I

104TH CONGRESS

2D SESSION H. R. 3368

To permit retired members of the Armed Forces and their dependents who

are entitled to Medicare to enroll in the Federal Employees Health

Benefits program.

IN THE HOUSE OF REPRESENTATIVES

APRIL 30, 1996

Mr. STEARNS 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 permit retired members of the Armed Forces and their

dependents who are 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,

3 SECTION 1. EXPANSION OF FEDERAL EMPLOYEES HEALTH

4 BENEFITS PROGRAM TO INCLUDE RETIRED

5 MEMBERS AND DEPENDENTS WHO ARE MEDI6 CARE ELIGIBLE.

7 (a) FEDERAL EMPLOYEE HEALTH BENEFITS PRO8 GRAM OPTION.—The Secretary of Defense, after consult-
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1 ing with the other administering Secretaries under chapter

2 55 of title 10, United States Code, shall enter into an

3 agreement with the Office of Personnel Management

4 under which certain persons are offered enrollment in a

5 health benefits plan under chapter 89 of title 5, United

6 States Code, in lieu of receiving care in treatment facilities

7 of the uniformed services or through the Civilian Health

8 and Medical Program of the Uniformed Services or the

9 TRICARE program. The agreement may provide for en10 rollment limitations if the Office of Personnel Manage11 ment determines that the limitations are necessary to

12 allow for adequate planning for access for services under

13 chapter 89 of title 5, United States Code.

14 (b) ELIGIBLE PERSONS.—(1) The following persons

15 shall be eligible for enrollment under this section:

16 (A) A member or former member of the uni17 formed services described in section 1074(b) of title

18 10, United States Code, who is or becomes entitled

19 to hospital insurance benefits under part A of title

20 XVIII of the Social Security Act (42 U.S.C. 1395c

21 et seq.).

22 (B) A dependent of a person described in sub23 paragraph (A) if the dependent is otherwise eligible

24 for health care under chapter 55 of title 10, United

25 States Code and is or becomes entitled to hospital
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1 insurance benefits under part A of title XVIII of the

2 Social Security Act (42 U.S.C. 1395c et seq.).

3 (2) Persons described in paragraph (1) shall not be

4 required to satisfy any eligibility criteria specified in chap5 ter 89 of title 5, United States Code, as a condition for

6 enrollment in a health benefits plan offered through the

7 Federal Employee Health Benefits program pursuant to

8 subsection (a).

9 (c) CONTRIBUTIONS.—(1) In the case of a person de10 scribed in subsection (b) who enrolls in a health benefits

11 plan offered through the Federal Employee Health Bene12 fits program pursuant to subsection (a), the administering

13 Secretary concerned shall be responsible for Government

14 contributions that the Office of Personnel Management

15 determines are necessary to cover all costs in excess of

16 beneficiary contributions under paragraph (2).

17 (2) The contribution required from an enrolled per18 son under this section shall be equal to the amount that

19 would be withheld from the pay of a similarly situated

20 Federal employee who enrolls in a health benefits plan

21 under chapter 89 of title 5, United States Code.

22 (d) MANAGEMENT OF PARTICIPATION.—The author23 ity responsible for approving retired or retainer pay or

24 equivalent pay in the case of a member or former member

25 shall manage the participation of the member or former
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1 member, and dependents of the member or former mem2 ber, who enroll in a health benefits plan offered through

3 the Federal Employee Health Benefits program pursuant

4 to subsection (a). The Office of Personnel Management

5 shall maintain separate risk pools for persons described

6 in subsection (b) until such time as the Director of the

7 Office of Personnel Management determines that complete

8 inclusion chapter 89 of title 5, United States Code, of per9 sons described in subsection (b) will not adversely affect

10 Federal employees and annuitants enrolled in health bene11 fits plans under such chapter.

12 (e) EFFECT OF CANCELLATION.—The cancellation

13 by a person described in subsection (b) of coverage under

14 the Federal Employee Health Benefits program shall be

15 irrevocable for purposes of this section.

16 (f) REPORTING REQUIREMENTS.—Not later than No17 vember 1 of each year, the Secretary of Defense and the

18 Director of the Office of Personnel Management shall

19 jointly submit a report to Congress describing the provi20 sion of health care services to persons under this section

21 during the preceding fiscal year. The report shall address

22 or contain the following:

23 (1) The number of persons enrolled in health

24 benefits plans offered through the Federal Employee

25 Health Benefits program pursuant to subsection (a),
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1 both in terms of total number and as a percentage

2 of all persons receiving health care through the

3 health care system of the uniformed services.

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

5 such health benefits plans.

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

7 Department of Defense, the Department of Trans8 portation, and the Department of Health and

9 Human Services) of providing care under such

10 health benefits plans.

11 (4) A comparison of the costs determined under

12 paragraphs (2) and (3) and the costs that would

13 have otherwise been incurred by the Government

14 and enrollees under alternative health care options

15 available to the administering Secretaries.

16 (5) The effect of this section on the cost, ac17 cess, and utilization rates of other health care op18 tions under the health care system of the uniformed

19 services.

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

21 shall begin to offer the health benefits option under sub22 section (a) not later than January 1, 1997.

23 (h) CONFORMING AMENDMENTS.—Chapter 89 of

24 title 5, United States Code, is amended—

25 (1) in section 8905—
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1 (A) by redesignating subsections (d)

2 through (f) as subsections (e) through (g), re3 spectively; and

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

5 following new subsection:

6 ‘‘(d) An individual whom the Secretary of Defense de7 termines is an eligible person under the special authority

8 provided to the Secretary may enroll in a health benefits

9 plan under this chapter in accordance with the agreement

10 between the Secretary and the Office and applicable regu11 lations under this chapter.’’;

12 (2) in section 8906(b)—

13 (A) in paragraph (1), by striking ‘‘para14 graphs (2) and (3)’’ and inserting in lieu there15 of ‘‘paragraphs (2), (3), and (4)’’; and

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

17 paragraph:

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

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

20 Government contribution shall be determined in accord21 ance with the agreement between the Secretary and the

22 Office.’’; and

23 (3) in section 8906(g)—
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1 (A) in paragraph (1), by striking ‘‘para2 graph (2)’’ and inserting in lieu thereof ‘‘para3 graphs (2) and (3)’’; and

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

5 paragraph:

6 ‘‘(3) The Government contribution described in sub7 section (b)(4) for beneficiaries who enroll in accordance

8 with section 8905(d) of this title shall be paid in accord9 ance with the agreement between the Secretary and the

10 Office.’’.

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