I 

111TH CONGRESS 

1ST SESSION H. R. 3937 

To establish a health benefits program, based on the Federal employees 

health benefits program, to provide health insurance coverage for the 

President, Vice President, and Members of Congress, and citizens not 

eligible for coverage under the Federal employees health benefits program. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 27, 2009 

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

on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform, Education and Labor, and Ways and 

Means, 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 establish a health benefits program, based on the Federal 

employees health benefits program, to provide health insurance coverage for the President, Vice President, and 

Members of Congress, and citizens not eligible for coverage under 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, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Simple Universal Healthcare Act of 2009’’. 

4 (b) TABLE OF CONTENTS.—The table of contents of 

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Establishment of Citizens Congressional Health Benefits Program 

(CCHBP). 

Sec. 3. Contracts with entities to offer qualified CCHBP health plans. 

Sec. 4. Scope of benefits and coverage. 

Sec. 5. Eligibility. 

Sec. 6. Enrollment. 

Sec. 7. Premiums. 

Sec. 8. High-risk reinsurance fund. 

Sec. 9. Definitions. 

Sec. 10. Effective date and treatment of collective bargaining agreements. 

6 SEC. 2. ESTABLISHMENT OF CITIZENS CONGRESSIONAL 

7 HEALTH BENEFITS PROGRAM (CCHBP). 

8 (a) IN GENERAL.—The Director of the Office of Per9 sonnel Management shall establish a program (to be 

10 known as the ‘‘Citizen’s Congressional Health Benefits 

11 Program’’) to provide comprehensive health insurance cov12 erage to— 

13 (1) Federal elected officials (including the 

14 President, Vice President, and Members of Con15 gress); and 

16 (2) residents of the United States who are not 

17 covered under the Federal Employees Health Bene18 fits Program (FEHBP). 

19 (b) SIMILAR TO FEHBP.—The coverage shall be 

20 provided in a manner similar to the manner in which covVerDate Nov 24 2008 01:50 Oct 28, 2009 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3937.IH H3937

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1 erage has been provided to Members of Congress and Fed2 eral Government employees and retirees and their depend3 ents under the Federal Employees Health Benefits Pro4 gram (FEHBP). 

5 SEC. 3. CONTRACTS WITH ENTITIES TO OFFER QUALIFIED 

6 CCHBP HEALTH PLANS. 

7 (a) IN GENERAL.—The Director shall enter into con8 tracts with entities for the offering of qualified CCHBP 

9 health plans in accordance with this Act. Such contracts 

10 shall be entered into in a manner similar to the process 

11 by which the Director is authorized to enter into contracts 

12 with entities offering health benefits plans under FEHBP. 

13 (b) REQUIREMENTS FOR ENTITIES OFFERING

14 PLANS.—The Director may only enter into a contract 

15 under subsection (a) with an entity that is— 

16 (1) licensed— 

17 (A) as a health maintenance organization 

18 in the State in which the entity will offer the 

19 qualified CCHBP health plan; or 

20 (B) to sell group health insurance coverage 

21 in such State; 

22 (2) meets such requirements, similar to require23 ments under FEHBP, as the Director may estab24 lish, relating to solvency, adequacy of plan benefits 


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1 (subject to section 4), organization, structure, gov2 ernance, access, and quality; and 

3 (3) agrees to participate in the high-risk rein4 surance fund described in section 8. 

5 (c) FEHBP PLANS.—Any health plan offered under 

6 FEHBP shall be treated as a qualified CCHBP health 

7 plan for purposes of this Act. 

8 (d) PREEMPTION OF STATE LAW.—The require9 ments of section 4, with respect to the scope and type of 

10 benefits required to be provided by a CCHBP health plan, 

11 shall supersede any and all State laws. 

12 SEC. 4. SCOPE OF BENEFITS AND COVERAGE. 

13 (a) COMPREHENSIVE BENEFITS.— 

14 (1) IN GENERAL.—Subject to paragraph (2), 

15 qualified CCHBP health plans shall provide for the 

16 same scope and type of benefits that are provided 

17 under FEHBP, including— 

18 (A) the types of benefits described in sec19 tion 8904 of title 5, United States Code; and 

20 (B) benefits required by regulation or 

21 guidance under FEHBP. 

22 (2) PREVENTIVE BENEFITS AND MENTAL

23 HEALTH PARITY.—Qualified CCHBP health plans 

24 shall provide a minimum level of preventive benefits 

25 determined by the Director, in consultation with the 


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1 U.S. Preventive Service Task Force, which shall in2 clude vaccines for both children and adults, an an3 nual physical, cancer screening (including 

4 mammographies for women of an appropriate age), 

5 and mental health parity. 

6 (b) NO EXCLUSION FOR PRE-EXISTING CONDI7 TIONS.—Subject to section 6(b)(2), qualified CCHBP 

8 health plans shall not impose pre-existing condition exclu9 sions or otherwise discriminate against any individual 

10 based on the health status of such individual (including 

11 genetic information relating to such enrollee, or any dis12 ease or condition). 

13 (c) ANNUAL AND LIFETIME OUT-OF-POCKET LIMIT

14 INFORMATION.—An entity offering a qualified CCHBP 

15 health plan must provide notice to any individual covered 

16 by such plan of any benefit or service that is not included 

17 in the calculation of the annual or lifetime out-of-pocket 

18 limit under such plan. 

19 SEC. 5. ELIGIBILITY. 

20 (a) IN GENERAL.—An individual is eligible to enroll 

21 in a qualified CCHBP health plan if— 

22 (1) the individual resides in the United States; 

23 and 

24 (2) the individual is— 


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1 (A) a citizen or national of the United 

2 States; 

3 (B) an alien lawfully admitted to the 

4 United States for permanent residence; 

5 (C) an alien admitted into the United 

6 States under section 207 of the Immigration 

7 and Nationality Act (relating to refugees); 

8 (D) an alien otherwise permanently resid9 ing in the United States under color of law (as 

10 specified by the Director); or 

11 (E) an alien with the status of a non12 immigrant who is within a class of long-term 

13 nonimmigrants under section 101(a)(15) of the 

14 Immigration and Nationality Act that the Di15 rector determines, in consultation with the Sec16 retary of Homeland Security, to be appropriate. 

17 (b) EXCEPTIONS.—The following individuals are not 

18 eligible to enroll in a qualified CCHBP health plan: 

19 (1) INDIVIDUALS ENROLLED UNDER PUBLIC

20 HEALTH INSURANCE PROGRAMS.—An individual who 

21 is enrolled under the Federal employees health bene22 fits program under chapter 89 of title 5, United 

23 States Code (except for a member of Congress, as 

24 defined by section 2106 of title 5, United States 

25 Code; or the President); the Medicare program 


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1 under title XVIII of the Social Security Act; the 

2 Medicaid program under title XIX of such Act; the 

3 Children’s Health Insurance Program under title 

4 XXI of such Act; or Tricare under chapter 55 of 

5 title 10, United States Code. 

6 (2) INCARCERATED INDIVIDUALS.—An indi7 vidual who is incarcerated (as specified by the Direc8 tor). 

9 (c) TREATMENT OF ELECTED OFFICIALS.—A mem10 ber of Congress (as defined under section 2106 of title 

11 5, United States Code) or the President may enroll in ei12 ther a qualified CCHBP health plan under this Act or an 

13 FEHBP plan under title 5, United States Code, but may 

14 not be enrolled in both types of plans at the same time. 

15 (d) CONFIRMATION OF IMMIGRATION STATUS.—The 

16 Director, in consultation with each entity offering a quali17 fied CCHBP plan, shall promulgate regulations for the 

18 use of the automated system known as the Systematic 

19 Alien Verification for Entitlements, as provided for by sec20 tion 404 of the Illegal Immigrations Reform and Immi21 grant Responsibility Act of 1996 (110 Stat. 3009–664) 

22 to verify the legal presence of the status of an individual, 

23 other than a United States citizen, who seeks to enroll 

24 in a qualified CCHBP plan. 

25 (e) EMPLOYER OPTION.— 


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1 (1) IN GENERAL.—An employer may choose to 

2 participate in CCHBP and offer qualified CCHBP 

3 health plans to employees of such employer as em4 ployer-sponsored health insurance. 

5 (2) NOTICE.—The employer shall inform the 

6 Director that the employer is taking such option in 

7 a form and manner determined by the Director. 

8 (3) MAINTENANCE OF EFFORT REQUIRED.—An 

9 employer who provides notice under paragraph (2) 

10 must pay the percentage of the cost of the premium, 

11 as determined under section 7, for each employee 

12 that enrolls in a qualified CCHBP health plan, that 

13 is the same as the percentage of the cost of the pre14 mium of the health insurance plan that such em15 ployer offered to its employees before the employer 

16 provided notice under paragraph (2). 

17 (4) TAX TREATMENT.—For purposes of the In18 ternal Revenue Code of 1986, a qualified CCHBP 

19 health plan offered by an employer under this sub20 section shall not fail to be treated as employer-pro21 vided coverage solely because such employer provides 

22 such plan through the CCHBP. 

23 SEC. 6. ENROLLMENT. 

24 (a) ENROLLMENT PROCESS.—The Director shall es25 tablish a process to enroll eligible individuals and their 


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1 families in qualified CCHBP health plans. Such process 

2 shall be conducted in a manner that is similar to the man3 ner enrollment is conducted under FEHBP. To the extent 

4 consistent with eligibility under section 3, the Director 

5 shall provide rules similar to the rules under FEHBP for 

6 the enrollment of family members who are CCHBP-eligi7 ble individuals in the same plan. 

8 (b) ENROLLMENT PERIOD.— 

9 (1) ENROLLMENT UPON INITIAL ELIGIBILITY.— 

10 (A) IN GENERAL.—An eligible individual 

11 may enroll in a qualified CCHBP health plan— 

12 (i) at any time during the 1-year pe13 riod beginning on the date that the Citi14 zen’s Congressional Health Benefits Pro15 gram begins to operate; or, if later, 

16 (ii) at any time during the 3-month 

17 period beginning on the date that such in18 dividual becomes eligible to enroll in any 

19 qualified CCHBP health plan. 

20 (B) TREATMENT OF PREEXISTING CONDI21 TIONS.—An individual who enrolls during the 

22 periods under paragraph (1) shall not be sub23 ject to exclusions or additional costs due to any 

24 preexisting conditions that such individual deVerDate Nov 24 2008 01:50 Oct 28, 2009 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3937.IH H3937

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1 veloped before the date such individual enrolled 

2 in a qualified CCHBP plan. 

3 (2) ANNUAL ENROLLMENT.— 

4 (A) IN GENERAL.—An eligible individual 

5 who does not enroll in a qualified CCHBP 

6 health plan under paragraph (1) may enroll in 

7 such a plan during an annual enrollment period 

8 of not more than 1 month, as determined by 

9 the Director. 

10 (B) TREATMENT OF PREEXISTING CONDI11 TIONS.—Subject to rules developed by the Di12 rector, the entity offering the qualified CCHBP 

13 health plan may exclude such individual from 

14 enrolling in such a plan under this paragraph 

15 due to any preexisting condition which such in16 dividual develops before the date of such annual 

17 enrollment period. Upon excluding such indi18 vidual, the entity offering the qualified CCHBP 

19 health plan shall provide such individual with 

20 notice of such exclusion and information about 

21 enrolling in a high risk pool. 

22 (c) CHANGES IN ENROLLMENT.—The Director shall 

23 establish enrollment procedures that include an annual 

24 open season of at least 1 month and permit changes in 

25 enrollment with qualified health plans at other times (such 


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1 as by reason of changes in marital or dependent status 

2 or eligibility). Such procedures shall be based on the en3 rollment procedures established under FEHBP. The Di4 rector shall provide for termination of such enrollment for 

5 an individual at the time the individual is no longer an 

6 eligible individual. 

7 (d) ENROLLMENT OF EMPLOYEES.—Notwith8 standing subsection (b)(2), the employees of an employer 

9 that provides notice to the Director under section 5(e)(2) 

10 may enroll in a qualified CCHBP health plan during ei11 ther the 3-month period beginning on the date that such 

12 employer provides such notice or the 3-month period be13 ginning on the date that such employee begins working 

14 for such employer, whichever is later. Such employee shall 

15 not be subject to any costs related to such employee’s pre16 existing conditions if so enrolled during such period. 

17 (e) ENROLLMENT GUIDES.—The Director shall pro18 vide for the broad dissemination of information on quali19 fied CCHBP health plans offered under this title. Such 

20 information shall be provided in a comparative manner, 

21 similar to that used under FEHBP, and shall include in22 formation, collected through surveys of enrollees, on meas23 ures of enrollee satisfaction with the different plans. 


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1 SEC. 7. PREMIUMS. 

2 The premiums established for a qualified CCHBP 

3 health plan under this Act for individual or family cov4 erage— 

5 (1) based on the rating system used under 

6 FEHBP; and 

7 (2) shall not vary based on age, gender, health 

8 status (including genetic information), or other fac9 tors. 

10 SEC. 8. HIGH-RISK REINSURANCE FUND. 

11 The Director shall establish an arrangement among 

12 the entities offering qualified health plans under which 

13 such entities contribute in an equitable manner (as deter14 mined by the Director) into a fund that provides payment 

15 to plans for a percentage (specified by the Director and 

16 not to exceed 90 percent) of the costs that they incur for 

17 enrollees beyond a predetermined threshold specified by 

18 the Director. Such fund shall be funded exclusively by 

19 such entities. 

20 SEC. 9. DEFINITIONS. 

21 For purposes of this Act: 

22 (1) The term ‘‘CCHBP-eligible individual’’ 

23 means an individual described in section 5. 

24 (2) The term ‘‘Director’’ means the Director of 

25 the Office of Personnel Management. 


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1 (3) The term ‘‘FEHBP’’ means the program 

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

3 (4) The term ‘‘qualified CCHBP health plan’’ 

4 means a fee-for-service plan, health maintenance or5 ganization plan, high deductible health insurance 

6 plan, or other health insurance plan that meets the 

7 requirements for a health insurance plan under 

8 FEHBP and is offered through the CCHBP under 

9 this Act by an entity that is qualified to offer such 

10 plans. 

11 SEC. 10. EFFECTIVE DATE AND TREATMENT OF COLLEC12 TIVE BARGAINING AGREEMENTS. 

13 (a) EFFECTIVE DATE.—Benefits shall first be made 

14 available under this title for items and services furnished 

15 on or after the last day of the 9-month period beginning 

16 on the date of the enactment of this Act. 

17 (b) NON-PREEMPTION OF EXISTING COLLECTIVE

18 BARGAINING AGREEMENTS.—Nothing in this Act shall be 

19 construed as preempting any collective bargaining agree20 ment that is in effect as of the date of the enactment of 

21 this Act, during the period in which such agreement is 

22 in effect (without regard to any extension of such agree23 ment effected as of such date of enactment). 

Æ 


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