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A BILL TO BE ENTITLED
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AN ACT
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relating to the administration of and benefits payable under the |
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Texas School Employees Uniform Group Health Coverage Act. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1579.002(4), Insurance Code, is amended |
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to read as follows: |
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(4) "Health coverage plan" means any [group policy or
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contract, hospital service agreement, health maintenance
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organization agreement, preferred provider arrangement, or any
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similar] group arrangement to provide health care benefits or to |
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pay or reimburse [or any combination of those policies, contracts,
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agreements, or arrangements that provides for, pays for, or
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reimburses] expenses for health care services. |
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SECTION 2. Subchapter A, Chapter 1579, Insurance Code, is |
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amended by adding Section 1579.0025 to read as follows: |
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Sec. 1579.0025. REFERENCES TO PRIMARY CARE COVERAGE PLAN. |
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A reference in this code to a "primary care coverage plan" under |
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this chapter means the health coverage plan provided under Section |
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1579.101. |
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SECTION 3. The heading to Subchapter C, Chapter 1579, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER C. COVERAGES; HEALTH SAVINGS ACCOUNTS |
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SECTION 4. The heading to Section 1579.101, Insurance Code, |
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is amended to read as follows: |
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Sec. 1579.101. HEALTH COVERAGE PLAN [PLANS OF GROUP
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COVERAGES]. |
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SECTION 5. Section 1579.101(a), Insurance Code, is amended |
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to read as follows: |
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(a) The trustee [by rule] shall establish or contract for |
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and make available a high deductible health coverage plan to be |
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offered to eligible [plans of group coverages for] employees of all |
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participating entities [in the program] and their eligible |
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dependents and that provides for, pays for, or reimburses expenses |
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for health care services that the trustee considers advisable. |
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SECTION 6. Subchapter C, Chapter 1579, Insurance Code, is |
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amended by adding Section 1579.109 to read as follows: |
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Sec. 1579.109. HEALTH SAVINGS ACCOUNT PROGRAM. The trustee |
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may establish or contract for and make available a health savings |
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account program to be offered to eligible employees and their |
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eligible dependents. |
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SECTION 7. Subchapter D, Chapter 1579, Insurance Code, is |
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amended by adding Sections 1579.1511, 1579.1521, and 1579.1531 to |
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read as follows: |
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Sec. 1579.1511. PARTICIPATION OF ENTITIES WITH 1,000 OR |
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FEWER EMPLOYEES. (a) Except as provided by Section 1579.1521(b), a |
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participating entity that had 1,000 or fewer employees on January |
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1, 2017, is required to continue to participate in the program on |
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and after September 1, 2018, unless the participating entity makes |
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a one-time election to discontinue its participation in the program |
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effective September 1, 2018. |
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(b) An entity eligible to become a participating entity that |
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had 1,000 or fewer employees on January 1, 2017, may make a one-time |
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election to participate in the program effective September 1, 2018. |
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(c) An entity otherwise eligible to become a participating |
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entity that is established after January 1, 2017, and has 1,000 or |
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fewer employees on the date the entity begins operating may make a |
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one-time election to participate in the program effective on: |
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(1) the earliest September 1 that occurs after the |
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first anniversary of the date the entity begins operating; or |
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(2) an earlier date if approved by the trustee. |
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(d) An entity otherwise eligible to become a participating |
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entity that had more than 1,000 employees on January 1, 2017, that |
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subsequently has 1,000 or fewer employees for five consecutive |
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years may make a one-time election to participate in the program. |
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(e) The trustee shall prescribe the time and manner for |
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making an election under this section. |
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Sec. 1579.1521. PARTICIPATION OF ENTITIES WITH MORE THAN |
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1,000 EMPLOYEES. (a) An entity that has more than 1,000 employees |
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on January 1, 2017, may not participate in the program on or after |
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September 1, 2018. |
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(b) An entity that continued to participate in or elected to |
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participate in the program under Section 1579.1511 that |
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subsequently has more than 1,000 employees for five consecutive |
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years may not continue to participate in the program. The trustee |
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shall prescribe the time and manner of a participating entity's |
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exit from the program under this subsection. |
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Sec. 1579.1531. PARTICIPATION BY ENTITIES IN RISK POOLS. |
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(a) For purposes of determining the number of employees of an |
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entity for purposes of Sections 1579.1511 and 1579.1521, members of |
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a risk pool established under Chapter 172, Local Government Code, |
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as provided by Section 22.004, Education Code, may elect to be |
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treated as a single unit by notifying the trustee in the time and |
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manner prescribed by the trustee. |
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(b) Entities that make an election under this section, |
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acting as a risk pool, have the same rights and are subject to the |
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same restrictions under Sections 1579.1511 and 1579.1521 as an |
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entity that does not make an election under this section. |
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SECTION 8. Section 1579.202(b), Insurance Code, is amended |
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to read as follows: |
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(b) An employee described by Subsection (a) who applies for |
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coverage during an open enrollment period prescribed by the trustee |
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is automatically covered by the health [catastrophic care] coverage |
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plan provided under Section 1579.101 unless the employee[:
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[(1) specifically waives coverage under this chapter;
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[(2) selects a higher tier coverage plan; or
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[(3)] is expelled from the program. |
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SECTION 9. Sections 1579.203(a) and (c), Insurance Code, |
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are amended to read as follows: |
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(a) A participating employee may select coverage in the |
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health [any] coverage plan offered by the trustee. |
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(c) If the combined contributions received from the state |
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and the employing participating entity under Subchapter F exceed |
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the cost of the [a] coverage for [plan selected by] the employee, |
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the employee may use the excess amount of contributions to [obtain
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coverage under a higher tier coverage plan or to] pay all or part of |
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the cost of coverage for the employee's dependents. |
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SECTION 10. Section 1579.204, Insurance Code, is amended to |
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read as follows: |
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Sec. 1579.204. CERTAIN PART-TIME EMPLOYEES. A part-time |
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employee of a participating entity who is not a participating |
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member in the Teacher Retirement System of Texas is eligible to |
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participate in the program only if the employee pays all of the |
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premiums and other costs associated with the [health] coverage for |
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[plan selected by] the employee under the program. |
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SECTION 11. Section 1579.205, Insurance Code, is amended to |
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read as follows: |
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Sec. 1579.205. PAYMENT BY PARTICIPATING ENTITY. |
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Notwithstanding Section 1579.204, a participating entity may pay |
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any portion of what otherwise would be the employee share of |
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premiums and other costs associated with the coverage for [selected
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by] the employee under the program. |
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SECTION 12. Section 1579.253, Insurance Code, is amended to |
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read as follows: |
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Sec. 1579.253. CONTRIBUTION BY EMPLOYEE. (a) An employee |
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covered by the program shall pay that portion of the cost of |
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coverage for [selected by] the employee and the employee's enrolled |
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dependents that exceeds the amount of the state contribution under |
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Section 1579.251 and the participating entity contribution under |
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Section 1579.252. |
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(b) The employee may pay the employee's contribution under |
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this section [subsection] from the amount distributed to the |
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employee under Subchapter D, Chapter 22, Education Code. |
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(c) Notwithstanding Subsection (a), a participating entity |
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may pay any portion of what otherwise would be the employee share of |
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premiums and other costs associated with the coverage for [selected
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by] the employee. |
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SECTION 13. The following provisions of the Insurance Code |
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are repealed: |
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(1) Sections 1579.101(b), (c), and (d); |
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(2) Sections 1579.102, 1579.151, 1579.152, and |
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1579.153; |
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(3) Section 1579.154(b); and |
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(4) Section 1579.203(b). |
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SECTION 14. The changes in law made by this Act apply only |
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to health coverage provided under Chapter 1579, Insurance Code, |
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beginning with the 2018 plan year. A plan year before the 2018 plan |
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year is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 15. This Act takes effect September 1, 2017. |