Tex. Ins. Code Section 1579.002
General Definitions


In this chapter:

(1)

“Administering firm” means any entity designated by the trustee to administer any coverages, services, benefits, or requirements under this chapter and the trustee’s rules adopted under this chapter.

(2)

“Trustee” means the Teacher Retirement System of Texas.

(3)

“Charter school” means an open-enrollment charter school established under Subchapter D (Authorization), Chapter 12 (Charters), Education Code.

(4)

“Health coverage plan” means any group policy or contract, hospital service agreement, health maintenance organization agreement, preferred provider arrangement, or any similar group arrangement or any combination of those policies, contracts, agreements, or arrangements that provides for, pays for, or reimburses expenses for health care services.

(5)

“Participating entity” means an entity participating in the uniform group coverage program established under this chapter. The term includes:

(A)

a school district;

(B)

another educational district whose employees are members of the Teacher Retirement System of Texas;

(C)

a regional education service center; and

(D)

a charter school that meets the requirements of Section 1579.154 (Participation by Charter Schools; Eligibility).

(6)

“Program” means the uniform group coverage program established under this chapter.

(7)

“Regional education service center” means a regional education service center established under Chapter 8 (Regional Education Service Centers), Education Code.

(8)

“Usual and customary rate” means the relevant allowable amount as described by the applicable master benefit plan document or policy.
Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.471(a), eff. Sept. 1, 2003.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.16, eff. September 1, 2019.

Source: Section 1579.002 — General Definitions, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1579.­htm#1579.­002 (accessed May 11, 2024).

1579.001
Short Title
1579.002
General Definitions
1579.003
Definition of Employee
1579.004
Definition of Dependent
1579.005
Confidentiality
1579.006
Exemption from Process
1579.007
Exemption from State Taxes and Fees
1579.008
Coverage Exempt from Insurance Law
1579.009
Balance Billing Prohibition Notice
1579.010
Information Regarding Appeals
1579.051
Administration of Group Program
1579.052
Authority to Adopt Rules
1579.053
Personnel
1579.054
Competitive Bidding Requirements
1579.055
Contract Award
1579.057
Pharmacy Benefit Manager Contracts
1579.101
Plans of Group Coverages
1579.102
Catastrophic Care Coverage Plan
1579.104
Optional Coverages
1579.105
Preexisting Condition Limitation
1579.106
Prior Authorization for Certain Drugs
1579.107
Disease Management Services
1579.108
Limitations
1579.109
Emergency Care Payments
1579.110
Out-of-network Facility-based Provider Payments
1579.111
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider Payments
1579.112
Out-of-network Emergency Medical Services Provider Payments
1579.152
Participation of Other School Districts
1579.153
Participation by Certain Risk Pools
1579.154
Participation by Charter Schools
1579.155
Program Participation: Election
1579.201
Definition
1579.202
Eligible Employees
1579.203
Selection of Coverage
1579.204
Certain Part-time Employees
1579.205
Payment by Participating Entity
1579.251
State Assistance
1579.252
Contribution by Participating Entities
1579.253
Contribution by Employee
1579.254
Contributions Held in Trust for Fund
1579.255
Interest Assessed on Late Payment of Contributions by Participating Entities
1579.301
Fund
1579.302
Composition of Fund
1579.303
Payments from Fund
1579.304
Investment of Fund
1579.1045
Alternative Group Health Coverage Prohibited
1579.1061
Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services

Accessed:
May 11, 2024

§ 1579.002’s source at texas​.gov