|(a) The health benefits program offered under the Texas School Employees Uniform Group Health Coverage Act may include separate contracts for: (1) health benefit plan; (2) prescription drug provider; (3) administrative services; (4) utilization review; and (5) ancillary services. (b) Except for health maintenance organizations, which must meet other requirements in this section, to be eligible to bid on health benefit services or products, prescription drugs or administrative services, a bidder must have: (1) annual health benefit premiums or services or product income of at least $1 billion; and (2) currently be servicing at least twice as many persons as will be covered under this program as determined by TRS. (c) TRS may approve a health maintenance organization (HMO) to offer a health benefit plan to participants in TRS-ActiveCare. In order to be eligible to bid, an HMO must satisfy all of the following conditions: (1) The HMO must hold a valid certificate of authority issued by the Texas Department of Insurance to operate in the State of Texas. (2) The HMO must have been providing services in the applicable service area for at least 12 months prior to the date the bid response is due to be filed with TRS. Also, the HMO must demonstrate the capacity to provide adequate services, as determined by TRS, to the program participants. (3) The HMO must submit a responsive bid, with rates, to TRS within the timeframe and in the manner and format prescribed by TRS. Once adopted by TRS, the rates and benefit may not be modified during a plan year without the prior written approval of TRS. A request for expansion to a non-contiguous service area shall require a separate responsive bid and approval by TRS. (4) Any other criteria established by TRS. (d) TRS shall use a competitive bidding process to approve one or more HMOs to offer a health benefit plan to TRS-ActiveCare participants in areas of the state determined by TRS. TRS may establish, for different areas of the state, different criteria for HMOs to qualify to bid. TRS may at any time establish or change the number, if any, of HMOs to approve in each area. If TRS elects to request bids for such plans, TRS will establish: (1) the criteria to be used to approve HMOs; (2) the length and terms of the contracts with approved HMOs; and (3) other matters at the discretion of TRS.
|Source Note: The provisions of this §41.31 adopted to be effective November 5, 2001, 26 TexReg 8850; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective March 8, 2007, 32 TexReg 1092