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Chapter 1579

Texas School Employees Uniform Group Health Coverage

Subchapter A. General Provisions

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

Subchapter B. Administration

1579.051 Administration of Group Program 1579.052 Authority to Adopt Rules; Other Authority 1579.053 Personnel 1579.054 Competitive Bidding Requirements; Rules 1579.055 Contract Award; Considerations 1579.057 Pharmacy Benefit Manager Contracts

Subchapter C. Coverages

1579.101 Plans of Group Coverages 1579.102 Catastrophic Care Coverage Plan 1579.104 Optional Coverages 1579.1045 Alternative Group Health Coverage Prohibited 1579.105 Preexisting Condition Limitation 1579.106 Prior Authorization for Certain Drugs 1579.1061 Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services 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

Subchapter D. Participating Entities

1579.151 Required Participation of School Districts with 500 or Fewer Employees 1579.152 Participation of Other School Districts 1579.153 Participation by Certain Risk Pools 1579.154 Participation by Charter Schools; Eligibility 1579.155 Program Participation: Election 1579.1551 Program Participation by Certain Entities

Subchapter E. Participation by Employee

1579.201 Definition 1579.202 Eligible Employees 1579.203 Selection of Coverage 1579.204 Certain Part-Time Employees 1579.205 Payment by Participating Entity

Subchapter F. Contributions

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

Subchapter G. Texas School Employees Uniform Group Coverage Trust Fund

1579.301 Fund; Administration 1579.302 Composition of Fund 1579.303 Payments from Fund 1579.304 Investment of Fund