301), Sec. (e) On discontinuation of a plan, any balance remaining in the special contingency reserve after all charges have been made shall be deposited to the credit of the employees life, accident, and health insurance and benefits fund. 1207 (S.B. Sec. (b) The board of trustees, in the board's sole discretion and under conditions the board approves, may reinsure any coverage the board determines will be provided directly from the employees life, accident, and health insurance and benefits fund under Subsection (a). Sec. (2) may include other information identified by the board. Eligible part-time employees get a 50% state contribution for themselves and 25% for their dependents. PREMIUM CONVERSION BENEFIT PORTION OF CAFETERIA PLAN. 4.01, eff. INFORMATION ON OPERATION AND ADMINISTRATION OF CHAPTER. (d) For a calendar year, the amount of any allocations made under Subsection (c) and Section 1551.455(c)(2), in the aggregate, may not exceed the sum of the monthly limitations imposed by federal law for health savings accounts. How much does COBRA coverage cost? (2) appropriations by the state for the administration of a cafeteria plan. Added by Acts 2005, 79th Leg., Ch. 1176), Sec. (d) The executive head of the Windham School District shall determine whether an educational professional employee of the school is a full-time employee for purposes of this chapter. This includes 4% of covered workers at firms that exclude coverage of abortion under any circumstance and 6% of covered workers at firms that exclude coverage of abortion except under some limited. 1551.102. In implementing this subchapter the board shall: (1) establish health savings accounts under this subchapter and administer or select an administrator in accordance with Section 1551.453 for the accounts; (2) finance a self-funded high deductible health plan that: (A) is an integral part of the state consumer-directed health plan; and, (B) provides health benefit coverage, including preventive health care, to a plan enrollee in the state consumer-directed health plan and to the dependents of a plan enrollee in accordance with Section 1551.455; and. 1419, Sec. (a) For those coverage plans for which the board of trustees determines to purchase coverage, the board shall notify eligible carriers: (1) that competitive bidding will be conducted; and. Employee Retirement Income and Security Act (ERISA) - 29 U.S.C. (e) An employee, participant, annuitant, or dependent expelled from the group benefits program may not participate in a coverage plan offered by the program for the period determined by the Employees Retirement System of Texas. Concerning the I-9 process, obtaining I-9 documentation from independent contractors is not necessary, according to U.S. Customs and Immigration Services guidance in the I-9 Handbook for Employers, Publication M-274, in question 6 on page 31 of the PDF version of the handbook (see https://www.uscis.gov/i-9-central/handbook-employers-m-274). Under 234.102 of the Texas law, all employers must report "each newly-hired or rehired employee" to the state directory of new hires. (e) The interest on, earnings of, and proceeds from the sale of investments of assets in the contingency reserve fund shall be credited to the fund. 1551.1022. 1107 (S.B. Sept. 1, 2003.
September 1, 2009. June 1, 2003. 1812), Sec. 213, Sec. 1664), Sec. . (b) An employee or retired employee of a community supervision and corrections department shall be treated as an employee or annuitant, as applicable, for purposes of this chapter only as provided by this section. 1551.456. 1551.216. 1276, Sec. Sec.
Part-Time / Full-Time Status< - Texas Texas law doesnt require you to have workers compensation insurance. 31, eff. The definitions here are almost identical to the definitions for the federal unemployment compensation statutes. COVERAGE EXEMPT FROM INSURANCE LAW. The State of Texas currently pays 100% of the health plan premium for eligible full-time employees and 50% of the premium for their eligible dependents. (12) "Serious mental illness" has the meaning assigned by Section 1355.001. 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. (4) induces the extension of coverage under any program provided under this chapter by supplying false information on an application for coverage or in related documentation or in any communication. 1551.153. Any coverage established under this chapter, including a policy, an insurance contract, a certificate of coverage, an evidence of coverage, and an agreement with a health maintenance organization or a plan administrator, is not subject to any state tax, regulatory fee, or surcharge, including a premium or maintenance tax or fee. 1111, Sec. 10A.411(a), eff. That individual remains eligible to participate in the group benefits program in the same manner as other employees of the college even if the individual's employment by the college is not continuous. A small group carrier may not non-renew coverage for an existing small group because the state and federal definitions of small group differ. "Employee" means "an individual employed by an employer". (b) Except as provided by Subsection (c), eligibility under Section 1551.102, for an individual who does not retire at the end of the last month for which the individual is on the payroll of a state agency before retirement, begins not later than the 90th day after the date the individual retires. Sec. 1551.057. 1249 (S.B. 417), Sec. Most insurance companies require at least 75% of your full-time employees to participate in your health plan. Sept. 1, 2003. May 27, 2005. (d) The board of trustees shall develop and implement a process to allow an employee, participant, annuitant, or covered dependent affected by a determination described by Section 1551.352 to participate directly in the process of appealing the determination. All benefit payments, contributions of employees and annuitants, and optional benefit payments, any rights, benefits, or payments accruing to a person under this chapter, and all money in a fund created by this chapter: (1) are exempt from execution, attachment, garnishment, or any other process; and, (A) for direct payment that a participant may assign to a provider of health care services; and. 1551.3195. 3, Sec. 3, eff. (16) appoint an advisory committee for the group benefits program under the terms provided by Section 815.509, Government Code. Jan. 11, 2004. Sept. 1, 2003. 1551.405. (d) The contribution set for each participant must be within the total amount appropriated in the General Appropriations Act. In Texas, state and local government health plans maintained by public employers with 2 to 19 employees would be covered by the Texas COBRA law. 1551.064. "'Employer' means: (A) a person who is engaged in an industry affecting commerce and who has 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year " This test is the same as for Title VII on the federal side. September 1, 2009. (2) shall pay for the coverage at the group rate as provided by Subsection (b). Workplace Health Screens and Medical Exams, Payroll Tax 101 -November 5, 2020; June 1, 2003. (d) An individual who participates in the group benefits program under this section is not considered an employee of an institution of higher education solely as a result of the individual's participation in the program. (a) Not later than November 1 preceding each regular session of the legislature, the board of trustees, in coordination with the Legislative Budget Board, shall certify to the budget division of the governor's office for information and review the amount necessary to pay the contributions of the state to the board for the coverages provided under this chapter during the following biennium.
PDF Termination - COBRA and State Continuation - Texas Department of Insurance Added by Acts 2003, 78th Leg., ch. (e) The board of trustees may establish accounts for money in the fund as the board considers necessary, including accounts for the administration of a cafeteria plan. (B) fraud detection and prevention procedures; (2) basic information about each group coverage plan provided under this chapter, including the number of participants in each plan and the claims amounts and administrative expenses incurred under each plan; (3) a summary of recent changes to the benefits provided under this chapter that highlights any key benefits the board of trustees evaluated but did not implement; (4) a discussion of trends in claims under group coverage plans as well as other areas of interest identified by the board of trustees; (5) recommendations for any statutory changes the board of trustees determines necessary to achieve its goals for the group benefits program; and. (c) The waiting period established by Subsections (a) and (b) applies only to the determination of initial eligibility to participate in the group benefits program and does not apply to the determination of initial eligibility to participate in optional and voluntary insurance coverages under the group benefits program. 2559), Sec.
Insurance Code Chapter 846. Multiple Employer Welfare Arrangements Acts 2009, 81st Leg., R.S., Ch. But employers that decide to provide it must make it equally available to all employees working 30 hours or more per week . 366, Sec. COBRA (federal law on health benefit continuation for 18 months in most cases) - 26 U.S.C. 1551.401. August 29, 2005. Large Employer, Association Plans State Law: Consumer Choice Plans (CCP) HMO-Specific Mandates HMO Basic Health . For that, youll need a separate workers compensation insurance policy. (6) The term 'employee' means any individual employed by an employer." 347 (S.B. Preexisting conditions. (2) prevailing cost patterns in the area in which the plan operates. However, 61.003 excludes public employers from coverage under that statute. September 1, 2009. Sec. Added by Acts 2003, 78th Leg., ch. 1419, Sec. (f) Payment under Subsection (b) or (c) bars recovery by any other person. June 14, 2013. Sec. Sec. How do I elect COBRA continuation coverage and when does it begin? 1551.403. 28, eff. (a) In this section, "emergency care" has the meaning assigned by Section 1301.155. Sec. (c) Each monthly installment shall be paid to the appropriate fund created by this chapter in the amount certified by the board of trustees. 899 (S.B. A qualified actuary selected by the board of trustees shall advise the board regarding an actuarially sound level of contributions required to provide coverage directly from the employees life, accident, and health insurance and benefits fund. (2) gifts and grants contributed to the fund. 1419, Sec. 1551.3076. Before sharing sensitive information, make sure youre on an official government site. 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. Sept. 1, 2003. 11, eff. Occupational Safety and Health Act (OSHA) - 29 U.S.C. BALANCE BILLING PROHIBITION NOTICE. June 1, 2003. 1.01, eff. 1551.308. 1551.362. Thus, employers with 15 or more employees are covered by GINA. Jan. 11, 2004. (B) postmarked or received not later than the 10th day of the month for which the premium is due; (2) the premium for group continuation coverage under Subchapter G, Chapter 1251, may not exceed the level established for other surviving dependents of deceased employees and annuitants; (3) at the time the group policy or contract is delivered, issued for delivery, renewed, amended, or extended, the Employees Retirement System of Texas shall give notice of the continuation option to each state agency covered by the group benefits program; and. You dont have to pay anything toward their premiums. Except in cases of gross negligence or an intentional act or omission of (c) The board of trustees may adopt rules necessary to implement this section, including rules regarding eligibility for the plan, available insurance products, and enrollment in the plan. 1419, Sec. ", or that "is a tax-exempt, non-profit organization under Sections 501(a) and 501(c)(3) of the Internal Revenue Code that employed at least four individuals in employment for a portion of at least one day during 20 or more different calendar weeks during the current year or during the preceding calendar year." 1111, Sec. Employers wanting to provide health coverage to their employees generally have three options: Buy group insurance (alone or as part of a larger group). 203(d):Top of Page
September 1, 2009. (c) To waive coverage under the basic coverage plan for annuitants for the purpose of eligibility for an incentive payment under Section 1551.222, an annuitant must demonstrate, in the manner required by the board of trustees, that the annuitant is: (1) covered by another health benefit plan that provides substantially equivalent coverage, as determined by the board of trustees, to the coverage provided to annuitants by the basic coverage plan; or. 1551.316. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. 10A.402, eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. Sec. Sec. (a) In this chapter, "dependent" with respect to an individual eligible to participate in the group benefits program means the individual's: (2) unmarried child younger than 26 years of age; (3) child of any age who the board of trustees determines lives with or has the child's care provided by the individual on a regular basis if the child is mentally or physically incapacitated to the extent that the child is dependent on the individual for care or support, as determined by the board of trustees; (4) child of any age who is unmarried, for purposes of health benefit coverage under this chapter, on expiration of the child's continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. Added by Acts 2011, 82nd Leg., R.S., Ch. Sept. 1, 2003. 1551.204. Acts 2005, 79th Leg., Ch. For purposes of this chapter, an individual described by Section 1551.101(e)(2) is considered a part-time employee. (b) An institution of higher education shall, at the time of employment, notify each of the institution's employees eligible to participate in the group benefits program under Section 1551.101(e)(2) of the employee's eligibility to participate. PARTICIPATION BY TEXAS TURNPIKE AUTHORITY. (e) A surviving dependent seeking group coverage under Subsection (d): Acts 2009, 81st Leg., R.S., Ch. If the employee chooses to remain enrolled in your health insurance plan, the employee must do so at their own expense. (c-1) An individual is eligible to participate in the group benefits program as provided by Subsection (a) if: (1) the individual meets the minimum requirements under Subsection (c) except that the individual does not have at least 10 years of eligible service credit as described by Subsection (c)(1); (2) the individual has at least 10 years of combined service in a position for which the individual was eligible to participate in the group benefits program or in the uniform program under Section 1601.101; and, (A) the individual's greatest number of years of state employment was in a position for which the individual was eligible to participate in the group benefits program; or. Texas and federal laws leave it up to an employer to define what constitutes full-time and part-time status within a company and to determine the specific schedule of hours. 1264), Sec. Added by Acts 2001, 77th Leg., ch. For more information about the tax credit opportunity, visit the Texas Workforce Commissions Work Opportunity Tax Credit page. Sec. 1551.352. 321), Sec. Sec. covered employees with income and medical benefits if they sustain a work-related injury or illness. Added by Acts 2009, 81st Leg., R.S., Ch. Amended by Acts 2003, 78th Leg., ch. 1.11, eff. September 1, 2011. 2559), Sec. September 1, 2017. BARIATRIC SURGERY COVERAGE. (4) an eligible dependent of a retired officer or employee described by Subdivision (3). CERTAIN GROUP HEALTH AND ACCIDENT POLICIES OR CONTRACTS. (b) The board of trustees shall determine and assign the compensation and duties of the employees. 1245, 88th Legislature, Regular Session, for amendments affecting the following section. (a) The board of trustees has exclusive authority to determine the eligibility of a plan enrollee to participate in any flexible spending account that is part of a cafeteria plan offered under this chapter. (b) The coverage is at the group rate for other participants if: (1) the coverage was previously secured by the deceased participant for the surviving spouse or dependent; and. 1551.406. The legislation applies to all individuals (employees and dependents) covered under fully insured business, but does not impact self-funded accounts. (2) policy exclusions and limitations, including: (A) limitations based on multiple sources of benefits; (B) preexisting condition exclusions; and. Added by Acts 2001, 77th Leg., ch. Sec. 3, eff. Sept. 1, 2003; Acts 2003, 78th Leg., 3rd C.S., ch. 1249 (S.B. Sec. September 1, 2019. 4.02, eff. 32, eff. (a) For those coverage plans that the board of trustees funds from the employees life, accident, and health insurance and benefits fund, the board may contract with one or more qualified and experienced administering firms to administer the plans in the best interest of the participants in the group benefits program. (d) A person who violates Subsection (c) is liable for the costs and attorney's fees incurred by the Employees Retirement System of Texas, a trustee, officer, or employee of the retirement system, or a carrier or administering firm for the retirement system as a result of the violation. 33, eff. 2559), Sec. Acts 2017, 85th Leg., R.S., Ch. June 14, 2013. (2) optional term life insurance in an amount equal to four times the employee's annual salary plus the amount of term life insurance provided under the basic coverage. 1551.004. Acts 2005, 79th Leg., Ch. However, employees must be "eligible employees" in order to take FMLA-protected leave. (a) A surviving dependent of an annuitant who was receiving monthly benefits paid by a retirement system named in this chapter may, following the death of the annuitant if there is not a surviving spouse, elect to retain any coverage previously secured by the annuitant until the dependent becomes ineligible for coverage for a reason other than the death of the member of the group. 1419, Sec. A preauthorization process used by a health benefit plan provided under this chapter is subject to the same limitations and requirements provided by Subchapter N, Chapter 4201, for a preauthorization process used by an insurer.
Texas Administrative Code - Secretary of State of Texas
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