Texas Education Code

§ 22.004 — GROUP HEALTH BENEFITS FOR SCHOOL EMPLOYEES

ED § 22.004Title 2. PUBLIC EDUCATION · Part D. EDUCATORS AND SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS · Ch. 22. SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS · Art. A. RIGHTS, DUTIES, AND BENEFITS

Statute text

View on source

(a)A district shall participate in the uniform group coverage program established under Chapter 1579, Insurance Code, as provided by Subchapter D of that chapter.

(b)A district that does not participate in the program described by Subsection (a) shall make available to its employees group health coverage provided by a risk pool established by one or more school districts under Chapter 172, Local Government Code, or under a policy of insurance or group contract issued by an insurer, a company subject to Chapter 842, Insurance Code, or a health maintenance organization under Chapter 843, Insurance Code. The coverage must meet the substantive coverage requirements of Chapter 1251, Subchapter A, Chapter 1364, and Subchapter A, Chapter 1366, Insurance Code, and any other law applicable to group health insurance policies or contracts issued in this state. The coverage must include major medical treatment but may exclude experimental procedures. In this subsection, "major medical treatment" means a medical, surgical, or diagnostic procedure for illness or injury. The coverage may include managed care or preventive care and must be comparable to the basic health coverage provided under Chapter 1551, Insurance Code. The following factors shall be considered in determining whether the district's coverage is comparable to the basic health coverage specified by this subsection:

(1)the deductible amount for service provided inside and outside of the network;

(2)the coinsurance percentages for service provided inside and outside of the network;

(3)the maximum amount of coinsurance payments a covered person is required to pay;

(4)the amount of the copayment for an office visit;

…

Legislative history

Acts 2005, 79th Leg., Ch. 386 (S.B. 1448), Sec. 1, eff. September 1, 2005. Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.108, eff. September 1, 2005. Acts 2005, 79th Leg., Ch. 899 (S.B. 1863), Sec. 18.01, eff. September 1, 2005. Acts 2005, 79th Leg., Ch. 1359 (S.B. 1691), Sec. 4, eff. September 1, 2005. Acts 2007, 80th Leg., R.S., Ch. 108 (H.B. 973), Sec. 1, eff. September 1, 2007. Acts 2007, 80th Leg., R.S., Ch. 1230 (H.B. 2427), Sec. 14, eff. September 1, 2007. Acts 2009, 81st Leg., R.S., Ch. 103 (H.B. 1364), Sec. 1, eff. September 1, 2009. Acts 2011, 82nd Leg., R.S., Ch. 370 (S.B. 155), Sec. 1, eff. September 1, 2011. Acts 2013, 83rd Leg., R.S., Ch. 1312 (S.B. 59), Sec. 99(1), eff. September 1, 2013. Acts 2017, 85th Leg., R.S., Ch. 931 (S.B. 1664), Sec. 1, eff. September 1, 2017.