II

105TH CONGRESS

1ST SESSION S. 1384

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 SENATE OF THE UNITED STATES

NOVEMBER 6, 1997

Mr. DASCHLE introduced the following bill; which was read twice and referred

to the Committee on Governmental Affairs

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 ‘‘Accessible Health Cov5 erage Act’’.
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1 SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE

2 GENERAL PUBLIC.

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

4 States Code, is amended by adding at the end the follow5 ing:

6 ‘‘§ 8915. Individual access to coverage

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

8 a plan approved unless the carrier agrees to offer to eligi9 ble individuals, throughout each term for which the con10 tract or approval remains effective, the same benefits (sub11 ject to the same maximums, limitations, exclusions, and

12 other similar terms or conditions) as would be offered

13 under such contract or plan to employees and annuitants

14 and their family members.

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

16 eligible to enroll under a plan or contract under this chap17 ter if such individual—

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

19 health plan (as such term is defined in section

20 2791(a) of the Public Health Service Act (42 U.S.C.

21 300gg–1(a));

22 ‘‘(2) provides the Office with documentation

23 that such individual has been denied individual

24 health insurance coverage (as such term is defined

25 in section 2791(b)(5) of the Public Health Service

26 Act (42 U.S.C. 300gg–1(b)(5));
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1 ‘‘(3) during the 6-month period prior to the

2 date on which such individual attempts to enroll

3 under such plan or contract, was not eligible for cov4 erage through a State high-risk health insurance

5 pool or coverage through a health insurer of last re6 sort;

7 ‘‘(4) is not eligible for medical assistance under

8 title XIX of the Social Security Act (42 U.S.C. 1396

9 et seq.); and

10 ‘‘(5) meets such other requirements as the Of11 fice, by regulation, may impose.

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

13 implementation of procedures to provide for an annual

14 open enrollment period during which individuals may en15 roll with a plan or contract for coverage under this section.

16 ‘‘(d) PREMIUMS.—

17 ‘‘(1) IN GENERAL.—Premiums for coverage

18 under this section shall be established in conform19 ance with such requirements as the Office shall by

20 regulation prescribe, including provisions to ensure

21 conformance with generally accepted standards and

22 practices associated with community rating.

23 ‘‘(2) LIMITATION.—With respect to coverage

24 under a health plan or contract under this section,

25 the Office, in establishing premiums under para-
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1 graph (1), shall ensure that the monthly premium

2 for coverage under this section does not exceed 200

3 percent of the monthly premium otherwise applicable

4 for the coverage of employees and annuitants and

5 their family members under such health plan or con6 tract under this chapter.

7 ‘‘(e) ADJUSTMENT IN AGENCY CONTRIBUTIONS.—

8 ‘‘(1) ANNUAL REPORTING.—Each carrier shall

9 maintain separate records with respect to individuals

10 covered under this section and employees and annu11 itants (and their family members) otherwise covered

12 under this chapter, and shall annually report to the

13 Office the amount which the carrier paid (including

14 claims and administrative costs) with respect to cov15 erage provided to individuals under this section.

16 ‘‘(2) DETERMINATION BY OFFICE.—If, based

17 on the reports received under paragraph (1), the Of18 fice determines that the average cost of providing

19 coverage to individuals under this section exceeds

20 200 percent of the premiums paid by such individ21 uals for such coverage, the Office shall increase the

22 biweekly Government contribution for coverage oth23 erwise provided under this chapter by an amount

24 equal to such excess amount.

25 ‘‘(f) CONTRIBUTIONS AND BENEFITS.—
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1 ‘‘(1) IN GENERAL.—In no event shall the enact2 ment of this section result in—

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

4 contributions by employees or annuitants as re5 quired under section 8906 or under any other

6 provision of this chapter, including copayments

7 or deductibles;

8 ‘‘(B) the payment by the Government of

9 any premiums associated with coverage under

10 this section except for the increase described in

11 subsection (e)(2);

12 ‘‘(C) any decrease in the types of benefits

13 offered under this chapter; or

14 ‘‘(D) any other change that would ad15 versely affect the coverage afforded under this

16 chapter to employees and annuitants and their

17 family members.

18 ‘‘(2) LIMITATION.—Coverage under this section

19 shall be provided on an individual, not a family

20 basis.

21 ‘‘(g) INDIVIDUALS ELIGIBLE FOR MEDICARE.—Ben22 efits under this section shall, with respect to an individual

23 who is entitled to benefits under part A of title XVIII of

24 the Social Security Act (42 U.S.C. 1395 et seq.), be of25 fered (for use in coordination with those Social Security
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1 benefits) to the same extent and in the same manner as

2 if coverage were under the preceding provisions of this

3 chapter, rather than under this section.

4 ‘‘(h) EXCLUSION OF CERTAIN CARRIERS.—

5 ‘‘(1) IN GENERAL.—A carrier may file an appli6 cation with the Office setting forth reasons why such

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

8 excluded from the requirements of this section.

9 ‘‘(2) CONSIDERATION OF FACTORS.—In review10 ing an application under paragraph (1), the Office

11 may consider such factors as—

12 ‘‘(A) any bona fide enrollment restrictions

13 which would make the application of this sec14 tion inappropriate, including those common to

15 plans which are limited to individuals having a

16 past or current employment relationship with a

17 particular agency or other authority of the Gov18 ernment;

19 ‘‘(B) whether compliance with this section

20 would jeopardize the financial solvency of the

21 plan or carrier, or otherwise compromise its

22 ability to offer health benefits under the preced23 ing provisions of this chapter; and

24 ‘‘(C) the anticipated duration of the re25 quested exclusion, and what efforts the plan or
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1 carrier proposes to take in order to be able to

2 comply with this section.

3 ‘‘(i) APPLICATION OF SECTION.—Except as the Of4 fice may by regulation prescribe, any reference to this

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

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

7 section (or any requirement of this section).

8 ‘‘(j) TERMINATION.—This section shall terminate on

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

10 this section.’’.

11 (b) CONFORMING AMENDMENT.—The table of sec12 tions for chapter 89 of title 5, United States Code, is

13 amended by adding at the end the following:

‘‘8915. Individual access to coverage.’’.

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