period may not be denied coverage under the prescription
2-19 drug benefit plan provided under this article [unless the person
2-20 has been found under Section 18A of this article to have defrauded
2-21 or attempted to defraud the Texas Public School Employees Group
2-22 Insurance Program].
2-23 SECTION 2.03. Section 22.004, Education Code, is amended by
2-24 amending Subsections (a) and (d) and adding Subsection (h) to read
2-25 as follows:
2-26 (a) Each district shall make available to its employees
2-27 group health coverage provided by a risk pool established by one or
3-1 more school districts under Chapter 172, Local Government Code, or
3-2 under a policy of insurance or group contract issued by an insurer,
3-3 a company subject to Chapter 20, Insurance Code, or a health
3-4 maintenance organization under the Texas Health Maintenance
3-5 Organization Act (Chapter 20A, Vernon's Texas Insurance Code). The
3-6 coverage must meet the substantive coverage requirements of Article
3-7 3.51-6, Insurance Code, and any other law applicable to group
3-8 health insurance policies or contracts issued in this state. The
3-9 coverage must include major medical treatment but may exclude
3-10 experimental procedures. In this subsection, "major medical
3-11 treatment" means a medical, surgical, or diagnostic procedure for
3-12 illness or injury. The coverage may include managed care or
3-13 preventive care and, except as provided by Subsection (h), must be
3-14 comparable to the basic health coverage provided under the Texas
3-15 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
3-16 Vernon's Texas Insurance Code). The board of trustees of the
3-17 Teacher Retirement System of Texas shall adopt rules to determine
3-18 whether a school district's group health coverage is comparable to
3-19 the basic health coverage specified by this subsection. The rules
3-20 must provide for consideration of the following factors concerning
3-21 the district's coverage in determining whether the district's
3-22 coverage is comparable to the basic health coverage specified by
3-23 this subsection:
3-24 (1) the deductible amount for service provided inside
3-25 and outside of the network;
3-26 (2) the coinsurance percentages for service provided
3-27 inside and outside of the network;
4-1 (3) the maximum amount of coinsurance payments a
4-2 covered person is required to pay;
4-3 (4) the amount of the copayment for an office visit;
4-4 (5) the schedule of benefits and the scope of
4-5 coverage;
4-6 (6) the lifetime maximum benefit amount; and
4-7 (7) verification that the coverage is issued by a
4-8 provider licensed to do business in this state by the Texas
4-9 Department of Insurance or is provided by a risk pool authorized
4-10 under Chapter 172, Local Government Code, or that a district is
4-11 capable of covering the assumed liabilities in the case of coverage
4-12 provided through district self-insurance.
4-13 (d) Based on the criteria prescribed by Subsection (a) and
4-14 except as provided by Subsection (h), the executive director of the
4-15 Teacher Retirement System of Texas shall certify whether a
4-16 district's coverage is comparable to the basic health coverage
4-17 provided under the Texas Employees Uniform Group Insurance Benefits
4-18 Act (Article 3.50-2, Vernon's Texas Insurance Code). If the
4-19 executive director of the Teacher Retirement System of Texas
4-20 determines that the group health coverage offered by a district is
4-21 not comparable, the executive director shall report that
4-22 information to the district and to the Legislative Budget Board.
4-23 The executive director shall submit a report to the legislature not
4-24 later than September 1 of each even-numbered year describing the
4-25 status of each district's group health coverage program based on
4-26 the information contained in the report required by Subsection (c)
4-27 and the certification required by this subsection.
5-1 (h) Group health coverage made available under this section
5-2 may not provide benefits for prescription drugs.
5-3 SECTION 2.04. Section 22.005, Education Code, is amended by
5-4 adding Subsection (d) to read as follows:
5-5 (d) A health care plan established under this section may
5-6 not provide benefits for prescription drugs.
5-7 SECTION 2.05. Article 26.036, Insurance Code, is amended by
5-8 adding Subsection (c) to read as follows:
5-9 (c) Notwithstanding any other provision of this chapter, a
5-10 small employer health benefit plan provided to an independent
5-11 school district under this chapter may not provide benefits for
5-12 prescription drugs.
5-13 ARTICLE 3. TRANSITION; EFFECTIVE DATE
5-14 SECTION 3.01. (a) During the 2001-2002 school year, the
5-15 Teacher Retirement System of Texas shall develop the prescription
5-16 drug benefit plan for active school district employees required by
5-17 Section 7B, Article 3.50-4, Insurance Code, as added by this Act.
5-18 The system may employ persons as necessary to implement this
5-19 subsection.
5-20 (b) Coverage under the prescription drug benefit plan for
5-21 active school district employees required by Section 7B, Article
5-22 3.50-4, Insurance Code, as added by this Act, shall begin with the
5-23 2002-2003 school year, but not later than September 1, 2002.
5-24 SECTION 3.02. (a) Except as provided by Subsection (b) of
5-25 this section, this Act takes effect September 1, 2001.
5-26 (b) Article 2 of this Act takes effect September 1, 2002.