I

104TH CONGRESS

2D SESSION H. R. 3012

To amend title 10, United States Code, to permit covered beneficiaries under

the military health care system who are also entitled to medicare to

enroll in the Federal Employees Health Benefits program.

IN THE HOUSE OF REPRESENTATIVES

MARCH 5, 1996

Mr. MORAN (for himself, Mr. SAXTON, Mr. DAVIS, Mr. FROST, Mr. PASTOR,

Mr. DEUTSCH, Mr. FARR of California, Mr. COLEMAN, Mr. HASTINGS of

Florida, Ms. NORTON, Mr. FILNER, Mr. BILBRAY, Mr. GENE GREEN of

Texas, Ms. LOFGREN, and Mr. NORWOOD) introduced the following bill;

which was referred to the Committee on National Security, and in addition to the Committee on Government Reform and Oversight, for a period

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee

concerned

A BILL

To amend title 10, United States Code, to permit covered

beneficiaries under the military health care system who

are also entitled to medicare to enroll in the Federal

Employees Health Benefits program.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 3012 IH

1 SECTION 1. INCLUSION OF MEDICARE ELIGIBLE COVERED

2 BENEFICIARIES IN FEDERAL EMPLOYEES

3 HEALTH BENEFITS PROGRAM.

4 (a) FEHBP OPTION.—(1) Chapter 55 of title 10,

5 United States Code, is amended by inserting after section

6 1079 the following new section:

7 ‘‘§ 1079a. Health care coverage through Federal Em8 ployees Health Benefits program

9 ‘‘(a) FEHBP OPTION.—The Secretary of Defense,

10 after consulting with the other administering Secretaries,

11 shall enter into an agreement with the Office of Personnel

12 Management under which covered beneficiaries described

13 in subsection (b) will be offered an opportunity to enroll

14 in a health benefits plan offered through the Federal Em15 ployee Health Benefits program under chapter 89 of title

16 5, in lieu of receiving care under this chapter in treatment

17 facilities of the uniformed services or through the Civilian

18 Health and Medical Program of the Uniformed Services

19 or the TRICARE program. The agreement may provide

20 for limitations on enrollment of covered beneficiaries in

21 the Federal Employee Health Benefits program if the Of22 fice of Personnel Management determines the limitations

23 are necessary to allow for adequate planning for access

24 for services under Federal Employee Health Benefits pro25 gram.
3

•HR 3012 IH

1 ‘‘(b) ELIGIBLE COVERED BENEFICIARIES.—A cov2 ered beneficiary referred to in subsection (a) is a member

3 or former member of the uniformed services described in

4 section 1074(b) of this title, and any dependents of the

5 member described in section 1076(b) of this title, who is

6 or becomes entitled to hospital insurance benefits under

7 part A of title XVIII of the Social Security Act (42 U.S.C.

8 1395c et seq.). The covered beneficiary shall not be re9 quired to satisfy any eligibility criteria specified in chapter

10 89 of title 5 as a condition for enrollment in a health bene11 fits plan offered through the Federal Employee Health

12 Benefits program pursuant to subsection (a).

13 ‘‘(c) CONTRIBUTIONS.—(1) In the case of covered

14 beneficiaries described in subsection (b) who enroll in a

15 health benefits plan offered through the Federal Employee

16 Health Benefits program pursuant to subsection (a), the

17 administering Secretary concerned shall be responsible for

18 Government contributions that the Office of Personnel

19 Management determines are necessary to cover all costs

20 in excess of beneficiary contributions under paragraph (2).

21 ‘‘(2) The contribution required from an enrolled cov22 ered beneficiary shall be equal to the amount that would

23 be withheld from the pay of a similarly situated Federal

24 employee who enrolls in a health benefits plan under chap25 ter 89 of title 5.
4

•HR 3012 IH

1 ‘‘(d) MANAGEMENT OF PARTICIPATION.—The au2 thority responsible for approving retired or retainer pay

3 or equivalent pay in the case of a member or former mem4 ber shall manage the participation of the member or

5 former member, and dependents of the member or former

6 member, who enroll in a health benefits plan offered

7 through the Federal Employee Health Benefits program

8 pursuant to subsection (a). The Office of Personnel Man9 agement shall maintain separate risk pools for enrolled

10 covered beneficiaries until such time as the Director of the

11 Office of Personnel Management determines that complete

12 inclusion of enrolled covered beneficiaries under chapter

13 89 of title 5 will not adversely affect Federal employees

14 and annuitants enrolled in health benefits plans under

15 such chapter.

16 ‘‘(e) EFFECT OF CANCELLATION.—The cancellation

17 by a covered beneficiary of coverage under the Federal

18 Employee Health Benefits program shall be irrevocable for

19 purposes of this section.

20 ‘‘(f) REPORTING REQUIREMENTS.—Not later than

21 November 1 of each year, the Secretary of Defense and

22 the Director of the Office of Personnel Management shall

23 jointly submit a report to Congress describing the provi24 sion of health care services to covered beneficiaries under
5

•HR 3012 IH

1 this section during the preceding fiscal year. The report

2 shall address or contain the following:

3 ‘‘(1) The number of covered beneficiaries en4 rolled in health benefits plans offered through the

5 Federal Employee Health Benefits program pursu6 ant to subsection (a), both in terms of total number

7 and as a percentage of all covered beneficiaries re8 ceiving health care through the health care system

9 of the uniformed services.

10 ‘‘(2) The out-of-pocket cost to enrollees under

11 such health benefits plans.

12 ‘‘(3) The cost to the Government (including the

13 Department of Defense, the Department of Trans14 portation, and the Department of Health and

15 Human Services) of providing care under such

16 health benefits plans.

17 ‘‘(4) A comparison of the costs determined

18 under paragraphs (2) and (3) and the costs that

19 would have otherwise been incurred by the Govern20 ment and enrollees under alternative health care op21 tions available to the administering Secretaries.

22 ‘‘(5) The effect of this section on the cost, ac23 cess, and utilization rates of other health care op24 tions under the health care system of the uniformed

25 services.
6

•HR 3012 IH

1 ‘‘(g) TIME FOR OPTION.—The Secretary of Defense

2 shall begin to offer the health benefits option under sub3 section (a) not later than January 1, 1997.’’.

4 (2) The table of sections at the beginning of such

5 chapter is amended by inserting after the item relating

6 to section 1079 the following new item:

‘‘1079a. Health care coverage through Federal Employees Health Benefits program.’’.

7 (b) CONFORMING AMENDMENTS.—Chapter 89 of

8 title 5, United States Code, is amended—

9 (1) in section 8905—

10 (A) by redesignating subsections (d)

11 through (f) as subsections (e) through (g), re12 spectively; and

13 (B) by inserting after subsection (c) the

14 following new subsection:

15 ‘‘(d) An individual whom the Secretary of Defense de16 termines is an eligible covered beneficiary under section

17 1079a(b) of title 10 may enroll in a health benefits plan

18 under this chapter in accordance with the agreement

19 under section 1079a(a) of title 10 between the Secretary

20 and the Office and applicable regulations under this chap21 ter.’’;

22 (2) in section 8906(b)—
7

•HR 3012 IH

1 (A) in paragraph (1), by striking ‘‘para2 graphs (2) and (3)’’ and inserting in lieu there3 of ‘‘paragraphs (2), (3), and (4)’’; and

4 (B) by adding at the end the following new

5 paragraph:

6 ‘‘(4) In the case of individuals who enroll in a health

7 plan in accordance with section 8905(d) of this title, the

8 Government contribution shall be determined under sec9 tion 1079a(c) of title 10.’’; and

10 (3) in section 8906(g)—

11 (A) in paragraph (1), by striking ‘‘para12 graph (2)’’ and inserting in lieu thereof ‘‘para13 graphs (2) and (3)’’; and

14 (B) by adding at the end the following new

15 paragraph:

16 ‘‘(3) The Government contribution described in sub17 section (b)(4) for beneficiaries who enroll in accordance

18 with section 8905(d) of this title shall be paid as provided

19 in section 1079a(c) of title 10.’’.

Æ