Texas 2017 - 85th Regular

Texas Senate Bill SB788 Compare Versions

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1	1	By: Huffman S.B. No. 788
2	2	(In the Senate - Filed February 9, 2017; February 22, 2017,
3	3	read first time and referred to Committee on State Affairs;
4	4	April 6, 2017, reported adversely, with favorable Committee
5	5	Substitute by the following vote: Yeas 8, Nays 1; April 6, 2017,
6	6	sent to printer.)
7	7	Click here to see the committee vote
8	8	COMMITTEE SUBSTITUTE FOR S.B. No. 788 By: Huffman
9	9
10	10
11	11	A BILL TO BE ENTITLED
12	12	AN ACT
13	13	relating to the administration of and benefits payable under the
14	14	Texas Public School Retired Employees Group Benefits Act.
15	15	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	16	SECTION 1. Section 1575.002, Insurance Code, is amended by
17	17	amending Subdivision (5) and adding Subdivisions (5-a) and (5-b) to
18	18	read as follows:
19	19	(5) "Health benefit plan" means any [a group insurance
20	20	policy, contract, or certificate, medical or hospital service
21	21	agreement, membership or subscription contract, salary
22	22	continuation plan, or similar] group arrangement to provide health
23	23	care benefits [services] or to pay or reimburse expenses for [of]
24	24	health care services.
25	25	(5-a) "Medicare Advantage plan" means a health benefit
26	26	plan operated under Part C of the Medicare program.
27	27	(5-b) "Medicare prescription drug plan" means a health
28	28	benefit plan operated under Part D of the Medicare program.
29	29	SECTION 2. Subchapter A, Chapter 1575, Insurance Code, is
30	30	amended by adding Section 1575.0025 to read as follows:
31	31	Sec. 1575.0025. REFERENCES TO BASIC PLAN. A reference in
32	32	this code to a "basic plan" under this chapter means a health
33	33	benefit plan provided under this chapter other than a Medicare
34	34	Advantage plan or a Medicare prescription drug plan.
35	35	SECTION 3. Section 1575.006(a), Insurance Code, is amended
36	36	to read as follows:
37	37	(a) The following are exempt from execution, attachment,
38	38	garnishment, or any other process:
39	39	(1) benefit payments, [including optional benefits
40	40	payments,] active employee and state contributions, and retiree,
41	41	surviving spouse, and surviving dependent child contributions;
42	42	(2) any rights, benefits, or payments accruing to any
43	43	person under this chapter; and
44	44	(3) any money in the fund.
45	45	SECTION 4. Section 1575.052(a), Insurance Code, is amended
46	46	to read as follows:
47	47	(a) The trustee may adopt rules, plans, procedures, and
48	48	orders reasonably necessary to implement this chapter, including:
49	49	(1) minimum benefit and financing standards for group
50	50	coverage for retirees, dependents, surviving spouses, and
51	51	surviving dependent children;
52	52	(2) [basic and optional] group coverage for retirees,
53	53	dependents, surviving spouses, and surviving dependent children;
54	54	(3) procedures for contributions and deductions;
55	55	(4) periods for enrollment and selection of [optional]
56	56	coverage and procedures for enrolling and exercising options under
57	57	the group program;
58	58	(5) procedures for claims administration;
59	59	(6) procedures to administer the fund; and
60	60	(7) a timetable for:
61	61	(A) developing minimum benefit and financial
62	62	standards for group coverage;
63	63	(B) establishing health benefit plans offered
64	64	under the group program [plans]; and
65	65	(C) taking bids and awarding contracts for health
66	66	benefit plans offered under the group program [plans].
67	67	SECTION 5. Section 1575.152, Insurance Code, is amended to
68	68	read as follows:
69	69	Sec. 1575.152. HEALTH BENEFIT [BASIC] PLAN MUST COVER
70	70	PREEXISTING CONDITIONS. A health benefit [basic] plan offered
71	71	under the group program, other than a Medicare Advantage plan or a
72	72	Medicare prescription drug plan, must cover preexisting
73	73	conditions.
74	74	SECTION 6. Section 1575.153, Insurance Code, is amended to
75	75	read as follows:
76	76	Sec. 1575.153. HEALTH BENEFIT PLAN [BASIC] COVERAGE FOR
77	77	RETIREES. (a) A retiree who applies for coverage during an
78	78	enrollment period may not be denied coverage in a health benefit
79	79	[basic] plan provided under this chapter for which the retiree is
80	80	eligible unless the trustee finds under Subchapter K that the
81	81	retiree defrauded or attempted to defraud the group program.
82	82	(b) A retiree who has coverage under a health benefit plan
83	83	offered under the group program shall pay a monthly contribution,
84	84	as determined by the trustee.
85	85	(c) As a condition of electing coverage under a health
86	86	benefit plan, the retiree must, in writing, authorize the trustee
87	87	to deduct the amount of the contribution from the retiree's monthly
88	88	annuity payment. The trustee shall deduct the contribution in the
89	89	manner and form determined by the trustee.
90	90	(d) Notwithstanding Subsection (b), a retiree is not
91	91	required to pay a monthly contribution under this section until the
92	92	2022 plan year if the retiree:
93	93	(1) has taken a disability retirement under the
94	94	Teacher Retirement System of Texas on or before January 1, 2017;
95	95	(2) is receiving disability retirement benefits from
96	96	the Teacher Retirement System of Texas; and
97	97	(3) is not eligible to enroll in Medicare.
98	98	(e) This subsection and Subsection (d) expire at the end of
99	99	the 2021 plan year on December 31, 2021.
100	100	SECTION 7. Section 1575.155(a), Insurance Code, is amended
101	101	to read as follows:
102	102	(a) A retiree participating in the group program is entitled
103	103	to secure for the retiree's dependents group coverage [provided for
104	104	the retiree] under this chapter for which the dependents are
105	105	eligible under this chapter or any other law, including
106	106	requirements established[, as determined] by the trustee.
107	107	SECTION 8. Section 1575.156, Insurance Code, is amended by
108	108	amending Subsection (a) and adding Subsections (c) and (d) to read
109	109	as follows:
110	110	(a) A surviving spouse who is entitled to group coverage
111	111	under this chapter may elect to retain or obtain coverage for which
112	112	the surviving spouse or dependents of the surviving spouse are
113	113	eligible [at the applicable rate for the deceased participant].
114	114	(c) A surviving spouse who elects under this section to
115	115	retain or obtain coverage under a health benefit plan offered under
116	116	the group program for the surviving spouse or dependents of the
117	117	surviving spouse shall pay a monthly contribution, as determined by
118	118	the trustee.
119	119	(d) As a condition of electing coverage under a health
120	120	benefit plan, the surviving spouse must, in writing, authorize the
121	121	trustee to deduct the amount of the contribution from the surviving
122	122	spouse's monthly annuity payment. The trustee shall deduct the
123	123	contribution in the manner and form determined by the trustee.
124	124	SECTION 9. Section 1575.157, Insurance Code, is amended to
125	125	read as follows:
126	126	Sec. 1575.157. COVERAGE FOR SURVIVING DEPENDENT CHILD.
127	127	(a) A surviving dependent child, the guardian of the child's
128	128	estate, or the person having custody of the child may elect to
129	129	retain or obtain group coverage for which the surviving dependent
130	130	child is eligible at the applicable rate for a dependent.
131	131	(b) A surviving dependent child who has coverage under a
132	132	health benefit plan offered under the group program shall pay a
133	133	monthly contribution, as determined by the trustee. The applicable
134	134	contributions must be provided by the surviving dependent child in
135	135	the manner established [by Section 1575.205 and] by the trustee.
136	136	SECTION 10. The heading to Section 1575.158, Insurance
137	137	Code, is amended to read as follows:
138	138	Sec. 1575.158. [OPTIONAL] GROUP HEALTH BENEFIT PLANS
139	139	[PLAN].
140	140	SECTION 11. Section 1575.158, Insurance Code, is amended by
141	141	amending Subsection (a) and adding Subsections (c) and (d) to read
142	142	as follows:
143	143	(a) The [Subject to Section 1575.1581, the] trustee shall
144	144	establish or [may, in addition to providing a basic plan,] contract
145	145	for and make available under the group program a high deductible [an
146	146	optional group] health [benefit] plan for retirees, dependents,
147	147	surviving spouses, or surviving dependent children who are eligible
148	148	under Section 1575.1582.
149	149	(c) The trustee shall establish or contract for and make
150	150	available under the group program a Medicare Advantage plan and a
151	151	Medicare prescription drug plan for retirees, dependents,
152	152	surviving spouses, and surviving dependent children who are
153	153	eligible under Section 1575.1582.
154	154	(d) Notwithstanding Subsection (c), if the trustee
155	155	determines that a Medicare Advantage plan or a Medicare
156	156	prescription drug plan is no longer appropriate for the group
157	157	program, the trustee may establish or contract for and make
158	158	available under the group program other health benefit plans to
159	159	provide medical or pharmacy benefits.
160	160	SECTION 12. Subchapter D, Chapter 1575, Insurance Code, is
161	161	amended by adding Section 1575.1582 to read as follows:
162	162	Sec. 1575.1582. ELIGIBILITY FOR GROUP HEALTH BENEFIT PLANS.
163	163	(a) A retiree, dependent, surviving spouse, or surviving
164	164	dependent child who is not eligible to enroll in Medicare is
165	165	eligible to enroll in a high deductible health plan offered under
166	166	the group program, subject to any other applicable eligibility
167	167	requirements, including requirements established by the trustee,
168	168	but is not eligible to enroll in another health benefit plan offered
169	169	under the group program.
170	170	(b) A retiree, dependent, surviving spouse, or surviving
171	171	dependent child who is eligible to enroll in Medicare is eligible to
172	172	enroll in a Medicare Advantage plan or a Medicare prescription drug
173	173	plan offered under the group program, subject to any other
174	174	applicable eligibility requirements, including requirements
175	175	established by the trustee, but is not eligible to enroll in another
176	176	health benefit plan offered under the group program unless
177	177	authorized by Subsection (c).
178	178	(c) If the trustee makes another health benefit plan
179	179	available under Section 1575.158(d), any individual otherwise
180	180	eligible under this section to enroll in a Medicare Advantage plan
181	181	or Medicare prescription drug plan is eligible to enroll in that
182	182	health benefit plan.
183	183	SECTION 13. Section 1575.159, Insurance Code, is amended to
184	184	read as follows:
185	185	Sec. 1575.159. COVERAGE FOR PROSTATE-SPECIFIC ANTIGEN
186	186	TEST. A health benefit plan offered under the group program, other
187	187	than a Medicare Advantage plan or a Medicare prescription drug
188	188	plan, must provide coverage for a medically accepted
189	189	prostate-specific antigen test used for the detection of prostate
190	190	cancer for each male enrolled in the health benefit plan who:
191	191	(1) is at least 50 years of age; or
192	192	(2) is at least 40 years of age and:
193	193	(A) has a family history of prostate cancer; or
194	194	(B) exhibits another cancer risk factor.
195	195	SECTION 14. The heading to Section 1575.161, Insurance
196	196	Code, is amended to read as follows:
197	197	Sec. 1575.161. [OPEN ENROLLMENT; ADDITIONAL] ENROLLMENT
198	198	PERIODS.
199	199	SECTION 15. Section 1575.161, Insurance Code, is amended by
200	200	amending Subsection (a) and adding Subsection (f) to read as
201	201	follows:
202	202	(a) A retiree, surviving spouse, or surviving dependent
203	203	child eligible for coverage under the group program may select for
204	204	that individual and the individual's eligible dependents any
205	205	coverage provided under this chapter for which each of those
206	206	individuals [the person] is otherwise eligible:
207	207	(1) on any date that is on or after the date the
208	208	retiree [person] retires and on or before the 90th day after that
209	209	date; and
210	210	(2) during any other open enrollment periods for
211	211	retirees set by the trustee by rule.
212	212	(f) An individual enrolled in a health benefit plan offered
213	213	under the group program may remain enrolled in that health benefit
214	214	plan as long as the individual remains eligible for that health
215	215	benefit plan. If an individual becomes ineligible for a health
216	216	benefit plan in which the individual is enrolled, the trustee shall
217	217	enroll the individual in a health benefit plan for which the
218	218	individual is eligible, if any, in accordance with procedures
219	219	established by the trustee.
220	220	SECTION 16. Section 1575.164(b), Insurance Code, is amended
221	221	to read as follows:
222	222	(b) A health benefit plan provided under this chapter, other
223	223	than a Medicare Advantage plan or a Medicare prescription drug
224	224	plan, must provide disease management services or coverage for
225	225	disease management services in the manner required by the Teacher
226	226	Retirement System of Texas, including:
227	227	(1) patient self-management education;
228	228	(2) provider education;
229	229	(3) evidence-based models and minimum standards of
230	230	care;
231	231	(4) standardized protocols and participation
232	232	criteria; and
233	233	(5) physician-directed or physician-supervised care.
234	234	SECTION 17. Section 1575.170(b), Insurance Code, is amended
235	235	to read as follows:
236	236	(b) A health benefit plan provided under this chapter, other
237	237	than a Medicare Advantage plan or a Medicare prescription drug
238	238	plan, that uses a drug formulary in providing a prescription drug
239	239	benefit must require prior authorization for coverage of the
240	240	following categories of prescribed drugs if the specific drug
241	241	prescribed is not included in the formulary:
242	242	(1) a gastrointestinal drug;
243	243	(2) a cholesterol-lowering drug;
244	244	(3) an anti-inflammatory drug;
245	245	(4) an antihistamine; and
246	246	(5) an antidepressant drug.
247	247	SECTION 18. Section 1575.201, Insurance Code, is amended by
248	248	amending Subsection (a) and adding Subsection (c) to read as
249	249	follows:
250	250	(a) The state through the trustee shall contribute from
251	251	money in the fund an[:
252	252	[(1) the total cost of the basic plan covering each
253	253	participating retiree; and
254	254	[(2) for each participating dependent, surviving
255	255	spouse, and surviving dependent child, the] amount prescribed by
256	256	the General Appropriations Act to cover all or part of the cost for
257	257	each retiree [of the basic plan covering the dependent], surviving
258	258	spouse, and surviving dependent child enrolled in a health benefit
259	259	plan offered under the group program.
260	260	(c) The trustee may spend a part of the money received for
261	261	the group program to offset a part of the costs for dependent
262	262	coverage if the group program is projected to remain financially
263	263	solvent during the currently funded biennium.
264	264	SECTION 19. Section 1575.202(a), Insurance Code, is amended
265	265	to read as follows:
266	266	(a) Each state fiscal year, the state shall contribute to
267	267	the fund an amount equal to 1.25 [one] percent of the salary of each
268	268	active employee.
269	269	SECTION 20. Section 1575.211(a), Insurance Code, is amended
270	270	to read as follows:
271	271	(a) The total costs for the operation of the group program
272	272	shall be shared among the state, the public schools, the active
273	273	employees, [and] the retirees, the surviving spouses, and the
274	274	surviving dependent children in the manner prescribed by the
275	275	General Appropriations Act.
276	276	SECTION 21. Section 1575.212, Insurance Code, is amended by
277	277	adding Subsection (a-1) and amending Subsection (b) to read as
278	278	follows:
279	279	(a-1) The trustee shall establish and collect payments for
280	280	the share of total costs allocated under Section 1575.211 to
281	281	retirees, surviving spouses, and surviving dependent children.
282	282	(b) In establishing the payments under Subsection (a-1)
283	283	[ranges for payment of the share of total costs allocated under
284	284	Section 1575.211 to retirees], the trustee may consider various
285	285	factors, including an enrollee's Medicare status, health benefit
286	286	plan election, and dependent coverage [the years of service credit
287	287	accrued by a retiree and may reward those retirees with more years
288	288	of service credit].
289	289	SECTION 22. Section 1575.302, Insurance Code, is amended to
290	290	read as follows:
291	291	Sec. 1575.302. PAYMENTS INTO FUND. The following shall be
292	292	paid into the fund:
293	293	(1) contributions from active employees and the
294	294	state[, including contributions for optional coverages];
295	295	(2) investment income;
296	296	(3) appropriations for implementation of the group
297	297	program; and
298	298	(4) other money required or authorized to be paid into
299	299	the fund.
300	300	SECTION 23. The following provisions of the Insurance Code
301	301	are repealed:
302	302	(1) Section 1575.103;
303	303	(2) Section 1575.156(b);
304	304	(3) Section 1575.158(b);
305	305	(4) Section 1575.1581;
306	306	(5) Sections 1575.161(b), (c), (d), and (e);
307	307	(6) Section 1575.201(b);
308	308	(7) Section 1575.205;
309	309	(8) Section 1575.211(b); and
310	310	(9) Section 1575.212(a).
311	311	SECTION 24. The changes in law made by this Act apply only
312	312	to health benefits provided under Chapter 1575, Insurance Code, as
313	313	amended by this Act, beginning with the 2018 plan year. A plan year
314	314	before the 2018 plan year is governed by the law as it existed
315	315	immediately before the effective date of this Act, and that law is
316	316	continued in effect for that purpose.
317	317	SECTION 25. This Act takes effect September 1, 2017.
318	318	* * * * *