Legislación
US (United States) Code. Title 5. Parte III. Subpart G: Insurance and Annuties. Chapter 89: Health insurance
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5 USC CHAPTER 89 - HEALTH INSURANCE 01/06/03
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TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
PART III - EMPLOYEES
Subpart G - Insurance and Annuities
CHAPTER 89 - HEALTH INSURANCE
.
-HEAD-
CHAPTER 89 - HEALTH INSURANCE
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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.
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5 USC Sec. 8901 01/06/03
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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.)
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Historical and Revision Notes
1966 Act
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Derivation U.S. Code Revised Statutes and
Statutes at Large
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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.
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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
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Section of title 5 Source (U.S. Code) Source (Statutes at
Large)
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8901(5) 5 App.: 3001(d). July 18, 1966, Pub.
L. 89-504, Sec.
601, 80 Stat. 303.
-------------------------------
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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.
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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.
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5 USC Sec. 8911 01/06/03
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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.)
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Historical and Revision Notes
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Derivation U.S. Code Revised Statutes and
Statutes at Large
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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.
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5 USC Sec. 8912 01/06/03
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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.)
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Historical and Revision Notes
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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.
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5 USC Sec. 8913 01/06/03
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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.)
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Historical and Revision Notes
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Derivation U.S. Code Revised Statutes and
Statutes at Large
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(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.
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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.
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| Enviado por: | El remitente no desea revelar su nombre |
| Idioma: | inglés |
| País: | Estados Unidos |
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