-CITE-
    5 USC CHAPTER 89 - HEALTH INSURANCE                         01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
                       CHAPTER 89 - HEALTH INSURANCE                   

-MISC1-
    Sec.                                                     
    8901.       Definitions.                                          
    8902.       Contracting authority.                                
    8902a.      Debarment and other sanctions.                        
    8903.       Health benefits plans.                                
    8903a.      Additional health benefits plans.                     
    8903b.      Authority to readmit an employee organization plan.   
    8904.       Types of benefits.                                    
    8905.       Election of coverage.                                 
    8905a.      Continued coverage.                                   
    8906.       Contributions.                                        
    8906a.      Temporary employees.                                  
    8907.       Information to individuals eligible to enroll.        
    8908.       Coverage of restored employees and survivor or
                 disability annuitants.                               
    8909.       Employees Health Benefits Fund.                       
    8909a.      Postal Service Retiree Health Benefits Fund.(!1)      

    8910.       Studies, reports, and audits.                         
    8911.       Advisory committee.                                   
    8912.       Jurisdiction of courts.                               
    8913.       Regulations.                                          
    8914.       Effect of other statutes.                             

                                AMENDMENTS                            
      2006 - Pub. L. 109-435, title VIII, Sec. 803(a)(2), Dec. 20,
    2006, 120 Stat. 3252, added item 8909a.
      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, Secs. 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.

-FOOTNOTE-               

    (!1) So in original. Does not conform to section catchline.


-End-



-CITE-
    5 USC Sec. 8901                                             01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
    Sec. 8901. Definitions

-STATUTE-
      For the purpose of this chapter - 
        (1) "employee" means - 
          (A) an employee as defined by section 2105 of this title;
          (B) a Member of Congress as defined by section 2106 of this
        title;
          (C) a Congressional employee as defined by section 2107 of
        this title;
          (D) the President;
          (E) an individual first employed by the government of the
        District of Columbia before October 1, 1987;
          (F) an individual employed by Gallaudet College; (!1)

          (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, Secs. 2, 3(b),
    Sept. 25, 1970, 84 Stat. 869; Pub. L. 93-160, Sec. 1(b), Nov. 27,
    1973, 87 Stat. 635; Pub. L. 95-368, Sec. 2, Sept. 17, 1978, 92
    Stat. 606; Pub. L. 95-454, title IX, Sec. 906(a)(2), (3), Oct. 13,
    1978, 92 Stat. 1224; Pub. L. 95-583, Sec. 2, Nov. 2, 1978, 92 Stat.
    2482; Pub. L. 96-54, Sec. 2(a)(52), Aug. 14, 1979, 93 Stat. 384;
    Pub. L. 96-70, title I, Sec. 1209(c), Sept. 27, 1979, 93 Stat. 463;
    Pub. L. 96-179, Sec. 2, Jan. 2, 1980, 93 Stat. 1299; Pub. L. 98-
    615, Sec. 3(1), Nov. 8, 1984, 98 Stat. 3202; Pub. L. 99-53, Sec.
    1(a), June 17, 1985, 99 Stat. 93; Pub. L. 99-251, title I, Sec.
    105(a), Feb. 27, 1986, 100 Stat. 15; Pub. L. 99-335, title II, Sec.
    207(l), June 6, 1986, 100 Stat. 598; Pub. L. 99-556, title V, Sec.
    503, Oct. 27, 1986, 100 Stat. 3141; Pub. L. 100-679, Sec. 13(c),
    Nov. 17, 1988, 102 Stat. 4071; Pub. L. 101-508, title VII, Sec.
    7202(l), Nov. 5, 1990, 104 Stat. 1388-339; Pub. L. 102-378, Sec.
    2(75), Oct. 2, 1992, 106 Stat. 1355; Pub. L. 105-266, Sec. 3(a),
    Oct. 19, 1998, 112 Stat. 2366.)

-MISC1-



                       HISTORICAL AND REVISION NOTES                   
                                 1966 ACT                             
    --------------------------------------------------------------------
     Derivation           U.S. Code              Revised Statutes and    
                                                   Statutes at Large     
    --------------------------------------------------------------------
                    5 U.S.C. 3001.           Sept. 28, 1959, Pub. L.     
                                              86-382, Sec. 2, 73 Stat.   
                                              709.                       
                                             July 8, 1963, Pub. L.       
                                              88-59, Sec. 1, 77 Stat. 76.
                                             Mar. 17, 1964, Pub. L.      
                                              88-284, Sec. 1(1)-(4), 78  
                                              Stat. 164.                 
                                             Aug. 31, 1964, Pub. L.      
                                              88-531, Sec. 1, 78 Stat.   
                                              737.                       
                    5 U.S.C. 3002(f)         July 1, 1960, Pub. L.       
                     (1st sentence, less      86-568, Sec. 115(d) "(f)   
                     words between 1st        (1st sentence, less words  
                     and 2d commas).          between 1st and 2d         
                                              commas)", 74 Stat. 303.    
    --------------------------------------------------------------------

      The definition of "employee" in section 2105 of this title is
    broad enough to cover the officers and employees covered by former
    section 3001 with the exception of a Member of Congress, the
    President, an individual employed by the government of the District
    of Columbia, an individual employed by Gallaudet College, a United
    States commissioner, and an Official Reporter of Debates of the
    Senate and an individual employed by him. The first five have been
    added in paragraphs (1)(B), (D), (E), (F), and (G). The latter are
    covered by the definition of "Congressional employee" in section
    2107 of this title and are included by the addition of a
    Congressional employee in paragraph (1)(C).
      In paragraph (1)(ii), the words "the United States" are
    substituted for "a State of the United States or the District of
    Columbia".
      Paragraph (1)(iv) is added for clarity.
      In paragraph (8), the words "before January 1, 1964" are
    substituted for "on or before December 31, 1963".
      The definition of "Commission" in former section 3001(h) is
    omitted as unnecessary as the full title "Civil Service Commission"
    is set forth the first time it is used in a section.
      Standard changes are made to conform with the definitions
    applicable and the style of this title as outlined in the preface
    to the report.



                                 1967 ACT                             
    --------------------------------------------------------------------
     Section of       Source (U.S. Code)      Source (Statutes at Large) 
       title 5                                                           
    --------------------------------------------------------------------
    8901(5)         5 App.: 3001(d).         July 18, 1966, Pub. L.      
                                              89-504, Sec. 601, 80 Stat. 
                                              303.                       
    --------------------------------------------------------------------


-REFTEXT-
                            REFERENCES IN TEXT                        
      Section 1(b) of the Act of August 25, 1958 (72 Stat. 838),
    referred to in par. (1)(H), is section 1(b) of Pub. L. 85-745 which
    is set out as a note under section 102 of Title 3, The President.
      Section 4 of the Presidential Transition Act of 1963, referred to
    in par. (1)(I), is section 4 of Pub. L. 88-277, which is set out as
    a note under section 102 of Title 3.
      The date of enactment of section 8903a of this title, referred to
    in par. (8)(B), means the date of enactment of Pub. L. 99-53, which
    enacted section 8903a and which was approved June 17, 1985.


-MISC2-
                                AMENDMENTS                            
      1998 - Par. (7). Pub. L. 105-266 substituted "organization and an
    association of organizations or other entities described in this
    paragraph sponsoring a health benefits plan;" for "organization;".
      1992 - Par. (3)(A)(iv). Pub. L. 102-378, Sec. 2(75)(A),
    substituted "8347(q)(2)" for "8347(p)(2)".
      Par. (10)(C)(ii). Pub. L. 102-378, Sec. 2(75)(B), inserted comma
    after "8341(h)".
      1990 - Par. (3)(A)(iv). Pub. L. 101-508 added cl. (iv).
      1988 - Par. (1)(H), (I). Pub. L. 100-679 added subpars. (H) and
    (I).
      1986 - Par. (1)(E). Pub. L. 99-335, Sec. 207(l)(1), amended
    subpar. (E) generally, substituting "first employed" for "employed"
    and inserting "before October 1, 1987".
      Par. (3)(A). Pub. L. 99-335, Sec. 207(l)(2), amended subpar. (A)
    generally. Prior to amendment, subpar. (A) read as follows: "an
    employee who retires on an immediate annuity under subchapter III
    of chapter 83 of this title or another retirement system for
    employees of the Government, after 5 or more years of service or
    for disability".
      Par. (3)(B). Pub. L. 99-556 inserted "(including a family member
    entitled to an amount under section 8442(b)(1)(A), whether or not
    such family member is entitled to an annuity under section
    8442(b)(1)(B))".
      Par. (4). Pub. L. 99-335, Sec. 207(l)(3), inserted "or chapter
    84".
      Par. (10)(C)(i). Pub. L. 99-335, Sec. 207(l)(4), inserted "or
    8467", "or 8445", and "or the Federal Employees' Retirement
    System".
      Par. (10)(C)(ii). Pub. L. 99-335, Sec. 207(l)(5), substituted
    "8345(j), 8445, or 8467" for "or 8345(j)" and inserted "or the
    Federal Employees' Retirement System" and "or 8417(b)".
      Par. (11). Pub. L. 99-251 added par. (11).
      1985 - Par. (8). Pub. L. 99-53 amended par. (8) generally,
    designating existing provisions as subpar. (A) and adding subpar.
    (B).
      1984 - Par. (10). Pub. L. 98-615 added par. (10).
      1980 - Par. (5). Pub. L. 96-179, Sec. 2(1), inserted "dependent"
    after "unmarried" in provisions preceding subpar. (A) and in
    provisions following subpar. (B), inserted "or recognized natural
    child" after "child" in subpar. (A), and substituted "or foster
    child but only if the child;" for ", foster child, or recognized
    natural child who" in subpar. (B).
      Par. (9). Pub. L. 96-179, Sec. 2(2)-(4), added par. (9).
      1979 - Par. (1). Pub. L. 96-70 in cl. (ii) substituted provisions
    relating to an individual who was an employee for the purpose of
    this chapter on Sept. 30, 1979, by reason of service in an
    Executive agency, United States Postal Service, or Smithsonian
    Institution in area which was then known as Canal Zone for
    provisions relating to Panama Canal Zone.
      Pub. L. 96-54 struck out cl. (G) which related to coverage of a
    United States Commissioner as an "employee", and redesignated cl.
    (H) as (G).
      1978 - Par. (1)(iv). Pub. L. 95-454 substituted "Office of
    Personnel Management" for "Civil Service Commission".
      Par. (3)(A). Pub. L. 95-583 reduced period of service to 5 from
    12 years.
      Par. (8). Pub. L. 95-454 substituted "Office" for "Commission".
      Pub. L. 95-368 substituted "after December 31, 1978, and before
    January 1, 1980" for "before January 1, 1964".
      1973 - Par. (1)(ii). Pub. L. 93-160 excluded from definition of
    "employee" persons who are not nationals of United States and whose
    permanent duty station is outside United States and Panama Canal
    Zone.
      1970 - Par. (1)(ii). Pub. L. 91-418, Sec. 3(b), excluded from
    definition of "employee" a noncitizen employee whose permanent duty
    station is outside Panama Canal Zone.
      Par. (3)(B). Pub. L. 91-418, Sec. 2(a), redefined "annuitant" to
    be a member of a family who receives an immediate annuity as the
    survivor of an employee rather than as the survivor of an employee
    who dies after completing 5 or more years of service.
      Par. (3)(D)(i). Pub. L. 91-418, Sec. 2(b), redefined "annuitant"
    to be a member of a family who receives monthly compensation as the
    surviving beneficiary of an employee who dies as a result of a
    compensable injury or illness rather than as the survivor of an
    employee who, having completed 5 or more years of service, so dies.

-CHANGE-
                              CHANGE OF NAME                          
      Gallaudet College, referred to in par. (1)(F), was redesignated
    Gallaudet University by section 101(a) of Pub. L. 99-371, which is
    classified to section 4301(a) of Title 20, Education.


-MISC3-
                     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.

-FOOTNOTE-               

    (!1) See Change of Name note below.


-End-



-CITE-
    5 USC Sec. 8902                                             01/03/2007

-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) (!1) of title
    XIII of the Public Health Service Act (42 U.S.C. 300c-9(d)).

      (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, Secs. 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, Secs. 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,
    Secs. 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.


-MISC2-
                                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.

-FOOTNOTE-
    (!1) See References in Text note below.


-End-



-CITE-
    5 USC Sec. 8902a                                            01/03/2007

-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; (!1)


      (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.


-MISC1-
                                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]."

-FOOTNOTE-               

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


-End-



-CITE-
    5 USC Sec. 8903                                             01/03/2007

-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, Secs.
    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.

-End-



-CITE-
    5 USC Sec. 8903a                                            01/03/2007

-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.)

-End-



-CITE-
    5 USC Sec. 8903b                                            01/03/2007

-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'."

-End-



-CITE-
    5 USC Sec. 8904                                             01/03/2007

-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)."

-End-



-CITE-
    5 USC Sec. 8905                                             01/03/2007

-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 (!1)

      (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,
    Secs. 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, Secs. 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. L.     
                     (1st sentence, less      86-382, Sec. 3(a) (1st     
                     words between 1st        sentence, less words       
                     and 4th commas),         between 1st and 4th        
                     (b)-(e).                 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, Secs. 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."

-FOOTNOTE-               

    (!1) So in original. Probably should be followed by a period.


-End-



-CITE-
    5 USC Sec. 8905a                                            01/03/2007

-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 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);

        (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); and

        (3) any employee who - 
          (A) is enrolled in a health benefits plan under this chapter;
          (B) is a member of a reserve component of the armed forces;
          (C) is called or ordered to active duty in support of a
        contingency operation (as defined in section 101(a)(13) of
        title 10);
          (D) is placed on leave without pay or separated from service
        to perform active duty; and
          (E) serves on active duty for a period of more than 30
        consecutive days.

      (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, 2010; or
        (ii) February 1, 2011, if specific notice of such separation
      was given to such individual before October 1, 2010.

      (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 4421 of the Atomic Energy Defense
    Act - 
        (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;
        (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); or
        (C) in the case of an employee described in subsection (b)(3),
      the date which is 24 months after the employee is placed on leave
      without pay or separated from service to perform active duty.

      (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.
    107-314, div. A, title XI, Sec. 1103, Dec. 2, 2002, 116 Stat. 2661;
    Pub. L. 107-314, div. D, title XLVI, Sec. 4603(h), formerly Pub. L.
    106-398, Sec. 1 [div. C, title XXXI, Sec. 3136(h)], Oct. 30, 2000,
    114 Stat. 1654, 1654A-459, renumbered Sec. 4603(h) of Pub. L. 107-
    314 by Pub. L. 108-136, div. C, title XXXI, Sec. 3141(i)(4)(A)-
    (C), Nov. 24, 2003, 117 Stat. 1777; Pub. L. 108-136, div. C, title
    XXXI, Sec. 3141(m)(3), Nov. 24, 2003, 117 Stat. 1787; Pub. L. 108-
    375, div. A, title XI, Sec. 1101(a), Oct. 28, 2004, 118 Stat.
    2072; Pub. L. 109-163, div. A, title XI, Sec. 1101, Jan. 6, 2006,
    119 Stat. 3447.)

-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.
      Section 4421 of the Atomic Energy Defense Act, referred to in
    subsec. (d)(5)(A), is classified to section 2601 of Title 50, War
    and National Defense.
      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.


-MISC1-
                                AMENDMENTS                            
      2006 - Subsec. (d)(4)(B)(i). Pub. L. 109-163, Sec. 1101(1),
    substituted "October 1, 2010" for "October 1, 2006".
      Subsec. (d)(4)(B)(ii). Pub. L. 109-163, Sec. 1101(2), substituted
    "February 1, 2011" for "February 1, 2007" and "October 1, 2010" for
    "October 1, 2006".
      2004 - Subsec. (a). Pub. L. 108-375, Sec. 1101(a)(1), struck out
    "paragraph (1) or (2) of" after "Any individual described in".
      Subsec. (b)(3). Pub. L. 108-375, Sec. 1101(a)(2), added par. (3).
      Subsec. (e)(1)(C). Pub. L. 108-375, Sec. 1101(a)(4), added
    subpar. (C).
      2003 - Subsec. (d)(5)(A). Pub. L. 108-136, Sec. 3141(m)(3),
    substituted "section 4421 of the Atomic Energy Defense Act" for
    "section 3143 of the National Defense Authorization Act for Fiscal
    Year 1997 (42 U.S.C. 7274n)".
      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. 107-314, Sec. 4603(h), formerly
    Pub. L. 106-398, Sec. 1 [div. C, title XXXI, Sec. 3136(h)], as
    renumbered by Pub. L. 108-136, Sec. 3141(i)(4)(A)-(C), 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 2004 AMENDMENT                 
      Pub. L. 108-375, div. A, title XI, Sec. 1101(c), Oct. 28, 2004,
    118 Stat. 2072, provided that: "The amendments made by this section
    [amending this section and section 8906 of this title] shall apply
    with respect to Federal employees called or ordered to active duty
    on or after September 14, 2001."

                     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."

-End-



-CITE-
    5 USC Sec. 8906                                             01/03/2007

-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 24 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
    through September 30, 2016, be paid by the United States Postal
    Service, and thereafter shall be paid first from the Postal Service
    Retiree Health Benefits Fund up to the amount contained in the
    Fund, with any remaining amount 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; Pub. L. 108-375, div. A, title XI, Sec. 1101(b), Oct.
    28, 2004, 118 Stat. 2072; Pub. L. 109-435, title VIII, Sec.
    803(a)(1)(A), Dec. 20, 2006, 120 Stat. 3251.)

-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       Source (U.S. Code)      Source (Statutes at Large) 
       title 5                                                           
    --------------------------------------------------------------------
    8906(a)         5 App.: 3006(a)(1).      July 18, 1966, Pub. L.      
                                              89-504, Secs. 406(b), 602, 
                                              80 Stat. 298, 303.         
    8906(b)                                                              
    8906(e)(2)                                                           
                    5 App.: 3006(a)(2).                                  
                    5 App.: 3006(b)(2).                                  
    --------------------------------------------------------------------

      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                            
      2006 - Subsec. (g)(2)(A). Pub. L. 109-435 substituted "shall
    through September 30, 2016, be paid by the United States Postal
    Service, and thereafter shall be paid first from the Postal Service
    Retiree Health Benefits Fund up to the amount contained in the
    Fund, with any remaining amount paid by the United States Postal
    Service" for "shall be paid by the United States Postal Service".
      2004 - Subsec. (e)(3)(C). Pub. L. 108-375 substituted "24 months"
    for "18 months".
      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 2006 AMENDMENT                 
      Amendment by Pub. L. 109-435 effective Oct. 1, 2006, see section
    805(a) of Pub. L. 109-435, set out as a note under section 8334 of
    this title.

                     EFFECTIVE DATE OF 2004 AMENDMENT                 
      Amendment by Pub. L. 108-375 applicable with respect to Federal
    employees called or ordered to active duty on or after Sept. 14,
    2001, see section 1101(c) of Pub. L. 108-375, set out as a note
    under section 8905a of this title.

                     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.

-End-



-CITE-
    5 USC Sec. 8906a                                            01/03/2007

-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]."

-End-



-CITE-
    5 USC Sec. 8907                                             01/03/2007

-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.

-End-



-CITE-
    5 USC Sec. 8908                                             01/03/2007

-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, Secs. 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.

-End-



-CITE-
    5 USC Sec. 8909                                             01/03/2007

-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."

-End-



-CITE-
    5 USC Sec. 8909a                                            01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
    Sec. 8909a. Postal Service Retiree Health Benefit Fund

-STATUTE-
      (a) There is in the Treasury of the United States a Postal
    Service Retiree Health Benefits Fund which is administered by the
    Office of Personnel Management.
      (b) The Fund is available without fiscal year limitation for
    payments required under section 8906(g)(2)(A).
      (c) The Secretary of the Treasury shall immediately invest, in
    interest-bearing securities of the United States such currently
    available portions of the Fund as are not immediately required for
    payments from the Fund. Such investments shall be made in the same
    manner as investments for the Civil Service Retirement and
    Disability Fund under section 8348.
      (d)(1) Not later than June 30, 2007, and by June 30 of each
    succeeding year, the Office shall compute the net present value of
    the future payments required under section 8906(g)(2)(A) and
    attributable to the service of Postal Service employees during the
    most recently ended fiscal year.
      (2)(A) Not later than June 30, 2007, the Office shall compute,
    and by June 30 of each succeeding year, the Office shall recompute
    the difference between - 
        (i) the net present value of the excess of future payments
      required under section 8906(g)(2)(A) for current and future
      United States Postal Service annuitants as of the end of the
      fiscal year ending on September 30 of that year; and
        (ii)(I) the value of the assets of the Postal Retiree Health
      Benefits Fund as of the end of the fiscal year ending on
      September 30 of that year; and
        (II) the net present value computed under paragraph (1).

      (B) Not later than June 30, 2017, the Office shall compute, and
    by June 30 of each succeeding year shall recompute, a schedule
    including a series of annual installments which provide for the
    liquidation of any liability or surplus by September 30, 2056, or
    within 15 years, whichever is later, of the net present value
    determined under subparagraph (A), including interest at the rate
    used in that computation.
      (3)(A) The United States Postal Service shall pay into such Fund -
     
        (i) $5,400,000,000, not later than September 30, 2007;
        (ii) $5,600,000,000, not later than September 30, 2008;
        (iii) $5,400,000,000, not later than September 30, 2009;
        (iv) $5,500,000,000, not later than September 30, 2010;
        (v) $5,500,000,000, not later than September 30, 2011;
        (vi) $5,600,000,000, not later than September 30, 2012;
        (vii) $5,600,000,000, not later than September 30, 2013;
        (viii) $5,700,000,000, not later than September 30, 2014;
        (ix) $5,700,000,000, not later than September 30, 2015; and
        (x) $5,800,000,000, not later than September 30, 2016.

      (B) Not later than September 30, 2017, and by September 30 of
    each succeeding year, the United States Postal Service shall pay
    into such Fund the sum of - 
        (i) the net present value computed under paragraph (1); and
        (ii) any annual installment computed under paragraph (2)(B).

      (4) Computations under this subsection shall be made consistent
    with the assumptions and methodology used by the Office for
    financial reporting under subchapter II of chapter 35 of title 31.
      (5)(A)(i) Any computation or other determination of the Office
    under this subsection shall, upon request of the United States
    Postal Service, be subject to a review by the Postal Regulatory
    Commission under this paragraph.
      (ii) Upon receiving a request under clause (i), the Commission
    shall promptly procure the services of an actuary, who shall hold
    membership in the American Academy of Actuaries and shall be
    qualified in the evaluation of healthcare insurance obligations, to
    conduct a review in accordance with generally accepted actuarial
    practices and principles and to provide a report to the Commission
    containing the results of the review. The Commission, upon
    determining that the report satisfies the requirements of this
    subparagraph, shall approve the report, with any comments it may
    choose to make, and submit it with any such comments to the Postal
    Service, the Office of Personnel Management, and Congress.
      (B) Upon receiving the report under subparagraph (A), the Office
    of Personnel Management shall reconsider its determination or
    redetermination in light of such report, and shall make any
    appropriate adjustments. The Office shall submit a report
    containing the results of its reconsideration to the Commission,
    the Postal Service, and Congress.
      (6) After consultation with the United States Postal Service, the
    Office shall promulgate any regulations the Office determines
    necessary under this subsection.

-SOURCE-
    (Added Pub. L. 109-435, title VIII, Sec. 803(a)(1)(B), Dec. 20,
    2006, 120 Stat. 3251.)


-MISC1-
                              EFFECTIVE DATE                          
      Section effective Oct. 1, 2006, see section 805(a) of Pub. L. 109-
    435, set out as a Effective Date of 2006 Amendment note under
    section 8334 of this title.

                  REVIEW BY POSTAL REGULATORY COMMISSION              
      Pub. L. 109-435, title VIII, Sec. 803(b), Dec. 20, 2006, 120
    Stat. 3252, provided that:
      "(1) In general. - 
        "(A) Request for review. - Any regulation established under
      section 8909a(d)(5) of title 5, United States Code (as added by
      subsection (a)), shall, upon request of the United States Postal
      Service, be subject to a review by the Postal Regulatory
      Commission under this paragraph.
        "(B) Report. - Upon receiving a request under subparagraph (A),
      the Commission shall promptly procure the services of an actuary,
      who shall hold membership in the American Academy of Actuaries
      and shall be qualified in the evaluation of healthcare insurance
      obligations, to conduct a review in accordance with generally
      accepted actuarial practices and principles and to provide a
      report to the Commission containing the results of the review.
      The Commission, upon determining that the report satisfies the
      requirements of this paragraph, shall approve the report, with
      any comments it may choose to make, and submit it with any such
      comments to the Postal Service, the Office of Personnel
      Management, and Congress.
      "(2) Reconsideration. - Upon receiving the report under paragraph
    (1), the Office of Personnel Management shall reconsider its
    determination or redetermination in light of such report, and shall
    make any appropriate adjustments. The Office shall submit a report
    containing the results of its reconsideration to the Commission,
    the Postal Service, and Congress."

-End-



-CITE-
    5 USC Sec. 8910                                             01/03/2007

-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 Government
      Accountability 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;
    Pub. L. 108-271, Sec. 8(b), July 7, 2004, 118 Stat. 814.)

-MISC1-



                       HISTORICAL AND REVISION NOTES                   
    --------------------------------------------------------------------
     Derivation           U.S. Code              Revised Statutes and    
                                                   Statutes at Large     
    --------------------------------------------------------------------
                    5 U.S.C. 3010.           Sept. 28, 1959, Pub. L.     
                                              86-382, Sec. 11, 73 Stat.  
                                              716.                       
    --------------------------------------------------------------------

      In subsection (b), the word "agency" is substituted for
    "department, agency, and independent establishment".
      Standard changes are made to conform with the definitions
    applicable and the style of this title as outlined in the preface
    to the report.

-REFTEXT-
                            REFERENCES IN TEXT                        
      The Social Security Act, referred to in subsec. (d), is act Aug.
    14, 1935, ch. 531, 49 Stat. 620, as amended. Parts A and B of title
    XVIII of the Social Security Act are classified generally to parts
    A (Sec. 1395c et seq.) and B (Sec. 1395j et seq.), respectively, of
    subchapter XVIII of chapter 7 of Title 42, The Public Health and
    Welfare. For complete classification of this Act to the Code, see
    section 1305 of Title 42 and Tables.


-MISC2-
                                AMENDMENTS                            
      2004 - Subsec. (b)(2). Pub. L. 108-271 substituted "Government
    Accountability Office" for "General Accounting Office".
      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.

-End-



-CITE-
    5 USC Sec. 8911                                             01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
    Sec. 8911. Advisory committee

-STATUTE-
      The Director of the Office of Personnel Management shall appoint
    a committee composed of five members, who serve without pay, to
    advise the Office regarding matters of concern to employees under
    this chapter. Each member of the committee shall be an employee
    enrolled under this chapter or an elected official of an employee
    organization.

-SOURCE-
    (Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 95-454, title
    IX, Sec. 906(a)(1), (4), Oct. 13, 1978, 92 Stat. 1224, 1225.)

-MISC1-



                       HISTORICAL AND REVISION NOTES                   
    --------------------------------------------------------------------
     Derivation           U.S. Code              Revised Statutes and    
                                                   Statutes at Large     
    --------------------------------------------------------------------
                    5 U.S.C. 3012.           Sept. 28, 1959, Pub. L.     
                                              86-382, Sec. 13, 73 Stat.  
                                              716.                       
    --------------------------------------------------------------------

      Standard changes are made to conform with the definitions
    applicable and the style of this title as outlined in the preface
    to the report.

                                AMENDMENTS                            
      1978 - Pub. L. 95-454 substituted "Director of the Office of
    Personnel Management" for "Chairman of the Civil Service
    Commission" and "Office" for "Commission".

                     EFFECTIVE DATE OF 1978 AMENDMENT                 
      Amendment by Pub. L. 95-454 effective 90 days after Oct. 13,
    1978, see section 907 of Pub. L. 95-454, set out as a note under
    section 1101 of this title.

                    TERMINATION OF ADVISORY COMMITTEES                
      Advisory committees in existence on Jan. 5, 1973, to terminate
    not later than the expiration of the 2-year period following Jan.
    5, 1973, unless, in the case of a committee established by the
    President or an officer of the Federal Government, such committee
    is renewed by appropriate action prior to the expiration of such 2-
    year period, or in the case of a committee established by the
    Congress, its duration is otherwise provided by law. See section 14
    of Pub. L. 92-463, Oct. 6, 1972, 86 Stat. 776, set out in the
    Appendix to this title.

-End-



-CITE-
    5 USC Sec. 8912                                             01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
    Sec. 8912. Jurisdiction of courts

-STATUTE-
      The district courts of the United States have original
    jurisdiction, concurrent with the United States Court of Federal
    Claims, of a civil action or claim against the United States
    founded on this chapter.

-SOURCE-
    (Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 97-164, title
    I, Sec. 160(a)(3), Apr. 2, 1982, 96 Stat. 48; Pub. L. 102-572,
    title IX, Sec. 902(b)(1), Oct. 29, 1992, 106 Stat. 4516.)

-MISC1-



                       HISTORICAL AND REVISION NOTES                   
    --------------------------------------------------------------------
     Derivation           U.S. Code              Revised Statutes and    
                                                   Statutes at Large     
    --------------------------------------------------------------------
                    5 U.S.C. 3014.           Sept. 28, 1959, Pub. L.     
                                              86-382, Sec. 15, 73 Stat.  
                                              716.                       
    --------------------------------------------------------------------

      Standard changes are made to conform with the definitions
    applicable and the style of this title as outlined in the preface
    to the report.

                                AMENDMENTS                            
      1992 - Pub. L. 102-572 substituted "United States Court of
    Federal Claims" for "United States Claims Court".
      1982 - Pub. L. 97-164 substituted "United States Claims Court"
    for "Court of Claims".

                     EFFECTIVE DATE OF 1992 AMENDMENT                 
      Amendment by Pub. L. 102-572 effective Oct. 29, 1992, see section
    911 of Pub. L. 102-572, set out as a note under section 171 of
    Title 28, Judiciary and Judicial Procedure.

                     EFFECTIVE DATE OF 1982 AMENDMENT                 
      Amendment by Pub. L. 97-164 effective Oct. 1, 1982, see section
    402 of Pub. L. 97-164, set out as a note under section 171 of Title
    28, Judiciary and Judicial Procedure.

-End-



-CITE-
    5 USC Sec. 8913                                             01/03/2007

-EXPCITE-
    TITLE 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
    PART III - EMPLOYEES
    Subpart G - Insurance and Annuities
    CHAPTER 89 - HEALTH INSURANCE

-HEAD-
    Sec. 8913. Regulations

-STATUTE-
      (a) The Office of Personnel Management may prescribe regulations
    necessary to carry out this chapter.
      (b) The regulations of the Office may prescribe the time at which
    and the manner and conditions under which an employee is eligible
    to enroll in an approved health benefits plan described in section
    8903 or 8903a of this title. The regulations may exclude an
    employee on the basis of the nature and type of his employment or
    conditions pertaining to it, such as short-term appointment,
    seasonal or intermittent employment, and employment of like nature.
    The Office may not exclude - 
        (1) an employee or group of employees solely on the basis of
      the hazardous nature of employment;
        (2) a teacher in the employ of the Board of Education of the
      District of Columbia, whose pay is fixed by section 1501 of title
      31, District of Columbia Code, on the basis of the fact that the
      teacher is serving under a temporary appointment if the teacher
      has been so employed by the Board for a period or periods
      totaling not less than two school years;
        (3) an employee who is occupying a position on a part-time
      career employment basis (as defined in section 3401(2) of this
      title); or
        (4) an employee who is employed on a temporary basis and is
      eligible under section 8906a(a).

      (c) The regulations of the Office shall provide for the beginning
    and ending dates of coverage of employees, annuitants, members of
    their families, and former spouses under health benefit plans. The
    regulations may permit the coverage to continue, exclusive of the
    temporary extension of coverage described by section 8902(g) of
    this title, until the end of the pay period in which an employee is
    separated from the service, or until the end of the month in which
    an annuitant or former spouse ceases to be entitled to annuity, and
    in case of the death of an employee or annuitant, may permit a
    temporary extension of the coverage of members of his family for
    not to exceed 90 days.
      (d) The Secretary of Agriculture shall prescribe regulations to
    effect the application and operation of this chapter to an
    individual named by section 8901(1)(H) of this title.

-SOURCE-
    (Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 95-437, Sec.
    4(c)(1), Oct. 10, 1978, 92 Stat. 1058; Pub. L. 95-454, title IX,
    Sec. 906(a)(2), (3), (c)(2)(F), (H), Oct. 13, 1978, 92 Stat. 1224,
    1227; Pub. L. 98-615, Sec. 3(7), Nov. 8, 1984, 98 Stat. 3204; Pub.
    L. 99-53, Sec. 2(a), June 17, 1985, 99 Stat. 94; Pub. L. 100-654,
    title III, Sec. 301(c), Nov. 14, 1988, 102 Stat. 3846.)

-MISC1-



                       HISTORICAL AND REVISION NOTES                   
    --------------------------------------------------------------------
     Derivation           U.S. Code              Revised Statutes and    
                                                   Statutes at Large     
    --------------------------------------------------------------------
    (a)             5 U.S.C. 3009(a).        Sept. 28, 1959, Pub. L.     
                                              86-382, Sec. 10(a), 73     
                                              Stat. 715.                 
    (b)             5 U.S.C. 3002(a)         Sept. 28, 1959, Pub. L.     
                     (words between 1st       86-382, Sec. 3(a) (words   
                     and 4th commas of        between 1st and 4th commas 
                     1st sentence, and 2d     of 1st sentence, and 2d    
                     sentence), (f)           sentence), 73 Stat. 710.   
                     (words between 1st                                  
                     and 2d commas of 1st                                
                     sentence).                                          
                                             July 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. L.       
                     sentence).               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.

-End-



-CITE-
    5 USC Sec. 8914                                             01/03/2007

-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.)

-End-