Tex. Codes » Insurance Code · TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES · SUBTITLE H. HEALTH BENEFITS AND OTHER COVERAGES FOR GOVERNMENTAL EMPLOYEES · CHAPTER 1551. TEXAS EMPLOYEES GROUP BENEFITS ACT
Texas Codes

Tex. Ins. Code § 1551.003 (2026)

General Definitions

✓ current as of May 2026
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Sec. 1551.003. GENERAL DEFINITIONS. In this chapter:

(1) "Administering firm" means a firm designated by the board of trustees to administer coverages, services, benefits, or requirements in accordance with this chapter and the rules adopted by the board of trustees under this chapter.

(2) "Annuitant" means an individual eligible to participate in the group benefits program under Section 1551.102.

(3) "Basic coverage" means the group coverage plans determined by the board of trustees in which each eligible full-time employee and annuitant participates automatically unless participation is specifically waived.

(4) "Board of trustees" means the board of trustees established under Chapter 815, Government Code, to administer the Employees Retirement System of Texas.

(5) "Cafeteria plan" means a plan defined and authorized by Section 125, Internal Revenue Code of 1986.

(6) "Employee" means an individual eligible to participate in the group benefits program under Section 1551.101.

(7) "Employer" means this state and its agencies.

(8) "Executive director" means the executive director of the Employees Retirement System of Texas.

(9) "Full-time employee" means an employee designated as a full-time employee under Section 1551.319(c) or (d) or an employee designated by the employer as working 30 or more hours a week.

(9-a) "Good cause" means that a person's failure to act was not because of a lack of due diligence the exercise of which would have caused a reasonable person to take prompt and timely action. A failure to act based on ignorance of the law or facts reasonably discoverable through the exercise of due diligence does not constitute good cause.

(10) "Group benefits program" means the state employees group benefits program provided by this chapter.

(10-a) "Participant" means an eligible individual who participates in the group benefits program.

(11) "Part-time employee" means an employee designated by the employer as working less than 30 hours a week. For purposes of this chapter, an individual described by Section 1551.101(e)(2) is considered a part-time employee.

(12) "Serious mental illness" has the meaning assigned by Section 1355.001.

(13) "Service" means personal service to the state creditable in accordance with rules adopted by the board of trustees.

(14) "State agency" means a commission, board, department, division, institution of higher education, or other agency of this state created by the constitution or statutes of this state. The term also includes the Texas Municipal Retirement System and the Texas County and District Retirement System.

(15) "Usual and customary rate" means the relevant allowable amount as described by the applicable master benefit plan document or policy.

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 3, eff. June 1, 2003. Amended by Acts 2003, 78th Leg., ch. 366, Sec. 2.01, eff. Sept. 1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch. 347 (S.B. 1176), Sec. 24, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.018, eff. April 1, 2009.

Acts 2009, 81st Leg., R.S., Ch. 1308 (H.B. 2559), Sec. 31, eff. September 1, 2009.

Acts 2013, 83rd Leg., R.S., Ch. 618 (S.B. 1459), Sec. 21, eff. September 1, 2013.

Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.10, eff. September 1, 2019.

Notes of Decisions
Cited in 6 cases (1 in the last 5 years), 2008–2022 · leading case: Brushy Creek Fam. Hosp., LLC v. Blue Cross & Blue Shield of Texas (W.D. Tex. 2022).
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Brushy Creek Fam. Hosp., LLC v. Blue Cross & Blue Shield of Texas (W.D. Tex. 2022). “155(b), but the 2019 amendment discussed above added a definition of that term as “the relevant allowable amount as described by the applicable master benefit plan document or policy” to several other chapters of the Texas Insurance Code. TEX. INS. CODE § 1551.”
Est. of Mitchell Van Meter (Tex. App. 2009). “Furthermore, courts of appeals have held that under section 245, attorney’s fees are assessed against a personal representative of an estate when the representative is removed for cause or in an action to obtain the representative’s compliance with a statutory duty because it…”
Stephen Maughan, as Guardian for Robert D. Maughan & Chris L. Maughan v. Employees Ret. Sys. of Texas (Tex. App. 2008). “Plaintiff has not been diligent in the prosecution of his suit as required under Tex. R. Civ.”
Daniel J. Peterson, D/B/A Chiarello Investments, D/B/A Home Equity lending.com v. Cnty. Line, Inc. James Houchins & Greg A. Weithoner (Tex. App. 2008). “Through his proffered argument and evidence, Plaintiff failed to show good cause for the delay as provided under Tex. Ins. Code § 1551.003(9-a).3 On August 17, 2007, Maughan filed a motion to reinstate.”
Untitled Texas Attorney Gen. Opinion (Tex. Att'y Gen. 2008). “GOV'T CODE ANN. §§ 811.001(7) (Vernon Supp. 2007) (including cafeteria plan within definition of"compensation"), 851.”
Texas Cnty. & Dist. Ret. Sys. v. Wexford Spectrum Fund, L.P., 953 F. Supp. 2d 726 (W.D. Tex. 2013). “Tex. Ins.Code § 1551.003(14); 34 Tex. Admin.”
Tex. Ins. Code § 1551.003(14): 1 case
Texas Cnty. & Dist. Ret. Sys. v. Wexford Spectrum Fund, L.P., 953 F. Supp. 2d 726 (W.D. Tex. 2013). “Tex. Ins.Code § 1551.003(14); 34 Tex. Admin.”
Tex. Ins. Code § 1551.003(15): 1 case
Brushy Creek Fam. Hosp., LLC v. Blue Cross & Blue Shield of Texas (W.D. Tex. 2022). “155(b), but the 2019 amendment discussed above added a definition of that term as “the relevant allowable amount as described by the applicable master benefit plan document or policy” to several other chapters of the Texas Insurance Code. TEX. INS. CODE § 1551.”
Tex. Ins. Code § 1551.003(5): 1 case
Untitled Texas Attorney Gen. Opinion (Tex. Att'y Gen. 2008). “GOV'T CODE ANN. §§ 811.001(7) (Vernon Supp. 2007) (including cafeteria plan within definition of"compensation"), 851.”
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