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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation of a voluntary consumer-directed health |
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plan for certain individuals eligible to participate in the group |
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benefits program provided under the Texas Employees Group Benefits |
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Act and their qualified dependents. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1551, Insurance Code, is amended by |
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adding Subchapter J to read as follows: |
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SUBCHAPTER J. STATE CONSUMER-DIRECTED HEALTH PLAN |
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Sec. 1551.451. DEFINITIONS. In this subchapter: |
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(1) "High deductible health plan" means a health |
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benefit plan that complies with Section 223(c), Internal Revenue |
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Code of 1986, and other federal law. |
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(2) "Plan enrollee" means an employee or annuitant who |
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is enrolled in the plan established under this subchapter. |
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(3) "Qualified medical expense" means an expense paid |
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by a plan enrollee for medical care, as defined by Section 213(d), |
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Internal Revenue Code of 1986, for the plan enrollee or the |
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enrollee's dependents as defined by Section 152, Internal Revenue |
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Code of 1986. |
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Sec. 1551.452. ESTABLISHMENT OF STATE CONSUMER-DIRECTED |
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HEALTH PLAN. (a) The state consumer-directed health plan is |
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established for the benefit of individuals eligible to participate |
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in the group benefits program and those individuals' eligible |
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dependents. |
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(b) The board of trustees may adopt rules necessary to |
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administer this subchapter. In implementing this subchapter the |
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board shall: |
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(1) establish health savings accounts under this |
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subchapter and administer or select an administrator for the |
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accounts; |
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(2) finance or purchase a high deductible health plan |
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that: |
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(A) is an integral part of the state |
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consumer-directed health plan; and |
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(B) provides health benefit coverage, including |
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preventive health care, to a plan enrollee in the state |
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consumer-directed health plan and to the dependents of a plan |
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enrollee in accordance with Section 1551.456; and |
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(3) provide to individuals eligible to participate in |
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the group benefits program information regarding the option to |
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participate in and operation of the state consumer-directed health |
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plan established under this subchapter. |
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(c) If the board of trustees purchases a high deductible |
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health plan under this subchapter, Sections 1551.215-1551.218 |
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apply to the high deductible health plan. |
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(d) In adopting rules and administering health savings |
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accounts or selecting administrators for health savings accounts |
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under this subchapter, the board of trustees shall ensure that the |
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health savings accounts are qualified for appropriate federal tax |
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exemptions. |
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Sec. 1551.453. PARTICIPATION IN STATE CONSUMER-DIRECTED |
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HEALTH PLAN; EFFECT OF PARTICIPATION. (a) The board of trustees |
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shall offer individuals eligible to participate in the basic |
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coverage plan the option of waiving participation in the basic |
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coverage plan and instead electing participation in the state |
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consumer-directed health plan. |
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(b) For purposes of this chapter, participation in the state |
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consumer-directed health plan is considered participation in the |
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group benefits program, and Sections 1551.301, 1551.303, 1551.305, |
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and 1551.306 apply to participation in the state consumer-directed |
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health plan in the same manner that those sections apply to the |
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basic coverage plan. |
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Sec. 1551.454. ACCOUNT ADMINISTRATOR. (a) The account |
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administrator selected to administer a health savings account |
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established under this subchapter must be a person: |
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(1) qualified to serve as trustee under Section |
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223(d)(1)(B), Internal Revenue Code of 1986, and the rules adopted |
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under that section; and |
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(2) experienced in administering health savings |
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accounts or other similar trust accounts. |
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(b) An account administrator is the fiduciary of a plan |
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enrollee who has a health savings account established under this |
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subchapter. |
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(c) Section 1551.056(b) does not apply to the account |
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administrator. |
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Sec. 1551.455. PARTICIPATION IN PROGRAM. (a) Each |
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individual eligible to participate in the basic coverage may choose |
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instead to participate in the state consumer-directed health plan |
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if the plan enrollee is an eligible individual under Section |
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223(c)(1), Internal Revenue Code of 1986. The dependents of a plan |
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enrollee may participate in the state consumer-directed health plan |
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in accordance with Section 1551.456. |
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(b) A plan enrollee must waive basic plan coverage to be |
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enrolled in a high deductible health plan. |
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(c) Participation in the state consumer-directed health |
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plan qualifies a plan enrollee to receive a contribution to a health |
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savings account under Section 1551.458. An individual who elects |
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not to participate in the plan is not eligible to receive a |
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contribution under that section. |
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(d) A plan enrollee is subject to Subchapter H in the same |
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manner as an individual who participates in the basic coverage |
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offered under the group benefits program. |
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(e) Under this section, the board of trustees has exclusive |
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authority to determine an individual's eligibility to participate |
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in the state consumer-directed health plan and may adopt rules |
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regarding eligibility to participate in the plan. |
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Sec. 1551.456. COVERAGE FOR DEPENDENTS; REQUIRED |
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CONTRIBUTIONS. (a) Subject to Subsection (d), a plan enrollee is |
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entitled to obtain for the enrollee's dependents coverage in the |
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state consumer-directed health plan in the manner determined by the |
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board of trustees. |
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(b) The plan enrollee shall make any required contribution |
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payments for the dependent coverage in the manner prescribed by the |
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board of trustees. |
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(c) Amounts contributed by a plan enrollee under this |
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section may be: |
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(1) used to pay the cost of coverage in the high |
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deductible health plan not paid by the state under Section |
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1551.458(b); or |
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(2) allocated by the board of trustees to an enrollee's |
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health savings account in the manner described by Section |
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1551.458(c). |
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(d) A covered dependent of a plan enrollee: |
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(1) is subject to Subchapter H in the same manner as a |
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dependent who is covered by the basic coverage offered under the |
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group benefits program; and |
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(2) must be a dependent for purposes of this chapter. |
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Sec. 1551.457. IDENTIFICATION CARDS FOR PLAN ENROLLEES. |
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(a) The board of trustees or the account administrator, as |
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applicable, shall issue to each plan enrollee an identification |
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card. |
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(b) The board of trustees or the account administrator, as |
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applicable, shall issue a duplicate identification card to each |
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plan enrollee's dependent for whom qualified medical expenses may |
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be paid out of a health savings account established under this |
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subchapter. |
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Sec. 1551.458. STATE CONTRIBUTION. (a) For each plan |
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enrollee, from the state contribution that would otherwise be made |
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for basic coverage for the enrollee, the state shall annually |
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contribute to a high deductible health plan provided under this |
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subchapter the amount that is necessary to pay the cost of coverage |
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under the high deductible health plan and does not exceed the amount |
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the state annually contributes for a full-time or part-time |
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employee, as applicable, who is covered by the basic coverage. |
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(b) For each plan enrollee's dependent covered under this |
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subchapter from the state contribution that would otherwise be made |
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for basic coverage for the dependent, the state shall annually |
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contribute to a high deductible health plan provided under this |
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subchapter the same percentage of the cost of coverage under the |
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high deductible health plan as the state annually contributes for |
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dependent coverage in the basic coverage. |
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(c) Before each plan year, the board of trustees may |
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determine how to allocate to an enrollee's health savings account |
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the portion, if any, of the state contribution that would otherwise |
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be made for basic coverage for the enrollee and that remains after |
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payment for coverage under Subsection (a) or (b). |
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(d) For a calendar year, the amount of any allocations made |
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under Subsection (c) and Section 1551.456(c)(2), in the aggregate, |
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may not exceed the sum of the monthly limitations imposed by federal |
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law for health savings accounts. |
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Sec. 1551.459. PLAN ENROLLEE CONTRIBUTIONS. (a) Each plan |
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enrollee, in accordance with Section 1551.305, shall contribute any |
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amount required to cover the selected participation in the high |
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deductible health plan that exceeds the state contribution amount |
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under Section 1551.458. |
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(b) A plan enrollee may contribute any amount allowed under |
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federal law to the enrollee's health savings account in addition to |
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receiving an allocation of the state contribution under Section |
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1551.458. |
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(c) A plan enrollee shall make contributions under this |
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section in the manner prescribed by the board of trustees. |
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Sec. 1551.460. COORDINATION WITH CAFETERIA PLAN. (a) The |
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board of trustees has exclusive authority to determine the |
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eligibility of a plan enrollee to participate in any flexible |
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spending account that is part of a cafeteria plan offered under this |
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chapter. |
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(b) The board of trustees may adopt rules regarding the |
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eligibility of a plan enrollee to participate in any flexible |
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spending account that is part of a cafeteria plan offered under this |
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chapter. |
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(c) A plan enrollee may not participate in any flexible |
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spending account that would disqualify the enrollee's health |
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savings account from favorable tax treatment under federal law. |
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Sec. 1551.461. CONFIDENTIALITY OF RECORDS. To the extent |
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allowed under federal law and subject to Section 1551.063, the |
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board of trustees or the account administrator, as applicable, may |
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disclose to a carrier information in an individual's records that |
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the board of trustees or administrator determines is necessary to |
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administer the state consumer-directed health plan. |
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Sec. 1551.462. EXEMPTION FROM EXECUTION; UNASSIGNABILITY. |
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A state contribution to a health savings account or a high |
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deductible health plan is exempt from execution and is unassignable |
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in the same manner and to the same extent as is an amount described |
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by Section 1551.011. |
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Sec. 1551.463. ASSISTANCE. Any state agency that the board |
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of trustees considers appropriate shall assist the board in |
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implementing and administering this subchapter. |
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Sec. 1551.464. EXPIRATION. This subchapter expires |
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September 1, 2019. |
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SECTION 2. The Employees Retirement System of Texas shall |
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develop the state consumer-directed health plan to be implemented |
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under Chapter 1551, Insurance Code, as amended by this Act, |
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including enrollment requirements, during the state fiscal |
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biennium beginning September 1, 2013, with coverage beginning |
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September 1, 2014. |
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SECTION 3. Not later than July 31, 2014, the Employees |
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Retirement System of Texas shall provide written information to |
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individuals eligible to participate in the state consumer-directed |
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health plan under Chapter 1551, Insurance Code, as amended by this |
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Act, that provides a general description of the requirements for |
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the plan as adopted under Chapter 1551, Insurance Code, as amended |
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by this Act. |
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SECTION 4. The Employees Retirement System of Texas shall |
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develop and implement the health savings account program under |
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Chapter 1551, Insurance Code, as amended by this Act, in a manner |
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that is as revenue neutral as is possible. |
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SECTION 5. (a) Not later than January 1, 2019, the board of |
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trustees of the Employees Retirement System of Texas shall submit a |
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report to the governor, lieutenant governor, speaker of the house |
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of representatives, and Legislative Budget Board concerning: |
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(1) the manner in which, and the level at which, plan |
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enrollees use the coverage provided under the state |
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consumer-directed health plan established under Subchapter J, |
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Chapter 1551, Insurance Code, as added by this Act; |
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(2) whether the coverage provided under the state |
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consumer-directed health plan established under Subchapter J, |
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Chapter 1551, Insurance Code, as added by this Act, is more or less |
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cost-effective for plan enrollees and the state than the coverage |
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provided under the basic coverage plan under Chapter 1551, |
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Insurance Code; and |
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(3) whether continuation of the state |
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consumer-directed health plan established under Subchapter J, |
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Chapter 1551, Insurance Code, as added by this Act, is feasible or |
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desirable. |
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(b) The report required by this section may be submitted |
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separately from, or included in, the annual report that is required |
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under Section 1551.061, Insurance Code, and is submitted closest to |
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January 1, 2019. |
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SECTION 6. It is the intent of the legislature that in |
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implementing an optional consumer-directed health plan, the |
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Employees Retirement System of Texas may not divide the self-funded |
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risk pool of the state employees group benefits program provided |
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under Chapter 1551, Insurance Code. |
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SECTION 7. This Act takes effect September 1, 2013. |