II

106TH CONGRESS

2D SESSION S. 3284

To amend title 5, United States Code, to establish a national health pr

administered by the Office of Personnel Management to offer Federal

employee health benefits plans to individuals who are not Federal emp

ees, and for other purposes.

IN THE SENATE OF THE UNITED STATES

DECEMBER 15 (legislative day, SEPTEMBER 22), 2000

Mr. DURBIN introduced the following bill; which was read twice and referre

to the Committee on Governmental Affairs

A BILL

To amend title 5, United States Code, to establish a nati

health program administered by the Office of Personne

Management to offer Federal employee health benefits

plans to individuals who are not Federal employees, a

for other purposes.

1 Be it enacted by the Senate and House of Represent

2 tives of the United States of America in Congress assem

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Offering People Tru

5 Insurance Options Nationwide Act of 2000’’.
2

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1 SEC. 2. OPTION HEALTH INSURANCE.

2 Subpart G of part III of title 5, United States Cod

3 is amended by adding at the end the following:

4 ‘‘CHAPTER 90A—HEALTH INSURANCE FOR

5 NON-FEDERAL EMPLOYEES

‘‘Sec.

‘‘9051. Definitions.

‘‘9052. Health insurance for non-Federal employees.

‘‘9053. Contract requirement.

‘‘9054. Eligibility.

‘‘9055. Alternative conditions to Federal employee plans.

‘‘9056. Coordination with social security benefits.

‘‘9057. Non-Federal employer participation.

6 ‘‘§ 9051. Definitions

7 ‘‘In this chapter—

8 ‘‘(1) the terms defined under section 8901 shall

9 have the meanings given such terms under that sec10 tion; and

11 ‘‘(2) the term ‘Office’ means the Office of Per

12 sonnel Management.

13 ‘‘§ 9052. Health insurance for non-Federal employees

14 ‘‘(a) The Office of Personnel Management shall ad15 minister a health insurance program for non-Federal em

16 ployees in accordance with this chapter.

17 ‘‘(b) Except as provided under this chapter, the O

18 fice shall prescribe regulations to apply the provisio

19 chapter 89 to the greatest extent practicable to eli

20 individuals covered under this chapter.
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1 ‘‘(c) In no event shall the enactment of this chap

2 result in—

3 ‘‘(1) any increase in the level of individual 

4 Government contributions required under chapter

5 89, including copayments or deductibles;

6 ‘‘(2) any decrease in the types of benefits o

7 fered under chapter 89; or

8 ‘‘(3) any other change that would adversely af9 fect the coverage afforded under chapter 89 to em10 ployees and annuitants and members of family

11 under that chapter.

12 ‘‘§ 9053. Contract requirement

13 ‘‘(a) Each contract entered into under section 890

14 shall require a carrier to offer to eligible individual

15 this chapter, throughout each term for which the contr

16 remains effective, the same benefits (subject to the 

17 maximums, limitations, exclusions, and other simila

18 terms or conditions) as would be offered under such co

19 tract or applicable health benefits plan to employees,

20 nuitants, and members of family.

21 ‘‘(b)(1) The Office may waive the requirements of

22 this subsection, if the Office determines, based on a 

23 tion submitted by a carrier that—

24 ‘‘(A) the carrier is unable to offer the applica

25 health benefits plan because of a limitation in t
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1 capacity of the plan to deliver services or assure

2 nancial solvency;

3 ‘‘(B) the applicable health benefits plan is n

4 sponsored by a carrier licensed under applicable

5 State law; or

6 ‘‘(C) bona fide enrollment restrictions make the

7 application of this chapter inappropriate, includi

8 restrictions common to plans which are limited to i

9 dividuals having a past or current employment rela

10 tionship with a particular agency or other authori

11 of the Government.

12 ‘‘(2) The Office may require a petition under thi

13 subsection to include—

14 ‘‘(A) a description of the efforts the carri

15 proposes to take in order to offer the applicab

16 health benefits plan under this chapter; and

17 ‘‘(B) the proposed date for offering such a

18 health benefits plan.

19 ‘‘(3) A waiver under this subsection may be for an

20 period determined by the Office. The Office may gran

21 subsequent waivers under this section.

22 ‘‘§ 9054. Eligibility

23 ‘‘An individual shall be eligible to enroll in a 

24 under this chapter, unless the individual is enrolled 

25 gible to enroll in a plan under chapter 89.
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1 ‘‘§ 9055. Alternative conditions to Federal employee

2 plans

3 ‘‘(a) For purposes of enrollment in a health benef

4 plan under this chapter, an individual who had covera

5 under a health insurance plan and is not a qualified b

6 ficiary as defined under section 4980B(g)(1) of the In

7 nal Revenue Code of 1986 shall be treated in a simil

8 manner as an individual who begins employment as an em9 ployee under chapter 89.

10 ‘‘(b) In the administration of this chapter, cove

11 individuals under this chapter shall be in a risk pool 

12 rate from covered individuals under chapter 89.

13 ‘‘(c)(1) Each contract under this chapter may includ

14 a preexisting condition exclusion as defined under sec

15 9801(b)(1) of the Internal Revenue Code of 1986.

16 ‘‘(2)(A) The preexisting condition exclusion unde

17 this subsection shall provide for coverage of a preexi

18 condition to begin not more than 1 year after the da

19 of coverage of an individual under a health benefits p

20 reduced by 1 month for each month that individual was

21 covered under a health insurance plan immediately pre

22 ceding the date the individual submitted an application

23 coverage under this chapter.

24 ‘‘(B) For purposes of this paragraph, a lapse in co

25 erage of not more than 31 days immediately preceding th
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1 date of the submission of an application for coverage 

2 not be considered a lapse in continuous coverage.

3 ‘‘(d)(1) Rates charged and premiums paid for a

4 health benefits plan under this chapter—

5 ‘‘(A) may be adjusted and differ from such

6 rates charged and premiums paid for the same

7 health benefits plan offered under chapter 89;

8 ‘‘(B) shall be negotiated in the same manner as

9 negotiated under chapter 89; and

10 ‘‘(C) shall be adjusted to cover the administra

11 tive costs of this chapter.

12 ‘‘(2) In determining rates and premiums under this

13 chapter—

14 ‘‘(A) the age of covered individuals may be con

15 sidered; and

16 ‘‘(B) rebates or lower rates and premiums shall

17 be set to encourage longevity of coverage.

18 ‘‘(e) No Government contribution shall be made for

19 any covered individual under this chapter.

20 ‘‘(f) If an individual who is enrolled in a health 

21 fits plan under this chapter terminates the enrollment,

22 individual shall not be eligible for reenrollment unt

23 first open enrollment period following 6 months after 

24 date of such termination.
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1 ‘‘§ 9056. Coordination with social security benefits

2 ‘‘Benefits under this chapter shall, with respect t

3 individual who is entitled to benefits under part A of

4 XVIII of the Social Security Act, be offered (for use

5 coordination with those social security benefits) to

6 same extent and in the same manner as if coverage wer

7 under chapter 89.

8 ‘‘§ 9057. Non-Federal employer participation

9 ‘‘(a) In this section the term—

10 ‘‘(1) ‘employee’, notwithstanding section 9051,

11 means an employee of a non-Federal employer; and

12 ‘‘(2) ‘non-Federal employer’ means an employer

13 that is not the Federal Government.

14 ‘‘(b)(1) The Office shall prescribe regulations p

15 viding for non-Federal employer participation under th

16 chapter, including—

17 ‘‘(A) the offering of health benefits plans und

18 this chapter to employees through participating non

19 Federal employers; and

20 ‘‘(B) a requirement for participating non-Fed21 eral employer contributions to the payment of pre

22 miums for employees who enroll in a health benefit

23 plan under this chapter.

24 ‘‘(2) A participating non-Federal employer shall pa

25 an employer contribution for the premiums of an employe

26 or other applicable covered individual as follows:
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1 ‘‘(A) A non-Federal employer that employs not

2 more than 2 employees shall not be required to pay

3 an employer contribution.

4 ‘‘(B) A non-Federal employer that employs

5 more than 2 and not more than 25 employees shall

6 pay not less than 30 percent of the total premiums

7 ‘‘(C) A non-Federal employer that employs

8 more than 25 and not more than 50 employees shall

9 pay not less than 40 percent of the total premiums

10 ‘‘(D) A non-Federal employer that employs

11 more than 50 employees shall pay not less than 50

12 percent of the total premiums.

13 ‘‘(3) Notwithstanding paragraph (2) (B), (C), or (D

14 a non-Federal employer that employs more than 2 employ15 ees shall pay not less than 20 percent of the total 

16 miums with respect to the first year in which that e

17 ployer participates under this chapter.’’.

18 SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS.

19 (a) CONTRACT REQUIREMENT UNDER CHAPTER

20 89.—Section 8902 of title 5, United States Code, i

21 amended by adding after subsection (o) the following:

22 ‘‘(p) Each contract under this chapter shall inclu

23 a provision that the carrier shall offer any health be

24 plan as required under chapter 90A.’’.
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1 (b) TABLE OF CHAPTERS.—The table of chapters for

2 part III of title 5, United States Code, is amended by

3 serting after the item relating to chapter 90 the foll

‘‘90A. Health Insurance for Non-Federal Employees ........... 9051’’.

4 SEC. 4. EFFECTIVE DATE.

5 This Act and the amendments made by this Act shall

6 take effect on the date of enactment of this Act and s

7 apply to contracts that take effect with respect to cal

8 year 2002 and each calendar year thereafter.

fi