II

105TH CONGRESS

2D SESSION S. 2020

To amend title 10, United States Code, to permit beneficiaries of the military

health care system to enroll in Federal employees health benefits plans;

to improve health care benefits under CHAMPUS and TRICARE Standard, and for other purposes.

IN THE SENATE OF THE UNITED STATES

APRIL 30, 1998

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

referred to the Committee on Armed Services

A BILL

To amend title 10, United States Code, to permit beneficiaries of the military health care system to enroll in

Federal employees health benefits plans; to improve

health care benefits under CHAMPUS and TRICARE

Standard, 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 ‘‘Military Health Care

5 Equality Act of 1998’’.
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1 SEC. 2. INCLUSION OF CERTAIN COVERED BENEFICIARIES

2 IN FEDERAL EMPLOYEES HEALTH BENEFITS

3 PROGRAM.

4 (a) FEHBP OPTION.—Chapter 55 of title 10, United

5 States Code, is amended by inserting after section 1079a

6 the following new section:

7 ‘‘§ 1079b. Health care coverage through Federal Em8 ployees Health Benefits program

9 ‘‘(a) FEHBP OPTION.—(1) Covered beneficiaries de10 scribed in subsection (b) shall be afforded an opportunity

11 to enroll in any health benefits plan under the Federal

12 Employee Health Benefits program offering medical and

13 dental care that is comparable to the care authorized by

14 section 1077 of this title to be provided under section

15 1076 of this title.

16 ‘‘(2) The Secretary of Defense and the other admin17 istering Secretaries shall jointly enter into an agreement

18 with the Director of the Office of Personnel Management

19 to carry out paragraph (1).

20 ‘‘(b) ELIGIBLE COVERED BENEFICIARIES.—(1) A

21 covered beneficiary referred to in subsection (a) is a mem22 ber or former member of the uniformed services described

23 in section 1074(b) of this title, and any dependent of the

24 member described in section 1076(b) of this title, who, as

25 determined pursuant to standards and procedures pro-
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1 vided in the agreement entered into pursuant to subsection

2 (a)(2)—

3 ‘‘(A) is not guaranteed access under

4 CHAMPUS or TRICARE Standard to health and

5 dental care that is comparable to the highest level of

6 health and dental care benefits provided under the

7 service benefit plan offered under the Federal Em8 ployee Health Benefits program;

9 ‘‘(B) is eligible to enroll in the TRICARE pro10 gram but is not enrolled because of the location of

11 the beneficiary, a limitation on the total enrollment,

12 or any other reason; or

13 ‘‘(C) is entitled to hospital insurance benefits

14 under part A of title XVIII of the Social Security

15 Act (42 U.S.C. 1395c et seq.).

16 ‘‘(2) A covered beneficiary shall not be required to

17 satisfy any eligibility criteria specified in chapter 89 of

18 title 5 as a condition for enrollment in a health benefits

19 plan of the Federal Employee Health Benefits program

20 under this section.

21 ‘‘(c) CONTRIBUTIONS.—(1) Contributions shall be

22 made for an enrollment of a covered beneficiary in a plan

23 of the Federal Employee Health Benefits program under

24 this section as if the beneficiary were an employee of the

25 Federal Government.
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1 ‘‘(2) The administering Secretary concerned shall be

2 responsible for the Government contributions that the Di3 rector of the Office of Personnel Management determines

4 would be payable by the Secretary under section 8906 of

5 title 5 for an enrolled covered beneficiary if the beneficiary

6 were an employee of the Secretary.

7 ‘‘(3) Each covered beneficiary enrolled in a health

8 benefits plan under this section shall be required to con9 tribute the amount that would be withheld from the pay

10 of a similarly situated Federal employee who is enrolled

11 in the same health benefits plan under chapter 89 of title

12 5.

13 ‘‘(d) MANAGEMENT OF PARTICIPATION.—The Direc14 tor of the Office of Personnel Management shall manage

15 the participation of a covered beneficiary in a health bene16 fits plan of the Federal Employee Health Benefits pro17 gram pursuant to an enrollment under this section. The

18 Director shall maintain separate risk pools for participat19 ing covered beneficiaries until such time as the Director

20 determines that a complete inclusion of participating cov21 ered beneficiaries under chapter 89 of title 5 will not ad22 versely affect Federal employees and annuitants enrolled

23 in health benefits plans under such chapter.

24 ‘‘(e) REPORTING REQUIREMENTS.—Not later than

25 November 1 of each year, the Secretary of Defense and
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1 the Director of the Office of Personnel Management shall

2 jointly submit to Congress a report describing the provi3 sion of health and dental care services to covered bene4 ficiaries under this section during the preceding fiscal

5 year. The report shall address or contain the following:

6 ‘‘(1) The number of covered beneficiaries who

7 are participating in health benefits plans of the Fed8 eral Employee Health Benefits program pursuant to

9 an enrollment under this section, both in terms of

10 total number and as a percentage of all covered

11 beneficiaries who are receiving health care through

12 the health care system of the uniformed services.

13 ‘‘(2) The extent to which covered beneficiaries

14 use the health and dental care services available to

15 the beneficiaries under health benefits plans pursu16 ant to enrollments under this section.

17 ‘‘(3) The cost to covered beneficiaries for health

18 and dental care under such health benefits plans.

19 ‘‘(4) The cost to the Department of Defense,

20 the Department of Transportation, the Department

21 of Health and Human Services, and any other de22 partments and agencies of the Federal Government

23 of providing care to covered beneficiaries pursuant

24 to enrollments in such health benefits plans under

25 this section.
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1 ‘‘(5) A comparison of the costs determined

2 under paragraphs (3) and (4) and the costs that

3 would otherwise have been incurred by the United

4 States and enrollees under alternative health care

5 options available to the administering Secretaries.

6 ‘‘(6) The effects of the exercise of authority

7 under this section on the cost, access, and utilization

8 rates of other health care options under the health

9 care system of the uniformed services.’’.

10 (b) CONFORMING AMENDMENTS.—(1) Section 8905

11 of title 5, United States Code, is amended—

12 (A) by redesignating subsections (d), (e), and

13 (f) as subsections (e), (f), and (g), respectively; and

14 (B) by inserting after subsection (c) the follow15 ing new subsection (d):

16 ‘‘(d) An individual whom the Secretary of Defense de17 termines is an eligible covered beneficiary under sub18 section (b) of section 1079b of title 10 may enroll in a

19 health benefits plan under this chapter in accordance with

20 the agreement entered into under subsection (a) of such

21 section between the Secretary and the Office and with ap22 plicable regulations under this chapter.’’.

23 (2) Section 8906 of title 5, United States Code, is

24 amended—

25 (A) in subsection (b)—
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1 (i) in paragraph (1), by striking ‘‘para2 graphs (2) and (3)’’ and inserting in lieu there3 of ‘‘paragraphs (2), (3), and (4)’’; and

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

5 paragraph:

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

7 plan under section 8905(d) of this title, the Government

8 contribution shall be determined under section 1079b(c)

9 of title 10.’’; and

10 (B) in subsection (g)—

11 (i) in paragraph (1), by striking ‘‘para12 graph (2)’’ and inserting in lieu thereof ‘‘para13 graphs (2) and (3)’’; and

14 (ii) by adding at the end the following new

15 paragraph:

16 ‘‘(3) The Government contribution described in sub17 section (b)(4) for beneficiaries who enroll under section

18 8905(d) of this title shall be paid as provided in section

19 1079b(c) of title 10.’’.

20 SEC. 3. IMPROVED BENEFITS UNDER CHAMPUS AND

21 TRICARE STANDARD.

22 Chapter 55 of title 10, United States Code, as

23 amended by section 2(a), is further amended by inserting

24 after section 1079b the following new section:
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1 ‘‘§ 1079c. CHAMPUS and TRICARE Standard benefits:

2 comparability with service benefit plan

3 of the Federal Employees Health Benefits

4 program

5 ‘‘(a) BENEFITS.—The health and dental care benefits

6 provided under CHAMPUS and TRICARE Standard

7 shall be comparable to the highest level of benefits pro8 vided under the service benefit plan of the Federal Em9 ployees Health Benefits program.

10 ‘‘(b) PROVIDER REIMBURSEMENT RATES.—The

11 rates prescribed for the reimbursement of health and den12 tal care providers under CHAMPUS and TRICARE

13 Standard shall be the same as those provided for the high14 est level of benefits under the service benefit plan of the

15 Federal Employees Health Benefits program.’’.

16 SEC. 4. DEFINITIONS.

17 Section 1072 of title 10, United States Code, is

18 amended—

19 (1) in paragraph (4), by striking out ‘‘The term

20 ‘Civilian Health and Medical Program of the Uni21 formed Services’ means’’ and inserting in lieu there22 of ‘‘The terms ‘Civilian Health and Medical Pro23 gram of the Uniformed Services’ and ‘CHAMPUS’

24 mean’’; and

25 (2) by adding at the end the following:
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1 ‘‘(8) The term ‘TRICARE Standard’ means a

2 CHAMPUS health care benefits option that, subject

3 to the deductibles and cost-sharing requirements

4 under CHAMPUS, pays a share of the cost of cov5 ered health care services that are provided by health

6 care providers outside the Federal Government who

7 are not part of the CHAMPUS network of health

8 care providers.

9 ‘‘(9) The term ‘Federal Employee Health Bene10 fits program’ means the Federal Employee Health

11 Benefits program under chapter 89 of title 5.’’.

12 SEC. 5. IMPLEMENTATION.

13 The Secretary of Defense shall begin to offer the

14 health benefits option under section 1079b(a) of title 10,

15 United States Code (as added by section 2(a)), and the

16 improved benefits under section 1079c of such title (as

17 added by section 3) not later than November 1, 1998.

18 SEC. 6. CLERICAL AMENDMENT.

19 The table of sections at the beginning of chapter 55

20 of title 10, United States Code, is amended by inserting

21 after the item relating to section 1079a the following:

‘‘1079b. Health care coverage through Federal Employees Health Benefits program.

‘‘1079c. CHAMPUS and TRICARE Standard benefits: comparability with service benefit plan of the Federal Employees Health Benefits program.’’.

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