Can a Texas school district run an on-site health clinic for its employees alongside TRS coverage?

Plain-English summary

The Harris County Department of Education wanted to set up an on-site health clinic where its employees could get care, on top of the health insurance they already had through the Teacher Retirement System (TRS). The catch was a statute, Education Code subsection 22.004(i), that bars a district participating in the statewide uniform group coverage program from making "group health coverage" available to its employees once that program is running. The county asked the Attorney General whether opening the clinic would break that rule.

The whole question turned on what "group health coverage" means, since the Education Code does not define it. The Attorney General used the ordinary meaning: "coverage" refers to the inclusion of a risk under an insurance policy. A clinic is not an insurance policy. The clinic the Department described would deliver healthcare directly to employees, as an optional service that supplements their existing options, rather than provide a second layer of insurance. Providing care is not the same as providing coverage.

On that reasoning, the Attorney General concluded the on-site clinic, as described, would not be "group health coverage" and so would not run afoul of subsection 22.004(i). One important limit: the request only asked about section 22.004, so the opinion addressed only compliance with that section. It did not decide the separate question of whether the Department has general legal authority to operate a clinic at all.

Currency note

This opinion was issued in 2011. Subsequent statutory amendments, court decisions, or later Attorney General opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

What the opinion meant for those who asked

School districts and the Department (as the opinion held for them): The opinion told them that running an on-site clinic offering optional, direct healthcare services to employees does not amount to making "group health coverage" available, so section 22.004(i) does not prohibit it. The opinion did not, however, confirm any general authority to operate a clinic.

Public employees (as the opinion described it): Under the opinion, a clinic of this kind supplements employees' available healthcare options as a direct service, which the opinion distinguished from supplemental health insurance coverage.

On the limit of the opinion (what the AG did not reach): Because the county framed the question solely around section 22.004, the opinion confined itself to that section and did not evaluate whether the Department had general authority to operate the clinic.

Common questions

Does an on-site clinic count as "group health coverage" under the statute?
No. The opinion concluded that a clinic providing optional, direct healthcare services does not meet the definition of group health coverage under subsection 22.004(i).

Why isn't a clinic the same as coverage?
The opinion used the ordinary meaning of "coverage," the inclusion of a risk under an insurance policy, and reasoned that a clinic provides healthcare itself, not healthcare insurance.

Can the district run the clinic and keep TRS insurance?
Based on the opinion, operating the clinic does not implicate subsection 22.004(i), which is the only provision the opinion analyzed; the district's TRS participation is separate.

Did the opinion confirm the Department can legally operate a clinic at all?
No. The opinion limited itself to section 22.004 and did not evaluate the Department's general authority to operate an on-site clinic.

Background and statutory framework

Education Code subsection 22.004(a) requires school districts to participate in the uniform group coverage program established under Insurance Code Chapter 1579, which the Department satisfies through the Teacher Retirement System's health benefit programs. Tex. Educ. Code Ann. § 22.004(a) (West Supp. 2010); Tex. Ins. Code Ann. ch. 1579. Subsection 22.004(i) provides that a district participating in that program may not make group health coverage available to its employees under the section after the Chapter 1579 program is implemented. Tex. Educ. Code Ann. § 22.004(i) (West Supp. 2010).

Because the Education Code does not define "group health coverage," the opinion looked to plain meaning, treating "coverage" as the inclusion of a risk under an insurance policy. Fitzgerald v. Advanced Spine Fixation Sys., Inc., 996 S.W.2d 864, 865 (Tex. 1999). A clinic providing direct care delivers healthcare itself rather than healthcare coverage, so the opinion concluded the described clinic does not fall within subsection 22.004(i).

Citations

Statutes:

• Tex. Educ. Code Ann. § 22.004(a) (West Supp. 2010)
• Tex. Educ. Code Ann. § 22.004(i) (West Supp. 2010)
• Tex. Ins. Code Ann. ch. 1579

Cases:

• Fitzgerald v. Advanced Spine Fixation Sys., Inc., 996 S.W.2d 864, 865 (Tex. 1999)

Source

• Landing page: https://www.texasattorneygeneral.gov/opinions/greg-abbott/ga-0854
• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/2011/ga0854.pdf

Original opinion text

Best-effort transcription from the official PDF. Minor extraction artifacts were corrected; the linked PDF is authoritative.

ATTORNEY GENERAL OF TEXAS
GREG ABBOTT

April 1, 2011

The Honorable Vince Ryan Opinion No. GA-0854
Harris County Attorney
1019 Congress, 15th Floor Re: Authority of the Harris County Department of
Houston, Texas 77002 Education to operate an on-site health clinic for its
employees (RQ-0928-GA)

Dear Mr. Ryan:

On behalf of the Harris County Department of Education (the "Department"), you ask whether a school district may "provide an on-site health clinic to its employees" without violating Education Code subsection 22.004(i).[1] At the outset, we note that you limit your request to section 22.004. As a result, we constrain our analysis to the Department's compliance with that section and do not evaluate whether the Department has general authority to operate an on-site clinic.

Education Code subsection 22.004(a) provides that school districts "shall participate in the uniform group coverage program established under Chapter 1579, Insurance Code." TEX. EDUC. CODE ANN. § 22.004(a) (West Supp. 2010). You tell us that pursuant to this provision, the Department participates in the Teacher Retirement System's ("TRS") health benefit programs. See Request Letter, supra note 1, at 1-2. Education Code subsection 22.004(i) provides:

Notwithstanding any other provision of this section, a district participating in the uniform group coverage program established under Chapter 1579, Insurance Code, may not make group health coverage available to its employees under this section after the date on which the program of coverages under Chapter 1579, Insurance Code, is implemented.

TEX. EDUC. CODE ANN. § 22.004(i) (West Supp. 2010). You explain that in addition to participating in the TRS program, the Department "desires to offer an on-site health clinic to its employees," which "would be an optional, available service for employees to use if they so desire." Id. at 2. The Department "does not intend for its health clinic to replace or circumvent the TRS health coverage program but rather, merely supplement employees' available healthcare options." Id. You ask whether the District may operate the on-site health clinic without violating subsection 22.004(i). Request Letter, supra note 1, at 1. Your question requires us to determine whether the on-site health clinic would be considered "group health coverage" under the statute.

The phrase "group health coverage" is not defined in the Education Code. When a word is not defined by statute, we look to its plain meaning, beginning with the commonly understood definition. See Fitzgerald v. Advanced Spine Fixation Sys., Inc., 996 S.W.2d 864, 865 (Tex. 1999). The common understanding of "coverage" is the "inclusion of a risk under an insurance policy." BLACK'S LAW DICTIONARY 422 (9th ed. 2009); see also AMERICAN HERITAGE COLLEGE DICTIONARY 329 (4th ed. 2002) (defining "coverage" to mean "inclusion in an insurance policy"). It does not include the separate operation of a clinic. The clinic, as you describe it, would provide direct care to employees. Such a clinic would provide healthcare itself, not healthcare coverage. As you describe it, the clinic would "supplement employees' available healthcare options," which is distinct from supplemental healthcare insurance coverage. Request Letter, supra note 1, at 2. Based on the facts described in the letter, the operation of an on-site clinic that provides optional health care services to employees does not meet the definition of group health coverage under subsection 22.004(i).

SUMMARY

By operating an on-site healthcare clinic, the Harris County Department of Education does not propose to offer healthcare insurance, but rather it proposes to provide optional healthcare services to its employees. Offering direct healthcare services does not implicate Education Code subsection 22.004(i), which prohibits districts from offering group healthcare coverage.

Very truly yours,

DANIEL T. HODGE
First Assistant Attorney General

DAVID J. SCHENCK
Deputy Attorney General for Legal Counsel

JASON BOATRIGHT
Chair, Opinion Committee

Virginia K. Hoelscher
Assistant Attorney General, Opinion Committee

[1] Letter from Honorable Vince Ryan, Harris County Attorney, to Honorable Greg Abbott, Attorney General of Texas at 1 (Oct. 26, 2010) (on file with the Opinion Committee, also available at http://www.texasattorneygeneral.gov) [hereinafter Request Letter].