Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698744873788.pdf (Micronesia, Federated States of)
FIFTEENTH CONGRESS OF THE FEDERATED STATES OF MICRONESIA FIRST REGULAR SESSION, 2007 C.B.

NO.
15-12 A BILL FOR AN ACT To further amend Title 52 of the Code of the Federated States of Micronesia, as amended, by amending section 403 to make enrollment in MiCare mandatory for employees of the national government and to require that post secondary institutions enroll in MiCare before students are permitted to enroll, by amending section 406 to delete the requirement that the Fund maintain separate accounts for each State and by amending section 409 to permit the plan to deny claims based on preexisting medical conditions, and for other purposes.
BE IT ENACTED BY THE CONGRESS OF THE FEDERATED STATES OF MICRONEIA: 1 Section 1.

Section 403 of title 52 of the Code of the 2 Federated States of Micronesia, as amended by Public Law Nos.

8- 3 53, 8-133 and 14-49 is hereby further amended to read as follows: “Section 403.

Eligiblity.

(1) All full time employees of the National Government of the Federated States of Micronesia [may] shall participate in the plan.
(2) Other persons who may participate in the plan are: (a) The full time employees of each participating agency and business which has entered into a contract with the Director, as administrator of the plan, whereby such agencies or businesses have agreed to participate in the plan.

(b) The dependents of full time employees of the National Government, participating agencies and participating businesses; (c) Members of an employee’s household who are CBL 15-13 C.B.

NO.
15-12 dependent upon the employee, but are not otherwise defined as "dependents" under the provisions of this act, if the employee pays 100 percent of the premiums for such persons to the plan; (d) Government employees whose State or agency does not participate in the plan, and their dependents, if they pay 100 percent of the premiums for themselves and the dependents to the plan; and (e) Former enrollees in the plan, and their dependents, if they pay 100 percent of the premiums for themselves and their dependents to the plan.
(f) Full time students enrolled at any post secondary institution in the FSM, if the post secondary institution has entered into a contract of participation with the plan and the students [they] pay 100 percent of the premiums for themselves to the plan.” Section 2.

Section 406 of title 52 of the Code of the 18 Federated States of Micronesia, as amended by Public Law Nos.

6- 19 114 and 8-53 is hereby further amended to read as follows: "Section 406.

Disposition of fund.


(1) All money deposited in the Employees’ Health Insurance Fund shall be used to pay claims, except that a sum representing not more than ten percent of the estimated income for that year from contributions and income on investments may be expended for costs of 2 of 5 C.B.

NO.

15-12 administration.
[(2) The Employees’ Health Insurance Fund shall maintain a separate account for each of the States, which shall include all contributions from that State, plus interest, minus administrative costs.

A State’s account may not be charged for any services rendered to a member who resides in any other State, unless, in the case of a state_wide emergency, both States transmit their agreement in writing to the Plan Director.
(3) If a State’s premium payments are current, the Plan may use any amount which remains in a State’s account at the end of the fiscal year, and which exceeds 25 percent of the total premium paid by that State in that fiscal year, to purchase hospital supplies, equipment or medicines for that State’s hospital.

]” Section 3.

Section 409 of title 52 of the Code of the 17 Federated States of Micronesia, as amended by Public Law Nos.
8- 18 53, 8-133, and 12-77, is hereby further amended to read as 19 follows: "Section 409.

Promulgation of regulations.

(1) The Board, with the approval of the President, shall promulgate regulations, pursuant to chapter 1 of title 17 of this code, governing the amount of the premium for insurance under the plan, the procedure for making claims under the plan, the amount and type of 3 of 5 C.B.

NO.
NO.

15-12 benefits under the plan, the policy limits under the plan, and such other matters as may be consistent with the contents and purpose of this chapter, including the implementation of those provisions of this chapter pertaining to participating agencies and participating businesses.
[(a) The Board shall promulgate no regulation allowing a claim for benefits under the plan to be denied on the grounds that the medical condition giving rise to the claim existed before the person making the claim began participating in the plan.

Any such existing regulation is hereby retroactively repealed for a period of six months from the date this act becomes law.]
(2) The plan may: (a) provide, arrange for, pay for, or reimburse the costs of medical, dental and vision treatment and care, hospitalization, surgery, prescription drugs, medicine, prosthetic appliances, out-patient care, and other medical care benefits, in cash or the equivalent in medicines and supplies; (b) provide life insurance benefits; (c) contract with private sector insurance companies to provide benefits; and (d) contract for other services as needed.” 4 of 5 C.B.

NO.

15-12 1 Section 4.


This law shall become effective at the beginning 2 of the 2008 fiscal year.

3 Section [4] 5.

This act shall become law upon approval by 4 the President of the Federated States of Micronesia or upon its 5 becoming law without such approval.

6 7 Date: 5/16/07 Introduced by: /s/ Resio S. Moses Resio S. Moses of 5