Untitled Texas Attorney General Opinion

P

THE ATTORSEY GENERAL
OF TEXAS

July 10, 1987

Mr. Kenneth H. Ashworth opinion No. m-744
commissioner
Coordinating Board Re: Whether an institution of higher
Texas College and University education is required to consider
System applications from all health main-
P. 0. Box 12788 tenance organizations in determining
Austin, Texas 78711 what coverage to offer its employees

Dear Mr. Ashworth:

You ask about the proper interpretation of certain language
contained in provisions of the Texas State College and University
Employees Uniform Insurance Benefits Act, codified as article 3.50-3
of the Insurance Code. Your request concerns the. methods to be
employed in selecting Health Maintenance Organizations (HMOS) to
provide health-care services to eligible public college and university
employees and retirees. Specifically, YOU note that section
4(b)(4)(D)(iv) of article 3.50-3 requires public colleges and
universities to offer to their employees the option of participating
in an HMO in lieu of the more traditional types of health insurance
offered pursuant to the act.

The relevant section of the act states:

The institution shall select and contract for
services performed by health maintenance organiza-
tions that are approved by the federal government,
if available, or by the State of Texas, if avail-
able, to offer health-care services to eligible
employees and retired persons in a specific area
of the state. Eligible employees and retired
persons may participate in a selected health
maintenance organization in lieu of participation
in the health insurance benefits under this Act,
and the employer contributions provided by Section
13 of this Act for health-care coverage shall be
paid to the selected health maintenance organiza-
tions on behalf of the participants. A health
maintenance organization that has been approved to
provide health-care services to employees and
retired persons of the state under the Texas

p. 3461
Mr. Kenneth H. Ashworth - Page 2 (~~-744)

Employees Uniform Group Insurance Benefits Act
(Article 3.50-2, Vernon's Texas Insurance Code) is
qualified upon proper application to the institu-
tion to provide similar services to eligible
employees and retired persons of any institution
or agency under this Act located in the same area
of the state. More stringent requirements may not
be imposed on health maintenance organizations
under this Act than are imposed by the state or by
the federal government. (Emphasis added).

Ins. Code art. 3.50-3. §4(b)(4)(D)(iv).

You ask whether the section requires an institution to consider
applications from all EM08 approved by the state or federal
governments rather thx just those that have been approved to provide
health-care services pursuant to the Texas Employees Group Insurance
Benefits Act to state employees and retirees of agencies other than
agencies of higher education. Ins. Code art. 3.50-2.

This statutory provision is unambiguous. In such a case, we do
not refer to the canons of statutory construction to determine the
intent of the legislature; rather, it is our duty merely to read the
plain language of the statute. Board of Insurance Commissioners of
Texas v. Guardian Life Insurance Co.. 180 S.W.2d 906 (Tex. 1944); Mrs.
Tucker's Foods, Inc. v. Calvert. 296 S.W.2d 787 (Tex. Civ. App.
Austin 1956, writ ref'd n.r.e.); 53 Tex. Jur. 2d Statutes $123 (1964).
The only possible construction of section 4(b)(4)(D)(iv) requires an
institution to consider applications from HMOs that are approved by
state or federal governments to offer services in Texas. An
institution may obtain a list of such approved BMOs from the Insurance
Board. Ins. Code art. 3.50-3, §4(D)(i). An HMO need not also be
approved to offer services to state employees, other than those who
work for public colleges and universities, in order to be eligible to
compete to offer services to public college and university employees,
although the statute clearly contemplates that such EMOs may submit
applications to offer services to public college and university
employees.

You also ask whether an institution must contract with all
approved BMOs that make application to provide service, or whether the
institution can select from among the eligible applicants.

p. 3462
Mr. Kenneth H. Ashworth - Page 3 (JM-744)

The plain meaning of the statute is evident on this point also:
"The institution shall select and contract for services performed by
health maintenance organizations that are approved. , . ." Ins. Code
art. 3.50-3, §4(b)(4)(D)(i"). "Select" means to "choose from a
number or group by fitness, excellence, or other distinguishing
characteristics." Webster's Third New International Dictionary 2058
(1961). The statute specifies that a competitive bidding process will
be used to determine which provider should be chosen to provide health
care services. Ins. Code art. 3.50-3, §4(b)(4)(D)(i-iii) (with the
exception of BMOs already approved to offer services to state
employees outside of higher education). If the statute required that
all applications from approved BMO providers be accepted, then the
statutory specification of a competitive bidding process would be
pointless.

SUMMARY

The Texas State College and University
Employees Uniform Insurance Benefits Act, article
3.50-3 of the Insurance Code, requires an
institution or agency subject to its provisions to
consider applications to provide health care
service from all health maintenance organizations
approved by the state or federal governments.

JIM MATTOX
Attorney General of Texas

WARY KELLER
Executive Assistant Attorney General

JUDGE ZOLLIE STEAKLEY
Special Assistant Attorney General

RICK GILPIN
Chairman, Opinion Committee

Prepared by Don Bustion
Assistant Attorney General

p. 3463