1551.001
Short Title 1551.002
Purposes 1551.003
General Definitions 1551.004
Definition of Dependent 1551.005
Definition of Health Benefit Plan 1551.006
Definition of Institution of Higher Education 1551.007
Definition of Carrier 1551.008
Applicability of Definitions 1551.009
Board of Trustees May Define Other Words 1551.010
Board of Trustees Approval for Payroll Deductions or Reductions 1551.011
Exemption from Execution 1551.012
Exemption from State Taxes and Fees 1551.013
Combining of Carriers Not Restraint of Trade 1551.014
Exclusive Remedies 1551.015
Balance Billing Prohibition Notice 1551.051
Administration and Implementation 1551.052
Authority for Rules, Plans, Procedures, and Orders 1551.053
Authority to Hire Employees 1551.055
General Powers of Board of Trustees Regarding Coverage Plans 1551.056
Independent Administrator 1551.057
Compensation of Person Employed by Board of Trustees 1551.058
Electronic Authorizations 1551.059
Certificate of Coverage 1551.060
Identification Cards 1551.061
Annual Report 1551.062
Information on Operation and Administration of Chapter 1551.063
Confidentiality of Certain Records 1551.064
Certain Group Health and Accident Policies or Contracts 1551.065
Disclosure of Social Security Number 1551.066
Information Relating to Misconduct 1551.067
Pharmacy Benefit Manager Contracts 1551.068
Qualification of Group Benefits Program 1551.101
Participation Eligibility: State Officers and Employees 1551.102
Participation Eligibility: Annuitants 1551.103
Right to Coverage 1551.104
Automatic Coverage 1551.105
Date Automatic Coverage Begins 1551.106
Group Coverage Plan Purchased to Provide for Automatic Coverage 1551.107
Contingent Coverage 1551.108
Continuing Eligibility of Certain Persons with Legislative Service or Employment 1551.109
Continuing Eligibility of Certain Members of Boards, Commissions, and Institutions of Higher Education 1551.110
Ineligibility of Certain Junior College Employees 1551.111
Participation by Certain Retirement Systems 1551.112
Participation by Texas Turnpike Authority 1551.113
Participation by Certain Employees Whose Positions Are Privatized or Eliminated 1551.114
Participation by Community Supervision and Corrections Departments 1551.115
Participation by Wrongfully Imprisoned Persons 1551.151
Entitlement to Coverage 1551.152
Eligibility of Foster Child 1551.153
Participant Residing Outside of Service Area 1551.154
Employee Payments 1551.155
Coverage Options for Surviving Spouse 1551.156
Coverage Options for Surviving Dependent 1551.157
Coverage Options After Expiration of Annuity Option 1551.158
Reinstatement of Health Benefit Plan Coverage by Certain Dependents 1551.201
Establishment 1551.202
Authority to Define Basic Coverages 1551.203
Authority to Define Optional Coverages 1551.204
Authority to Define Voluntary Coverages 1551.205
Limitations 1551.206
Cafeteria Plan 1551.207
Premium Conversion Benefit Portion of Cafeteria Plan 1551.208
Determination to Self-fund 1551.209
Coverage Exempt from Insurance Law 1551.210
Actuarial Advice for Self-funded Coverage 1551.211
Contingency Reserve Fund for Self-funded Coverage 1551.212
Firms to Administer Self-funded Coverage 1551.213
Bids for Purchased Coverage 1551.214
Selection of Bids for Purchased Coverage 1551.215
Accounting by Carrier Providing Purchased Coverage 1551.216
Special Contingency Reserve 1551.217
Use of Employee’s Salary in Computation of Premium or Coverage 1551.218
Prior Authorization for Certain Drugs 1551.219
Disease Management Services 1551.220
Beneficiary Causing Death of Participant or Beneficiary of Participant 1551.222
Incentive Payments 1551.224
Mail Order Requirement for Prescription Drug Coverage Prohibited 1551.225
Bariatric Surgery Coverage 1551.226
Tobacco Cessation Coverage 1551.227
Tricare Military Health System Supplemental Plan 1551.228
Emergency Care Payments 1551.229
Out-of-network Facility-based Provider Payments 1551.230
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider Payments 1551.231
Out-of-network Emergency Medical Services Provider Payments 1551.251
Group Life Insurance Coverage Plan 1551.252
Additional Term Life Insurance 1551.253
Determination of Annual Salary 1551.254
Accelerated Life Insurance Benefits 1551.255
Inclusion of Provisions for Viatical Settlements 1551.256
Optional Term Life Insurance Coverage After Retirement 1551.257
Eligibility of Annuitant for Extended Insurance Benefits 1551.258
Termination of Accidental Death and Dismemberment Insurance Coverage on Retirement 1551.259
Order of Precedence of Payment to Survivors 1551.301
Funding of Basic Coverage 1551.302
Allocation of Employer Contributions 1551.303
Funding of Optional Coverages 1551.304
Funding of Voluntary Coverages 1551.305
Cost of Basic Coverage Exceeding Employer Contributions 1551.306
Payment of Excess Cost over Basic Coverage Contribution 1551.307
Payment for Voluntary Coverages 1551.308
No Contribution on Refusal of Coverage 1551.309
Employee Payments for Participation in Cafeteria Plan 1551.310
State Contribution Required 1551.311
Amount of State Contribution 1551.313
Amount of State Contribution for Certain Surviving Dependents 1551.314
Certain State Contributions Prohibited 1551.315
Required Contributions by State Agencies 1551.316
Allocation to Board of Trustees of Employer Contributions 1551.317
Payment of Employer Contributions Allocated by the State 1551.318
Payment of Employer Contributions Not Allocated by the State 1551.319
Amount of Contribution for Full-time and Part-time Employees 1551.320
Certain Costs 1551.323
Cost of Certain Annuitants 1551.324
Reduction in Contribution for Certain Active Employees and Annuitants 1551.351
Administrative Process and Sanctions for Program Violations 1551.352
Executive Director Determines Questions Relating to Enrollment or Payment of Claims 1551.354
Double or Multiple Liability 1551.355
Appeal of Executive Director’s Determination 1551.356
Standing 1551.357
Determination of Appeal by Board of Trustees 1551.358
Negotiation 1551.359
Judicial Review 1551.360
Delegation 1551.361
Diligent Prosecution of Suit 1551.362
Subpoena 1551.363
Precedent Manual 1551.401
Employees Life, Accident, and Health Insurance and Benefits Fund 1551.402
State Employees Cafeteria Plan Trust Fund 1551.403
Fees for State Employees Cafeteria Plan Trust Fund 1551.404
Insufficient Earnings for Employee to Participate in Cafeteria Fund 1551.405
Employees’ Health Care Stabilization Trust Fund 1551.406
Investment of Funds 1551.407
Management of Assets 1551.451
Definitions 1551.452
Establishment of State Consumer-directed Health Plan 1551.453
Account Administrator 1551.454
Participation in Program 1551.455
Coverage for Dependents 1551.456
State Contribution 1551.457
Plan Enrollee Contributions 1551.458
Coordination with Cafeteria Plan 1551.459
Exemption from Execution 1551.460
Single Undivided Risk Pool 1551.1021
Participation Eligibility: Certain Faculty of Institutions of Higher Education 1551.1022
Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students 1551.1045
Waiver 1551.1055
Date Eligibility Begins 1551.2011
Employee Awareness and Education 1551.2181
Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services 1551.3015
Cost Assessment for Certain Participants 1551.3075
Tobacco User Premium Differential 1551.3076
Employer Enrollment Fee 1551.3111
Amount of State Contribution for Certain Junior College Employees 1551.3195
Amount of Contribution for Annuitants Who Were Part-time Employees 1551.3196
Amount of Contribution for Certain Annuitants
Short Title 1551.002
Purposes 1551.003
General Definitions 1551.004
Definition of Dependent 1551.005
Definition of Health Benefit Plan 1551.006
Definition of Institution of Higher Education 1551.007
Definition of Carrier 1551.008
Applicability of Definitions 1551.009
Board of Trustees May Define Other Words 1551.010
Board of Trustees Approval for Payroll Deductions or Reductions 1551.011
Exemption from Execution 1551.012
Exemption from State Taxes and Fees 1551.013
Combining of Carriers Not Restraint of Trade 1551.014
Exclusive Remedies 1551.015
Balance Billing Prohibition Notice 1551.051
Administration and Implementation 1551.052
Authority for Rules, Plans, Procedures, and Orders 1551.053
Authority to Hire Employees 1551.055
General Powers of Board of Trustees Regarding Coverage Plans 1551.056
Independent Administrator 1551.057
Compensation of Person Employed by Board of Trustees 1551.058
Electronic Authorizations 1551.059
Certificate of Coverage 1551.060
Identification Cards 1551.061
Annual Report 1551.062
Information on Operation and Administration of Chapter 1551.063
Confidentiality of Certain Records 1551.064
Certain Group Health and Accident Policies or Contracts 1551.065
Disclosure of Social Security Number 1551.066
Information Relating to Misconduct 1551.067
Pharmacy Benefit Manager Contracts 1551.068
Qualification of Group Benefits Program 1551.101
Participation Eligibility: State Officers and Employees 1551.102
Participation Eligibility: Annuitants 1551.103
Right to Coverage 1551.104
Automatic Coverage 1551.105
Date Automatic Coverage Begins 1551.106
Group Coverage Plan Purchased to Provide for Automatic Coverage 1551.107
Contingent Coverage 1551.108
Continuing Eligibility of Certain Persons with Legislative Service or Employment 1551.109
Continuing Eligibility of Certain Members of Boards, Commissions, and Institutions of Higher Education 1551.110
Ineligibility of Certain Junior College Employees 1551.111
Participation by Certain Retirement Systems 1551.112
Participation by Texas Turnpike Authority 1551.113
Participation by Certain Employees Whose Positions Are Privatized or Eliminated 1551.114
Participation by Community Supervision and Corrections Departments 1551.115
Participation by Wrongfully Imprisoned Persons 1551.151
Entitlement to Coverage 1551.152
Eligibility of Foster Child 1551.153
Participant Residing Outside of Service Area 1551.154
Employee Payments 1551.155
Coverage Options for Surviving Spouse 1551.156
Coverage Options for Surviving Dependent 1551.157
Coverage Options After Expiration of Annuity Option 1551.158
Reinstatement of Health Benefit Plan Coverage by Certain Dependents 1551.201
Establishment 1551.202
Authority to Define Basic Coverages 1551.203
Authority to Define Optional Coverages 1551.204
Authority to Define Voluntary Coverages 1551.205
Limitations 1551.206
Cafeteria Plan 1551.207
Premium Conversion Benefit Portion of Cafeteria Plan 1551.208
Determination to Self-fund 1551.209
Coverage Exempt from Insurance Law 1551.210
Actuarial Advice for Self-funded Coverage 1551.211
Contingency Reserve Fund for Self-funded Coverage 1551.212
Firms to Administer Self-funded Coverage 1551.213
Bids for Purchased Coverage 1551.214
Selection of Bids for Purchased Coverage 1551.215
Accounting by Carrier Providing Purchased Coverage 1551.216
Special Contingency Reserve 1551.217
Use of Employee’s Salary in Computation of Premium or Coverage 1551.218
Prior Authorization for Certain Drugs 1551.219
Disease Management Services 1551.220
Beneficiary Causing Death of Participant or Beneficiary of Participant 1551.222
Incentive Payments 1551.224
Mail Order Requirement for Prescription Drug Coverage Prohibited 1551.225
Bariatric Surgery Coverage 1551.226
Tobacco Cessation Coverage 1551.227
Tricare Military Health System Supplemental Plan 1551.228
Emergency Care Payments 1551.229
Out-of-network Facility-based Provider Payments 1551.230
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider Payments 1551.231
Out-of-network Emergency Medical Services Provider Payments 1551.251
Group Life Insurance Coverage Plan 1551.252
Additional Term Life Insurance 1551.253
Determination of Annual Salary 1551.254
Accelerated Life Insurance Benefits 1551.255
Inclusion of Provisions for Viatical Settlements 1551.256
Optional Term Life Insurance Coverage After Retirement 1551.257
Eligibility of Annuitant for Extended Insurance Benefits 1551.258
Termination of Accidental Death and Dismemberment Insurance Coverage on Retirement 1551.259
Order of Precedence of Payment to Survivors 1551.301
Funding of Basic Coverage 1551.302
Allocation of Employer Contributions 1551.303
Funding of Optional Coverages 1551.304
Funding of Voluntary Coverages 1551.305
Cost of Basic Coverage Exceeding Employer Contributions 1551.306
Payment of Excess Cost over Basic Coverage Contribution 1551.307
Payment for Voluntary Coverages 1551.308
No Contribution on Refusal of Coverage 1551.309
Employee Payments for Participation in Cafeteria Plan 1551.310
State Contribution Required 1551.311
Amount of State Contribution 1551.313
Amount of State Contribution for Certain Surviving Dependents 1551.314
Certain State Contributions Prohibited 1551.315
Required Contributions by State Agencies 1551.316
Allocation to Board of Trustees of Employer Contributions 1551.317
Payment of Employer Contributions Allocated by the State 1551.318
Payment of Employer Contributions Not Allocated by the State 1551.319
Amount of Contribution for Full-time and Part-time Employees 1551.320
Certain Costs 1551.323
Cost of Certain Annuitants 1551.324
Reduction in Contribution for Certain Active Employees and Annuitants 1551.351
Administrative Process and Sanctions for Program Violations 1551.352
Executive Director Determines Questions Relating to Enrollment or Payment of Claims 1551.354
Double or Multiple Liability 1551.355
Appeal of Executive Director’s Determination 1551.356
Standing 1551.357
Determination of Appeal by Board of Trustees 1551.358
Negotiation 1551.359
Judicial Review 1551.360
Delegation 1551.361
Diligent Prosecution of Suit 1551.362
Subpoena 1551.363
Precedent Manual 1551.401
Employees Life, Accident, and Health Insurance and Benefits Fund 1551.402
State Employees Cafeteria Plan Trust Fund 1551.403
Fees for State Employees Cafeteria Plan Trust Fund 1551.404
Insufficient Earnings for Employee to Participate in Cafeteria Fund 1551.405
Employees’ Health Care Stabilization Trust Fund 1551.406
Investment of Funds 1551.407
Management of Assets 1551.451
Definitions 1551.452
Establishment of State Consumer-directed Health Plan 1551.453
Account Administrator 1551.454
Participation in Program 1551.455
Coverage for Dependents 1551.456
State Contribution 1551.457
Plan Enrollee Contributions 1551.458
Coordination with Cafeteria Plan 1551.459
Exemption from Execution 1551.460
Single Undivided Risk Pool 1551.1021
Participation Eligibility: Certain Faculty of Institutions of Higher Education 1551.1022
Participation Eligibility: Certain Postdoctoral Fellows and Graduate Students 1551.1045
Waiver 1551.1055
Date Eligibility Begins 1551.2011
Employee Awareness and Education 1551.2181
Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services 1551.3015
Cost Assessment for Certain Participants 1551.3075
Tobacco User Premium Differential 1551.3076
Employer Enrollment Fee 1551.3111
Amount of State Contribution for Certain Junior College Employees 1551.3195
Amount of Contribution for Annuitants Who Were Part-time Employees 1551.3196
Amount of Contribution for Certain Annuitants
