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106th CONGRESS
2d Session
S. 3284
To amend title 5, United States Code, to establish a national health
program administered by the Office of Personnel Management to offer
Federal employee health benefits plans to individuals who are not
Federal employees, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 15 (legislative day, September 22), 2000
Mr. Durbin introduced the following bill; which was read twice and
referred to the Committee on Governmental Affairs
_______________________________________________________________________
A BILL
To amend title 5, United States Code, to establish a national health
program administered by the Office of Personnel Management to offer
Federal employee health benefits plans to individuals who are not
Federal employees, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Offering People True Insurance
Options Nationwide Act of 2000''.
SEC. 2. OPTION HEALTH INSURANCE.
Subpart G of part III of title 5, United States Code, is amended by
adding at the end the following:
``CHAPTER 90A--HEALTH INSURANCE FOR NON-FEDERAL EMPLOYEES
``Sec.
``9051. Definitions.
``9052. Health insurance for non-Federal employees.
``9053. Contract requirement.
``9054. Eligibility.
``9055. Alternative conditions to Federal employee plans.
``9056. Coordination with social security benefits.
``9057. Non-Federal employer participation.
``Sec. 9051. Definitions
``In this chapter--
``(1) the terms defined under section 8901 shall have the
meanings given such terms under that section; and
``(2) the term `Office' means the Office of Personnel
Management.
``Sec. 9052. Health insurance for non-Federal employees
``(a) The Office of Personnel Management shall administer a health
insurance program for non-Federal employees in accordance with this
chapter.
``(b) Except as provided under this chapter, the Office shall
prescribe regulations to apply the provisions of chapter 89 to the
greatest extent practicable to eligible individuals covered under this
chapter.
``(c) In no event shall the enactment of this chapter result in--
``(1) any increase in the level of individual or Government
contributions required under chapter 89, including copayments
or deductibles;
``(2) any decrease in the types of benefits offered under
chapter 89; or
``(3) any other change that would adversely affect the
coverage afforded under chapter 89 to employees and annuitants
and members of family under that chapter.
``Sec. 9053. Contract requirement
``(a) Each contract entered into under section 8902 shall require a
carrier to offer to eligible individuals under this chapter, throughout
each term for which the contract remains effective, the same benefits
(subject to the same maximums, limitations, exclusions, and other
similar terms or conditions) as would be offered under such contract or
applicable health benefits plan to employees, annuitants, and members
of family.
``(b)(1) The Office may waive the requirements of this subsection,
if the Office determines, based on a petition submitted by a carrier
that--
``(A) the carrier is unable to offer the applicable health
benefits plan because of a limitation in the capacity of the
plan to deliver services or assure financial solvency;
``(B) the applicable health benefits plan is not sponsored
by a carrier licensed under applicable State law; or
``(C) bona fide enrollment restrictions make the
application of this chapter inappropriate, including
restrictions common to plans which are limited to individuals
having a past or current employment relationship with a
particular agency or other authority of the Government.
``(2) The Office may require a petition under this subsection to
include--
``(A) a description of the efforts the carrier
proposes to take in order to offer the applicable
health benefits plan under this chapter; and
``(B) the proposed date for offering such a health
benefits plan.
``(3) A waiver under this subsection may be for any period
determined by the Office. The Office may grant subsequent waivers under
this section.
``Sec. 9054. Eligibility
``An individual shall be eligible to enroll in a plan under this
chapter, unless the individual is enrolled or eligible to enroll in a
plan under chapter 89.
``Sec. 9055. Alternative conditions to Federal employee plans
``(a) For purposes of enrollment in a health benefits plan under
this chapter, an individual who had coverage under a health insurance
plan and is not a qualified beneficiary as defined under section
4980B(g)(1) of the Internal Revenue Code of 1986 shall be treated in a
similar manner as an individual who begins employment as an employee
under chapter 89.
``(b) In the administration of this chapter, covered individuals
under this chapter shall be in a risk pool separate from covered
individuals under chapter 89.
``(c)(1) Each contract under this chapter may include a preexisting
condition exclusion as defined under section 9801(b)(1) of the Internal
Revenue Code of 1986.
``(2)(A) The preexisting condition exclusion under this subsection
shall provide for coverage of a preexisting condition to begin not more
than 1 year after the date of coverage of an individual under a health
benefits plan, reduced by 1 month for each month that individual was
covered under a health insurance plan immediately preceding the date
the individual submitted an application for coverage under this
chapter.
``(B) For purposes of this paragraph, a lapse in coverage of not
more than 31 days immediately preceding the date of the submission of
an application for coverage shall not be considered a lapse in
continuous coverage.
``(d)(1) Rates charged and premiums paid for a health benefits plan
under this chapter--
``(A) may be adjusted and differ from such rates charged
and premiums paid for the same health benefits plan offered
under chapter 89;
``(B) shall be negotiated in the same manner as negotiated
under chapter 89; and
``(C) shall be adjusted to cover the administrative costs
of this chapter.
``(2) In determining rates and premiums under this chapter--
``(A) the age of covered individuals may be considered; and
``(B) rebates or lower rates and premiums shall be set to
encourage longevity of coverage.
``(e) No Government contribution shall be made for any covered
individual under this chapter.
``(f) If an individual who is enrolled in a health benefits plan
under this chapter terminates the enrollment, the individual shall not
be eligible for reenrollment until the first open enrollment period
following 6 months after the date of such termination.
``Sec. 9056. Coordination with social security benefits
``Benefits under this chapter shall, with respect to an individual
who is entitled to benefits under part A of title XVIII of the Social
Security Act, be offered (for use in coordination with those social
security benefits) to the same extent and in the same manner as if
coverage were under chapter 89.
``Sec. 9057. Non-Federal employer participation
``(a) In this section the term--
``(1) `employee', notwithstanding section 9051, means an
employee of a non-Federal employer; and
``(2) `non-Federal employer' means an employer that is not
the Federal Government.
``(b)(1) The Office shall prescribe regulations providing for non-
Federal employer participation under this chapter, including--
``(A) the offering of health benefits plans under this
chapter to employees through participating non-Federal
employers; and
``(B) a requirement for participating non-Federal employer
contributions to the payment of premiums for employees who
enroll in a health benefits plan under this chapter.
``(2) A participating non-Federal employer shall pay an employer
contribution for the premiums of an employee or other applicable
covered individual as follows:
``(A) A non-Federal employer that employs not more than 2
employees shall not be required to pay an employer
contribution.
``(B) A non-Federal employer that employs more than 2 and
not more than 25 employees shall pay not less than 30 percent
of the total premiums.
``(C) A non-Federal employer that employs more than 25 and
not more than 50 employees shall pay not less than 40 percent
of the total premiums.
``(D) A non-Federal employer that employs more than 50
employees shall pay not less than 50 percent of the total
premiums.
``(3) Notwithstanding paragraph (2) (B), (C), or (D), a non-Federal
employer that employs more than 2 employees shall pay not less than 20
percent of the total premiums with respect to the first year in which
that employer participates under this chapter.''.
SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS.
(a) Contract Requirement Under Chapter 89.--Section 8902 of title
5, United States Code, is amended by adding after subsection (o) the
following:
``(p) Each contract under this chapter shall include a provision
that the carrier shall offer any health benefits plan as required under
chapter 90A.''.
(b) Table of Chapters.--The table of chapters for part III of title
5, United States Code, is amended by inserting after the item relating
to chapter 90 the following:
``90A. Health Insurance for Non-Federal Employees........... 9051''.
SEC. 4. EFFECTIVE DATE.
This Act and the amendments made by this Act shall take effect on
the date of enactment of this Act and shall apply to contracts that
take effect with respect to calendar year 2002 and each calendar year
thereafter.
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