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1459), Sec. (2) the policy or policies purchased by the board of trustees. Whether or not you currently hold office. Sec. (13) "Service" means personal service to the state creditable in accordance with rules adopted by the board of trustees. (a) The board of trustees may develop a system for a participant to electronically authorize: (1) enrollment in a coverage or benefit; (2) contributions to a coverage or benefit; and. Frequently Asked Questions for Health Carriers - Texas Department of ." (c) The contract must define the information that the pharmacy benefit manager is required to provide to the board of trustees concerning the audit of the retail, independent, and mail order pharmacies performing services under the contract and describe how the results of these audits must be reported to the board of trustees, including how often the results must be reported. (2) for payment of expenses of administering this chapter within the limitations that may be specified annually by the legislature. (a) The amount of group life coverage and group accidental death and dismemberment coverage in force for a participant on the date the participant dies shall be paid, on the establishment of a valid claim, to a person surviving the death in the following order of precedence: (1) to the beneficiary designated by the participant in a signed and witnessed document mailed before the death of the participant; (2) if a beneficiary is not designated, to the spouse of the participant; (3) if Subdivisions (1) and (2) do not apply, to the children of the participant and descendants of the deceased children by representation; (4) if Subdivisions (1)-(3) do not apply, to the parents of the participant or the survivor of the parents; (5) if Subdivisions (1)-(4) do not apply, to the executor or administrator of the estate of the participant; or. 1419, Sec. 1664), Sec. 25, eff. Return to Businesses & Employers Thus, the discrimination provision in this law applies to any employer with four or more employees. HEALTH INSURANCE AND OTHER HEALTH COVERAGES, SUBTITLE H. HEALTH BENEFITS AND OTHER COVERAGES FOR GOVERNMENTAL EMPLOYEES, CHAPTER 1551. 940 (S.B. CERTAIN GROUP HEALTH AND ACCIDENT POLICIES OR CONTRACTS. 1551.212. EMPLOYER ENROLLMENT FEE. 37, eff. 1, eff. 31, eff. Added by Acts 2001, 77th Leg., ch. (b) The coverage is at the group rate for other participants. Sec. SINGLE UNDIVIDED RISK POOL. Note: Texas insurance law defines a small employer as a business with two to 50 employees, regardless of how many hours the employees work. (a) In this chapter, except as provided by Subsection (b), "institution of higher education" means a public junior college, a senior college or university, or any other agency of higher education within the meaning and jurisdiction of Chapter 61, Education Code. June 1, 2003. (a) An adjunct faculty member at a public institution of higher education is eligible to participate in the group benefits program as an employee if the faculty member: (1) receives compensation for services rendered to a public institution of higher education as an adjunct faculty member; (2) was employed as a faculty member by the same public institution of higher education and taught at least one course in the regular fall and spring semester at the public institution of higher education in the preceding academic year; and. To assist employees with HIPP enrollment, you will need to provide your employee or the HIPP program with a list of all the health insurance plans and rate sheets your company provides to employees. September 1, 2009. 1551.252. (2) is not required to select the lowest bid but shall take into consideration other relevant criteria, including ability to service contracts, past experience, and financial ability. (d) If before the fourth anniversary of the date of death of the participant payment has not been made under this section and a claim for payment by a person entitled under this section is not pending, the amount payable escheats to the credit of the employees life, accident, and health insurance and benefits fund. 3, eff. subchapter a: definitions, severability, and small employer health regulations: subchapter b: texas health reinsurance system plan of operation: subchapter c: Texas Guidebook for Employers is a vital resource. Sept. 1, 2003; Acts 2003, 78th Leg., 3rd C.S., ch. Self insure or "self-fund" a health plan (alone or as part of a larger group). (a) This section applies to: (1) the Employees Retirement System of Texas; (2) a carrier or other insurance company or health maintenance organization; (3) an administering firm or other insurance support organization that provides information or services to the group benefits program or the Employees Retirement System of Texas; (4) an agent or third-party administrator authorized under this chapter or licensed under this code; (5) a regulatory authority or department; and. June 1, 2003. Sec. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 99-272), reinstate health benefit plan coverage under this chapter if the child, or the child's participating parent, pays the full cost of the health benefit plan coverage. From the several funds from which employees receive their respective salaries, all employer contributions computed in accordance with this chapter and rules adopted under this chapter are allocated to the board of trustees as provided by this chapter. 653a:Top of Page 2476, 88th Legislature, Regular Session, for amendments affecting the following section. Section 1097c. (c) Each state agency shall keep records, make certifications, and furnish the board of trustees with information and reports necessary to enable the board to perform its functions under this chapter. June 1, 2003. (b) The board of trustees shall administer the fund. PARTICIPATION BY WRONGFULLY IMPRISONED PERSONS. Sec. The administration and implementation of this chapter are vested solely in the board of trustees. Notwithstanding any other provision of law, the board of trustees may impose against an employer whose employees are not paid salaries from amounts appropriated by the General Appropriations Act and whose participation in the group benefits program begins after August 31, 2003, as a condition for participation in the program, a one-time assessment of administrative costs for participation of the employees and annuitants in the program, which may include the actuarial costs of including the group in the program and a participation premium determined by the board. June 1, 2003. 1551.013. 9, eff. 1, eff. June 20, 2003. 1664), Sec. (2) shall pay for the coverage at the group rate as provided by Subsection (b). (e) The board of trustees shall give effect to a full or partial disclaimer of benefits executed in accordance with Chapter 240, Property Code. (d) In administering the fund, the board of trustees shall make investments in a manner that preserves the purchasing power of the fund's assets. RIGHT TO COVERAGE. (b) The Employees Retirement System of Texas is not required to change the recipient of any benefits, funds, or account balances under this section unless it receives actual notice of the conviction or adjudication of a beneficiary. Sept. 1, 2003; Acts 2003, 78th Leg., ch. Sec. 2003; Acts 2003, 78th Leg., ch. But employers that decide to provide it must make it equally available to all employees working 30 hours or more per week . 2G.019, eff. Plans bought before March 23, 2010, and some plans bought before October 1, 2013, aren't required to cover the essential health benefits. If a participant's records have become part of the public record of a proceeding and the records are not the subject of a protective order, the participant is considered to have waived the privacy of the participant's records. (a) In this section, "employee of a community supervision and corrections department" means an employee of a department established under Chapter 76, Government Code. Sec. Preexisting conditions. (2) the surviving spouse directs the applicable retirement system to deduct required contributions from the monthly benefits paid to the spouse by the retirement system. Sec. 1290), Sec. To get a print version of this book email us at: document.services@twc.texas.gov . Sec. Health insurance: 5 things you may not know - Texas Department of Insurance For purposes of this section, a record includes any identifying information about a person, living or deceased, who is or was an employee, annuitant, dependent, or participant in the group benefits program. Small employer health insurance guide. 1276, Sec. The site is secure. 1018 (H.B. Sept. 1, 2003. (a) A full-time employee receives the benefits of a full state contribution for coverage under this chapter. (2) for which an out-of-network provider, before providing the service, provides a complete written disclosure to the participant that: (A) explains that the provider does not have a contract with the participant's managed care plan; (B) discloses projected amounts for which the participant may be responsible; and. (c) To accomplish the purposes of this chapter, the board of trustees may release the records to: (1) an administering firm, carrier, agent, or attorney acting on behalf of the board; (2) another governmental entity having a legitimate need for the information to perform a function of the board of trustees; (3) an authorized medical provider of the participant; or. 1107 (S.B. Sec. Whether an individual or entity is an independent contractor, regardless of what the individual or entity calls itself, will be determined on a case-by-case basis. Acts 2009, 81st Leg., R.S., Ch. September 1, 2017. Sec. ACTUARIAL ADVICE FOR SELF-FUNDED COVERAGE. 34, eff. Sec. 22.049, eff. (b) The board of trustees shall state in writing the specific reason for the board's determination. There is an opportunity for you to receive a tax credit if your employees participate in HIPP. 1551.015. September 1, 2005. 1274, Sec. 41(8), eff. 109 (H.B. 2. Acts 2013, 83rd Leg., R.S., Ch. Sept. 1, 2003. Within this guidebook, you will find valuable information on a variety of workplace issues, including important state and federal laws, key employer contact information, unemployment and tax information, and samples of resource materials as well. The HIPP program will reimburse the employee for the employee's portion of the health insurance premiums. 1, eff. 4980B(d) and 29 U.S.C. (b) For the purpose of determining the amount of an employee's optional term life insurance coverage, an employee's annual salary includes benefit replacement pay under Subchapter H, Chapter 659, Government Code, as added by Chapter 417, Acts of the 74th Legislature, Regular Session, 1995. The standard of review for the appeal of a determination made by the board of trustees under this subchapter is by substantial evidence. An individual who is eligible to participate in the group benefits program under Section 1551.101 or 1551.102 and who resides outside of a health maintenance organization service area is entitled to group coverages for a dependent of the individual without evidence of insurability if the individual applies for the coverage for the dependent during the annual enrollment period. (a) The board of trustees may allow an incentive payment under this section to an employee or annuitant who elects to waive coverage under the basic coverage plan for employees or annuitants as provided by Section 1551.1045(b) or (c). (a) The board of trustees shall certify to the governing board of each state agency participating in the group benefits program that provides contributions for its employees' group coverages and dependents' group coverages from operating budgets provided from sources other than the General Appropriations Act the proportionate amounts required to pay its contributions. June 1, 2003. (7) any other similar group arrangement or a combination of policies, plans, contracts, agreements, or arrangements described by this subsection. Sept. 1, 2003. September 1, 2011. Sec. AMOUNT OF CONTRIBUTION FOR FULL-TIME AND PART-TIME EMPLOYEES. There is no minimum number of employees or contractors involved for the law to apply, so even one worker of any kind makes the employer liable under this statute. FUNDING OF BASIC COVERAGE. Sec. AUTHORITY FOR RULES, PLANS, PROCEDURES, AND ORDERS. 2101(a)(1):Top of Page 99-272). It wont pay for non-work-related injuries and illnesses or for routine health care. September 1, 2005. "[T]he term 'employer' means any business enterprise that employs (A) 100 or more employees, excluding part-time employees; or (B) 100 or more employees who in the aggregate work at least 4,000 hours per week (exclusive of hours of overtime);" Although the statute does not specifically define "employee", the term "employs" invokes the common-law direction and control test for employment. June 14, 2013. (c) An individual is eligible to participate in the group benefits program as provided by Subsection (a) if: (1) the individual retires under the jurisdiction of the Teacher Retirement System of Texas and has at least 10 years of eligible service credit, including not more than five years of military service credited in the Employees Retirement System of Texas, or has five years of eligible service credit and is the sole surviving spouse of military personnel who was killed in action; (A) has accumulated eligible service credit in an amount so that the sum of the person's age and amount of service credit, including months of age and credit, equals or exceeds the number 80; or. (2) pursue any other available legal remedy. 3, eff. DEFINITION OF HEALTH BENEFIT PLAN. 1551.403. Sec. This chapter may be cited as the Texas Employees Group Benefits Act. Sec. (6) The term 'employee' means any individual employed by an employer." 2277), Sec. An annuitant who as an employee received the benefits of a state contribution under Section 1551.319(b) for coverage during any portion of the annuitant's last employment by a state agency is not eligible to receive more than the state contribution provided under Section 1551.319(b) unless the annuitant was designated by the annuitant's employer as a full-time employee during the three-consecutive-month period before retirement. In subsection (a)(3), an employer of a domestic service employee is liable if it pays $1,000 or more in wages in a calendar quarter. Sept. 1, 2003. 2, eff. This law applies to both private and public sector employers, as well as churches, unions, and other organizations that employ workers in Texas. 29, eff. Sec. Except as provided by Subsection (b), the board of trustees shall determine the amount of the monthly installments of the premium differential. (2) an individual who has at least 10 years of service credit in the Employees Retirement System of Texas as an employee of the legislature, on ending the individual's service for the legislature, remains eligible for participation in the group benefits program. Subject to veto by the governor, the following section was amended by the 88th Legislature. (i) Subject to Section 1551.323, an individual and the individual's dependents are eligible to participate in the group benefits program as an annuitant and the dependents of an annuitant if the individual: (1) served in a position for which the individual was eligible to participate in the group benefits program under Section 1551.101 on or before August 31, 2003; and. The administrator shall make a payment required by this subsection directly to the provider not later than, as applicable: (c) Except as provided by Subsection (d), an out-of-network provider who is a facility-based provider or a person asserting a claim as an agent or assignee of the provider may not bill a participant receiving a health care or medical service or supply described by Subsection (b) in, and the participant does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the participant's managed care plan that: (d) This section does not apply to a nonemergency health care or medical service: (1) that a participant elects to receive in writing in advance of the service with respect to each out-of-network provider providing the service; and. Sec. No. (8) "Executive director" means the executive director of the Employees Retirement System of Texas. Large Employer, Association Plans State Law: Consumer Choice Plans (CCP) HMO-Specific Mandates HMO Basic Health . AMOUNT OF STATE CONTRIBUTION. Sept. 1, 2003. (a) The board of trustees shall develop a plan for providing under any health benefit plan provided under the group benefits program tobacco cessation coverage for participants. The definitions here are almost identical to the definitions for the federal unemployment compensation statutes. (b) A participant described by this section may not receive a state contribution for premiums. (3) deductions or reductions to the participant's compensation or annuity for participation in a coverage or benefit. Amended by Acts 2003, 78th Leg., ch. Thus, the Texas Payday Law applies to even the smallest employers in the private sector. June 1, 2003. 60 or above Must be holding office at retirement. 8704, but not including duties performed by nonimmigrant crewmen defined in sections 101(a)(10) and (a)(15)(D) of the Act. 1507 and 28 TAC Ch. 1111, Sec. 1551.451. To Learn More Call the HIPP Employer line at 800-471-7792, Monday through Friday, from 7 a.m. to 7 p.m. Central Time. 652(5) provides that "'employer' means a person engaged in a business affecting commerce who has employees, but does not include the United States (not including the United States Postal Service) or any State or political subdivision of a State " Texas has not submitted a state plan to DOL for approval under 29 U.S.C. DETERMINATION TO SELF-FUND. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. 1551.355. Americans with Disabilities Act (ADA) (disability discrimination) - 42 U.S.C. Added by Acts 2001, 77th Leg., ch. WAIVER. Health Plans | U.S. Department of Labor September 1, 2017. (g) For purposes of Subsection (a)(1), a designation, change, or cancellation of a beneficiary in a document, including a will, that is not executed and filed in the manner described by that subsection is not valid. 1601 Congress Avenue, Austin, TX 78701 | P.O. Added by Acts 2013, 83rd Leg., R.S., Ch. September 1, 2009. 30, eff. (2) the employer contributions for basic and optional coverages. One employee is sufficient for coverage, since 29 U.S.C. The definition of "employee" is the same as in Title VII. (c) A plan enrollee shall make contributions under this section in the manner prescribed by the board of trustees. DEFINITIONS. Each employee must be enrolled in the premium conversion benefit portion of a cafeteria plan established under Section 1551.206. Amended by Acts 2003, 78th Leg., ch. 1419, Sec. Acts 2019, 86th Leg., R.S., Ch. Small Business and the Affordable Care Act (ACA) | HealthCare.gov (4) the provisions of the plan document, in summary form, that principally affect the participant. 1106 (H.B. (c) Before each plan year, the board of trustees may determine the amount of allocation of the state's contribution, if any, to an enrollee's health savings account that would otherwise be made for basic coverage for the enrollee and that remains after payment for coverage under Subsection (a) or (b). 1419, Sec. AUTOMATIC COVERAGE. Sec. 1249 (S.B. (b) The board of trustees shall administer the fund. 1812), Sec. 1551.401. 2559), Sec. 2.14. (2) is not based on any additional amount determined to be owed to the provider under Chapter 1467. In implementing and administering the state consumer-directed health plan established under this subchapter, the board of trustees may not divide the self-funded risk pool of the group benefits program provided under this chapter or create a separate self-funded risk pool for that program. The use of labor or services of an independent contractor are subject to the restrictions in section 274A(a)(4) of the Act and 274a.5 of this part. (b) The board of trustees may adopt a plan, procedure, or order reasonably necessary to implement this chapter and its purposes. Should You Be Getting Health Insurance From Your Employer? (c) An expulsion under Subsection (b) may be permanent or for a specified period. (3) would not adversely affect the coverage plans provided under the group benefits program. Added by Acts 2001, 77th Leg., ch. 1551.001. 1551.008. Amended by Acts 2003, 78th Leg., ch. (d) An individual is eligible to participate in the group benefits program as provided by Subsection (a) if: (1) the individual retires under the optional retirement program established by Chapter 830, Government Code; (2) the individual has at least 10 years of eligible service credit; and, (A) is at least 65 years of age, or would have been eligible to retire and receive a service or disability retirement annuity from the Teacher Retirement System of Texas or the Employees Retirement System of Texas in an amount such that the sum of the person's age and amount of service credit, including months of age and credit, equals or exceeds the number 80 or would have been eligible to retire and receive a disability retirement annuity from the Teacher Retirement System of Texas or the Employees Retirement System of Texas, if the individual had not elected to participate in the optional retirement program, and is eligible to receive an annuity or periodic distribution of funds from an account under the optional retirement program; or.

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