US (United States) Code. Title 5. Parte III. Subpart G: Insurance and Annuties. Chapter 89: Health insurance

Codificación normativa de EEUU (Estados Unidos). Legislación federal estadounidense # Government organization and employees

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-CITE-

5 USC CHAPTER 89 - HEALTH INSURANCE 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

.

-HEAD-

CHAPTER 89 - HEALTH INSURANCE

-MISC1-

Sec.

8901. Definitions.

8902. Contracting authority.

8902a. Debarment and other sanctions.

8903. Health benefits plans.

8903a. Additional health benefits plans.

8903b. Authority to readmit an employee organization plan.

8904. Types of benefits.

8905. Election of coverage.

8905a. Continued coverage.

8906. Contributions.

8906a. Temporary employees.

8907. Information to individuals eligible to enroll.

8908. Coverage of restored employees and survivor or disability

annuitants.

8909. Employees Health Benefits Fund.

8910. Studies, reports, and audits.

8911. Advisory committee.

8912. Jurisdiction of courts.

8913. Regulations.

8914. Effect of other statutes.

AMENDMENTS

1998 - Pub. L. 105-266, Sec. 6(a)(2), Oct. 19, 1998, 112 Stat.

2369, added item 8903b.

1988 - Pub. L. 100-654, title I, Sec. 101(b), title II, Sec.

201(a)(2), title III, Sec. 301(b), Nov. 14, 1988, 102 Stat. 3841,

3845, 3846, added items 8902a, 8905a, and 8906a.

Pub. L. 100-238, title I, Sec. 108(a)(3)(B), Jan. 8, 1988, 101

Stat. 1748, added item 8914.

1985 - Pub. L. 99-53, Sec. 1(b)(2), 3(a)(2)(B), June 17, 1985, 99

Stat. 94, 95, added item 8903a and inserted ''or disability'' after

''and survivor'' in item 8908.

1984 - Pub. L. 98-615, Sec. 3(8), Nov. 8, 1984, 98 Stat. 3204,

substituted ''Information to individuals eligible to enroll'' for

''Information to employees'' in item 8907.

1976 - Pub. L. 94-342, Sec. 1(b), July 6, 1976, 90 Stat. 808,

substituted ''employees and survivor annuitants'' for ''employee''

in item 8908.

-SECREF-

CHAPTER REFERRED TO IN OTHER SECTIONS

This chapter is referred to in sections 3373, 3374, 3582, 6386 of

this title; title 2 sections 31b-5, 72a, 92, 130a, 162b, 2063;

title 10 section 1108; title 22 sections 2391, 3649, 3664, 4069c,

4069c-1, 4606, 7002; title 25 section 450i; title 26 sections 35,

9801; title 28 sections 179, 332, 627, 634, 996; title 29 sections

1181, 2918; title 39 section 1005; title 42 sections 300e-1,

300e-6, 300gg, 426a, 1320a-7b, 1320d, 1395w-21, 1395y, 2996d,

10704, 14402; title 45 section 1206; title 49 section 40122; title

50 section 403p.

-CITE-

5 USC Sec. 8901 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8901. Definitions

-STATUTE-

For the purpose of this chapter -

(1) ''employee'' means -

(A) an employee as defined by section 2105 of this title;

(B) a Member of Congress as defined by section 2106 of this

title;

(C) a Congressional employee as defined by section 2107 of

this title;

(D) the President;

(E) an individual first employed by the government of the

District of Columbia before October 1, 1987;

(F) an individual employed by Gallaudet College; (FOOTNOTE 1)

(FOOTNOTE 1) See Change of Name note below.

(G) an individual employed by a county committee established

under section 590h(b) of title 16;

(H) an individual appointed to a position on the office staff

of a former President under section 1(b) of the Act of August

25, 1958 (72 Stat. 838); and

(I) an individual appointed to a position on the office staff

of a former President, or a former Vice President under section

4 of the Presidential Transition Act of 1963, as amended (78

Stat. 153), who immediately before the date of such appointment

was an employee as defined under any other subparagraph of this

paragraph;

but does not include -

(i) an employee of a corporation supervised by the Farm

Credit Administration if private interests elect or appoint a

member of the board of directors;

(ii) an individual who is not a citizen or national of the

United States and whose permanent duty station is outside the

United States, unless the individual was an employee for the

purpose of this chapter on September 30, 1979, by reason of

service in an Executive agency, the United States Postal

Service, or the Smithsonian Institution in the area which was

then known as the Canal Zone;

(iii) an employee of the Tennessee Valley Authority; or

(iv) an employee excluded by regulation of the Office of

Personnel Management under section 8913(b) of this title;

(2) ''Government'' means the Government of the United States

and the government of the District of Columbia;

(3) ''annuitant'' means -

(A) an employee who retires -

(i) on an immediate annuity under subchapter III of chapter

83 of this title, or another retirement system for employees

of the Government, after 5 or more years of service;

(ii) under section 8412 or 8414 of this title;

(iii) for disability under subchapter III of chapter 83 of

this title, chapter 84 of this title, or another retirement

system for employees of the Government; or

(iv) on an immediate annuity under a retirement system

established for employees described in section 2105(c), in

the case of an individual who elected under section

8347(q)(2) or 8461(n)(2) to remain subject to such a system;

(B) a member of a family who receives an immediate annuity as

the survivor of an employee (including a family member entitled

to an amount under section 8442(b)(1)(A), whether or not such

family member is entitled to an annuity under section

8442(b)(1)(B)) or of a retired employee described by

subparagraph (A) of this paragraph;

(C) an employee who receives monthly compensation under

subchapter I of chapter 81 of this title and who is determined

by the Secretary of Labor to be unable to return to duty; and

(D) a member of a family who receives monthly compensation

under subchapter I of chapter 81 of this title as the surviving

beneficiary of -

(i) an employee who dies as a result of injury or illness

compensable under that subchapter; or

(ii) a former employee who is separated after having

completed 5 or more years of service and who dies while

receiving monthly compensation under that subchapter and who

has been held by the Secretary to have been unable to return

to duty;

(4) ''service'', as used by paragraph (3) of this section,

means service which is creditable under subchapter III of chapter

83 or chapter 84 of this title;

(5) ''member of family'' means the spouse of an employee or

annuitant and an unmarried dependent child under 22 years of age,

including -

(A) an adopted child or recognized natural child; and

(B) a stepchild or foster child but only if the child lives

with the employee or annuitant in a regular parent-child

relationship;

or such an unmarried dependent child regardless of age who is

incapable of self-support because of mental or physical

disability which existed before age 22;

(6) ''health benefits plan'' means a group insurance policy or

contract, medical or hospital service agreement, membership or

subscription contract, or similar group arrangements provided by

a carrier for the purpose of providing, paying for, or

reimbursing expenses for health services;

(7) ''carrier'' means a voluntary association, corporation,

partnership, or other nongovernmental organization which is

lawfully engaged in providing, paying for, or reimbursing the

cost of, health services under group insurance policies or

contracts, medical or hospital service agreements, membership or

subscription contracts, or similar group arrangements, in

consideration of premiums or other periodic charges payable to

the carrier, including a health benefits plan duly sponsored or

underwritten by an employee organization and an association of

organizations or other entities described in this paragraph

sponsoring a health benefits plan;

(8) ''employee organization'' means -

(A) an association or other organization of employees which

is national in scope, or in which membership is open to all

employees of a Government agency who are eligible to enroll in

a health benefits plan under this chapter and which, after

December 31, 1978, and before January 1, 1980, applied to the

Office for approval of a plan provided under section 8903(3) of

this title; and

(B) an association or other organization which is national in

scope, in which membership is open only to employees,

annuitants, or former spouses, or any combination thereof, and

which, during the 90-day period beginning on the date of

enactment of section 8903a of this title, applied to the Office

for approval of a plan provided under such section;

(9) ''dependent'', in the case of any child, means that the

employee or annuitant involved is either living with or

contributing to the support of such child, as determined in

accordance with such regulations as the Office shall prescribe;

(10) ''former spouse'' means a former spouse of an employee,

former employee, or annuitant -

(A) who has not remarried before age 55 after the marriage to

the employee, former employee, or annuitant was dissolved,

(B) who was enrolled in an approved health benefits plan

under this chapter as a family member at any time during the

18-month period before the date of the dissolution of the

marriage to the employee, former employee, or annuitant, and

(C)(i) who is receiving any portion of an annuity under

section 8345(j) or 8467 of this title or a survivor annuity

under section 8341(h) or 8445 of this title (or benefits

similar to either of the aforementioned annuity benefits under

a retirement system for Government employees other than the

Civil Service Retirement System or the Federal Employees'

Retirement System),

(ii) as to whom a court order or decree referred to in

section 8341(h), 8345(j), 8445, or 8467 of this title (or

similar provision of law under any such retirement system other

than the Civil Service Retirement System or the Federal

Employees' Retirement System) has been issued, or for whom an

election has been made under section 8339(j)(3) or 8417(b) of

this title (or similar provision of law), or

(iii) who is otherwise entitled to an annuity or any portion

of an annuity as a former spouse under a retirement system for

Government employees,

except that such term shall not include any such unremarried

former spouse of a former employee whose marriage was dissolved

after the former employee's separation from the service (other

than by retirement); and

(11) ''qualified clinical social worker'' means an individual -

(A) who is licensed or certified as a clinical social worker

by the State in which such individual practices; or

(B) who, if such State does not provide for the licensing or

certification of clinical social workers -

(i) is certified by a national professional organization

offering certification of clinical social workers; or

(ii) meets equivalent requirements (as prescribed by the

Office).

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 600; Pub. L. 90-83, Sec.

1(95), Sept. 11, 1967, 81 Stat. 219; Pub. L. 91-418, Sec. 2, 3(b),

Sept. 25, 1970, 84 Stat. 869; Pub. L. 93-160, Sec. 1(b), Nov. 27,

1973, 87 Stat. 635; Pub. L. 95-368, Sec. 2, Sept. 17, 1978, 92

Stat. 606; Pub. L. 95-454, title IX, Sec. 906(a)(2), (3), Oct. 13,

1978, 92 Stat. 1224; Pub. L. 95-583, Sec. 2, Nov. 2, 1978, 92 Stat.

2482; Pub. L. 96-54, Sec. 2(a)(52), Aug. 14, 1979, 93 Stat. 384;

Pub. L. 96-70, title I, Sec. 1209(c), Sept. 27, 1979, 93 Stat. 463;

Pub. L. 96-179, Sec. 2, Jan. 2, 1980, 93 Stat. 1299; Pub. L.

98-615, Sec. 3(1), Nov. 8, 1984, 98 Stat. 3202; Pub. L. 99-53, Sec.

1(a), June 17, 1985, 99 Stat. 93; Pub. L. 99-251, title I, Sec.

105(a), Feb. 27, 1986, 100 Stat. 15; Pub. L. 99-335, title II, Sec.

207(l), June 6, 1986, 100 Stat. 598; Pub. L. 99-556, title V, Sec.

503, Oct. 27, 1986, 100 Stat. 3141; Pub. L. 100-679, Sec. 13(c),

Nov. 17, 1988, 102 Stat. 4071; Pub. L. 101-508, title VII, Sec.

7202(l), Nov. 5, 1990, 104 Stat. 1388-339; Pub. L. 102-378, Sec.

2(75), Oct. 2, 1992, 106 Stat. 1355; Pub. L. 105-266, Sec. 3(a),

Oct. 19, 1998, 112 Stat. 2366.)

-MISC1-

Historical and Revision Notes

1966 Act

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3001. Sept. 28, 1959, Pub.

L. 86-382, Sec. 2,

73 Stat. 709. July

8, 1963, Pub. L. 88-

59, Sec. 1, 77 Stat.

76.

Mar. 17, 1964, Pub.

L. 88-284, Sec.

1(1)-(4), 78 Stat.

164.

Aug. 31, 1964, Pub.

L. 88-531, Sec. 1,

78 Stat. 737.

5 U.S.C. 3002(f) July 1, 1960, Pub.

(1st sentence, less L. 86-568, Sec.

words between 1st 115(d) ''(f) (1st

and 2d commas). sentence, less

words between 1st

and 2d commas)'',

74 Stat. 303.

-------------------------------

The definition of ''employee'' in section 2105 of this title is

broad enough to cover the officers and employees covered by former

section 3001 with the exception of a Member of Congress, the

President, an individual employed by the government of the District

of Columbia, an individual employed by Gallaudet College, a United

States commissioner, and an Official Reporter of Debates of the

Senate and an individual employed by him. The first five have been

added in paragraphs (1)(B), (D), (E), (F), and (G). The latter are

covered by the definition of ''Congressional employee'' in section

2107 of this title and are included by the addition of a

Congressional employee in paragraph (1)(C).

In paragraph (1)(ii), the words ''the United States'' are

substituted for ''a State of the United States or the District of

Columbia''.

Paragraph (1)(iv) is added for clarity.

In paragraph (8), the words ''before January 1, 1964'' are

substituted for ''on or before December 31, 1963''.

The definition of ''Commission'' in former section 3001(h) is

omitted as unnecessary as the full title ''Civil Service

Commission'' is set forth the first time it is used in a section.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

1967 Act

---------------------------------------------------------------------

Section of title 5 Source (U.S. Code) Source (Statutes at

Large)

---------------------------------------------------------------------

8901(5) 5 App.: 3001(d). July 18, 1966, Pub.

L. 89-504, Sec.

601, 80 Stat. 303.

-------------------------------

-REFTEXT-

REFERENCES IN TEXT

Section 1(b) of the Act of August 25, 1958 (72 Stat. 838),

referred to in par. (1)(H), is section 1(b) of Pub. L. 85-745 which

is set out as a note under section 102 of Title 3, The President.

Section 4 of the Presidential Transition Act of 1963, referred to

in par. (1)(I), is section 4 of Pub. L. 88-277, which is set out as

a note under section 102 of Title 3.

The date of enactment of section 8903a of this title, referred to

in par. (8)(B), means the date of enactment of Pub. L. 99-53, which

enacted section 8903a and which was approved June 17, 1985.

-MISC2-

AMENDMENTS

1998 - Par. (7). Pub. L. 105-266 substituted ''organization and

an association of organizations or other entities described in this

paragraph sponsoring a health benefits plan;'' for

''organization;''.

1992 - Par. (3)(A)(iv). Pub. L. 102-378, Sec. 2(75)(A),

substituted ''8347(q)(2)'' for ''8347(p)(2)''.

Par. (10)(C)(ii). Pub. L. 102-378, Sec. 2(75)(B), inserted comma

after ''8341(h)''.

1990 - Par. (3)(A)(iv). Pub. L. 101-508 added cl. (iv).

1988 - Par. (1)(H), (I). Pub. L. 100-679 added subpars. (H) and

(I).

1986 - Par. (1)(E). Pub. L. 99-335, Sec. 207(l)(1), amended

subpar. (E) generally, substituting ''first employed'' for

''employed'' and inserting ''before October 1, 1987''.

Par. (3)(A). Pub. L. 99-335, Sec. 207(l)(2), amended subpar. (A)

generally. Prior to amendment, subpar. (A) read as follows: ''an

employee who retires on an immediate annuity under subchapter III

of chapter 83 of this title or another retirement system for

employees of the Government, after 5 or more years of service or

for disability''.

Par. (3)(B). Pub. L. 99-556 inserted ''(including a family member

entitled to an amount under section 8442(b)(1)(A), whether or not

such family member is entitled to an annuity under section

8442(b)(1)(B))''.

Par. (4). Pub. L. 99-335, Sec. 207(l)(3), inserted ''or chapter

84''.

Par. (10)(C)(i). Pub. L. 99-335, Sec. 207(l)(4), inserted ''or

8467'', ''or 8445'', and ''or the Federal Employees' Retirement

System''.

Par. (10)(C)(ii). Pub. L. 99-335, Sec. 207(l)(5), substituted

''8345(j), 8445, or 8467'' for ''or 8345(j)'' and inserted ''or the

Federal Employees' Retirement System'' and ''or 8417(b)''.

Par. (11). Pub. L. 99-251 added par. (11).

1985 - Par. (8). Pub. L. 99-53 amended par. (8) generally,

designating existing provisions as subpar. (A) and adding subpar.

(B).

1984 - Par. (10). Pub. L. 98-615 added par. (10).

1980 - Par. (5). Pub. L. 96-179, Sec. 2(1), inserted

''dependent'' after ''unmarried'' in provisions preceding subpar.

(A) and in provisions following subpar. (B), inserted ''or

recognized natural child'' after ''child'' in subpar. (A), and

substituted ''or foster child but only if the child;'' for '',

foster child, or recognized natural child who'' in subpar. (B).

Par. (9). Pub. L. 96-179, Sec. 2(2)-(4), added par. (9).

1979 - Par. (1). Pub. L. 96-70 in cl. (ii) substituted provisions

relating to an individual who was an employee for the purpose of

this chapter on Sept. 30, 1979, by reason of service in an

Executive agency, United States Postal Service, or Smithsonian

Institution in area which was then known as Canal Zone for

provisions relating to Panama Canal Zone.

Pub. L. 96-54 struck out cl. (G) which related to coverage of a

United States Commissioner as an ''employee'', and redesignated cl.

(H) as (G).

1978 - Par. (1)(iv). Pub. L. 95-454 substituted ''Office of

Personnel Management'' for ''Civil Service Commission''.

Par. (3)(A). Pub. L. 95-583 reduced period of service to 5 from

12 years.

Par. (8). Pub. L. 95-454 substituted ''Office'' for

''Commission''.

Pub. L. 95-368 substituted ''after December 31, 1978, and before

January 1, 1980'' for ''before January 1, 1964''.

1973 - Par. (1)(ii). Pub. L. 93-160 excluded from definition of

''employee'' persons who are not nationals of United States and

whose permanent duty station is outside United States and Panama

Canal Zone.

1970 - Par. (1)(ii). Pub. L. 91-418, Sec. 3(b), excluded from

definition of ''employee'' a noncitizen employee whose permanent

duty station is outside Panama Canal Zone.

Par. (3)(B). Pub. L. 91-418, Sec. 2(a), redefined ''annuitant''

to be a member of a family who receives an immediate annuity as the

survivor of an employee rather than as the survivor of an employee

who dies after completing 5 or more years of service.

Par. (3)(D)(i). Pub. L. 91-418, Sec. 2(b), redefined

''annuitant'' to be a member of a family who receives monthly

compensation as the surviving beneficiary of an employee who dies

as a result of a compensable injury or illness rather than as the

survivor of an employee who, having completed 5 or more years of

service, so dies.

-CHANGE-

CHANGE OF NAME

Gallaudet College, referred to in par. (1)(F), was redesignated

Gallaudet University by section 101(a) of Pub. L. 99-371, which is

classified to section 4301(a) of Title 20, Education.

-MISC4-

EFFECTIVE DATE OF 1992 AMENDMENT

Amendment by section 2(75)(A) of Pub. L. 102-378 effective Nov.

5, 1990, and amendment by section 2(75)(B) of Pub. L. 102-378

effective Oct. 2, 1992, see section 9(a), (b)(6) of Pub. L.

102-378, set out as a note under section 6303 of this title.

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by Pub. L. 101-508 applicable with respect to any

individual who, on or after Jan. 1, 1987, moves from employment in

nonappropriated fund instrumentality of Department of Defense or

Coast Guard, that is described in section 2105(c) of this title, to

employment in Department or Coast Guard, that is not described in

section 2105(c), or who moves from employment in Department or

Coast Guard, that is not described in section 2105(c), to

employment in nonappropriated fund instrumentality of Department or

Coast Guard, that is described in section 2105(c), see section

7202(m)(1) of Pub. L. 101-508, set out as a note under section 2105

of this title.

EFFECTIVE DATE OF 1986 AMENDMENTS

Amendment by Pub. L. 99-335 effective Jan. 1, 1987, see section

702(a) of Pub. L. 99-335, set out as an Effective Date note under

section 8401 of this title.

Section 105(c) of Pub. L. 99-251 provided that: ''The amendments

made by subsections (a) and (b) (amending this section and section

8902 of this title) shall be effective with respect to contracts

entered into or renewed for calendar years beginning after December

31, 1986.''

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1980 AMENDMENT

Amendment by Pub. L. 96-179 effective Jan. 2, 1980, except that

no benefits under this chapter that are made available by reason of

amendment of this section and section 8341 of this title by Pub. L.

96-179 shall be payable for any period before Oct. 1, 1979, see

section 5(a) of Pub. L. 96-179, set out as a note under section

8341 of this title.

EFFECTIVE DATE OF 1979 AMENDMENTS

Amendment by Pub. L. 96-70 effective Oct. 1, 1979, see section

3304 of Pub. L. 96-70, set out as an Effective Date note under

section 3601 of Title 22, Foreign Relations and Intercourse.

Amendment by Pub. L. 96-54 effective July 12, 1979, see section

2(b) of Pub. L. 96-54, set out as a note under section 305 of this

title.

EFFECTIVE DATE OF 1978 AMENDMENTS

Amendment by Pub. L. 95-583 effective Nov. 2, 1978, see section 3

of Pub. L. 95-583, set out as a note under section 8706 of this

title.

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

SHORT TITLE OF 2000 AMENDMENT

Pub. L. 106-394, Sec. 1, Oct. 30, 2000, 114 Stat. 1629, provided

that: ''This Act (amending sections 8421a and 8905 of this title

and enacting provisions set out as a note under section 8421a of

this title) may be cited as the 'Federal Employees Health Benefits

Children's Equity Act of 2000'.''

SHORT TITLE OF 1998 AMENDMENT

Pub. L. 105-266, Sec. 1, Oct. 19, 1998, 112 Stat. 2363, provided

that: ''This Act (enacting section 8903b of this title, amending

this section and sections 5948, 8902 to 8903, and 8909 of this

title, and enacting provisions set out as notes under this section

and sections 5948, 8902, 8902a, 8903b, and 8909 of this title) may

be cited as the 'Federal Employees Health Care Protection Act of

1998'.''

SHORT TITLE OF 1988 AMENDMENT

Pub. L. 100-654, Sec. 1, Nov. 14, 1988, 102 Stat. 3837, provided

that: ''This Act (enacting sections 8440a, 8902a, 8905a, and 8906a

of this title, amending sections 8902, 8903, 8905, 8909, and 8913

of this title, and enacting provisions set out as notes under

sections 8902, 8902a, and 8906a of this title) may be cited as the

'Federal Employees Health Benefits Amendments Act of 1988'.''

SHORT TITLE OF 1986 AMENDMENT

Section 1 of Pub. L. 99-251 provided that: ''This Act (amending

this section, sections 1103, 3502, 5334, 5924, 6312, 8332, 8339 to

8342, 8345, 8902, 8903, 8905, and 8909 of this title, and section

35 of Title 24, Hospitals and Asylums, enacting provisions set out

as notes under this section and sections 7901, 8339, 8341, 8345,

8902, 8904, 8905, and 8909 of this title, and amending provisions

set out as notes under sections 8341 and 8902 of this title) may be

cited as the 'Federal Employees Benefits Improvement Act of

1986'.''

CONTINUATION OF HEALTH BENEFITS COVERAGE FOR INDIVIDUALS ENROLLED

IN A PLAN ADMINISTERED BY THE OVERSEAS PRIVATE INVESTMENT

CORPORATION

Pub. L. 107-304, Sec. 4, Nov. 27, 2002, 116 Stat. 2364, provided

that:

''(a) Enrollment in Chapter 89 Plan. - For purposes of the

administration of chapter 89 of title 5, United States Code, any

period of enrollment under a health benefits plan administered by

the Overseas Private Investment Corporation before the effective

date of this Act (probably means Nov. 27, 2002, the date of

enactment of Pub. L. 107-304) shall be deemed to be a period of

enrollment in a health benefits plan under chapter 89 of such

title.

''(b) Continued Coverage. -

''(1) In general. - Any individual who, as of the enrollment

eligibility date, is covered by a health benefits plan

administered by the Overseas Private Investment Corporation may

enroll in an approved health benefits plan described under

section 8903 or 8903a of title 5, United States Code -

''(A) either as an individual or for self and family, if such

individual is an employee, annuitant, or former spouse as

defined under section 8901 of such title; and

''(B) for coverage effective on and after such date.

''(2) Individuals currently under continued coverage. - An

individual who, as of the enrollment eligibility date, is

entitled to continued coverage under a health benefits plan

administered by the Overseas Private Investment Corporation -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of title 5, United States Code, for the

same period that would have been permitted under the plan

administered by the Overseas Private Investment Corporation;

and

''(B) may enroll in an approved health benefits plan

described under section 8903 or 8903a of such title in

accordance with section 8905a of such title for coverage

effective on and after such date.

''(3) Unmarried dependent children. - An individual who, as of

the enrollment eligibility date, is covered as an unmarried

dependent child under a health benefits plan administered by the

Overseas Private Investment Corporation and who is not a member

of family as defined under section 8901(5) of title 5, United

States Code -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of such title as though the individual had

ceased to meet the requirements for being considered an

unmarried dependent child under chapter 89 of such title as of

such date; and

''(B) may enroll in an approved health benefits plan

described under section 8903 or 8903a of such title in

accordance with section 8905a for continued coverage effective

on and after such date.

''(c) Transfers to the Employees Health Benefits Fund. -

''(1) In general. - The Overseas Private Investment Corporation

shall transfer to the Employees Health Benefits Fund established

under section 8909 of title 5, United States Code, amounts

determined by the Director of the Office of Personnel Management,

after consultation with the Overseas Private Investment

Corporation, to be necessary to reimburse the Fund for the cost

of providing benefits under this section not otherwise paid for

by the individuals covered by this section.

''(2) Availability of funds. - The amounts transferred under

paragraph (1) shall be held in the Fund and used by the Office in

addition to amounts available under section 8906(g)(1) of title

5, United States Code.

''(d) Administration and Regulations. - The Office of Personnel

Management -

''(1) shall administer this section to provide for -

''(A) a period of notice and open enrollment for individuals

affected by this section; and

''(B) no lapse of health coverage for individuals who enroll

in a health benefits plan under chapter 89 of title 5, United

States Code, in accordance with this section; and

''(2) may prescribe regulations to implement this section.

''(e) Enrollment Eligibility Date. - For purposes of this

section, the term 'enrollment eligibility date' means the last day

on which coverage under a health benefits plan administered by the

Overseas Private Investment Corporation is available. Such date

shall be determined by the Office of Personnel Management in

consultation with the Overseas Private Investment Corporation.''

CONTINUED COVERAGE FOR INDIVIDUALS ENROLLED IN PLAN ADMINISTERED BY

FEDERAL DEPOSIT INSURANCE CORPORATION OR FOR EMPLOYEES OF BOARD OF

GOVERNORS OF FEDERAL RESERVE SYSTEM

Pub. L. 105-266, Sec. 4, Oct. 19, 1998, 112 Stat. 2367, provided

that:

''(a) Enrollment in Chapter 89 Plan. - For purposes of chapter 89

of title 5, United States Code, any period of enrollment -

''(1) in a health benefits plan administered by the Federal

Deposit Insurance Corporation before the termination of such plan

on or before January 2, 1999; or

''(2) subject to subsection (c), in a health benefits plan (not

under chapter 89 of such title) with respect to which the

eligibility of any employees or retired employees of the Board of

Governors of the Federal Reserve System terminates on or before

January 2, 1999,

shall be deemed to be a period of enrollment in a health benefits

plan under chapter 89 of such title.

''(b) Continued Coverage. - (1) Subject to subsection (c), any

individual who, on or before January 2, 1999, is enrolled in a

health benefits plan described in subsection (a)(1) or (2) may

enroll in an approved health benefits plan under chapter 89 of

title 5, United States Code, either as an individual or for self

and family, if, after taking into account the provisions of

subsection (a), such individual -

''(A) meets the requirements of such chapter for eligibility to

become so enrolled as an employee, annuitant, or former spouse

(within the meaning of such chapter); or

''(B) would meet those requirements if, to the extent such

requirements involve either retirement system under such title 5,

such individual satisfies similar requirements or provisions of

the Retirement Plan for Employees of the Federal Reserve System.

Any determination under subparagraph (B) shall be made under

guidelines which the Office of Personnel Management shall establish

in consultation with the Board of Governors of the Federal Reserve

System.

''(2) Subject to subsection (c), any individual who, on or before

January 2, 1999, is entitled to continued coverage under a health

benefits plan described in subsection (a)(1) or (2) shall be deemed

to be entitled to continued coverage under section 8905a of title

5, United States Code, but only for the same remaining period as

would have been allowable under the health benefits plan in which

such individual was enrolled on or before January 2, 1999, if -

''(A) such individual had remained enrolled in such plan; and

''(B) such plan did not terminate, or the eligibility of such

individual with respect to such plan did not terminate, as

described in subsection (a).

''(3) Subject to subsection (c), any individual (other than an

individual under paragraph (2)) who, on or before January 2, 1999,

is covered under a health benefits plan described in subsection

(a)(1) or (2) as an unmarried dependent child, but who does not

then qualify for coverage under chapter 89 of title 5, United

States Code, as a family member (within the meaning of such

chapter) shall be deemed to be entitled to continued coverage under

section 8905a of such title, to the same extent and in the same

manner as if such individual had, on or before January 2, 1999,

ceased to meet the requirements for being considered an unmarried

dependent child of an enrollee under such chapter.

''(4) Coverage under chapter 89 of title 5, United States Code,

pursuant to an enrollment under this section shall become effective

on January 3, 1999 or such earlier date as established by the

Office of Personnel Management after consultation with the Federal

Deposit Insurance Corporation or the Board of Governors of the

Federal Reserve System, as appropriate.

''(c) Eligibility for FEHBP Limited to Individuals Losing

Eligibility Under Former Health Plan. - Nothing in subsection

(a)(2) or any paragraph of subsection (b) (to the extent such

paragraph relates to the plan described in subsection (a)(2)) shall

be considered to apply with respect to any individual whose

eligibility for coverage under such plan does not involuntarily

terminate on or before January 2, 1999.

''(d) Transfers to the Employees Health Benefits Fund. - The

Federal Deposit Insurance Corporation and the Board of Governors of

the Federal Reserve System shall transfer to the Employees Health

Benefits Fund under section 8909 of title 5, United States Code,

amounts determined by the Director of the Office of Personnel

Management, after consultation with the Federal Deposit Insurance

Corporation and the Board of Governors of the Federal Reserve

System, to be necessary to reimburse the Fund for the cost of

providing benefits under this section not otherwise paid for by the

individuals covered by this section. The amounts so transferred

shall be held in the Fund and used by the Office of Personnel

Management in addition to amounts available under section

8906(g)(1) of such title.

''(e) Administration and Regulations. - The Office of Personnel

Management -

''(1) shall administer the provisions of this section to

provide for -

''(A) a period of notice and open enrollment for individuals

affected by this section; and

''(B) no lapse of health coverage for individuals who enroll

in a health benefits plan under chapter 89 of title 5, United

States Code, in accordance with this section; and

''(2) may prescribe regulations to implement this section.''

CONTINUED COVERAGE FOR INDIVIDUALS ENROLLED IN PLAN ADMINISTERED BY

FARM CREDIT ADMINISTRATION

Pub. L. 104-37, title VI, Sec. 601, Oct. 21, 1995, 109 Stat. 328,

provided that:

''(a) For purposes of the administration of chapter 89 of title

5, United States Code, any period of enrollment under a health

benefits plan administered by the Farm Credit Administration prior

to the effective date of this Act (Oct. 21, 1995) shall be deemed

to be a period of enrollment in a health benefits plan under

chapter 89 of such title.

''(b)(1) An individual who, on September 30, 1995, is covered by

a health benefits plan administered by the Farm Credit

Administration may enroll in an approved health benefits plan

described under section 8903 or 8903a of title 5, United States

Code -

''(A) either as an individual or for self and family, if such

individual is an employee, annuitant, or former spouse as defined

under section 8901 of such title; and

''(B) for coverage effective on and after September 30, 1995.

''(2) An individual who, on September 30, 1995, is entitled to

continued coverage under a health benefits plan administered by the

Farm Credit Administration -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of title 5, United States Code, for the same

period that would have been permitted under the plan administered

by the Farm Credit Administration; and

''(B) may enroll in an approved health benefits plan described

under sections 8903 or 8903a of such title in accordance with

section 8905A of such title for coverage effective on and after

September 30, 1995.

''(3) An individual who, on September 30, 1995, is covered as an

unmarried dependent child under a health benefits plan administered

by the Farm Credit Administration and who is not a member of family

as defined under section 8901(5) of title 5, United States Code -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of such title as though the individual had,

on September 30, 1995, ceased to meet the requirements for being

considered an unmarried dependent child under chapter 89 of such

title; and

''(B) may enroll in an approved health benefits plan described

under section 8903 or 8903a of such title in accordance with

section 8905a for continued coverage on and after September 30,

1995.

''(c) The Farm Credit Administration shall transfer to the

Federal Employees Health Benefits Fund established under section

8909 of title 5, United States Code, amounts determined by the

Director of the Office of Personnel Management, after consultation

with the Farm Credit Administration, to be necessary to reimburse

the Fund for the cost of providing benefits under this section not

otherwise paid for by the individuals covered by this section. The

amount so transferred shall be held in the Fund and used by the

Office in addition to the amounts available under section

8906(g)(1) of such title.

''(d) The Office of Personnel Management -

''(1) shall administer the provisions of this section to

provide for -

''(A) a period of notice and open enrollment for individuals

affected by this section; and

''(B) no lapse of health coverage for individuals who enroll

in a health benefits plan under chapter 89 of title 5, United

States Code, in accordance with this section; and

''(2) may prescribe regulations to implement this section.''

CONTINUED COVERAGE FOR INDIVIDUALS ENROLLED IN PLAN ADMINISTERED BY

OFFICE OF THE COMPTROLLER OF THE CURRENCY OR OFFICE OF THRIFT

SUPERVISION

Pub. L. 103-409, Sec. 5, Oct. 25, 1994, 108 Stat. 4232, provided

that:

''(a) Enrollment in Chapter 89 Plan. - For purposes of the

administration of chapter 89 of title 5, United States Code, any

period of enrollment under a health benefits plan administered by

the Office of the Comptroller of the Currency or the Office of

Thrift Supervision before the termination of such plans on January

7, 1995, shall be deemed to be a period of enrollment in a health

benefits plan under chapter 89 of such title.

''(b) Continued Coverage. - (1) Any individual who, on January 7,

1995, is covered by a health benefits plan administered by the

Office of the Comptroller of the Currency or the Office of Thrift

Supervision may enroll in an approved health benefits plan

described under section 8903 or 8903a of title 5, United States

Code -

''(A) either as an individual or for self and family, if such

individual is an employee, annuitant, or former spouse as defined

under section 8901 of such title; and

''(B) for coverage effective on and after January 8, 1995.

''(2) An individual who, on January 7, 1995, is entitled to

continued coverage under a health benefits plan administered by the

Office of the Comptroller of the Currency or the Office of Thrift

Supervision -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of title 5, United States Code, for the same

period that would have been permitted under the plan administered

by the Office of the Comptroller of the Currency or the Office of

Thrift Supervision; and

''(B) may enroll in an approved health benefits plan described

under section 8903 or 8903a of such title in accordance with

section 8905a of such title for coverage effective on and after

January 8, 1995.

''(3) An individual who, on January 7, 1995, is covered as an

unmarried dependent child under a health benefits plan administered

by the Office of the Comptroller of the Currency or the Office of

Thrift Supervision and who is not a member of family as defined

under section 8901(5) of title 5, United States Code -

''(A) shall be deemed to be entitled to continued coverage

under section 8905a of such title as though the individual had,

on January 7, 1995, ceased to meet the requirements for being

considered an unmarried dependent child under chapter 89 of such

title; and

''(B) may enroll in an approved health benefits plan described

under section 8903 or 8903a of such title in accordance with

section 8905a for continued coverage effective on and after

January 8, 1995.

''(c) Transfers to the Employees Health Benefits Fund. - The

Office of the Comptroller of the Currency and the Office of Thrift

Supervision shall transfer to the Employees Health Benefits Fund

established under section 8909 of title 5, United States Code,

amounts determined by the Director of the Office of Personnel

Management, after consultation with the Office of the Comptroller

of the Currency and the Office of Thrift Supervision, to be

necessary to reimburse the Fund for the cost of providing benefits

under this section not otherwise paid for by the individuals

covered by this section. The amounts so transferred shall be held

in the Fund and used by the Office in addition to amounts available

under section 8906(g)(1) of such title.

''(d) Administration and Regulations. - The Office of Personnel

Management -

''(1) shall administer the provisions of this section to

provide for -

''(A) a period of notice and open enrollment for individuals

affected by this section; and

''(B) no lapse of health coverage for individuals who enroll

in a health benefits plan under chapter 89 of title 5, United

States Code, in accordance with this section; and

''(2) may prescribe regulations to implement this section.''

CONTINUED COVERAGE UNDER CERTAIN FEDERAL EMPLOYEE BENEFIT PROGRAMS

FOR CERTAIN EMPLOYEES OF SAINT ELIZABETHS HOSPITAL

For provisions relating to treatment of certain Federal employees

of Saint Elizabeths Hospital under certain Federal employee benefit

programs, see section 207(o) of Pub. L. 99-335, set out as a note

under section 8331 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8902, 8903, 8903a, 8905,

8905a, 8906, 8909, 8913, 9001 of this title; title 2 sections 162b,

2063; title 10 section 1108; title 42 section 251.

-CITE-

5 USC Sec. 8902 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8902. Contracting authority

-STATUTE-

(a) The Office of Personnel Management may contract with

qualified carriers offering plans described by section 8903 or

8903a of this title, without regard to section 5 of title 41 or

other statute requiring competitive bidding. Each contract shall

be for a uniform term of at least 1 year, but may be made

automatically renewable from term to term in the absence of notice

of termination by either party.

(b) To be eligible as a carrier for the plan described by section

8903(2) of this title, a company must be licensed to issue group

health insurance in all the States and the District of Columbia.

(c) A contract for a plan described by section 8903(1) or (2) of

this title shall require the carrier -

(1) to reinsure with other companies which elect to

participate, under an equitable formula based on the total amount

of their group health insurance benefit payments in the United

States during the latest year for which the information is

available, to be determined by the carrier and approved by the

Office; or

(2) to allocate its rights and obligations under the contract

among its affiliates which elect to participate, under an

equitable formula to be determined by the carrier and the

affiliates and approved by the Office.

(d) Each contract under this chapter shall contain a detailed

statement of benefits offered and shall include such maximums,

limitations, exclusions, and other definitions of benefits as the

Office considers necessary or desirable.

(e) The Office may prescribe reasonable minimum standards for

health benefits plans described by section 8903 or 8903a of this

title and for carriers offering the plans. Approval of a plan may

be withdrawn only after notice and opportunity for hearing to the

carrier concerned without regard to subchapter II of chapter 5 and

chapter 7 of this title. The Office may terminate the contract of

a carrier effective at the end of the contract term, if the Office

finds that at no time during the preceding two contract terms did

the carrier have 300 or more employees and annuitants, exclusive of

family members, enrolled in the plan.

(f) A contract may not be made or a plan approved which excludes

an individual because of race, sex, health status, or, at the time

of the first opportunity to enroll, because of age.

(g) A contract may not be made or a plan approved which does not

offer to each employee, annuitant, family member, former spouse, or

person having continued coverage under section 8905a of this title

whose enrollment in the plan is ended, except by a cancellation of

enrollment, a temporary extension of coverage during which he may

exercise the option to convert, without evidence of good health, to

a nongroup contract providing health benefits. An employee,

annuitant, family member, former spouse, or person having continued

coverage under section 8905a of this title who exercises this

option shall pay the full periodic charges of the nongroup

contract.

(h) The benefits and coverage made available under subsection (g)

of this section are noncancelable by the carrier except for fraud,

over-insurance, or nonpayment of periodic charges.

(i) Rates charged under health benefits plans described by

section 8903 or 8903a of this title shall reasonably and equitably

reflect the cost of the benefits provided. Rates under health

benefits plans described by section 8903(1) and (2) of this title

shall be determined on a basis which, in the judgment of the

Office, is consistent with the lowest schedule of basic rates

generally charged for new group health benefit plans issued to

large employers. The rates determined for the first contract term

shall be continued for later contract terms, except that they may

be readjusted for any later term, based on past experience and

benefit adjustments under the later contract. Any readjustment in

rates shall be made in advance of the contract term in which they

will apply and on a basis which, in the judgment of the Office, is

consistent with the general practice of carriers which issue group

health benefit plans to large employers.

(j) Each contract under this chapter shall require the carrier to

agree to pay for or provide a health service or supply in an

individual case if the Office finds that the employee, annuitant,

family member, former spouse, or person having continued coverage

under section 8905a of this title is entitled thereto under the

terms of the contract.

(k)(1) When a contract under this chapter requires payment or

reimbursement for services which may be performed by a clinical

psychologist, optometrist, nurse midwife, nursing school

administered clinic, or nurse practitioner/clinical specialist,

licensed or certified as such under Federal or State law, as

applicable, or by a qualified clinical social worker as defined in

section 8901(11), an employee, annuitant, family member, former

spouse, or person having continued coverage under section 8905a of

this title covered by the contract shall be free to select, and

shall have direct access to, such a clinical psychologist,

qualified clinical social worker, optometrist, nurse midwife,

nursing school administered clinic, or nurse practitioner/nurse

clinical specialist without supervision or referral by another

health practitioner and shall be entitled under the contract to

have payment or reimbursement made to him or on his behalf for the

services performed.

(2) Nothing in this subsection shall be considered to preclude a

health benefits plan from providing direct access or direct payment

or reimbursement to a provider in a health care practice or

profession other than a practice or profession listed in paragraph

(1), if such provider is licensed or certified as such under

Federal or State law.

(3) The provisions of this subsection shall not apply to

comprehensive medical plans as described in section 8903(4) of this

title.

(l) The Office shall contract under this chapter for a plan

described in section 8903(4) of this title with any qualified

health maintenance carrier which offers such a plan. For the

purpose of this subsection, ''qualified health maintenance

carrier'' means any qualified carrier which is a qualified health

maintenance organization within the meaning of section 1310(d)(1)

(FOOTNOTE 1) of title XIII of the Public Health Service Act (42

U.S.C. 300c-9(d)).

(FOOTNOTE 1) See References in Text note below.

(m)(1) The terms of any contract under this chapter which relate

to the nature, provision, or extent of coverage or benefits

(including payments with respect to benefits) shall supersede and

preempt any State or local law, or any regulation issued

thereunder, which relates to health insurance or plans.

(2)(A) Notwithstanding the provisions of paragraph (1) of this

subsection, if a contract under this chapter provides for the

provision of, the payment for, or the reimbursement of the cost of

health services for the care and treatment of any particular health

condition, the carrier shall provide, pay, or reimburse up to the

limits of its contract for any such health service properly

provided by any person licensed under State law to provide such

service if such service is provided to an individual covered by

such contract in a State where 25 percent or more of the population

is located in primary medical care manpower shortage areas

designated pursuant to section 332 of the Public Health Service Act

(42 U.S.C. 254e).

(B) The provisions of subparagraph (A) shall not apply to

contracts entered into providing prepayment plans described in

section 8903(4) of this title.

(n) A contract for a plan described by section 8903(1), (2), or

(3), or section 8903a, shall require the carrier -

(1) to implement hospitalization-cost-containment measures,

such as measures -

(A) for verifying the medical necessity of any proposed

treatment or surgery;

(B) for determining the feasibility or appropriateness of

providing services on an outpatient rather than on an inpatient

basis;

(C) for determining the appropriate length of stay (through

concurrent review or otherwise) in cases involving inpatient

care; and

(D) involving case management, if the circumstances so

warrant; and

(2) to establish incentives to encourage compliance with

measures under paragraph (1).

(o) A contract may not be made or a plan approved which includes

coverage for any benefit, item, or service for which funds may not

be used under the Assisted Suicide Funding Restriction Act of 1997.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 601; Pub. L. 93-246, Sec.

3, Jan. 31, 1974, 88 Stat. 4; Pub. L. 93-363, Sec. 1, July 30,

1974, 88 Stat. 398; Pub. L. 94-183, Sec. 2(43), Dec. 31, 1975, 89

Stat. 1059; Pub. L. 94-460, title I, Sec. 110(b), Oct. 8, 1976, 90

Stat. 1952; Pub. L. 95-368, Sec. 1, Sept. 17, 1978, 92 Stat. 606;

Pub. L. 95-454, title IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92

Stat. 1224; Pub. L. 96-179, Sec. 3, Jan. 2, 1980, 93 Stat. 1299;

Pub. L. 98-615, Sec. 3(2), Nov. 8, 1984, 98 Stat. 3203; Pub. L.

99-53, Sec. 2(a), June 17, 1985, 99 Stat. 94; Pub. L. 99-251, title

I, Sec. 105(b), 106(a)(3), Feb. 27, 1986, 100 Stat. 15, 16; Pub. L.

100-202, Sec. 101(m) (title VI, Sec. 626), Dec. 22, 1987, 101 Stat.

1329-390, 1329-430; Pub. L. 100-654, title II, Sec. 201(b), 202(a),

Nov. 14, 1988, 102 Stat. 3845; Pub. L. 101-508, title VII, Sec.

7002(a), Nov. 5, 1990, 104 Stat. 1388-329; Pub. L. 101-509, title

IV, Sec. 1, Nov. 5, 1990, 104 Stat. 1421; Pub. L. 102-393, title V,

Sec. 537(a), (b), Oct. 6, 1992, 106 Stat. 1765; Pub. L. 105-12,

Sec. 9(g), Apr. 30, 1997, 111 Stat. 27; Pub. L. 105-266, Sec. 3(c),

8, Oct. 19, 1998, 112 Stat. 2366, 2370.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3005. Sept. 28, 1959, Pub.

L. 86-382, Sec. 6,

73 Stat. 712.

Mar. 17, 1964, Pub.

L. 88-284, Sec.

1(7)-(9), 78 Stat.

165.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

-REFTEXT-

REFERENCES IN TEXT

Section 1310(d)(1) of title XIII of the Public Health Service Act

(42 U.S.C. 300c-9(d)), referred to in subsec. (l), probably is

intended as a reference to section 300e-9(d) of Title 42, The

Public Health and Welfare. Section 300e-9(d) of Title 42 was

redesignated section 300e-9(c) of Title 42 by Pub. L. 100-517, Sec.

7(b), Oct. 24, 1988, 102 Stat. 2580.

The Assisted Suicide Funding Restriction Act of 1997, referred to

in subsec. (o), is Pub. L. 105-12, Apr. 30, 1997, 111 Stat. 23,

which is classified principally to chapter 138 (Sec. 14401 et seq.)

of Title 42, The Public Health and Welfare. For complete

classification of this Act to the Code, see Short Title note set

out under section 14401 of Title 42 and Tables.

-COD-

CODIFICATION

Another section 1 of title IV of Pub. L. 101-509, 104 Stat. 1416,

enacted sections 2701 to 2706 of Title 44, Public Printing and

Documents, and provisions set out as a note under section 2102 of

Title 44.

-MISC3-

AMENDMENTS

1998 - Subsec. (k)(2), (3). Pub. L. 105-266, Sec. 8, added par.

(2) and redesignated former par. (2) as (3).

Subsec. (m)(1). Pub. L. 105-266, Sec. 3(c), added par. (1) and

struck out former par. (1) which read as follows: ''The provisions

of any contract under this chapter which relate to the nature or

extent of coverage or benefits (including payments with respect to

benefits) shall supersede and preempt any State or local law, or

any regulation issued thereunder, which relates to health insurance

or plans to the extent that such law or regulation is inconsistent

with such contractual provisions.''

1997 - Subsec. (o). Pub. L. 105-12 added subsec. (o).

1992 - Pub. L. 102-393 amended subsec. (k) generally. Prior to

amendment, subsec. (k) read as follows:

''(1) When a contract under this chapter requires payment or

reimbursement for services which may be performed by a clinical

psychologist, optometrist, nurse midwife, or nurse

practitioner/clinical specialist, licensed or certified as such

under Federal or State law, as applicable, or by a qualified

clinical social worker as defined in section 8901(11), an employee,

annuitant, family member, former spouse, or person having continued

coverage under section 8905a of this title covered by the contract

shall be free to select, and shall have direct access to, such a

clinical psychologist, qualified clinical social worker,

optometrist, nurse midwife, or nurse practitioner/nurse clinical

specialist without supervision or referral by another health

practitioner and shall be entitled under the contract to have

payment or reimbursement made to him or on his behalf for the

services performed.

''(2) The provisions of this subsection shall not apply to group

practice prepayment plans.''

1990 - Subsec. (k)(1). Pub. L. 101-509 substituted ''performed by

a clinical psychologist, optometrist, nurse midwife, or nurse

practitioner/clinical specialist'' for ''performed by a clinical

psychologist or optometrist'' and ''qualified clinical social

worker, optometrist, nurse midwife, or nurse practitioner/nurse

clinical specialist'' for ''qualified clinical social worker or

optometrist''.

Subsec. (n). Pub. L. 101-508 added subsec. (n).

1988 - Subsecs. (g), (j), (k)(1). Pub. L. 100-654 substituted

''former spouse, or person having continued coverage under section

8905a of this title'' for ''or former spouse'' wherever appearing.

1987 - Subsec. (k)(1). Pub. L. 100-202, Sec. 101(m) (title VI,

Sec. 626(1), (2)), inserted ''or by a qualified clinical social

worker as defined in section 8901(11),'' after ''as applicable,'',

and '', qualified clinical social worker'' after ''such a clinical

psychologist''.

Subsec. (k)(2), (3). Pub. L. 100-202, Sec. 101(m) (title VI, Sec.

626(3)), redesignated par. (3) as (2) and struck out former par.

(2) which read as follows: ''When a contract under this chapter

requires payment or reimbursement for services which may be

performed by a qualified clinical social worker, an employee,

annuitant, family member, or former spouse covered by the contract

shall be entitled under the contract to have payment or

reimbursement made to him or on his behalf for the services

performed. As a condition for the payment or reimbursement, the

contract -

''(A) may require that the services be performed pursuant to a

referral by a psychiatrist; but

''(B) may not require that the services be performed under the

supervision of a psychiatrist or other health practitioner.''

Subsec. (m)(2)(A). Pub. L. 100-202, Sec. 101(m) (title VI, Sec.

626(4)), struck out ''This paragraph shall apply with respect to a

qualified clinical social worker covered by subsection (k)(2) of

this section without regard to whether such contract contains the

requirement authorized by clause (i) of the second sentence of

subparagraph (A) of such subsection (k)(2).''

1986 - Subsec. (k). Pub. L. 99-251, Sec. 105(b), designated

existing provisions as par. (1), struck out last sentence providing

that the provisions of this subsection shall not apply to group

practice prepayment plans, and added pars. (2) and (3).

Subsec. (m)(2)(A). Pub. L. 99-251, Sec. 106(a)(3), inserted last

sentence relating to applicability of this paragraph with respect

to a qualified clinical social worker covered by subsection (k)(2)

of this section.

1985 - Subsecs. (a), (e), (i). Pub. L. 99-53 inserted reference

to section 8903a of this title.

1984 - Subsec. (g). Pub. L. 98-615, Sec. 3(2)(A), substituted

''employee, annuitant, family member, or former spouse'' for

''employee or annuitant'' in two places.

Subsecs. (j), (k). Pub. L. 98-615, Sec. 3(2)(B), substituted

''family member, or former spouse'' for ''or family member''.

1980 - Subsec. (m)(2)(A). Pub. L. 96-179 substituted ''in a State

where 25 percent or more of the population is located in primary

medical care manpower shortage areas designated pursuant to section

332 of the Public Health Service Act (42 U.S.C. 254e)'' for ''who

is a member of a medically underserved population (within the

meaning of section 1302(7) of the Public Health Service Act (42

U.S.C. 300e-17))''.

1978 - Subsecs. (a), (c) to (e), (i), (j), (l). Pub. L. 95-454

substituted ''Office of Personnel Management'' for ''Civil Service

Commission'' and ''Office'' for ''Commission'' wherever appearing.

Subsec. (m). Pub. L. 95-368 added subsec. (m).

1976 - Subsec. (l). Pub. L. 94-460 added subsec. (l).

1975 - Subsecs. (j), (k). Pub. L. 94-183 redesignated subsec.

(j), added by Pub. L. 93-363 and relating to services performed by

a clinical psychologist or optometrist, as (k).

1974 - Subsec. (j). Pub. L. 93-363 added subsec. (j) covering

services performed by a clinical psychologist or optometrist.

Pub. L. 93-246 added subsec. (j) requiring the carrier to pay for

or provide a health service or supply in specified cases.

EFFECTIVE DATE OF 1997 AMENDMENT

Amendment by Pub. L. 105-12 effective Apr. 30, 1997, and

applicable to Federal payments made pursuant to obligations

incurred after Apr. 30, 1997, for items and services provided on or

after such date, subject to also being applicable with respect to

contracts entered into, renewed, or extended after Apr. 30, 1997,

as well as contracts entered into before Apr. 30, 1997, to the

extent permitted under such contracts, see section 11 of Pub. L.

105-12, set out as an Effective Date note under section 14401 of

Title 42, The Public Health and Welfare.

EFFECTIVE DATE OF 1992 AMENDMENT

Section 537(c) of Pub. L. 102-393 provided that: ''The amendments

made by this section (amending this section) shall be effective

with respect to contract years beginning after the date of

enactment of this Act (Oct. 6, 1992).''

EFFECTIVE DATE OF 1990 AMENDMENT

Section 7002(g) of Pub. L. 101-508 provided that: ''Except as

provided in subsection (f) (set out as a note under section 8904 of

this title), the amendments made by this section (amending this

section, sections 8904, 8909, and 8910 of this title, and

provisions set out as a note under section 8906 of this title)

shall apply with respect to contract years beginning on or after

January 1, 1991.''

EFFECTIVE DATE OF 1988 AMENDMENT

Section 203 of title II of Pub. L. 100-654 provided that:

''(a) In General. - The amendments made by this title (enacting

section 8905a of this title and amending this section and sections

8903, 8905, and 8909 of this title) shall apply with respect to -

''(1) any calendar year beginning, and contracts entered into

or renewed for any calendar year beginning, after the end of the

9-month period beginning on the date of the enactment of this Act

(Nov. 14, 1988); and

''(2) any qualifying event occurring on or after the first day

of the first calendar year beginning after the end of the 9-month

period referred to in paragraph (1).

''(b) Definition. - For the purpose of this section, the term

'qualifying event' means any of the following events:

''(1) A separation from Government service.

''(2) A divorce, annulment, or legal separation.

''(3) Any change in circumstances which causes an individual to

become ineligible to be considered an unmarried dependent child

under chapter 89 of such title (section 8901 et seq. of this

title).''

EFFECTIVE DATE OF 1986 AMENDMENT

Amendment by section 105(b) of Pub. L. 99-251 effective with

respect to contracts entered into or renewed for calendar years

beginning after Dec. 31, 1986, see section 105(c) of Pub. L.

99-251, set out as a note under section 8901 of this title.

Section 106(b) of Pub. L. 99-251 provided that: ''The amendments

made by subsection (a) (amending this section and provisions set

out as notes under this section) shall take effect with respect to

services provided after December 31, 1984.''

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1980 AMENDMENT

Section 5(b) of Pub. L. 96-179, as amended by Pub. L. 99-251,

title I, Sec. 106(a)(2), Feb. 27, 1986, 100 Stat. 16, provided

that: ''The amendments made by section 3 (amending this section)

shall apply to services provided after December 31, 1979, under any

contract entered into or renewed after December 31, 1979.''

EFFECTIVE DATE OF 1978 AMENDMENTS

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

Section 3 of Pub. L. 95-368, as amended by Pub. L. 99-251, title

I, Sec. 106(a)(1), Feb. 27, 1986, 100 Stat. 16, provided that:

''The provisions of section 8902(m)(2) of title 5, United States

Code, as added by the first section of this Act, shall apply to

services provided under any contract entered into or renewed after

December 31, 1979.''

EFFECTIVE DATE OF 1976 AMENDMENT

Amendment by Pub. L. 94-460 effective Oct. 8, 1976, see section

118 of Pub. L. 94-460, set out as a note under section 300e of

Title 42, The Public Health and Welfare.

EFFECTIVE DATE OF 1974 AMENDMENTS

Section 2 of Pub. L. 93-363 provided that: ''The amendment made

by this Act (amending this section) shall become effective with

respect to any contract entered into or renewed on or after the

date of enactment of this Act (July 30, 1974).''

Section 4(c) of Pub. L. 93-246 provided that: ''Section 3

(amending this section) shall become effective with respect to any

contract entered into or renewed on or after the date of enactment

of this Act (Jan. 31, 1974).''

FULL DISCLOSURE IN HEALTH PLAN CONTRACTS

Pub. L. 105-266, Sec. 5, Oct. 19, 1998, 112 Stat. 2368, provided

that: ''The Office of Personnel Management shall encourage carriers

offering health benefits plans described by section 8903 or section

8903a of title 5, United States Code, with respect to contractual

arrangements made by such carriers with any person for purposes of

obtaining discounts from providers for health care services or

supplies furnished to individuals enrolled in such plan, to seek

assurance that the conditions for such discounts are fully

disclosed to the providers who grant them.''

RATE REDUCTION FOR MEDICARE ELIGIBLE FEDERAL ANNUITANTS

Pub. L. 100-360, title IV, Sec. 422, July 1, 1988, 102 Stat. 810,

which directed the Office of Personnel Management to reduce the

rates charged medicare eligible individuals participating in health

benefit plans by a prorated amount, was repealed by Pub. L.

101-234, title III, Sec. 301(a), Dec. 13, 1989, 103 Stat. 1985.

AUTHORITY OF CARRIER TO CONTRACT FOR COMPREHENSIVE MEDICAL SERVICES

FROM A GROUP PRACTICE UNIT OR ORGANIZATION

Pub. L. 91-515, title IV, Sec. 401, Oct. 30, 1970, 84 Stat. 1309,

authorized Secretary of Health, Education, and Welfare to permit

any carrier which is a party to a contract entered into under this

chapter or under the Retired Federal Employees Health Benefits Act,

or which participates in carrying out of any such contract, to

issue in any State contracts entitling any person as a beneficiary

to receive comprehensive medical services from a group practice

unit or organization with which such carrier has contracted or

otherwise arranged for the provision of such services.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8902a, 8910, 8913 of this

title.

-CITE-

5 USC Sec. 8902a 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8902a. Debarment and other sanctions

-STATUTE-

(a)(1) For the purpose of this section -

(A) the term ''provider of health care services or supplies''

or ''provider'' means a physician, hospital, or other individual

or entity which furnishes health care services or supplies;

(B) the term ''individual covered under this chapter'' or

''covered individual'' means an employee, annuitant, family

member, or former spouse covered by a health benefits plan

described by section 8903 or 8903a;

(C) an individual or entity shall be considered to have been

''convicted'' of a criminal offense if -

(i) a judgment of conviction for such offense has been

entered against the individual or entity by a Federal, State,

or local court;

(ii) there has been a finding of guilt against the individual

or entity by a Federal, State, or local court with respect to

such offense;

(iii) a plea of guilty or nolo contendere by the individual

or entity has been accepted by a Federal, State, or local court

with respect to such offense; or

(iv) in the case of an individual, the individual has entered

a first offender or other program pursuant to which a judgment

of conviction for such offense has been withheld;

without regard to the pendency or outcome of any appeal (other

than a judgment of acquittal based on innocence) or request for

relief on behalf of the individual or entity; and

(D) the term ''should know'' means that a person, with respect

to information, acts in deliberate ignorance of, or in reckless

disregard of, the truth or falsity of the information, and no

proof of specific intent to defraud is required; (FOOTNOTE 1)

(FOOTNOTE 1) So in original. The semicolon probably should be a

period.

(2)(A) Notwithstanding section 8902(j) or any other provision of

this chapter, if, under subsection (b), (c), or (d) a provider is

barred from participating in the program under this chapter, no

payment may be made by a carrier pursuant to any contract under

this chapter (either to such provider or by reimbursement) for any

service or supply furnished by such provider during the period of

the debarment.

(B) Each contract under this chapter shall contain such

provisions as may be necessary to carry out subparagraph (A) and

the other provisions of this section.

(b) The Office of Personnel Management shall bar the following

providers of health care services or supplies from participating in

the program under this chapter:

(1) Any provider that has been convicted, under Federal or

State law, of a criminal offense relating to fraud, corruption,

breach of fiduciary responsibility, or other financial misconduct

in connection with the delivery of a health care service or

supply.

(2) Any provider that has been convicted, under Federal or

State law, of a criminal offense relating to neglect or abuse of

patients in connection with the delivery of a health care service

or supply.

(3) Any provider that has been convicted, under Federal or

State law, in connection with the interference with or

obstruction of an investigation or prosecution of a criminal

offense described in paragraph (1) or (2).

(4) Any provider that has been convicted, under Federal or

State law, of a criminal offense relating to the unlawful

manufacture, distribution, prescription, or dispensing of a

controlled substance.

(5) Any provider that is currently debarred, suspended, or

otherwise excluded from any procurement or nonprocurement

activity (within the meaning of section 2455 of the Federal

Acquisition Streamlining Act of 1994).

(c) The Office may bar the following providers of health care

services from participating in the program under this chapter:

(1) Any provider -

(A) whose license to provide health care services or supplies

has been revoked, suspended, restricted, or not renewed, by a

State licensing authority for reasons relating to the

provider's professional competence, professional performance,

or financial integrity; or

(B) that surrendered such a license while a formal

disciplinary proceeding was pending before such an authority,

if the proceeding concerned the provider's professional

competence, professional performance, or financial integrity.

(2) Any provider that is an entity directly or indirectly

owned, or with a control interest of 5 percent or more held, by

an individual who has been convicted of any offense described in

subsection (b), against whom a civil monetary penalty has been

assessed under subsection (d), or who has been debarred from

participation under this chapter.

(3) Any individual who directly or indirectly owns or has a

control interest in a sanctioned entity and who knows or should

know of the action constituting the basis for the entity's

conviction of any offense described in subsection (b), assessment

with a civil monetary penalty under subsection (d), or debarment

from participation under this chapter.

(4) Any provider that the Office determines, in connection with

claims presented under this chapter, has charged for health care

services or supplies in an amount substantially in excess of such

provider's customary charge for such services or supplies (unless

the Office finds there is good cause for such charge), or charged

for health care services or supplies which are substantially in

excess of the needs of the covered individual or which are of a

quality that fails to meet professionally recognized standards

for such services or supplies.

(5) Any provider that the Office determines has committed acts

described in subsection (d).

Any determination under paragraph (4) relating to whether a charge

for health care services or supplies is substantially in excess of

the needs of the covered individual shall be made by trained

reviewers based on written medical protocols developed by

physicians. In the event such a determination cannot be made based

on such protocols, a physician in an appropriate specialty shall be

consulted.

(d) Whenever the Office determines -

(1) in connection with claims presented under this chapter,

that a provider has charged for a health care service or supply

which the provider knows or should have known involves -

(A) an item or service not provided as claimed;

(B) charges in violation of applicable charge limitations

under section 8904(b); or

(C) an item or service furnished during a period in which the

provider was debarred from participation under this chapter

pursuant to a determination by the Office under this section,

other than as permitted under subsection (g)(2)(B);

(2) that a provider of health care services or supplies has

knowingly made, or caused to be made, any false statement or

misrepresentation of a material fact which is reflected in a

claim presented under this chapter; or

(3) that a provider of health care services or supplies has

knowingly failed to provide any information required by a carrier

or by the Office to determine whether a payment or reimbursement

is payable under this chapter or the amount of any such payment

or reimbursement;

the Office may, in addition to any other penalties that may be

prescribed by law, and after consultation with the Attorney

General, impose a civil monetary penalty of not more than $10,000

for any item or service involved. In addition, such a provider

shall be subject to an assessment of not more than twice the amount

claimed for each such item or service. In addition, the Office may

make a determination in the same proceeding to bar such provider

from participating in the program under this chapter.

(e) The Office -

(1) may not initiate any debarment proceeding against a

provider, based on such provider's having been convicted of a

criminal offense, later than 6 years after the date on which such

provider is so convicted; and

(2) may not initiate any action relating to a civil penalty,

assessment, or debarment under this section, in connection with

any claim, later than 6 years after the date the claim is

presented, as determined under regulations prescribed by the

Office.

(f) In making a determination relating to the appropriateness of

imposing or the period of any debarment under this section (where

such debarment is not mandatory), or the appropriateness of

imposing or the amount of any civil penalty or assessment under

this section, the Office shall take into account -

(1) the nature of any claims involved and the circumstances

under which they were presented;

(2) the degree of culpability, history of prior offenses or

improper conduct of the provider involved; and

(3) such other matters as justice may require.

(g)(1)(A) Except as provided in subparagraph (B), debarment of a

provider under subsection (b) or (c) shall be effective at such

time and upon such reasonable notice to such provider, and to

carriers and covered individuals, as shall be specified in

regulations prescribed by the Office. Any such provider that is

debarred from participation may request a hearing in accordance

with subsection (h)(1).

(B) Unless the Office determines that the health or safety of

individuals receiving health care services warrants an earlier

effective date, the Office shall not make a determination adverse

to a provider under subsection (c)(5) or (d) until such provider

has been given reasonable notice and an opportunity for the

determination to be made after a hearing as provided in accordance

with subsection (h)(1).

(2)(A) Except as provided in subparagraph (B), a debarment shall

be effective with respect to any health care services or supplies

furnished by a provider on or after the effective date of such

provider's debarment.

(B) A debarment shall not apply with respect to inpatient

institutional services furnished to an individual who was admitted

to the institution before the date the debarment would otherwise

become effective until the passage of 30 days after such date,

unless the Office determines that the health or safety of the

individual receiving those services warrants that a shorter period,

or that no such period, be afforded.

(3) Any notice of debarment referred to in paragraph (1) shall

specify the date as of which debarment becomes effective and the

minimum period of time for which such debarment is to remain

effective. In the case of a debarment under paragraph (1), (2),

(3), or (4) of subsection (b), the minimum period of debarment

shall not be less than 3 years, except as provided in paragraph

(4)(B)(ii).

(4)(A) A provider barred from participating in the program under

this chapter may, after the expiration of the minimum period of

debarment referred to in paragraph (3), apply to the Office, in

such manner as the Office may by regulation prescribe, for

termination of the debarment.

(B) The Office may -

(i) terminate the debarment of a provider, pursuant to an

application filed by such provider after the end of the minimum

debarment period, if the Office determines, based on the conduct

of the applicant, that -

(I) there is no basis under subsection (b), (c), or (d) for

continuing the debarment; and

(II) there are reasonable assurances that the types of

actions which formed the basis for the original debarment have

not recurred and will not recur; or

(ii) notwithstanding any provision of subparagraph (A),

terminate the debarment of a provider, pursuant to an application

filed by such provider before the end of the minimum debarment

period, if the Office determines that -

(I) based on the conduct of the applicant, the requirements

of subclauses (I) and (II) of clause (i) have been met; and

(II) early termination under this clause is warranted based

on the fact that the provider is the sole community provider or

the sole source of essential specialized services in a

community, or other similar circumstances.

(5) The Office shall -

(A) promptly notify the appropriate State or local agency or

authority having responsibility for the licensing or

certification of a provider barred from participation in the

program under this chapter of the fact of the debarment, as well

as the reasons for such debarment;

(B) request that appropriate investigations be made and

sanctions invoked in accordance with applicable law and policy;

and

(C) request that the State or local agency or authority keep

the Office fully and currently informed with respect to any

actions taken in response to the request.

(h)(1) Any provider of health care services or supplies that is

the subject of an adverse determination by the Office under this

section shall be entitled to reasonable notice and an opportunity

to request a hearing of record, and to judicial review as provided

in this subsection after the Office renders a final decision. The

Office shall grant a request for a hearing upon a showing that due

process rights have not previously been afforded with respect to

any finding of fact which is relied upon as a cause for an adverse

determination under this section. Such hearing shall be conducted

without regard to subchapter II of chapter 5 and chapter 7 of this

title by a hearing officer who shall be designated by the Director

of the Office and who shall not otherwise have been involved in the

adverse determination being appealed. A request for a hearing

under this subsection shall be filed within such period and in

accordance with such procedures as the Office shall prescribe by

regulation.

(2) Any provider adversely affected by a final decision under

paragraph (1) made after a hearing to which such provider was a

party may seek review of such decision in the United States

District Court for the District of Columbia or for the district in

which the plaintiff resides or has his or her principal place of

business by filing a notice of appeal in such court within 60 days

after the date the decision is issued, and by simultaneously

sending copies of such notice by certified mail to the Director of

the Office and to the Attorney General. In answer to the appeal,

the Director of the Office shall promptly file in such court a

certified copy of the transcript of the record, if the Office

conducted a hearing, and other evidence upon which the findings and

decision complained of are based. The court shall have power to

enter, upon the pleadings and evidence of record, a judgment

affirming, modifying, or setting aside, in whole or in part, the

decision of the Office, with or without remanding the case for a

rehearing. The district court shall not set aside or remand the

decision of the Office unless there is not substantial evidence on

the record, taken as whole, to support the findings by the Office

of a cause for action under this section or unless action taken by

the Office constitutes an abuse of discretion.

(3) Matters that were raised or that could have been raised in a

hearing under paragraph (1) or an appeal under paragraph (2) may

not be raised as a defense to a civil action by the United States

to collect a penalty or assessment imposed under this section.

(i) A civil action to recover civil monetary penalties or

assessments under subsection (d) shall be brought by the Attorney

General in the name of the United States, and may be brought in the

United States district court for the district where the claim

involved was presented or where the person subject to the penalty

resides. Amounts recovered under this section shall be paid to the

Office for deposit into the Employees Health Benefits Fund. The

amount of a penalty or assessment as finally determined by the

Office, or other amount the Office may agree to in compromise, may

be deducted from any sum then or later owing by the United States

to the party against whom the penalty or assessment has been

levied.

(j) The Office shall prescribe regulations under which, with

respect to services or supplies furnished by a debarred provider to

a covered individual during the period of such provider's

debarment, payment or reimbursement under this chapter may be made,

notwithstanding the fact of such debarment, if such individual did

not know or could not reasonably be expected to have known of the

debarment. In any such instance, the carrier involved shall take

appropriate measures to ensure that the individual is informed of

the debarment and the minimum period of time remaining under the

terms of the debarment.

-SOURCE-

(Added Pub. L. 100-654, title I, Sec. 101(a), Nov. 14, 1988, 102

Stat. 3837; amended Pub. L. 105-266, Sec. 2(a), Oct. 19, 1998, 112

Stat. 2363.)

-REFTEXT-

REFERENCES IN TEXT

Section 2455 of the Federal Acquisition Streamlining Act of 1994,

referred to in subsec. (b)(5), is section 2455 of Pub. L. 103-355,

which is set out as a note under section 6101 of Title 31, Money

and Finance.

-MISC2-

AMENDMENTS

1998 - Subsec. (a)(1)(D). Pub. L. 105-266, Sec. 2(a)(1)(A), added

subpar. (D).

Subsec. (a)(2)(A). Pub. L. 105-266, Sec. 2(a)(1)(B), substituted

''subsection (b), (c), or (d)'' for ''subsection (b) or (c)''.

Subsec. (b). Pub. L. 105-266, Sec. 2(a)(2)(A), substituted

''shall'' for ''may'' in introductory provisions.

Subsec. (b)(5). Pub. L. 105-266, Sec. 2(a)(2)(B), amended par.

(5) generally. Prior to amendment, par. (5) read as follows: ''Any

provider -

''(A) whose license to provide health care services or supplies

has been revoked, suspended, restricted, or not renewed, by a

State licensing authority for reasons relating to the provider's

professional competence, professional performance, or financial

integrity; or

''(B) that surrendered such a license while a formal

disciplinary proceeding was pending before such an authority, if

the proceeding concerned the provider's professional competence,

professional performance, or financial integrity.''

Subsec. (c). Pub. L. 105-266, Sec. 2(a)(3), added subsec. (c).

Former subsec. (c) redesignated (d).

Subsec. (d). Pub. L. 105-266, Sec. 2(a)(3), redesignated subsec.

(c) as (d). Former subsec. (d) redesignated (e).

Subsec. (d)(1). Pub. L. 105-266, Sec. 2(a)(4), amended par. (1)

generally. Prior to amendment, par. (1) read as follows: ''in

connection with a claim presented under this chapter, that a

provider of health care services or supplies -

''(A) has charged for health care services or supplies that the

provider knows or should have known were not provided as claimed;

or

''(B) has charged for health care services or supplies in an

amount substantially in excess of such provider's customary

charges for such services or supplies, or charged for health care

services or supplies which are substantially in excess of the

needs of the covered individual or which are of a quality that

fails to meet professionally recognized standards for such

services or supplies;''.

Subsec. (e). Pub. L. 105-266, Sec. 2(a)(3), redesignated subsec.

(d) as (e). Former subsec. (e) redesignated (f).

Subsec. (f). Pub. L. 105-266, Sec. 2(a)(3), (5), redesignated

subsec. (e) as (f) and inserted ''(where such debarment is not

mandatory)'' after ''debarment under this section''. Former

subsec. (f) redesignated (g).

Subsec. (g). Pub. L. 105-266, Sec. 2(a)(3), redesignated subsec.

(f) as (g). Former subsec. (g) redesignated (h).

Subsec. (g)(1). Pub. L. 105-266, Sec. 2(a)(6)(A), added par. (1)

and struck out former par. (1) which read as follows: ''The

debarment of a provider under subsection (b) or (c) shall be

effective at such time and upon such reasonable notice to such

provider, and to carriers and covered individuals, as may be

specified in regulations prescribed by the Office.''

Subsec. (g)(3). Pub. L. 105-266, Sec. 2(a)(6)(B), inserted ''of

debarment'' after ''notice'' and inserted at end ''In the case of a

debarment under paragraph (1), (2), (3), or (4) of subsection (b),

the minimum period of debarment shall not be less than 3 years,

except as provided in paragraph (4)(B)(ii).''

Subsec. (g)(4)(B)(i)(I). Pub. L. 105-266, Sec. 2(a)(6)(C),

substituted ''subsection (b), (c), or (d)'' for ''subsection (b) or

(c)''.

Subsec. (g)(6). Pub. L. 105-266, Sec. 2(a)(6)(D), struck out par.

(6) which read as follows: ''The Office shall, upon written request

and payment of a reasonable charge to defray the cost of complying

with such request, furnish a current list of any providers barred

from participating in the program under this chapter, including the

minimum period of time remaining under the terms of each provider's

debarment.''

Subsec. (h). Pub. L. 105-266, Sec. 2(a)(3), redesignated subsec.

(g) as (h). Former subsec. (h) redesignated (i).

Subsec. (h)(1), (2). Pub. L. 105-266, Sec. 2(a)(7), added pars.

(1) and (2) and struck out former pars. (1) and (2) which read as

follows:

''(1) The Office may not make a determination under subsection

(b) or (c) adverse to a provider of health care services or

supplies until such provider has been given written notice and an

opportunity for a hearing on the record. A provider is entitled to

be represented by counsel, to present witnesses, and to

cross-examine witnesses against the provider in any such hearing.

''(2) Notwithstanding section 8912, any person adversely affected

by a final decision under paragraph (1) may obtain review of such

decision in the United States Court of Appeals for the Federal

Circuit. A written petition requesting that the decision be

modified or set aside must be filed within 60 days after the date

on which such person is notified of such decision.''

Subsec. (i). Pub. L. 105-266, Sec. 2(a)(3), (8), redesignated

subsec. (h) as (i), substituted ''subsection (d)'' for ''subsection

(c)'', and inserted at end ''The amount of a penalty or assessment

as finally determined by the Office, or other amount the Office may

agree to in compromise, may be deducted from any sum then or later

owing by the United States to the party against whom the penalty or

assessment has been levied.'' Former subsec. (i) redesignated (j).

Subsec. (j). Pub. L. 105-266, Sec. 2(a)(3), redesignated subsec.

(i) as (j).

EFFECTIVE DATE OF 1998 AMENDMENT

Pub. L. 105-266, Sec. 2(b), Oct. 19, 1998, 112 Stat. 2366,

provided that:

''(1) In general. - Except as provided in paragraph (2), the

amendments made by this section (amending this section) shall take

effect on the date of the enactment of this Act (Oct. 19, 1998).

''(2) Exceptions. - (A) Paragraphs (2), (3), and (5) of section

8902a(c) of title 5, United States Code, as amended by subsection

(a)(3), shall apply only to the extent that the misconduct which is

the basis for debarment under paragraph (2), (3), or (5), as

applicable, occurs after the date of the enactment of this Act.

''(B) Paragraph (1)(B) of section 8902a(d) of title 5, United

States Code, as amended by subsection (a)(4), shall apply only with

respect to charges which violate section 8904(b) of such title for

items or services furnished after the date of the enactment of this

Act.

''(C) Paragraph (3) of section 8902a(g) of title 5, United States

Code, as amended by subsection (a)(6)(B), shall apply only with

respect to debarments based on convictions occurring after the date

of the enactment of this Act.''

EFFECTIVE DATE; PRIOR CONDUCT

Section 102 of title I of Pub. L. 100-654 provided that:

''(a) Applicability. - The amendments made by this title

(enacting this section) shall be effective with respect to any

calendar year beginning, and contracts entered into or renewed for

any calendar year beginning, after the date of the enactment of

this Act (Nov. 14, 1988).

''(b) Prior Conduct Not To Be Considered. - In carrying out

section 8902a of title 5, United States Code, as added by this

title, no debarment, civil monetary penalty, or assessment may be

imposed under such section based on any criminal or other conduct

occurring before the beginning of the first calendar year which

begins after the date of the enactment of this Act (Nov. 14,

1988).''

-CITE-

5 USC Sec. 8903 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8903. Health benefits plans

-STATUTE-

The Office of Personnel Management may contract for or approve

the following health benefits plans:

(1) Service Benefit Plan. - One Government-wide plan, which may

be underwritten by participating affiliates licensed in any

number of States, offering two levels of benefits, under which

payment is made by a carrier under contracts with physicians,

hospitals, or other providers of health services for benefits of

the types described by section 8904(1) of this title given to

employees, annuitants, members of their families, former spouses,

or persons having continued coverage under section 8905a of this

title, or, under certain conditions, payment is made by a carrier

to the employee, annuitant, family member, former spouse, or

person having continued coverage under section 8905a of this

title.

(2) Indemnity Benefit Plan. - One Government-wide plan,

offering two levels of benefits, under which a carrier agrees to

pay certain sums of money, not in excess of the actual expenses

incurred, for benefits of the types described by section 8904(2)

of this title.

(3) Employee Organization Plans. - Employee organization plans

which offer benefits of the types referred to by section 8904(3)

of this title, which are sponsored or underwritten, and are

administered, in whole or substantial part, by employee

organizations described in section 8901(8)(A) of this title,

which are available only to individuals, and members of their

families, who at the time of enrollment are members of the

organization.

(4) Comprehensive Medical Plans. -

(A) Group-practice prepayment plans. - Group-practice

prepayment plans which offer health benefits of the types

referred to by section 8904(4) of this title, in whole or in

substantial part on a prepaid basis, with professional services

thereunder provided by physicians practicing as a group in a

common center or centers. The group shall include at least 3

physicians who receive all or a substantial part of their

professional income from the prepaid funds and who represent 1

or more medical specialties appropriate and necessary for the

population proposed to be served by the plan.

(B) Individual-practice prepayment plans. -

Individual-practice prepayment plans which offer health

services in whole or substantial part on a prepaid basis, with

professional services thereunder provided by individual

physicians who agree, under certain conditions approved by the

Office, to accept the payments provided by the plans as full

payment for covered services given by them including, in

addition to in-hospital services, general care given in their

offices and the patients' homes, out-of-hospital diagnostic

procedures, and preventive care, and which plans are offered by

organizations which have successfully operated similar plans

before approval by the Office of the plan in which employees

may enroll.

(C) Mixed model prepayment plans. - Mixed model prepayment

plans which are a combination of the type of plans described in

subparagraph (A) and the type of plans described in

subparagraph (B).

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 602; Pub. L. 95-454, title

IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L.

98-615, Sec. 3(3), Nov. 8, 1984, 98 Stat. 3203; Pub. L. 99-53, Sec.

2(b), June 17, 1985, 99 Stat. 94; Pub. L. 99-251, title I, Sec.

102, 111, Feb. 27, 1986, 100 Stat. 14, 19; Pub. L. 100-654, title

II, Sec. 202(b), Nov. 14, 1988, 102 Stat. 3845; Pub. L. 105-266,

Sec. 3(b), Oct. 19, 1998, 112 Stat. 2366.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3003. Sept. 28, 1959, Pub.

L. 86-382, Sec. 4,

73 Stat. 711.

July 8, 1963, Pub.

L. 88-59, Sec.

1(b), 77 Stat. 77.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1998 - Par. (1). Pub. L. 105-266 substituted ''plan, which may be

underwritten by participating affiliates licensed in any number of

States,'' for ''plan,''.

1988 - Par. (1). Pub. L. 100-654 substituted ''former spouses, or

persons having continued coverage under section 8905a of this

title,'' for ''or former spouses,'' and ''former spouse, or person

having continued coverage under section 8905a of this title.'' for

''or former spouse.''

1986 - Par. (4)(A). Pub. L. 99-251, Sec. 102, amended second

sentence generally, substituting ''at least 3 physicians'' for

''physicians representing at least three major medical

specialties'' and inserted ''and who represent 1 or more medical

specialties appropriate and necessary for the population proposed

to be served by the plan''.

Par. (4)(C). Pub. L. 99-251, Sec. 111, added subpar. (C).

1985 - Par. (3). Pub. L. 99-53 inserted ''described in section

8901(8)(A) of this title'' after ''employee organizations''.

1984 - Par. (1). Pub. L. 98-615, Sec. 3(3), substituted

''employees, annuitants, members of their families, or former

spouses'' for ''employees or annuitants, or members of their

families'' and ''employee, annuitant, family member, or former

spouse'' for ''employee or annuitant or member of his family''.

1978 - Pub. L. 95-454 substituted ''Office of Personnel

Management'' and ''Office'' for ''Civil Service Commission'' and

''Commission'', respectively, wherever appearing.

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100-654 applicable with respect to any

calendar year beginning, and contracts entered into or renewed for

any calendar year beginning, after end of 9-month period beginning

Nov. 14, 1988, and with respect to any qualifying event occurring

on or after first day of first calendar year beginning after end of

such 9-month period, see section 203 of Pub. L. 100-654, set out as

a note under section 8902 of this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8901, 8902, 8902a, 8903a,

8903b, 8904, 8905, 8907, 8908, 8909, 8910, 8913 of this title;

title 42 sections 1395s, 1397cc.

-CITE-

5 USC Sec. 8903a 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8903a. Additional health benefits plans

-STATUTE-

(a) In addition to any plan under section 8903 of this title, the

Office of Personnel Management may contract for or approve one or

more health benefits plans under this section.

(b) A plan under this section may not be contracted for or

approved unless it -

(1) is sponsored or underwritten, and administered, in whole or

substantial part, by an employee organization described in

section 8901(8)(B) of this title;

(2) offers benefits of the types named by paragraph (1) or (2)

of section 8904 of this title or both;

(3) provides for benefits only by paying for, or providing

reimbursement for, the cost of such benefits (as provided for

under paragraph (1) or (2) of section 8903 of this title) or a

combination thereof; and

(4) is available only to individuals who, at the time of

enrollment, are full members of the organization and to members

of their families.

(c) A contract for a plan approved under this section shall

require the carrier -

(1) to enter into an agreement approved by the Office with an

underwriting subcontractor licensed to issue group health

insurance in all the States and the District of Columbia; or

(2) to demonstrate ability to meet reasonable minimum financial

standards prescribed by the Office.

(d) For the purpose of this section, an individual shall be

considered a full member of an organization if such individual is

eligible to exercise all rights and privileges incident to full

membership in such organization (determined without regard to the

right to hold elected office).

-SOURCE-

(Added Pub. L. 99-53, Sec. 1(b)(1), June 17, 1985, 99 Stat. 93.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8901, 8902, 8902a, 8903b,

8905, 8907, 8908, 8909, 8910, 8913 of this title; title 42 section

1395s.

-CITE-

5 USC Sec. 8903b 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8903b. Authority to readmit an employee organization plan

-STATUTE-

(a) In the event that a plan described by section 8903(3) or

8903a is discontinued under this chapter (other than in the

circumstance described in section 8909(d)), that discontinuation

shall be disregarded, for purposes of any determination as to that

plan's eligibility to be considered an approved plan under this

chapter, but only for purposes of any contract year later than the

third contract year beginning after such plan is so discontinued.

(b) A contract for a plan approved under this section shall

require the carrier -

(1) to demonstrate experience in service delivery within a

managed care system (including provider networks) throughout the

United States; and

(2) if the carrier involved would not otherwise be subject to

the requirement set forth in section 8903a(c)(1), to satisfy such

requirement.

-SOURCE-

(Added Pub. L. 105-266, Sec. 6(a)(1), Oct. 19, 1998, 112 Stat.

2368.)

-MISC1-

EFFECTIVE DATE

Pub. L. 105-266, Sec. 6(a)(3), Oct. 19, 1998, 112 Stat. 2369,

provided that:

''(A) In general. - The amendments made by this subsection

(enacting this section) shall apply as of the date of the enactment

of this Act (Oct. 19, 1998), including with respect to any plan

which has been discontinued as of such date.

''(B) Transition rule. - For purposes of applying section

8903b(a) of title 5, United States Code (as amended by this

subsection) with respect to any plan seeking to be readmitted for

purposes of any contract year beginning before January 1, 2000,

such section shall be applied by substituting 'second contract

year' for 'third contract year'.''

-CITE-

5 USC Sec. 8904 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8904. Types of benefits

-STATUTE-

(a) The benefits to be provided under plans described by section

8903 of this title may be of the following types:

(1) Service Benefit Plan. -

(A) Hospital benefits.

(B) Surgical benefits.

(C) In-hospital medical benefits.

(D) Ambulatory patient benefits.

(E) Supplemental benefits.

(F) Obstetrical benefits.

(2) Indemnity Benefit Plan. -

(A) Hospital care.

(B) Surgical care and treatment.

(C) Medical care and treatment.

(D) Obstetrical benefits.

(E) Prescribed drugs, medicines, and prosthetic devices.

(F) Other medical supplies and services.

(3) Employee Organization Plans. - Benefits of the types named

under paragraph (1) or (2) of this subsection or both.

(4) Comprehensive Medical Plans. - Benefits of the types named

under paragraph (1) or (2) of this subsection or both.

All plans contracted for under paragraphs (1) and (2) of this

subsection shall include benefits both for costs associated with

care in a general hospital and for other health services of a

catastrophic nature.

(b)(1)(A) A plan, other than a prepayment plan described in

section 8903(4) of this title, may not provide benefits, in the

case of any retired enrolled individual who is age 65 or older and

is not covered to receive Medicare hospital and insurance benefits

under part A of title XVIII of the Social Security Act (42 U.S.C.

1395c et seq.), to pay a charge imposed by any health care

provider, for inpatient hospital services which are covered for

purposes of benefit payments under this chapter and part A of title

XVIII of the Social Security Act, to the extent that such charge

exceeds applicable limitations on hospital charges established for

Medicare purposes under section 1886 of the Social Security Act (42

U.S.C. 1395ww). Hospital providers who have in force participation

agreements with the Secretary of Health and Human Services

consistent with sections 1814(a) and 1866 of the Social Security

Act (42 U.S.C. 1395f(a) and 1395cc), whereby the participating

provider accepts Medicare benefits as full payment for covered

items and services after applicable patient copayments under

section 1813 of such Act (42 U.S.C. 1395e) have been satisfied,

shall accept equivalent benefit payments and enrollee copayments

under this chapter as full payment for services described in the

preceding sentence. The Office of Personnel Management shall

notify the Secretary of Health and Human Services if a hospital is

found to knowingly and willfully violate this subsection on a

repeated basis and the Secretary may invoke appropriate sanctions

in accordance with section 1866(b)(2) of the Social Security Act

(42 U.S.C. 1395cc(b)(2)) and applicable regulations.

(B)(i) A plan, other than a prepayment plan described in section

8903(4), may not provide benefits, in the case of any retired

enrolled individual who is age 65 or older and is not entitled to

Medicare supplementary medical insurance benefits under part B of

title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.),

to pay a charge imposed for physicians' services (as defined in

section 1848(j) of such Act, 42 U.S.C. 1395w-4(j)) which are

covered for purposes of benefit payments under this chapter and

under such part, to the extent that such charge exceeds the fee

schedule amount under section 1848(a) of such Act (42 U.S.C.

1395w-4(a)).

(ii) Physicians and suppliers who have in force participation

agreements with the Secretary of Health and Human Services

consistent with section 1842(h)(1) of such Act (42 U.S.C.

1395u(h)(1)), whereby the participating provider accepts Medicare

benefits (including allowable deductible and coinsurance amounts)

as full payment for covered items and services shall accept

equivalent benefit and enrollee cost-sharing under this chapter as

full payment for services described in clause (i). Physicians and

suppliers who are nonparticipating physicians and suppliers for

purposes of part B of title XVIII of such Act shall not impose

charges that exceed the limiting charge under section 1848(g) of

such Act (42 U.S.C. 1395w-4(g)) with respect to services described

in clause (i) provided to enrollees described in such clause. The

Office of Personnel Management shall notify a physician or supplier

who is found to have violated this clause and inform them of the

requirements of this clause and sanctions for such a violation.

The Office of Personnel Management shall notify the Secretary of

Health and Human Services if a physician or supplier is found to

knowingly and willfully violate this clause on a repeated basis and

the Secretary of Health and Human Services may invoke appropriate

sanctions in accordance with sections 1128A(a) and 1848(g)(1) of

such Act (42 U.S.C. 1320a-7a(a), 1395w-4(g)(1)) and applicable

regulations.

(C) If the Secretary of Health and Human Services determines that

a violation of this subsection warrants excluding a provider from

participation for a specified period under title XVIII of the

Social Security Act, the Office shall enforce a corresponding

exclusion of such provider for purposes of this chapter.

(2) Notwithstanding any other provision of law, the Secretary of

Health and Human Services and the Director of the Office of

Personnel Management, and their agents, shall exchange any

information necessary to implement this subsection.

(3)(A) Not later than December 1, 1991, and periodically

thereafter, the Secretary of Health and Human Services (in

consultation with the Director of the Office of Personnel

Management) shall supply to carriers of plans described in

paragraphs (1) through (3) of section 8903 the Medicare program

information necessary for them to comply with paragraph (1).

(B) For purposes of this paragraph, the term ''Medicare program

information'' includes (i) the limitations on hospital charges

established for Medicare purposes under section 1886 of the Social

Security Act (42 U.S.C. 1395ww) and the identity of hospitals which

have in force agreements with the Secretary of Health and Human

Services consistent with section 1814(a) and 1866 of the Social

Security Act (42 U.S.C. 1395f(a) and 1395cc), and (ii) the fee

schedule amounts and limiting charges for physicians' services

established under section 1848 of such Act (42 U.S.C. 1395w-4) and

the identity of participating physicians and suppliers who have in

force agreements with such Secretary under section 1842(h) of such

Act (42 U.S.C. 1395u(h)).

(4) The Director of the Office of Personnel Management shall

enter into an arrangement with the Secretary of Health and Human

Services, to be effective before the first day of the fifth month

that begins before each contract year, under which -

(A) physicians and suppliers (whether or not participating)

under the Medicare program will be notified of the requirements

of paragraph (1)(B);

(B) enforcement procedures will be in place to carry out such

paragraph (including enforcement of protections against

overcharging of beneficiaries); and

(C) Medicare program information described in paragraph

(3)(B)(ii) will be supplied to carriers under paragraph (3)(A).

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 603; Pub. L. 101-508,

title VII, Sec. 7002(f)(1), Nov. 5, 1990, 104 Stat. 1388-330; Pub.

L. 102-378, Sec. 2(76), Oct. 2, 1992, 106 Stat. 1355; Pub. L.

103-66, title XI, Sec. 11003(a), Aug. 10, 1993, 107 Stat. 409.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3004. Sept. 28, 1959, Pub.

L. 86-382, Sec. 5,

73 Stat. 712.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

-REFTEXT-

REFERENCES IN TEXT

The Social Security Act, referred to in subsec. (b)(1), is act

Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. Title XVIII of

the Act is classified generally to subchapter XVIII (Sec. 1395 et

seq.) of chapter 7 of Title 42, The Public Health and Welfare.

Parts A and B of title XVIII of the Act are classified generally to

part A (Sec. 1395c et seq.) and part B (Sec. 1395j et seq.),

respectively, of subchapter XVIII of chapter 7 of Title 42. For

complete classification of this Act to the Code, see section 1305

of Title 42 and Tables.

-MISC2-

AMENDMENTS

1993 - Subsec. (b)(1). Pub. L. 103-66, Sec. 11003(a)(1),

designated existing provisions as subpar. (A) and added subpars.

(B) and (C).

Subsec. (b)(3)(B). Pub. L. 103-66, Sec. 11003(a)(2), inserted cl.

(i) designation and added cl. (ii).

Subsec. (b)(4). Pub. L. 103-66, Sec. 11003(a)(3), added par. (4).

1992 - Subsec. (a). Pub. L. 102-378 substituted ''this

subsection'' for ''this section'' in pars. (3) and (4) and in last

sentence.

1990 - Pub. L. 101-508 designated existing provisions as subsec.

(a) and added subsec. (b).

EFFECTIVE DATE OF 1993 AMENDMENT

Section 11003(b) of Pub. L. 103-66 provided that: ''The

amendments made by subsection (a) (amending this section) shall

apply with respect to contract years beginning on or after January

1, 1995.''

EFFECTIVE DATE OF 1990 AMENDMENT

Section 7002(f)(2) of Pub. L. 101-508 provided that: ''The

amendments made by this subsection (amending this section) shall

apply with respect to contract years beginning on or after January

1, 1992.''

MENTAL HEALTH, ALCOHOLISM, AND DRUG ADDICTION BENEFITS;

CONGRESSIONAL FINDINGS; SENSE OF CONGRESS

Pub. L. 99-251, title I, Sec. 107, Feb. 27, 1986, 100 Stat. 16,

provided that:

''(a) Findings. - The Congress finds that -

''(1) the treatment of mental illness, alcoholism, and drug

addiction are basic health care services which are needed by

approximately 40,000,000 Americans each year;

''(2) treatment of mental illness, alcoholism, and drug

addiction is increasingly successful;

''(3) timely and appropriate treatment of mental illness,

alcoholism, and drug addiction is cost effective in terms of

restored productivity, reduced utilization of other health

services, and reduced social dependence; and

''(4) mental illness is a problem of grave concern to the

people of the United States and is widely but unnecessarily

feared and misunderstood.

''(b) Sense of the Congress. - It is the sense of the Congress -

''(1) that participants in the Federal employees health

benefits program should receive adequate benefits coverage for

treatment of mental illness, alcoholism, and drug addiction; and

''(2) that the Office of Personnel Management should encourage

participating health benefits plans to provide adequate benefits

relating to treatment of mental illness, alcoholism, and drug

addiction (including benefits relating to coverage for inpatient

and outpatient treatment and catastrophic protection benefits).''

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8902a, 8903, 8903a of

this title.

-CITE-

5 USC Sec. 8905 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8905. Election of coverage

-STATUTE-

(a) An employee may enroll in an approved health benefits plan

described by section 8903 or 8903a of this title either as an

individual or for self and family.

(b) An annuitant who at the time he becomes an annuitant was

enrolled in a health benefits plan under this chapter -

(1) as an employee for a period of not less than -

(A) the 5 years of service immediately before retirement;

(B) the full period or periods of service between the last

day of the first period, as prescribed by regulations of the

Office of Personnel Management, in which he is eligible to

enroll in the plan and the date on which he becomes an

annuitant; or

(C) the full period or periods of service beginning with the

enrollment which became effective before January 1, 1965, and

ending with the date on which he becomes an annuitant;

whichever is shortest; or

(2) as a member of the family of an employee or annuitant;

may continue his enrollment under the conditions of eligibility

prescribed by regulations of the Office. The Office may, in its

sole discretion, waive the requirements of this subsection in the

case of an individual who fails to satisfy such requirements if the

Office determines that, due to exceptional circumstances, it would

be against equity and good conscience not to allow such individual

to be enrolled as an annuitant in a health benefits plan under this

chapter (FOOTNOTE 1)

(FOOTNOTE 1) So in original. Probably should be followed by a

period.

(c)(1) A former spouse may -

(A) within 60 days after the dissolution of the marriage, or

(B) in the case of a former spouse of a former employee whose

marriage was dissolved after the employee's retirement, within 60

days after the dissolution of the marriage or, if later, within

60 days after an election is made under section 8339(j)(3) or

8417(b) of this title for such former spouse by the retired

employee,

enroll in an approved health benefits plan described by section

8903 or 8903a of this title as an individual or for self and family

as provided in paragraph (2) of this subsection, subject to

agreement to pay the full subscription charge of the enrollment,

including the amounts determined by the Office to be necessary for

administration and reserves pursuant to section 8909(b) of this

title. The former spouse shall submit an enrollment application

and make premium payments to the agency which, at the time of

divorce or annulment, employed the employee to whom the former

spouse was married or, in the case of a former spouse who is

receiving annuity payments under section 8341(h), 8345(j), 8445, or

8467 of this title, to the Office of Personnel Management.

(2) Coverage for self and family under this subsection shall be

limited to -

(A) the former spouse; and

(B) unmarried dependent natural or adopted children of the

former spouse and the employee who are -

(i) under 22 years of age; or

(ii) incapable of self-support because of mental or physical

disability which existed before age 22.

(d) An individual whom the Secretary of Defense determines is an

eligible beneficiary under subsection (b) of section 1108 of title

10 may enroll, as part of the demonstration project under such

section, in a health benefits plan under this chapter in accordance

with the agreement under subsection (a) of such section between the

Secretary and the Office and applicable regulations under this

chapter.

(e) If an employee, annuitant, or other individual eligible to

enroll in a health benefits plan under this chapter has a spouse

who is also eligible to enroll, either spouse, but not both, may

enroll for self and family, or each spouse may enroll as an

individual. However, an individual may not be enrolled both as an

employee, annuitant, or other individual eligible to enroll and as

a member of the family.

(f) An employee, annuitant, former spouse, or person having

continued coverage under section 8905a of this title enrolled in a

health benefits plan under this chapter may change his coverage or

that of himself and members of his family by an application filed

within 60 days after a change in family status or at other times

and under conditions prescribed by regulations of the Office.

(g)(1) Under regulations prescribed by the Office, the Office

shall, before the start of any contract term in which -

(A) an adjustment is made in any of the rates charged or

benefits provided under a health benefits plan described by

section 8903 or 8903a of this title,

(B) a newly approved health benefits plan is offered, or

(C) an existing plan is terminated,

provide a period of not less than 3 weeks during which any

employee, annuitant, former spouse, or person having continued

coverage under section 8905a of this title enrolled in a health

benefits plan described by such section shall be permitted to

transfer that individual's enrollment to another such plan or to

cancel such enrollment.

(2) In addition to any opportunity afforded under paragraph (1)

of this subsection, an employee, annuitant, former spouse, or

person having continued coverage under section 8905a of this title

enrolled in a health benefits plan under this chapter shall be

permitted to transfer that individual's enrollment to another such

plan, or to cancel such enrollment, at such other times and subject

to such conditions as the Office may prescribe in regulations.

(3)(A) In addition to any informational requirements otherwise

applicable under this chapter, the regulations shall include

provisions to ensure that each employee eligible to enroll in a

health benefits plan under this chapter (whether actually enrolled

or not) is notified in writing as to the rights afforded under

section 8905a of this title.

(B) Notification under this paragraph shall be provided by

employing agencies at an appropriate point in time before each

period under paragraph (1) so that employees may be aware of their

rights under section 8905a of this title when making enrollment

decisions during such period.

(h)(1) An unenrolled employee who is required by a court or

administrative order to provide health insurance coverage for a

child who meets the requirements of section 8901(5) may enroll for

self and family coverage in a health benefits plan under this

chapter. If such employee fails to enroll for self and family

coverage in a health benefits plan that provides full benefits and

services in the location in which the child resides, and the

employee does not provide documentation showing that such coverage

has been provided through other health insurance, the employing

agency shall enroll the employee in a self and family enrollment in

the option which provides the lower level of coverage under the

Service Benefit Plan.

(2) An employee who is enrolled as an individual in a health

benefits plan under this chapter and who is required by a court or

administrative order to provide health insurance coverage for a

child who meets the requirements of section 8901(5) may change to a

self and family enrollment in the same or another health benefits

plan under this chapter. If such employee fails to change to a

self and family enrollment and the employee does not provide

documentation showing that such coverage has been provided through

other health insurance, the employing agency shall change the

enrollment of the employee to a self and family enrollment in the

plan in which the employee is enrolled if that plan provides full

benefits and services in the location where the child resides. If

the plan in which the employee is enrolled does not provide full

benefits and services in the location in which the child resides,

or, if the employee fails to change to a self and family enrollment

in a plan that provides full benefits and services in the location

where the child resides, the employing agency shall change the

coverage of the employee to a self and family enrollment in the

option which provides the lower level of coverage under the Service

Benefits Plan.

(3) The employee may not discontinue the self and family

enrollment in a plan that provides full benefits and services in

the location in which the child resides for so long as the court or

administrative order remains in effect and the child continues to

meet the requirements of section 8901(5), unless the employee

provides documentation showing that such coverage has been provided

through other health insurance.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 603; Pub. L. 95-454, title

IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L.

98-615, Sec. 3(4), Nov. 8, 1984, 98 Stat. 3203; Pub. L. 99-53, Sec.

2(a), (c), June 17, 1985, 99 Stat. 94; Pub. L. 99-251, title I,

Sec. 103, 104(a), Feb. 27, 1986, 100 Stat. 14; Pub. L. 99-335,

title II, Sec. 207(m), June 6, 1986, 100 Stat. 598; Pub. L.

100-654, title II, Sec. 201(c), (d), 202(c), Nov. 14, 1988, 102

Stat. 3845; Pub. L. 102-378, Sec. 2(77), Oct. 2, 1992, 106 Stat.

1355; Pub. L. 105-261, div. A, title VII, Sec. 721(b)(1), Oct. 17,

1998, 112 Stat. 2065; Pub. L. 106-394, Sec. 2, Oct. 30, 2000, 114

Stat. 1629.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3002(a) Sept. 28, 1959, Pub.

(1st sentence, less L. 86-382, Sec.

words between 1st 3(a) (1st sentence,

and 4th commas), less words between

(b)-(e). 1st and 4th

commas), (b)-(e),

73 Stat. 710.

Mar. 17, 1964, Pub.

L. 88-284, Sec.

1(5), 78 Stat. 164.

-------------------------------

In subsection (b)(1), the words ''as an employee'' are inserted

for clarity.

In subsection (b)(1)(C), the words ''before January 1, 1965'' are

substituted for ''not later than December 31, 1964''.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

2000 - Subsec. (h). Pub. L. 106-394 added subsec. (h).

1998 - Subsecs. (d) to (g). Pub. L. 105-261 added subsec. (d) and

redesignated former subsecs. (d) to (f) as (e) to (g),

respectively.

1992 - Subsec. (b). Pub. L. 102-378, Sec. 2(77)(A), substituted

''this chapter'' for ''this subchapter.'' at end.

Subsec. (c)(1). Pub. L. 102-378, Sec. 2(77)(B), inserted comma

after ''8341(h)'' in last sentence.

1988 - Subsec. (d). Pub. L. 100-654, Sec. 202(c), amended subsec.

(d) generally. Prior to amendment, subsec. (d) read as follows:

''If an employee has a spouse who is an employee, either spouse,

but not both, may enroll for self and family, or each spouse may

enroll as an individual. However, an individual may not be

enrolled both as an employee or annuitant and as a member of the

family.''

Subsecs. (e), (f)(1), (2). Pub. L. 100-654, Sec. 201(c), (d)(1),

substituted ''former spouse, or person having continued coverage

under section 8905a of this title'' for ''or former spouse''.

Subsec. (f)(3). Pub. L. 100-654, Sec. 201(d)(2), added par. (3).

1986 - Subsec. (b). Pub. L. 99-251, Sec. 103, inserted last

sentence relating to waiver of the requirements of this subsection

if it would be against equity to prohibit enrollment.

Subsec. (c)(1). Pub. L. 99-335 inserted in subpar. (B) ''or

8417(b)'' and substituted in provision following subpar. (B)

''8345(j), 8445, or 8467'' for ''or 8345(j)''.

Subsec. (f). Pub. L. 99-251, Sec. 104(a), amended subsec. (f)

generally. Prior to amendment, subsec. (f) read as follows: ''An

employee, annuitant, or former spouse enrolled in a health benefits

plan under this chapter may change his coverage or that of himself

and members of his family by an application filed within 60 days

after a change in family status or at other times and under

conditions prescribed by regulations of the Office.''

1985 - Subsecs. (a), (c)(1). Pub. L. 99-53, Sec. 2(a), inserted

reference to section 8903a of this title.

Subsec. (f). Pub. L. 99-53, Sec. 2(a), (c), inserted reference to

section 8903a of this title and substituted ''such plan'' for

''plan described by that section''.

1984 - Subsec. (c). Pub. L. 98-615, Sec. 3(4)(A), added subsec.

(c). Former subsec. (c) redesignated (d).

Subsec. (d). Pub. L. 98-615, Sec. 3(4)(A), redesignated former

subsec. (c) as (d). Former subsec. (d) redesignated (e).

Subsec. (e). Pub. L. 98-615, Sec. 3(4), redesignated former

subsec. (d) as (e) and substituted ''An employee, annuitant, or

former spouse'' for ''An employee or annuitant''. Former subsec.

(e) redesignated (f).

Subsec. (f). Pub. L. 98-615, Sec. 3(4), redesignated former

subsec. (e) as (f) and substituted ''An employee, annuitant, or

former spouse'' for ''An employee or annuitant''.

1978 - Subsecs. (b), (d), (e). Pub. L. 95-454 substituted

''Office of Personnel Management'' and ''Office'' for ''Civil

Service Commission'' and ''Commission'', respectively, wherever

appearing.

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100-654 applicable with respect to any

calendar year beginning, and contracts entered into or renewed for

any calendar year beginning, after end of 9-month period beginning

Nov. 14, 1988, and with respect to any qualifying event occurring

on or after first day of first calendar year beginning after end of

such 9-month period, see section 203 of Pub. L. 100-654, set out as

a note under section 8902 of this title.

EFFECTIVE DATE OF 1986 AMENDMENTS

Amendment by Pub. L. 99-335 effective Jan. 1, 1987, see section

702(a) of Pub. L. 99-335, set out as an Effective Date note under

section 8401 of this title.

Section 104(b) of Pub. L. 99-251 provided that: ''The amendment

made by subsection (a) (amending this section) shall be effective

with respect to contracts entered into or renewed for calendar

years beginning after December 31, 1986.''

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

ELECTION OF HEALTH BENEFITS COVERAGE AND ENTITLEMENT TO HEALTH

BENEFITS UNDER THIS CHAPTER RATHER THAN UNDER RETIRED FEDERAL

EMPLOYEES HEALTH BENEFITS ACT

Pub. L. 93-246, Sec. 2, 4(b), Jan. 31, 1974, 88 Stat. 4, provided

that:

''Sec. 2. (a) Notwithstanding any other provision of law, an

annuitant, as defined under section 8901(3) of title 5, United

States Code, who is participating or who is eligible to participate

in the health benefits program offered under the Retired Federal

Employees Health Benefits Act (74 Stat. 849; Public Law 86-724),

may elect, in accordance with regulations prescribed by the United

States Civil Service Commission, to be covered under the provisions

of chapter 89 of title 5, United States Code (this chapter), in

lieu of coverage under such Act.

''(b) An annuitant who elects to be covered under the provisions

of chapter 89 of title 5, United States Code (this chapter), in

accordance with subsection (a) of this section, shall be entitled

to the benefits under such chapter 89.

''(Sec. 4) (b) Section 2 (set out above) shall take effect on the

one hundred and eightieth day following the date of enactment (Jan.

1, 1974) or on such earlier date as the United States Civil Service

Commission may prescribe.''

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 6302 of this title; title

2 section 162b; title 28 section 179.

-CITE-

5 USC Sec. 8905a 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8905a. Continued coverage

-STATUTE-

(a) Any individual described in paragraph (1) or (2) of

subsection (b) may elect to continue coverage under this chapter in

accordance with the provisions of this section.

(b) This section applies with respect to -

(1) any employee who -

(A) is separated from service, whether voluntarily or

involuntarily, except that if the separation is involuntary,

this section shall not apply if the separation is for gross

misconduct (as defined under regulations which the Office of

Personnel Management shall prescribe); and

(B) would not otherwise be eligible for any benefits under

this chapter (determined without regard to any temporary

extension of coverage and without regard to any benefits

available under a nongroup contract); and

(2) any individual who -

(A) ceases to meet the requirements for being considered an

unmarried dependent child under this chapter;

(B) on the day before so ceasing to meet the requirements

referred to in subparagraph (A), was covered under a health

benefits plan under this chapter as a member of the family of

an employee or annuitant; and

(C) would not otherwise be eligible for any benefits under

this chapter (determined without regard to any temporary

extension of coverage and without regard to any benefits

available under a nongroup contract).

(c)(1) The Office shall prescribe regulations and provide for the

inclusion of appropriate terms in contracts with carriers to

provide that -

(A) with respect to an employee who becomes (or will become)

eligible for continued coverage under this section as a result of

separation from service, the separating agency shall, before the

end of the 30-day period beginning on the date as of which

coverage (including any temporary extensions of coverage) would

otherwise end, notify the individual of such individual's rights

under this section; and

(B) with respect to a child of an employee or annuitant who

becomes eligible for continued coverage under this section as a

result of ceasing to meet the requirements for being considered a

member of the employee's or annuitant's family -

(i) the employee or annuitant may provide written notice of

the child's change in status (complete with the child's name,

address, and such other information as the Office may by

regulation require) -

(I) to the employee's employing agency; or

(II) in the case of an annuitant, to the Office; and

(ii) if the notice referred to in clause (i) is received

within 60 days after the date as of which the child involved

first ceases to meet the requirements involved, the employing

agency or the Office (as the case may be) must, within 14 days

after receiving such notice, notify the child of such child's

rights under this section.

(2) In order to obtain continued coverage under this section, an

appropriate written election (submitted in such manner as the

Office by regulation prescribes) must be made -

(A) in the case of an individual seeking continued coverage

based on a separation from service, before the end of the 60-day

period beginning on the later of -

(i) the effective date of the separation; or

(ii) the date the separated individual receives the notice

required under paragraph (1)(A); or

(B) in the case of an individual seeking continued coverage

based on a change in circumstances making such individual

ineligible for coverage as an unmarried dependent child, before

the end of the 60-day period beginning on the later of -

(i) the date as of which such individual first ceases to meet

the requirements for being considered an unmarried dependent

child; or

(ii) the date such individual receives notice under paragraph

(1)(B)(ii);

except that if a parent fails to provide the notice required

under paragraph (1)(B)(i) in timely fashion, the 60-day period

under this subparagraph shall be based on the date under clause

(i), irrespective of whether or not any notice under paragraph

(1)(B)(ii) is provided.

(d)(1)(A) Except as provided in paragraphs (4) and (5), an

individual receiving continued coverage under this section shall be

required to pay currently into the Employees Health Benefits Fund,

under arrangements satisfactory to the Office, an amount equal to

the sum of -

(i) the employee and agency contributions which would be

required in the case of an employee enrolled in the same health

benefits plan and level of benefits; and

(ii) an amount, determined under regulations prescribed by the

Office, necessary for administrative expenses, but not to exceed

2 percent of the total amount under clause (i).

(B) Payments under this section to the Fund shall -

(i) in the case of an individual whose continued coverage is

based on such individual's separation, be made through the agency

which last employed such individual; or

(ii) in the case of an individual whose continued coverage is

based on a change in circumstances referred to in subsection

(c)(2)(B), be made through -

(I) the Office, if, at the time coverage would (but for this

section) otherwise have been discontinued, the individual was

covered as the child of an annuitant; or

(II) if, at the time referred to in subclause (I), the

individual was covered as the child of an employee, the

employee's employing agency as of such time.

(2) If an individual elects to continue coverage under this

section before the end of the applicable period under subsection

(c)(2), but after such individual's coverage under this chapter

(including any temporary extensions of coverage) expires, coverage

shall be restored retroactively, with appropriate contributions

(determined in accordance with paragraph (1), (4), or (5), as the

case may be) and claims (if any), to the same extent and effect as

though no break in coverage had occurred.

(3)(A) An individual making an election under subsection

(c)(2)(B) may, at such individual's option, elect coverage either

as an individual or, if appropriate, for self and family.

(B) For the purpose of this paragraph, members of an individual's

family shall be determined in the same way as would apply under

this chapter in the case of an enrolled employee.

(C) Nothing in this paragraph shall be considered to limit an

individual making an election under subsection (c)(2)(A) to

coverage for self alone.

(4)(A) If the basis for continued coverage under this section is

an involuntary separation from a position, or a voluntary

separation from a surplus position, in or under the Department of

Defense due to a reduction in force, or the Department of Energy

due to a reduction in force resulting from the establishment of the

National Nuclear Security Administration -

(i) the individual shall be liable for not more than the

employee contributions referred to in paragraph (1)(A)(i); and

(ii) the agency which last employed the individual shall pay

the remaining portion of the amount required under paragraph

(1)(A).

(B) This paragraph shall apply with respect to any individual

whose continued coverage is based on a separation occurring on or

after the date of enactment of this paragraph and before -

(i) October 1, 2006; or

(ii) February 1, 2007, if specific notice of such separation

was given to such individual before October 1, 2006.

(C) For the purpose of this paragraph, ''surplus position'' means

a position which is identified in pre-reduction-in-force planning

as no longer required, and which is expected to be eliminated under

formal reduction-in-force procedures.

(5)(A) If the basis for continued coverage under this section is

an involuntary separation from a position in or under the

Department of Veterans Affairs due to a reduction in force or a

title 38 staffing readjustment, or a voluntary or involuntary

separation from a Department of Energy position at a Department of

Energy facility at which the Secretary is carrying out a closure

project selected under section 3143 of the National Defense

Authorization Act for Fiscal Year 1997 (42 U.S.C. 7274n) -

(i) the individual shall be liable for not more than the

employee contributions referred to in paragraph (1)(A)(i); and

(ii) the agency which last employed the individual shall pay

the remaining portion of the amount required under paragraph

(1)(A).

(B) This paragraph shall only apply with respect to individuals

whose continued coverage is based on a separation occurring on or

after the date of the enactment of this paragraph.

(e)(1) Continued coverage under this section may not extend

beyond -

(A) in the case of an individual whose continued coverage is

based on separation from service, the date which is 18 months

after the effective date of the separation; or

(B) in the case of an individual whose continued coverage is

based on ceasing to meet the requirements for being considered an

unmarried dependent child, the date which is 36 months after the

date on which the individual first ceases to meet those

requirements, subject to paragraph (2).

(2) In the case of an individual who -

(A) ceases to meet the requirements for being considered an

unmarried dependent child;

(B) as of the day before so ceasing to meet the requirements

referred to in subparagraph (A), was covered as the child of a

former employee receiving continued coverage under this section

based on the former employee's separation from service; and

(C) so ceases to meet the requirements referred to in

subparagraph (A) before the end of the 18-month period beginning

on the date of the former employee's separation from service,

extended coverage under this section may not extend beyond the date

which is 36 months after the separation date referred to in

subparagraph (C).

(f)(1) The Office shall prescribe regulations under which, in

addition to any individual otherwise eligible for continued

coverage under this section, and to the extent practicable,

continued coverage may also, upon appropriate written application,

be afforded under this section -

(A) to any individual who -

(i) if subparagraphs (A) and (C) of paragraph (10) of section

8901 were disregarded, would be eligible to be considered a

former spouse within the meaning of such paragraph; but

(ii) would not, but for this subsection, be eligible to be so

considered; and

(B) to any individual whose coverage as a family member would

otherwise terminate as a result of a legal separation.

(2) The terms and conditions for coverage under the regulations

shall include -

(A) consistent with subsection (c), any necessary notification

provisions, and provisions under which an election period of at

least 60 days' duration is afforded;

(B) terms and conditions identical to those under subsection

(d), except that contributions to the Employees Health Benefits

Fund shall be made through such agency as the Office by

regulation prescribes;

(C) provisions relating to the termination of continued

coverage, except that continued coverage under this section may

not (subject to paragraph (3)) extend beyond the date which is 36

months after the date on which the qualifying event under this

subsection (the date of divorce, annulment, or legal separation,

as the case may be) occurs; and

(D) provisions designed to ensure that any coverage pursuant to

this subsection does not adversely affect any eligibility for

coverage which the individual involved might otherwise have under

this chapter (including as a result of any change in personal

circumstances) if this subsection had not been enacted.

(3) In the case of an individual -

(A) who becomes eligible for continued coverage under this

subsection based on a divorce, annulment, or legal separation

from a person who, as of the day before the date of the divorce,

annulment, or legal separation (as the case may be) was receiving

continued coverage under this section for self and family based

on such person's separation from service; and

(B) whose divorce, annulment, or legal separation (as the case

may be) occurs before the end of the 18-month period beginning on

the date of the separation from service referred to in

subparagraph (A),

extended coverage under this section may not extend beyond the date

which is 36 months after the date of the separation from service,

as referred to in subparagraph (A).

-SOURCE-

(Added Pub. L. 100-654, title II, Sec. 201(a)(1), Nov. 14, 1988,

102 Stat. 3841; amended Pub. L. 102-484, div. D, title XLIV, Sec.

4438(a), Oct. 23, 1992, 106 Stat. 2725; Pub. L. 103-337, div. A,

title III, Sec. 341(d), Oct. 5, 1994, 108 Stat. 2720; Pub. L.

104-106, div. A, title X, Sec. 1036, Feb. 10, 1996, 110 Stat. 431;

Pub. L. 106-65, div. A, title XI, Sec. 1104(c), div. C, title

XXXII, Sec. 3244, Oct. 5, 1999, 113 Stat. 777, 965; Pub. L.

106-117, title XI, Sec. 1106, Nov. 30, 1999, 113 Stat. 1598; Pub.

L. 106-398, Sec. 1 (div. C, title XXXI, Sec. 3136(h)), Oct. 30,

2000, 114 Stat. 1654, 1654A-459; Pub. L. 107-314, div. A, title

XI, Sec. 1103, Dec. 2, 2002, 116 Stat. 2661.)

-REFTEXT-

REFERENCES IN TEXT

The date of enactment of this paragraph, referred to in subsec.

(d)(4)(B), is the date of enactment of Pub. L. 102-484, which was

approved Oct. 23, 1992.

The date of the enactment of this paragraph, referred to in

subsec. (d)(5)(B), is the date of enactment of Pub. L. 106-117,

which was approved Nov. 30, 1999.

-MISC2-

AMENDMENTS

2002 - Subsec. (d)(4)(B)(i). Pub. L. 107-314, Sec. 1103(1),

substituted ''2006'' for ''2003''.

Subsec. (d)(4)(B)(ii). Pub. L. 107-314, Sec. 1103(2), substituted

''2007'' and ''2006'' for ''2004'' and ''2003'', respectively.

2000 - Subsec. (d)(5)(A). Pub. L. 106-398, in introductory

provisions, inserted '', or a voluntary or involuntary separation

from a Department of Energy position at a Department of Energy

facility at which the Secretary is carrying out a closure project

selected under section 3143 of the National Defense Authorization

Act for Fiscal Year 1997 (42 U.S.C. 7274n)'' after

''readjustment''.

1999 - Subsec. (d)(1)(A). Pub. L. 106-117, Sec. 1106(1),

substituted ''paragraphs (4) and (5)'' for ''paragraph (4)'' in

introductory provisions.

Subsec. (d)(2). Pub. L. 106-117, Sec. 1106(2), substituted ''(1),

(4), or (5)'' for ''(1) or (4)''.

Subsec. (d)(4)(A). Pub. L. 106-65, Sec. 3244, inserted '', or the

Department of Energy due to a reduction in force resulting from the

establishment of the National Nuclear Security Administration''

after ''reduction in force'' in introductory provisions.

Subsec. (d)(4)(B). Pub. L. 106-65, Sec. 1104(c), added cls. (i)

and (ii) and struck out former cls. (i) and (ii) which read as

follows:

''(i) October 1, 1999; or

''(ii) February 1, 2000, if specific notice of such separation

was given to such individual before October 1, 1999.''

Subsec. (d)(5). Pub. L. 106-117, Sec. 1106(3), added par. (5).

1996 - Subsec. (d)(4)(A). Pub. L. 104-106, Sec. 1036(1), inserted

'', or a voluntary separation from a surplus position,'' after ''an

involuntary separation from a position'' in introductory

provisions.

Subsec. (d)(4)(C). Pub. L. 104-106, Sec. 1036(2), added subpar.

(C).

1994 - Subsec. (d)(4)(B). Pub. L. 103-337 substituted ''October

1, 1999'' for ''October 1, 1997'' in cls. (i) and (ii) and

''February 1, 2000'' for ''February 1, 1998'' in cl. (ii).

1992 - Subsec. (d)(1)(A). Pub. L. 102-484, Sec. 4438(a)(1),

substituted ''Except as provided in paragraph (4), an individual''

for ''An individual''.

Subsec. (d)(2). Pub. L. 102-484, Sec. 4438(a)(2), substituted

''in accordance with paragraph (1) or (4), as the case may be)''

for ''in accordance with paragraph (1))''.

Subsec. (d)(4). Pub. L. 102-484, Sec. 4438(a)(3), added par. (4).

EFFECTIVE DATE OF 1999 AMENDMENT

Amendment by section 3244 of Pub. L. 106-65 effective Mar. 1,

2000, see section 3299 of Pub. L. 106-65, set out as an Effective

Date note under section 2401 of Title 50, War and National Defense.

EFFECTIVE DATE

Section applicable with respect to any calendar year beginning,

and contracts entered into or renewed for any calendar year

beginning, after the end of the 9-month period beginning Nov. 14,

1988, and with respect to any qualifying event occurring on or

after the first day of the first calendar year beginning after the

end of such 9-month period, see section 203 of Pub. L. 100-654, set

out as an Effective Date of 1988 Amendment note under section 8902

of this title.

SOURCE OF PAYMENTS

Section 4438(b)(1) of Pub. L. 102-484 provided that: ''Any amount

which becomes payable by an agency as a result of the enactment of

subsection (a) (amending this section) shall be paid out of funds

or appropriations available for salaries and expenses of such

agency.''

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8902, 8903, 8905, 8909 of

this title; title 10 sections 1078a, 1086a, 1145.

-CITE-

5 USC Sec. 8906 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8906. Contributions

-STATUTE-

(a)(1) Not later than October 1 of each year, the Office of

Personnel Management shall determine the weighted average of the

subscription charges that will be in effect during the following

contract year with respect to -

(A) enrollments under this chapter for self alone; and

(B) enrollments under this chapter for self and family.

(2) In determining each weighted average under paragraph (1), the

weight to be given to a particular subscription charge shall, with

respect to each plan (and option) to which it is to apply, be

commensurate with the number of enrollees enrolled in such plan

(and option) as of March 31 of the year in which the determination

is being made.

(3) For purposes of paragraph (2), the term ''enrollee'' means

any individual who, during the contract year for which the weighted

average is to be used under this section, will be eligible for a

Government contribution for health benefits.

(b)(1) Except as provided in paragraphs (2), (3), and (4), the

biweekly Government contribution for health benefits for an

employee or annuitant enrolled in a health benefits plan under this

chapter is adjusted to an amount equal to 72 percent of the

weighted average under subsection (a)(1)(A) or (B), as applicable.

For an employee, the adjustment begins on the first day of the

employee's first pay period of each year. For an annuitant, the

adjustment begins on the first day of the first period of each year

for which an annuity payment is made.

(2) The biweekly Government contribution for an employee or

annuitant enrolled in a plan under this chapter shall not exceed 75

percent of the subscription charge.

(3) In the case of an employee who is occupying a position on a

part-time career employment basis (as defined in section 3401(2) of

this title), the biweekly Government contribution shall be equal to

the percentage which bears the same ratio to the percentage

determined under this subsection (without regard to this paragraph)

as the average number of hours of such employee's regularly

scheduled workweek bears to the average number of hours in the

regularly scheduled workweek of an employee serving in a comparable

position on a full-time career basis (as determined under

regulations prescribed by the Office).

(4) In the case of persons who are enrolled in a health benefits

plan as part of the demonstration project under section 1108 of

title 10, the Government contribution shall be subject to the

limitation set forth in subsection (i) of that section.

(c) There shall be withheld from the pay of each enrolled

employee and (except as provided in subsection (i) of this section)

the annuity of each enrolled annuitant and there shall be

contributed by the Government, amounts, in the same ratio as the

contributions of the employee or annuitant and the Government under

subsection (b) of this section, which are necessary for the

administrative costs and the reserves provided for by section

8909(b) of this title.

(d) The amount necessary to pay the total charge for enrollment,

after the Government contribution is deducted, shall be withheld

from the pay of each enrolled employee and (except as provided in

subsection (i) of this section) from the annuity of each enrolled

annuitant. The withholding for an annuitant shall be the same as

that for an employee enrolled in the same health benefits plan and

level of benefits.

(e)(1)(A) An employee enrolled in a health benefits plan under

this chapter who is placed in a leave without pay status may have

his coverage and the coverage of members of his family continued

under the plan for not to exceed 1 year under regulations

prescribed by the Office.

(B) During each pay period in which an enrollment continues under

subparagraph (A) -

(i) employee and Government contributions required by this

section shall be paid on a current basis; and

(ii) if necessary, the head of the employing agency shall

approve advance payment, recoverable in the same manner as under

section 5524a(c), of a portion of basic pay sufficient to pay

current employee contributions.

(C) Each agency shall establish procedures for accepting direct

payments of employee contributions for the purposes of this

paragraph.

(2) An employee who enters on approved leave without pay to serve

as a full-time officer or employee of an organization composed

primarily of employees as defined by section 8901 of this title,

within 60 days after entering on that leave without pay, may file

with his employing agency an election to continue his health

benefits enrollment and arrange to pay currently into the Employees

Health Benefits Fund, through his employing agency, both employee

and agency contributions from the beginning of leave without pay.

The employing agency shall forward the enrollment charges so paid

to the Fund. If the employee does not so elect, his enrollment will

continue during nonpay status and end as provided by paragraph (1)

of this subsection and implementing regulations.

(3)(A) An employing agency may pay both the employee and

Government contributions, and any additional administrative

expenses otherwise chargeable to the employee, with respect to

health care coverage for an employee described in subparagraph (B)

and the family of such employee.

(B) An employee referred to in subparagraph (A) is an employee

who -

(i) is enrolled in a health benefits plan under this chapter;

(ii) is a member of a reserve component of the armed forces;

(iii) is called or ordered to active duty in support of a

contingency operation (as defined in section 101(a)(13) of title

10);

(iv) is placed on leave without pay or separated from service

to perform active duty; and

(v) serves on active duty for a period of more than 30

consecutive days.

(C) Notwithstanding the one-year limitation on coverage described

in paragraph (1)(A), payment may be made under this paragraph for a

period not to exceed 18 months.

(f) The Government contribution, and any additional payments

under subsection (e)(3)(A), for health benefits for an employee

shall be paid -

(1) in the case of employees generally, from the appropriation

or fund which is used to pay the employee;

(2) in the case of an elected official, from an appropriation

or fund available for payment of other salaries of the same

office or establishment;

(3) in the case of an employee of the legislative branch who is

paid by the Chief Administrative Officer of the House of

Representatives, from the applicable accounts of the House of

Representatives; and

(4) in the case of an employee in a leave without pay status,

from the appropriation or fund which would be used to pay the

employee if he were in a pay status.

(g)(1) Except as provided in paragraphs (2) and (3), the

Government contributions authorized by this section for health

benefits for an annuitant shall be paid from annual appropriations

which are authorized to be made for that purpose and which may be

made available until expended.

(2)(A) The Government contributions authorized by this section

for health benefits for an individual who first becomes an

annuitant by reason of retirement from employment with the United

States Postal Service on or after July 1, 1971, or for a survivor

of such an individual or of an individual who died on or after July

1, 1971, while employed by the United States Postal Service, shall

be paid by the United States Postal Service.

(B) In determining any amount for which the Postal Service is

liable under this paragraph, the amount of the liability shall be

prorated to reflect only that portion of total service which is

attributable to civilian service performed (by the former postal

employee or by the deceased individual referred to in subparagraph

(A), as the case may be) after June 30, 1971, as estimated by the

Office of Personnel Management.

(3) The Government contribution for persons enrolled in a health

benefits plan as part of the demonstration project under section

1108 of title 10 shall be paid as provided in subsection (i) of

that section.

(h) The Office shall provide for conversion of biweekly rates of

contribution specified by this section to rates for employees and

annuitants paid on other than a biweekly basis, and for this

purpose may provide for the adjustment of the converted rate to the

nearest cent.

(i) An annuitant whose annuity is insufficient to cover the

withholdings required for enrollment in a particular health

benefits plan may enroll (or remain enrolled) in such plan,

notwithstanding any other provision of this section, if the

annuitant elects, under conditions prescribed by regulations of the

Office, to pay currently into the Employees Health Benefits Fund,

through the retirement system that administers the annuitant's

health benefits enrollment, an amount equal to the withholdings

that would otherwise be required under this section.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 604; Pub. L. 90-83, Sec.

1(96), Sept. 11, 1967, 81 Stat. 219; Pub. L. 91-418, Sec. 1(a),

Sept. 25, 1970, 84 Stat. 869; Pub. L. 93-246, Sec. 1, Jan. 31,

1974, 88 Stat. 3; Pub. L. 94-310, Sec. 3(a), June 15, 1976, 90

Stat. 687; Pub. L. 95-437, Sec. 4(c)(2)(A), Oct. 10, 1978, 92 Stat.

1059; Pub. L. 95-454, title IX, Sec. 906(a)(15), (c)(2)(F), Oct.

13, 1978, 92 Stat. 1226, 1227; Pub. L. 96-54, Sec. 2(a)(53), Aug.

14, 1979, 93 Stat. 384; Pub. L. 99-272, title XV, Sec. 15202(b),

Apr. 7, 1986, 100 Stat. 334; Pub. L. 101-239, title IV, Sec.

4003(a), Dec. 19, 1989, 103 Stat. 2135; Pub. L. 101-303, Sec. 1(a),

(b), May 29, 1990, 104 Stat. 250; Pub. L. 101-508, title VII, Sec.

7102(a), (b), Nov. 5, 1990, 104 Stat. 1388-333; Pub. L. 102-378,

Sec. 2(78), Oct. 2, 1992, 106 Stat. 1355; Pub. L. 104-186, title

II, Sec. 215(19), Aug. 20, 1996, 110 Stat. 1747; Pub. L. 104-208,

div. A, title I, Sec. 101(f) (title IV, Sec. 422), Sept. 30, 1996,

110 Stat. 3009-314, 3009-343; Pub. L. 105-33, title VII, Sec.

7002(a), Aug. 5, 1997, 111 Stat. 662; Pub. L. 105-261, div. A,

title VII, Sec. 721(b)(2), (3), Oct. 17, 1998, 112 Stat. 2065; Pub.

L. 107-107, div. A, title V, Sec. 519(a), (b), Dec. 28, 2001, 115

Stat. 1096.)

-MISC1-

Historical and Revision Notes

1966 Act

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3006. Sept. 28, 1959, Pub.

L. 86-382, Sec. 7,

73 Stat. 713.

Mar. 17, 1964, Pub.

L. 88-284, Sec.

1(10), (11), 78

Stat. 165.

-------------------------------

In subsection (f)(1), the words ''in the case of employees

generally'' are inserted for clarity.

In subsection (h), the word ''biweekly'' is inserted for clarity.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

1967 Act

---------------------------------------------------------------------

Section of title 5 Source (U.S. Code) Source (Statutes at

Large)

---------------------------------------------------------------------

8906(a) 8906(b) 5 App.: 3006(a)(1). July 18, 1966, Pub.

8906(e)(2) 5 App.: 3006(a)(2). L. 89-504, Sec.

5 App.: 3006(b)(2). 406(b), 602, 80

Stat. 298, 303.

-------------------------------

In subsection (a), the words ''subsection (b) of this section'',

''this chapter'', and ''subsection (c) of this section'' are

substituted for ''paragraph (2) of this subsection'', ''this Act'',

and ''paragraph (3)'', respectively, to reflect the codification of

title 5, United States Code.

In subsection (e)(2), the words ''as defined by section 8901 of

this title'' are substituted for ''as defined in section 2 of this

Act'' to reflect the codification of that section in 5 U.S.C. 8901.

The words ''Employees Health Benefits Fund'' and ''Fund'' are

substituted for ''fund'' and ''fund'', respectively. In the

penultimate sentence, the words ''will continue during nonpay

status and end'' are substituted for ''will terminate'' for clarity

and on authority of 5 U.S.C. 8906(e)(1).

AMENDMENTS

2001 - Subsec. (e)(3). Pub. L. 107-107, Sec. 519(a), added par.

(3).

Subsec. (f). Pub. L. 107-107, Sec. 519(b), amended introductory

provisions generally. Prior to amendment, introductory provisions

read as follows: ''The Government contributions for health benefits

for an employee shall be paid - ''.

1998 - Subsec. (b)(1). Pub. L. 105-261, Sec. 721(b)(2)(A),

substituted ''paragraphs (2), (3), and (4)'' for ''paragraphs (2)

and (3)''.

Subsec. (b)(4). Pub. L. 105-261, Sec. 721(b)(2)(B), added par.

(4).

Subsec. (g)(1). Pub. L. 105-261, Sec. 721(b)(3)(A), substituted

''paragraphs (2) and (3)'' for ''paragraph (2)''.

Subsec. (g)(3). Pub. L. 105-261, Sec. 721(b)(3)(B), added par.

(3).

1997 - Subsec. (a). Pub. L. 105-33 added subsec. (a) and struck

out former subsec. (a) which read as follows: ''The Office of

Personnel Management shall determine the average of the

subscription charges in effect on the beginning date of each

contract year with respect to self alone or self and family

enrollments under this chapter, as applicable, for the highest

level of benefits offered by -

''(1) the service benefit plan;

''(2) the indemnity benefit plan;

''(3) the two employee organization plans with the largest

number of enrollments, as determined by the Office; and

''(4) the two comprehensive medical plans with the largest

number of enrollments, as determined by the Office.''

Subsec. (b)(1). Pub. L. 105-33 added par. (1) and struck out

former par. (1) which read as follows: ''Except as provided by

paragraphs (2) and (3) of this subsection, the biweekly Government

contribution for health benefits for an employee or annuitant

enrolled in a health benefits plan under this chapter is adjusted

to an amount equal to 60 percent of the average subscription charge

determined under subsection (a) of this section. For an employee,

the adjustment begins on the first day of the employee's first pay

period of each year. For an annuitant, the adjustment begins on

the first day of the first period of each year for which an annuity

payment is made.''

1996 - Subsec. (e)(1). Pub. L. 104-208 struck out at end ''The

regulations may provide for the waiving of contributions by the

employee and the Government.'', inserted subpar. (A) designation,

and added subpars. (B) and (C).

Subsec. (f)(3). Pub. L. 104-186 substituted ''Chief

Administrative Officer of the House of Representatives, from the

applicable accounts of the House of Representatives'' for ''Clerk

of the House of Representatives, from the contingent fund of the

House''.

1992 - Subsec. (b)(3). Pub. L. 102-378, Sec. 2(78)(A), inserted

period after ''Office)''.

Subsec. (c). Pub. L. 102-378, Sec. 2(78)(B), substituted ''and

(except'' for ''and except''.

1990 - Subsec. (c). Pub. L. 101-303, Sec. 1(b)(1), inserted

''except as provided in subsection (i) of this section)'' after

''enrolled employee and''.

Subsec. (d). Pub. L. 101-303, Sec. 1(b)(2), inserted ''(except as

provided in subsection (i) of this section)'' after ''enrolled

employee and''.

Subsec. (g)(2). Pub. L. 101-508 designated existing provisions as

subpar. (A), substituted ''July 1, 1971,'' for ''October 1, 1986,''

in two places, and added subpar. (B).

Subsec. (i). Pub. L. 101-303, Sec. 1(a), added subsec. (i).

1989 - Subsec. (g)(2). Pub. L. 101-239 inserted ''or for a

survivor of such an individual or of an individual who died on or

after October 1, 1986, while employed by the United States Postal

Service,'' after ''1986,''.

1986 - Subsec. (g). Pub. L. 99-272 designated existing provisions

as par. (1) and added par. (2).

1979 - Subsec. (b)(1). Pub. L. 96-54 substituted provisions

setting forth adjustment amount of the Government contribution of

equal to 60 percent of the average subscription charge under

subsec. (a) and determinations respecting the commencement date of

the adjustment, for provisions setting forth adjustment amounts of

the Government contribution of equal to 50 percent of the average

subscription charge under subsec. (a) for applicable pay periods

beginning in 1974, and equal to 60 percent for pay periods

beginning in 1975 and after, and determinations respecting the

commencement date of the adjustment.

1978 - Subsec. (a). Pub. L. 95-454, Sec. 906(a)(15), substituted

''Office of Personnel Management'' for ''Commission'' in

introductory material, and ''Office'' for ''Commission'' in cls.

(3) and (4).

Subsec. (b)(1). Pub. L. 95-437, Sec. 4(c)(2)(A)(i), substituted

''paragraphs (2) and (3)'' for ''paragraph (2)''.

Subsec. (b)(3). Pub. L. 95-454, Sec. 906(a)(15), (c)(2)(F),

substituted ''Office'' for ''Commission'', and ''3401'' for

''3391''.

Pub. L. 95-437, Sec. 4(c)(2)(A)(ii), added par. (3).

Subsecs. (e)(1), (h). Pub. L. 95-454, Sec. 906(a)(15),

substituted ''Office'' for ''Commission''.

1976 - Subsec. (g). Pub. L. 94-310 provided for payment of

Government contributions from annual appropriations which may be

made available until expended.

1974 - Subsec. (a). Pub. L. 93-246, Sec. 1(a), struck out

introductory text ''Except as provided by subsection (b) of this

section, the biweekly Government contribution for health benefits

for employees or annuitants enrolled in health benefits plans under

this chapter shall be adjusted'', now incorporated in subsec.

(b)(1) of this section, required Commission determination of

average of subscription charges, and reenacted remainder of

existing provisions, substituting ''beginning date of each contract

year'' for ''beginning date of the adjustment''.

Subsec. (b)(1). Pub. L. 93-246, Sec. 1(a), incorporated

introductory text of former subsec. (a) reading ''Except as

provided by subsection (b) of this section, the biweekly Government

contribution for health benefits for employees or annuitants

enrolled in health benefits plans under this chapter shall be

adjusted'', as initial text of provisions designated as subsec.

(b)(1), substituted provision for amount of biweekly Government

contribution equal to 50 percent of average subscription charge for

applicable pay periods commencing in 1974 and 60 percent for

applicable pay periods commencing in 1975, and annually thereafter,

for former subsec. (a) provision for an amount equal to 40 percent

of average of subscription charges and former subsec. (b) provision

for 50 percent of subscription charge where the biweekly

subscription charge was less than twice the Government

contribution.

Subsec. (b)(2). Pub. L. 93-246, Sec. 1(a), added par. (2).

Subsec. (c). Pub. L. 93-246, Sec. 1(b), struck out reference to

subsec. (a).

Subsec. (g). Pub. L. 93-246, Sec. 1(c), substituted ''by this

section'' for ''by subsection (a) of this section''.

1970 - Subsec. (a). Pub. L. 91-418, in increasing the Government

contribution to the cost of health benefits insurance, substituted

provision for adjustment of such contribution, beginning on the

first day of the first pay period of each year, to an amount equal

to 40 percent of the adjustment, with respect to self alone or self

and family enrollments, as applicable, for the highest level of

benefits offered by the service benefit plan, the indemnity benefit

plan, the two employee organization plans, and the two

comprehensive medical plans, for prior provision for a

contribution, in addition to requirement of subsec. (c) of this

section, of $1.62 if the enrollment is for self or $3.94 if the

enrollment is for self and family.

EFFECTIVE DATE OF 2001 AMENDMENT

Pub. L. 107-107, div. A, title V, Sec. 519(c), Dec. 28, 2001,

115 Stat. 1096, provided that: ''The amendments made by this

section (amending this section) apply with respect to employees

called to active duty on or after December 8, 1995, and an agency

may make retroactive payments to such employees for premiums paid

on or after such date.''

EFFECTIVE DATE OF 1997 AMENDMENT

Section 7002(b) of Pub. L. 105-33 provided that: ''This section

(amending this section) shall take effect on the first day of the

contract year that begins in 1999. Nothing in this subsection shall

prevent the Office of Personnel Management from taking any action,

before such first day, which it considers necessary in order to

ensure the timely implementation of this section.''

EFFECTIVE DATE OF 1990 AMENDMENTS

Section 7102(c) of Pub. L. 101-508 provided that: ''The

amendments made by this section (amending this section) shall take

effect on October 1, 1990, and shall apply with respect to amounts

payable for periods beginning on or after that date.''

Section 1(c) of Pub. L. 101-303 provided that: ''The amendments

made by this section (amending this section) shall take effect on

the date of enactment of this Act (May 29, 1990). Any annuitant

whose enrollment was terminated at any time before such date on

account of such annuitant's annuity being insufficient to cover the

amount of the required withholdings may, under regulations

prescribed by the Office of Personnel Management, be prospectively

reinstated in any available health benefits plan upon application

of the annuitant.''

EFFECTIVE DATE OF 1989 AMENDMENT

Section 4003(b) of Pub. L. 101-239 provided that: ''The amendment

made by subsection (a) (amending this section) shall take effect on

October 1, 1989, and shall apply with respect to amounts payable

for periods beginning on or after that date.''

EFFECTIVE DATE OF 1979 AMENDMENT

Amendment by Pub. L. 96-54 effective July 12, 1979, see section

2(b) of Pub. L. 96-54, set out as a note under section 305 of this

title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

EFFECTIVE DATE OF 1976 AMENDMENT

Amendment by Pub. L. 94-310 effective Oct. 1, 1976, see section 4

of Pub. L. 94-310, set out as a note under section 130b of Title 2,

The Congress.

EFFECTIVE DATE OF 1974 AMENDMENT

Section 4(a) of Pub. L. 93-246 provided that: ''The first section

of this Act (amending this section) shall take effect on the first

day of the first applicable pay period which begins on or after

January 1, 1974.''

Section 4(d) of Pub. L. 93-246 provided that: ''The determination

of the average of subscription charges and the adjustment of the

Government contributions for 1973, under section 8906 of title 5,

United States Code, as amended by the first section of this Act

(amending this section), shall take effect on the first day of the

first applicable pay period which begins on or after the thirtieth

day following the date of enactment of this Act (Jan. 31, 1974).''

EFFECTIVE DATE OF 1970 AMENDMENT

Section 1(b) of Pub. L. 91-418 provided that: ''The amendment

made by subsection (a) of this section (amending this section)

shall become effective at the beginning of the first applicable pay

period which commences after December 31, 1970.''

PAYMENTS BY POSTAL SERVICE RELATING TO CORRECTED CALCULATIONS FOR

PAST HEALTH BENEFITS

Pub. L. 103-66, title XI, Sec. 11101(b), Aug. 10, 1993, 107 Stat.

413, provided that: ''In addition to any other payments required

under section 8906(g)(2) of title 5, United States Code, or any

other provision of law, the United States Postal Service shall pay

into the Employees Health Benefits Fund a total of $348,000,000, of

which -

''(1) at least one-third shall be paid not later than September

30, 1996;

''(2) at least two-thirds shall be paid not later than

September 30, 1997; and

''(3) any remaining balance shall be paid not later than

September 30, 1998.''

COMPUTATION OF GOVERNMENT CONTRIBUTIONS TO FEDERAL EMPLOYEES HEALTH

BENEFITS PROGRAM FOR 1990 THROUGH 1993

Pub. L. 101-76, Aug. 11, 1989, 103 Stat. 556, as amended by Pub.

L. 101-508, title VII, Sec. 7002(e), Nov. 5, 1990, 104 Stat.

1388-330; Pub. L. 103-66, title XI, Sec. 11005, Aug. 10, 1993, 107

Stat. 412, provided: ''That (a)(1) in the administration of chapter

89 of title 5, United States Code, for each of contract years 1990

through 1998 (inclusive), in order to compute the average

subscription charges under section 8906(a) of such title for such

contract years, the subscription charges in effect for the

indemnity benefit plan on the beginning date of each such contract

year -

''(A) shall be deemed to be the subscription charges which were

in effect for such plan on the beginning date of the preceding

contract year as adjusted under paragraph (2); or

''(B) if subparagraph (A) does not apply, shall be deemed to be

-

''(i) the subscription charges which were deemed under this

Act to have been in effect for such plan with respect to the

preceding contract year as adjusted under paragraph (2), except

as provided in clause (ii); or

''(ii) for each of contract years 1997 and 1998, the

subscription charges which would be derived by applying the

terms of clause (i), reduced by 1 percent.

''(2) The subscription charges under paragraph (1) shall be

increased or decreased (as appropriate) by the average percentage

by which the respective subscription charges taken into account

under paragraphs (1), (3), and (4) of such section 8906(a) for that

contract year increased or decreased from the subscription charges

taken into account under such paragraphs (1), (3), and (4) for the

preceding contract year.

''(b) Separate percentages shall be computed under subsection

(a)(2) with respect to enrollments for self alone and enrollments

for self and family, respectively.

''(c) The provisions of this Act shall not apply to a contract

year (or any period thereafter), if comprehensive reform

legislation is enacted to amend section 8906 of title 5, United

States Code, and such amendment is required to be implemented by

the commencement of negotiations pertaining to rates and benefits

for such contract year.

''(d) Any reference in this Act to a 'contract year' shall be

considered to be a reference to a contract year under chapter 89 of

title 5, United States Code.

''(e) No later than 180 days after the date of the enactment of

this Act (Aug. 11, 1989), the Director of the Office of Personnel

Management shall transmit recommendations to the Congress for

comprehensive reform of the Federal Employee Health Benefits

Program.''

CONTRIBUTIONS BY UNITED STATES POSTAL SERVICE TO EMPLOYEES HEALTH

BENEFITS FUND

Pub. L. 100-203, title VI, Sec. 6003, Dec. 22, 1987, 101 Stat.

1330-277, directed Postal Service to pay $160,000,000 in fiscal

year 1988 and $270,000,000 in fiscal year 1989 into Employee Health

Benefits Fund in addition to any amount deposited into Fund

pursuant to this section in each such fiscal year.

EMPLOYEES SERVING ON PART-TIME CAREER EMPLOYMENT BASIS ON OCTOBER

10, 1978

Section 4(c)(2)(B) of Pub. L. 95-437 provided that: ''The

amendments made by subparagraph (A) (amending subsec. (b)(1) and

(3) of this section) shall not apply with respect to any employee

serving in a position on a part-time career employment basis on the

date of the enactment of this Act (Oct. 10, 1978) for such period

as the employee continues to serve without a break in service in

that or any other position on such part-time basis.''

CALCULATION AND PAYMENT BY GOVERNMENT OF CONTRIBUTIONS TO

CONTINGENCY RESERVES OF ALL HEALTH BENEFIT PLANS

Pub. L. 97-346, Sec. 4, Oct. 15, 1982, 96 Stat. 1650, directed

Office of Personnel Management to determine amount by which

Government contribution under 5 U.S.C. 8906(b) for the 1983

contract year was less than the Government contribution which would

have been determined under such section for such contract year if

Government contribution had been calculated by using the two

employee organization plans which in 1981 satisfied the standard

set forth in 5 U.S.C. 8906(a)(3) directed Government to pay amount

of difference thus determined to contingency reserves of all health

benefits plans for contract year 1983 in proportion to estimated

number of individuals enrolled in such plans during 1983, and

directed such payments be paid by appropriate agencies (including

Postal Service and Postal Rate Commission) from appropriations

referred to in 5 U.S.C. 8906(f) and (g) in same manner as if such

payments were Government contributions, and in amounts determined

appropriate by Office of Personnel Management.

ELECTION OF HEALTH BENEFITS DURING PERIOD OF SERVICE AS OFFICER OR

EMPLOYEE OF AN EMPLOYEE ORGANIZATION; CONTRIBUTIONS INTO EMPLOYEES

HEALTH BENEFITS FUND; NON-ELECTION; REGULATIONS

Election of health benefits within sixty days after July 18,

1966, by certain employees on leave without pay for service as

officer or employee of an employee organization, contributions into

Fund, effect of non-election of benefits, and regulations, see note

set out under section 8706 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 8906a, 8909 of this

title; title 2 sections 162b, 2063; title 10 section 1108; title 42

sections 1395s, 2297h-8; title 45 section 1212.

-CITE-

5 USC Sec. 8906a 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8906a. Temporary employees

-STATUTE-

(a)(1) The Office of Personnel Management shall prescribe

regulations to provide for offering health benefits plans to

temporary employees (who meet the requirements of paragraph (2))

under the provisions of this chapter.

(2) To be eligible to participate in a health benefits plan

offered under this section a temporary employee shall have

completed 1 year of current continuous employment, excluding any

break in service of 5 days or less.

(b) Notwithstanding the provisions of section 8906 -

(1) any temporary employee enrolled in a health benefits plan

under this section shall have an amount withheld from the pay of

such employee, as determined by the Office of Personnel

Management, equal to -

(A) the amount withheld from the pay of an employee under the

provisions of section 8906; and

(B) the amount of the Government contribution for an employee

under section 8906; and

(2) the employing agency of any such temporary employee shall

not pay the Government contribution under the provisions of

section 8906.

-SOURCE-

(Added Pub. L. 100-654, title III, Sec. 301(a), Nov. 14, 1988, 102

Stat. 3846.)

-MISC1-

EFFECTIVE DATE

Section 301(d) of Pub. L. 100-654 provided that: ''The amendments

made by this section (enacting this section and amending section

8913 of this title) shall be effective 120 days after the date of

enactment of this section (Nov. 14, 1988).''

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 8913 of this title.

-CITE-

5 USC Sec. 8907 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8907. Information to individuals eligible to enroll

-STATUTE-

(a) The Office of Personnel Management shall make available to

each individual eligible to enroll in a health benefits plan under

this chapter such information, in a form acceptable to the Office

after consultation with the carrier, as may be necessary to enable

the individual to exercise an informed choice among the types of

plans described by sections 8903 and 8903a of this title.

(b) Each individual enrollee in a health benefits plan shall be

issued an appropriate document setting forth or summarizing the -

(1) services or benefits, including maximums, limitations, and

exclusions, to which the enrollee or the enrollee and any

eligible family members are entitled thereunder;

(2) procedure for obtaining benefits; and

(3) principal provisions of the plan affecting the enrollee and

any eligible family members.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 605; Pub. L. 95-454, title

IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L.

98-615, Sec. 3(5), Nov. 8, 1984, 98 Stat. 3204; Pub. L. 99-53, Sec.

2(d), June 17, 1985, 99 Stat. 94.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3009(d). Sept. 28, 1959, Pub.

L. 86-382, Sec.

10(d), 73 Stat.

715.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1985 - Subsec. (a). Pub. L. 99-53 inserted reference to section

8903a of this title.

1984 - Pub. L. 98-615, Sec. 3(5)(C), substituted ''individuals

eligible to enroll'' for ''employees'' in section catchline.

Subsec. (a). Pub. L. 98-615, Sec. 3(5)(A), substituted

''individual'' for ''employee'' in two places.

Subsec. (b). Pub. L. 98-615, Sec. 3(5)(B)(i), substituted

''enrollee'' for ''employee enrolled'' in provisions preceding par.

(1).

Subsec. (b)(1). Pub. L. 98-615, Sec. 3(5)(B)(ii), substituted

''enrollee or the enrollee and any eligible family members'' for

''employee or the employee and members of his family''.

Subsec. (b)(3). Pub. L. 98-615, Sec. 3(5)(B)(iii), substituted

''the enrollee and any eligible family members'' for ''the employee

or members of his family''.

1978 - Subsec. (a). Pub. L. 95-454 substituted ''Office of

Personnel Management'' and ''Office'' for ''Civil Service

Commission'' and ''Commission'', respectively.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

-CITE-

5 USC Sec. 8908 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8908. Coverage of restored employees and survivor or

disability annuitants

-STATUTE-

(a) An employee enrolled in a health benefits plan under this

chapter who is removed or suspended without pay and later

reinstated or restored to duty on the ground that the removal or

suspension was unjustified or unwarranted may, at his option,

enroll as a new employee or have his coverage restored, with

appropriate adjustments made in contributions and claims, to the

same extent and effect as though the removal or suspension had not

taken place.

(b) A surviving spouse whose survivor annuity under this title

was terminated because of remarriage and is later restored may,

under such regulations as the Office of Personnel Management may

prescribe, enroll in a health benefits plan described by section

8903 or 8903a of this title if such spouse was covered by any such

plan immediately before such annuity was terminated.

(c) A disability annuitant whose disability annuity under section

8337 of this title was terminated and is later restored under the

second or third sentence of subsection (e) of such section may,

under regulations prescribed by the Office, enroll in a health

benefits plan described by section 8903 or 8903a of this title if

such annuitant was covered by any such plan immediately before such

annuity was terminated.

(d) A surviving child whose survivor annuity under section

8341(e) or 8443(b) was terminated and is later restored under

paragraph (4) of section 8341(e) or the last sentence of section

8443(b) may, under regulations prescribed by the Office, enroll in

a health benefits plan described by section 8903 or 8903a if such

surviving child was covered by any such plan immediately before

such annuity was terminated.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 605; Pub. L. 94-342, Sec.

1(a), July 6, 1976, 90 Stat. 808; Pub. L. 95-454, title IX, Sec.

906(a)(2), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 99-53, Sec. 2(a),

3(a)(1), (2)(A), June 17, 1985, 99 Stat. 94, 95; Pub. L. 104-208,

div. A, title I, Sec. 101(f) (title VI, Sec. 633(a)(3)), Sept. 30,

1996, 110 Stat. 3009-314, 3009-363.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3009(c). Sept. 28, 1959, Pub.

L. 86-382, Sec.

10(c), 73 Stat.

715.

Mar. 17, 1964, Pub.

L. 88-284, Sec. 1

(less (1)-(13)), 78

Stat. 165.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1996 - Subsec. (d). Pub. L. 104-208 added subsec. (d).

1985 - Pub. L. 99-53, Sec. 3(a)(2)(A), inserted ''or disability''

after ''and survivor'' in section catchline.

Subsec. (b). Pub. L. 99-53, Sec. 2(a), inserted reference to

section 8903a of this title.

Subsec. (c). Pub. L. 99-53, Sec. 3(a)(1), added subsec. (c).

1978 - Subsec. (b). Pub. L. 95-454 substituted ''Office of

Personnel Management'' for ''Civil Service Commission''.

1976 - Pub. L. 94-342 designated existing provisions as subsec.

(a), added subsec. (b), and substituted ''employees and survivor

annuitants'' for ''employee'' in section catchline.

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by Pub. L. 104-208 applicable with respect to

termination of marriage taking effect before, on, or after Sept.

30, 1996, except that benefits are payable only with respect to

amounts accruing for periods beginning on first day of month

beginning after the later of termination of marriage or Sept. 30,

1996, see section 101(f) (title VI, Sec. 633(b)) of Pub. L.

104-208, set out as a note under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

EFFECTIVE DATE OF 1976 AMENDMENT

Section 2 of Pub. L. 94-342 provided that: ''The amendments made

by the first section of this Act (amending this section) shall take

effect on October 1, 1976, or on the date of the enactment of this

Act (July 6, 1976), whichever date is later. Such amendments shall

apply with respect to individuals whose survivor annuities are

restored before, on, or after such date.''

INSURANCE COVERAGE FOR RESTORED DISABILITY ANNUITANTS

For provisions directing that subsec. (c) of this section shall

apply with respect to any individual whose disability annuity is or

was restored under section 8337(e) of this title after December 31,

1983, directing that the Office of Personnel Management notify each

individual of any rights which such individual may have under

subsec. (c) of this section, including any procedures or deadlines

which might apply with respect to the exercise of those rights,

directing that such notification be provided to any individual who,

as of the 90th day after June 17, 1985, is receiving a disability

annuity which was restored to such individual under section 8337(e)

of this title after December 31, 1983, directing that nothing in

subsec. (c) of this section be construed to authorize coverage

under this chapter in the case of any individual who becomes

enrolled in a health benefits plan under subsec. (c) of this

section for any period before the date as of which such individual

becomes so enrolled, and directing that such rule of construction

apply with respect to any individual receiving a disability annuity

which is or was restored under section 8337(e) of this title after

December 31, 1983, and before the expiration of the 90-day period

beginning on June 17, 1985, see section 3(c) of Pub. L. 99-53, set

out as a note under section 8706 of this title.

-CITE-

5 USC Sec. 8909 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8909. Employees Health Benefits Fund

-STATUTE-

(a) There is in the Treasury of the United States an Employees

Health Benefits Fund which is administered by the Office of

Personnel Management. The contributions of enrollees and the

Government described by section 8906 of this title shall be paid

into the Fund. The Fund is available -

(1) without fiscal year limitation for all payments to approved

health benefits plans; and

(2) to pay expenses for administering this chapter within the

limitations that may be specified annually by Congress.

Payments from the Fund to a plan participating in a

letter-of-credit arrangement under this chapter shall, in

connection with any payment or reimbursement to be made by such

plan for a health service or supply, be made, to the maximum extent

practicable, on a checks-presented basis (as defined under

regulations of the Department of the Treasury).

(b) Portions of the contributions made by enrollees and the

Government shall be regularly set aside in the Fund as follows:

(1) A percentage, not to exceed 1 percent of all contributions,

determined by the Office to be reasonably adequate to pay the

administrative expenses made available by subsection (a) of this

section.

(2) For each health benefits plan, a percentage, not to exceed

3 percent of the contributions toward the plan, determined by the

Office to be reasonably adequate to provide a contingency

reserve.

The Office, from time to time and in amounts it considers

appropriate, may transfer unused funds for administrative expenses

to the contingency reserves of the plans then under contract with

the Office. When funds are so transferred, each contingency reserve

shall be credited in proportion to the total amount of the

subscription charges paid and accrued to the plan for the contract

term immediately before the contract term in which the transfer is

made. The income derived from dividends, rate adjustments, or

other refunds made by a plan shall be credited to its contingency

reserve. The contingency reserves may be used to defray increases

in future rates, or may be applied to reduce the contributions of

enrollees and the Government to, or to increase the benefits

provided by, the plan from which the reserves are derived, as the

Office from time to time shall determine.

(c) The Secretary of the Treasury may invest and reinvest any of

the money in the Fund in interest-bearing obligations of the United

States, and may sell these obligations for the purposes of the

Fund. The interest on and the proceeds from the sale of these

obligations become a part of the Fund.

(d) When the assets, liabilities, and membership of employee

organizations sponsoring or underwriting plans approved under

section 8903(3) or 8903a of this title are merged, the assets

(including contingency reserves) and liabilities of the plans

sponsored or underwritten by the merged organizations shall be

transferred at the beginning of the contract term next following

the date of the merger to the plan sponsored or underwritten by the

successor organization. Each employee, annuitant, former spouse,

or person having continued coverage under section 8905a of this

title affected by a merger shall be transferred to the plan

sponsored or underwritten by the successor organization unless he

enrolls in another plan under this chapter. If the successor

organization is an organization described in section 8901(8)(B) of

this title, any employee, annuitant, former spouse, or person

having continued coverage under section 8905a of this title so

transferred may not remain enrolled in the plan after the end of

the contract term in which the merger occurs unless that individual

is a full member of such organization (as determined under section

8903a(d) of this title).

(e)(1) Except as provided by subsection (d) of this section, when

a plan described by section 8903(3) or (4) or 8903a of this title

is discontinued under this chapter, the contingency reserve of that

plan shall be credited to the contingency reserves of the plans

continuing under this chapter for the contract term following that

in which termination occurs, each reserve to be credited in

proportion to the amount of the subscription charges paid and

accrued to the plan for the year of termination.

(2) Any crediting required under paragraph (1) pursuant to the

discontinuation of any plan under this chapter shall be completed

by the end of the second contract year beginning after such plan is

so discontinued.

(3) The Office shall prescribe regulations in accordance with

which this subsection shall be applied in the case of any plan

which is discontinued before being credited with the full amount to

which it would otherwise be entitled based on the discontinuation

of any other plan.

(f)(1) No tax, fee, or other monetary payment may be imposed,

directly or indirectly, on a carrier or an underwriting or plan

administration subcontractor of an approved health benefits plan by

any State, the District of Columbia, or the Commonwealth of Puerto

Rico, or by any political subdivision or other governmental

authority thereof, with respect to any payment made from the Fund.

(2) Paragraph (1) shall not be construed to exempt any carrier or

underwriting or plan administration subcontractor of an approved

health benefits plan from the imposition, payment, or collection of

a tax, fee, or other monetary payment on the net income or profit

accruing to or realized by such carrier or underwriting or plan

administration subcontractor from business conducted under this

chapter, if that tax, fee, or payment is applicable to a broad

range of business activity.

(g) The fund described in subsection (a) is available to pay

costs that the Office incurs for activities associated with

implementation of the demonstration project under section 1108 of

title 10.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 605; Pub. L. 95-454, title

IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L.

98-615, Sec. 3(6), Nov. 8, 1984, 98 Stat. 3204; Pub. L. 99-53, Sec.

2(e), (f), June 17, 1985, 99 Stat. 94; Pub. L. 99-251, title I,

Sec. 101, Feb. 27, 1986, 100 Stat. 14; Pub. L. 100-654, title II,

Sec. 202(a), Nov. 14, 1988, 102 Stat. 3845; Pub. L. 101-508, title

VII, Sec. 7002(b), (c), Nov. 5, 1990, 104 Stat. 1388-330; Pub. L.

105-261, div. A, title VII, Sec. 721(b)(4), Oct. 17, 1998, 112

Stat. 2065; Pub. L. 105-266, Sec. 6(b)(1), Oct. 19, 1998, 112 Stat.

2369.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3007. Sept. 28, 1959, Pub.

L. 86-382, Sec. 8,

73 Stat. 714.

Mar. 17, 1964, Pub.

L. 88-284, Sec.

1(12), (13), 78

Stat. 165.

5 U.S.C. 3008(b). Sept. 23, 1959, Pub.

L. 86-382, Sec.

9(b), 73 Stat. 715.

-------------------------------

In subsection (a), the words ''hereby created'' are omitted as

executed. The words ''hereinafter referred to as the 'Fund' '' are

omitted as unnecessary. The words ''to reimburse the Employees

Health Benefits Fund for sums expended by the Commission in

administering the provisions of this chapter for the fiscal years

1960 and 1961'' in former section 3008(b) are omitted as executed.

In subsection (d), the requirement that the assets and

liabilities of plans of organizations that have been merged be

transferred at the beginning of the contract term next following

the date of the merger or enactment of this subsection is omitted

as executed. The next beginning contract term referred to was

November 1, 1964, and the transfers have been made. In the last

sentence, the word ''hereafter'' is omitted as unnecessary.

In subsection (e), the word ''is'' is substituted for ''is or has

been'' as this title is stated prospectively, and any existing

rights and duties are preserved by technical section 8.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

of the report.

AMENDMENTS

1998 - Subsec. (e). Pub. L. 105-266 designated existing

provisions as par. (1) and added pars. (2) and (3).

Subsec. (g). Pub. L. 105-261 added subsec. (g).

1990 - Subsec. (a). Pub. L. 101-508, Sec. 7002(b), inserted at

end ''Payments from the Fund to a plan participating in a

letter-of-credit arrangement under this chapter shall, in

connection with any payment or reimbursement to be made by such

plan for a health service or supply, be made, to the maximum extent

practicable, on a checks-presented basis (as defined under

regulations of the Department of the Treasury).''

Subsec. (f). Pub. L. 101-508, Sec. 7002(c), added subsec. (f).

1988 - Subsec. (d). Pub. L. 100-654 substituted ''former spouse,

or person having continued coverage under section 8905a of this

title'' for ''or former spouse'' in two places.

1986 - Subsec. (b). Pub. L. 99-251 substituted ''enrollees'' for

''employees'' in last sentence.

1985 - Subsec. (d). Pub. L. 99-53, Sec. 2(e), substituted

''section 8903(3) or 8903a'' for ''section 8903(3)'' and inserted

provision directing that if the successor organization is an

organization described in section 8901(8)(B) of this title, any

transferred employee, annuitant, or former spouse may not remain

enrolled in the plan after the end of the contract term in which

the merger occurs unless the individual is a full member of such

organization (as determined under section 8903a(d) of this title).

Subsec. (e). Pub. L. 99-53, Sec. 2(f), inserted ''or 8903a''

before ''of this title''.

1984 - Subsecs. (a), (b). Pub. L. 98-615, Sec. 3(6)(A),

substituted ''enrollees'' for ''employees, annuitants,'' in

provisions preceding par. (1).

Subsec. (d). Pub. L. 98-615, Sec. 3(6)(B), substituted ''Each

employee, annuitant, or former spouse'' for ''Each employee or

annuitant''.

1978 - Subsecs. (a), (b). Pub. L. 95-454 substituted ''Office of

Personnel Management'' for ''Civil Service Commission'' and

''Office'' for ''Commission'' wherever appearing.

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by Pub. L. 101-508 applicable with respect to contract

years beginning on or after Jan. 1, 1991, see section 7002(g) of

Pub. L. 101-508, set out as a note under section 8902 of this

title.

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100-654 applicable with respect to any

calendar year beginning, and contracts entered into or renewed for

any calendar year beginning, after end of 9-month period beginning

Nov. 14, 1988, and with respect to any qualifying event occurring

on or after first day of first calendar year beginning after end of

such 9-month period, see section 203 of Pub. L. 100-654, set out as

a note under section 8902 of this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

DISPOSAL OF AMOUNTS REMAINING AS OF OCTOBER 19, 1998, IN

CONTINGENCY RESERVE OF DISCONTINUED PLAN

Pub. L. 105-266, Sec. 6(b)(2), Oct. 19, 1998, 112 Stat. 2369,

provided that: ''In the case of any amounts remaining as of the

date of the enactment of this Act (Oct. 19, 1998) in the

contingency reserve of a discontinued plan, such amounts shall be

disposed of in accordance with section 8909(e) of title 5, United

States Code, as amended by this subsection, by -

''(A) the deadline set forth in section 8909(e) of such title

(as so amended); or

''(B) if later, the end of the 6-month period beginning on such

date of enactment.''

AMOUNTS TO BE REFUNDED FROM CARRIERS' SPECIAL RESERVES

Pub. L. 99-272, title XV, Sec. 15202(a), Apr. 7, 1986, 100 Stat.

333, provided that:

''(1) The Office of Personnel Management -

''(A) shall determine the minimum level of financial reserves

necessary to be held by a carrier for each health benefits plan

under chapter 89 of such title for the purpose of ensuring the

stable and efficient operation of such plan; and

''(B) shall require the carrier to refund to the Employees

Health Benefits Fund (described in section 8909(a) of title 5,

United States Code) any such reserves in excess of such minimum

level in such amounts and at such times during fiscal years 1986

and 1987 as the Office determines appropriate.

''(2) In carrying out its responsibilities under this subsection,

the Office shall ensure that the aggregate amount to be refunded to

the Employees Health Benefits Fund under this subsection -

''(A) during fiscal year 1986 shall be not less than

$800,000,000; and

''(B) during fiscal year 1987 shall be not less than

$300,000,000.

''(3) No amount in the Employees Health Benefits Fund may be

transferred to the general fund of the Treasury of the United

States as a result of a refund made under this subsection.

''(4)(A) Subject to subparagraphs (B) and (C), any amounts

refunded to the Employees Health Benefits Fund under this

subsection may be used solely for the purpose of paying the

Government contribution under chapter 89 of title 5, United States

Code, for health benefits for annuitants, as defined by section

8901(3) of title 5, United States Code, (including the Government

contribution for former employees of the United States Postal

Service) enrolled in health benefits plans under such chapter.

''(B) This paragraph applies to a refund to the extent that such

refund represents amounts attributable to Government contributions

which were made under section 8906(b) of title 5, United States

Code, (including contributions made by the United States Postal

Service) as determined under regulations which the Office of

Personnel Management shall prescribe.

''(C) Any part of the amount in the Employees Health Benefits

Fund as a result of a refund made under this subsection may be

transferred -

''(i) to the government of the District of Columbia, except

that the amount of any such part so transferred shall not exceed

the amount attributable to the contributions made by the

government of the District of Columbia to subscription charges

under this chapter (as determined by the Office of Personnel

Management); and

''(ii) to the United States Postal Service, except that the

amount of any such part so transferred shall not exceed the

amount attributable to the contributions made by the United

States Postal Service to subscription charges under this chapter

(as determined by the Office).

''(5) The provisions of this subsection shall apply

notwithstanding any provision of the Federal Employees Benefits

Improvement Act of 1985 (probably means the Federal Employees

Benefits Improvement Act of 1986, Pub. L. 99-251, see Short Title

of 1986 Amendment note set out under section 8901 of this title for

classification).''

RESTRICTIONS RELATING TO AMOUNTS REFUNDED TO EMPLOYEES HEALTH

BENEFITS FUND FROM CARRIERS' SPECIAL RESERVES

Section 112 of Pub. L. 99-251 provided that:

''(a) Prohibited Transfers. - (1) No amount in the Employees

Health Benefits Fund may be transferred to the general fund of the

Treasury of the United States or the United States Postal Service

as a result of a refund described in paragraph (2).

''(2) This subsection applies with respect to any refund made by

a carrier during fiscal year 1986 or 1987 to the Employees Health

Benefits Fund to the extent that such refund represents amounts in

excess of the minimum level of financial reserves necessary to be

held by such carrier to ensure the stable and efficient operation

of its health benefits plan.

''(b) Restriction Relating to Use of Certain Amounts in the Fund.

- (1) Any amount which is in the Employees Health Benefits Fund,

and which is described in paragraph (2), may be used solely for the

purpose of paying the Government contribution under chapter 89 of

title 5, United States Code, for health benefits for annuitants

enrolled in health benefits plans (without regard to the health

benefits plan or plans from which the refunds were received).

''(2) This subsection applies with respect to any amounts -

''(A) which are referred to in subsection (a)(2); and

''(B) which are attributable to Government contributions (other

than contributions by the government of the District of Columbia,

which shall be returned to such government) that were made under

section 8906(b) of title 5, United States Code, as determined

under regulations which the Office of Personnel Management shall

prescribe.

''(c) Definitions. - For the purpose of this section -

''(1) the term 'Employees Health Benefits Fund' refers to the

fund described in section 8909(a) of title 5, United States Code;

''(2) the term 'carrier' has the meaning given such term by

section 8901(7) of such title; and

''(3) the term 'health benefits plan' has the meaning given

such term by section 8901(6) of such title.''

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 6386, 8903b, 8905, 8906

of this title; title 22 sections 4069c, 4069c-1; title 25 section

450i; title 50 section 403p.

-CITE-

5 USC Sec. 8910 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8910. Studies, reports, and audits

-STATUTE-

(a) The Office of Personnel Management shall make a continuing

study of the operation and administration of this chapter,

including surveys and reports on health benefits plans available to

employees and on the experience of the plans.

(b) Each contract entered into under section 8902 of this title

shall contain provisions requiring carriers to -

(1) furnish such reasonable reports as the Office determines to

be necessary to enable it to carry out its functions under this

chapter; and

(2) permit the Office and representatives of the General

Accounting Office to examine records of the carriers as may be

necessary to carry out the purposes of this chapter.

(c) Each Government agency shall keep such records, make such

certifications, and furnish the Office with such information and

reports as may be necessary to enable the Office to carry out its

functions under this chapter.

(d) The Office, in consultation with the Department of Health and

Human Services, shall develop and implement a system through which

the carrier for an approved health benefits plan described by

section 8903 or 8903a will be able to identify those annuitants or

other individuals covered by such plan who are entitled to benefits

under part A or B of title XVIII of the Social Security Act in

order to ensure that payments under coordination of benefits with

Medicare do not exceed the statutory maximums which physicians may

charge Medicare enrollees.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 606; Pub. L. 95-454, title

IX, Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L.

101-508, title VII, Sec. 7002(d), Nov. 5, 1990, 104 Stat.

1388-330.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3010. Sept. 28, 1959, Pub.

L. 86-382, Sec. 11,

73 Stat. 716.

-------------------------------

In subsection (b), the word ''agency'' is substituted for

''department, agency, and independent establishment''.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

-REFTEXT-

REFERENCES IN TEXT

The Social Security Act, referred to in subsec. (d), is act Aug.

14, 1935, ch. 531, 49 Stat. 620, as amended. Parts A and B of

title XVIII of the Social Security Act are classified generally to

parts A (Sec. 1395c et seq.) and B (Sec. 1395j et seq.),

respectively, of subchapter XVIII of chapter 7 of Title 42, The

Public Health and Welfare. For complete classification of this Act

to the Code, see section 1305 of Title 42 and Tables.

-MISC2-

AMENDMENTS

1990 - Subsec. (d). Pub. L. 101-508 added subsec. (d).

1978 - Subsecs. (a) to (c). Pub. L. 95-454 substituted ''Office

of Personnel Management'' for ''Civil Service Commission'' and

''Office'' for ''Commission'' wherever appearing.

EFFECTIVE DATE OF 1990 AMENDMENT

Amendment by Pub. L. 101-508 applicable with respect to contract

years beginning on or after Jan. 1, 1991, see section 7002(g) of

Pub. L. 101-508, set out as a note under section 8902 of this

title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

-CITE-

5 USC Sec. 8911 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8911. Advisory committee

-STATUTE-

The Director of the Office of Personnel Management shall appoint

a committee composed of five members, who serve without pay, to

advise the Office regarding matters of concern to employees under

this chapter. Each member of the committee shall be an employee

enrolled under this chapter or an elected official of an employee

organization.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 95-454, title

IX, Sec. 906(a)(1), (4), Oct. 13, 1978, 92 Stat. 1224, 1225.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3012. Sept. 28, 1959, Pub.

L. 86-382, Sec. 13,

73 Stat. 716.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1978 - Pub. L. 95-454 substituted ''Director of the Office of

Personnel Management'' for ''Chairman of the Civil Service

Commission'' and ''Office'' for ''Commission''.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

TERMINATION OF ADVISORY COMMITTEES

Advisory committees in existence on Jan. 5, 1973, to terminate

not later than the expiration of the 2-year period following Jan.

5, 1973, unless, in the case of a committee established by the

President or an officer of the Federal Government, such committee

is renewed by appropriate action prior to the expiration of such

2-year period, or in the case of a committee established by the

Congress, its duration is otherwise provided by law. See section

14 of Pub. L. 92-463, Oct. 6, 1972, 86 Stat. 776, set out in the

Appendix to this title.

-CITE-

5 USC Sec. 8912 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8912. Jurisdiction of courts

-STATUTE-

The district courts of the United States have original

jurisdiction, concurrent with the United States Court of Federal

Claims, of a civil action or claim against the United States

founded on this chapter.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 97-164, title

I, Sec. 160(a)(3), Apr. 2, 1982, 96 Stat. 48; Pub. L. 102-572,

title IX, Sec. 902(b)(1), Oct. 29, 1992, 106 Stat. 4516.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

5 U.S.C. 3014. Sept. 28, 1959, Pub.

L. 86-382, Sec. 15,

73 Stat. 716.

-------------------------------

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1992 - Pub. L. 102-572 substituted ''United States Court of

Federal Claims'' for ''United States Claims Court''.

1982 - Pub. L. 97-164 substituted ''United States Claims Court''

for ''Court of Claims''.

EFFECTIVE DATE OF 1992 AMENDMENT

Amendment by Pub. L. 102-572 effective Oct. 29, 1992, see section

911 of Pub. L. 102-572, set out as a note under section 171 of

Title 28, Judiciary and Judicial Procedure.

EFFECTIVE DATE OF 1982 AMENDMENT

Amendment by Pub. L. 97-164 effective Oct. 1, 1982, see section

402 of Pub. L. 97-164, set out as a note under section 171 of Title

28, Judiciary and Judicial Procedure.

-CITE-

5 USC Sec. 8913 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8913. Regulations

-STATUTE-

(a) The Office of Personnel Management may prescribe regulations

necessary to carry out this chapter.

(b) The regulations of the Office may prescribe the time at which

and the manner and conditions under which an employee is eligible

to enroll in an approved health benefits plan described in section

8903 or 8903a of this title. The regulations may exclude an

employee on the basis of the nature and type of his employment or

conditions pertaining to it, such as short-term appointment,

seasonal or intermittent employment, and employment of like

nature. The Office may not exclude -

(1) an employee or group of employees solely on the basis of

the hazardous nature of employment;

(2) a teacher in the employ of the Board of Education of the

District of Columbia, whose pay is fixed by section 1501 of title

31, District of Columbia Code, on the basis of the fact that the

teacher is serving under a temporary appointment if the teacher

has been so employed by the Board for a period or periods

totaling not less than two school years;

(3) an employee who is occupying a position on a part-time

career employment basis (as defined in section 3401(2) of this

title); or

(4) an employee who is employed on a temporary basis and is

eligible under section 8906a(a).

(c) The regulations of the Office shall provide for the beginning

and ending dates of coverage of employees, annuitants, members of

their families, and former spouses under health benefit plans. The

regulations may permit the coverage to continue, exclusive of the

temporary extension of coverage described by section 8902(g) of

this title, until the end of the pay period in which an employee is

separated from the service, or until the end of the month in which

an annuitant or former spouse ceases to be entitled to annuity, and

in case of the death of an employee or annuitant, may permit a

temporary extension of the coverage of members of his family for

not to exceed 90 days.

(d) The Secretary of Agriculture shall prescribe regulations to

effect the application and operation of this chapter to an

individual named by section 8901(1)(H) of this title.

-SOURCE-

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 95-437, Sec.

4(c)(1), Oct. 10, 1978, 92 Stat. 1058; Pub. L. 95-454, title IX,

Sec. 906(a)(2), (3), (c)(2)(F), (H), Oct. 13, 1978, 92 Stat. 1224,

1227; Pub. L. 98-615, Sec. 3(7), Nov. 8, 1984, 98 Stat. 3204; Pub.

L. 99-53, Sec. 2(a), June 17, 1985, 99 Stat. 94; Pub. L. 100-654,

title III, Sec. 301(c), Nov. 14, 1988, 102 Stat. 3846.)

-MISC1-

Historical and Revision Notes

---------------------------------------------------------------------

Derivation U.S. Code Revised Statutes and

Statutes at Large

---------------------------------------------------------------------

(a) 5 U.S.C. 3009(a). Sept. 28, 1959, Pub.

L. 86-382, Sec.

10(a), 73 Stat.

715.

(b) 5 U.S.C. 3002(a) Sept. 28, 1959, Pub.

(words between 1st L. 86-382, Sec.

and 4th commas of 3(a) (words between

1st sentence, and 1st and 4th commas

2d sentence), (f) of 1st sentence,

(words between 1st and 2d sentence),

and 2d commas of 73 Stat. 710. July

1st sentence). 1, 1960, Pub. L. 86-

568, Sec. 115(d)

''(f) (words

between 1st and 2d

commas of 1st

sentence)'', 74

Stat. 303.

Oct. 6, 1964, Pub.

L. 88-631, Sec. 1,

78 Stat. 1007.

(c) 5 U.S.C. 3009(b). Sept. 28, 1959, Pub.

L. 86-382, Sec.

10(b), 73 Stat.

715.

(d) 5 U.S.C. 3002(f) (2d July 1, 1960, Pub.

sentence). L. 86-568, Sec.

115(d) ''(f) (2d

sentence)'', 74

Stat. 303.

-------------------------------

In subsection (b)(2), the words ''section 1501 of title 31,

District of Columbia Code'' are substituted for ''section 1 of the

District of Columbia Teachers' Salary Act of 1955 (69 Stat. 521),

as amended (sec. 31-1501, D.C. Code, 1961 edition)''.

Standard changes are made to conform with the definitions

applicable and the style of this title as outlined in the preface

to the report.

AMENDMENTS

1988 - Subsec. (b)(4). Pub. L. 100-654 added par. (4).

1985 - Subsec. (b). Pub. L. 99-53 inserted reference to section

8903a of this title.

1984 - Subsec. (c). Pub. L. 98-615, Sec. 3(7), substituted

''employees, annuitants, members of their families, and former

spouses'' for ''employees and annuitants and members of their

families'', and ''in which an annuitant or former spouse'' for ''in

which an annuitant''.

1978 - Subsecs. (a), (b). Pub. L. 95-454, Sec. 906(a)(2), (3),

substituted ''Office of Personnel Management'' for ''Civil Service

Commission'' and ''Office'' for ''Commission'' wherever appearing.

Subsec. (b)(3). Pub. L. 95-454, Sec. 906(c)(2)(F), (H),

substituted ''3401'' for ''3391''.

Pub. L. 95-437 added par. (3).

Subsec. (c). Pub. L. 95-454, Sec. 906(a)(3), substituted

''Office'' for ''Commission''.

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100-654 effective 120 days after Nov. 14,

1988, see section 301(d) of Pub. L. 100-654, set out as an

Effective Date note under section 8906a of this title.

EFFECTIVE DATE OF 1984 AMENDMENT

Amendment by Pub. L. 98-615 effective May 7, 1985, with

enumerated exceptions, and applicable to any individual who is

married to an employee or annuitant on or after that date, see

section 4(a)(2) of Pub. L. 98-615, as amended, set out as a note

under section 8341 of this title.

EFFECTIVE DATE OF 1978 AMENDMENT

Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,

1978, see section 907 of Pub. L. 95-454, set out as a note under

section 1101 of this title.

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 8901 of this title.

-CITE-

5 USC Sec. 8914 01/06/03

-EXPCITE-

TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES

PART III - EMPLOYEES

Subpart G - Insurance and Annuities

CHAPTER 89 - HEALTH INSURANCE

-HEAD-

Sec. 8914. Effect of other statutes

-STATUTE-

Any provision of law outside of this chapter which provides

coverage or any other benefit under this chapter to any individuals

who (based on their being employed by an entity other than the

Government) would not otherwise be eligible for any such coverage

or benefit shall not apply with respect to any individual

appointed, transferred, or otherwise commencing that type of

employment on or after October 1, 1988.

-SOURCE-

(Added Pub. L. 100-238, title I, Sec. 108(a)(3)(A), Jan. 8, 1988,

101 Stat. 1747.)

-SECREF-

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in title 22 section 6103; title 25

section 450i.

-CITE-