I

106TH CONGRESS

2D SESSION H. R. 5115

To amend title 5, United States Code, to make the Federal Employees

Health Benefits Program available to the general public, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 6, 2000

Mr. KLINK introduced the following bill; which was referred to the Committee

on Government Reform

A BILL

To amend title 5, United States Code, to make the Federal

Employees Health Benefits Program available to the general public, and for other purposes.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Same Insurance as

5 Congress Act’’.
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1 SEC. 2. PROVISIONS TO MAKE FEHBP COVERAGE AVAIL2 ABLE TO INDIVIDUALS AND SMALL EMPLOY3 ERS.

4 (a) IN GENERAL.—Chapter 89 of title 5, United

5 States Code, is amended by adding at the end the fol6 lowing:

7 ‘‘§ 8915. Expanded access to coverage

8 ‘‘(a) IN GENERAL.—A contract may not be made or

9 a plan approved unless the carrier agrees to offer to eligi10 ble individuals, throughout each term for which the con11 tract or approval remains effective, the same benefits (sub12 ject to the same maximums, limitations, exclusions, and

13 other similar terms or conditions and the same guidelines

14 as are applied by the Office of Personnel Management)

15 as would be offered under such contract or plan to employ16 ees and annuitants and their family members.

17 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual shall be

18 eligible to enroll under a plan or contract under this chap19 ter pursuant to subsection (a) if such individual—

20 ‘‘(1) is not eligible to be enrolled in a group

21 health plan (as such term is defined in section

22 2791(a) of the Public Health Service Act (42 U.S.C.

23 300gg–1(a));

24 ‘‘(2) is not eligible for benefits under the medi25 care program under title XVIII of the Social Secu26 rity Act (42 U.S.C. 1395 et seq.), for medical assist-
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1 ance under a State medicaid plan under title XIX of

2 such Act (42 U.S.C. 1396 et seq.), or child health

3 assistance under a State children’s health insurance

4 program under title XXI of such Act (42 U.S.C.

5 1397aa et seq.); and

6 ‘‘(3) meets such other requirements as the Of7 fice, by regulation, may impose.

8 ‘‘(c) ENROLLMENT.—The Office shall provide for the

9 implementation of procedures to provide for an annual

10 open enrollment period during which individuals may en11 roll with a plan or contract for coverage under this section.

12 ‘‘(d) PREMIUMS.—Premiums for coverage under this

13 section shall be established by the carriers in conformance

14 with such requirements as the Office shall by regulation

15 prescribe, including provisions to ensure conformance with

16 generally accepted standards and practices associated with

17 community rating. Nothing in this section shall be con18 strued as providing or requiring that the premiums so es19 tablished shall be the same as the premiums established

20 for coverage offered under this chapter other than under

21 this section.

22 ‘‘(e) CONTRIBUTIONS AND BENEFITS.—In no event

23 shall the enactment of this section result in—

24 ‘‘(1) any increase in the level of individual con25 tributions by employees or annuitants as required
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1 under section 8906 or under any other provision of

2 this chapter, including copayments or deductibles;

3 ‘‘(2) the payment by the Government of any

4 premiums associated with coverage under this sec5 tion;

6 ‘‘(3) any decrease in the types of benefits of7 fered under this chapter; or

8 ‘‘(4) any other change that would adversely af9 fect the coverage afforded under this chapter to em10 ployees and annuitants and their family members.

11 ‘‘(f) EXCLUSION OF CERTAIN CARRIERS.—

12 ‘‘(1) IN GENERAL.—A carrier may file an appli13 cation with the Office setting forth reasons why such

14 carrier, or a plan provided by such carrier, should be

15 excluded from the requirements of this section.

16 ‘‘(2) CONSIDERATION OF FACTORS.—In review17 ing an application under paragraph (1), the Office

18 may consider such factors as—

19 ‘‘(A) any bona fide enrollment restrictions

20 which would make the application of this sec21 tion inappropriate, including those common to

22 plans which are limited to individuals having a

23 past or current employment relationship with a

24 particular agency or other authority of the Gov25 ernment;
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1 ‘‘(B) whether compliance with this section

2 would jeopardize the financial solvency of the

3 plan or carrier, or otherwise compromise its

4 ability to offer health benefits under the pre5 ceding provisions of this chapter; and

6 ‘‘(C) the anticipated duration of the re7 quested exclusion and what efforts the plan or

8 carrier proposes to take in order to be able to

9 comply with this section.

10 ‘‘(g) APPLICATION OF SECTION.—Except as the Of11 fice may by regulation prescribe, any reference to this

12 chapter (or any requirement of this chapter), made in any

13 provision of law, shall not be considered to include this

14 section (or any requirement of this section).

15 ‘‘(h) TERMINATION.—This section shall terminate on

16 the date that is 10 years after the date of enactment of

17 this section.’’.

18 (b) CLERICAL AMENDMENT.—The table of sections

19 for such is amended by adding at the end the following:

‘‘8915. Expanded access to coverage.’’.

Æ