SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Citizenship Should Count for Something Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Establishment of Citizens Congressional Health Benefits Program 
(CCHBP). 
Sec. 3. Eligibility; enrollment. 
Sec. 4. Qualified health plans; benefits; premiums. 
Sec. 5. Government contribution. 
Sec. 6. Administration. 
Sec. 7. Definitions. 
SEC. 2. ESTABLISHMENT OF CITIZENS CONGRESSIONAL 
HEALTH BENEFITS PROGRAM (CCHBP). 
(a) IN GENERAL.—There is established under this 
title a program (to be known as the ‘‘Citizens Congres-
sional Health Benefits Program’’) to provide comprehen-
sive health insurance coverage to Federal elected officials 
and to all other citizens who are not covered under the 
Federal Employees Health Benefits Program (FEHBP). 
The coverage shall be provided in a manner similar to the 
manner in which coverage has been provided to Members 
of Congress and Federal Government employees and retir-
ees and their dependents under the Federal Employees 
Health Benefits Program (FEHBP). 
(b) EFFECTIVE DATE.—Benefits shall first be made 
available under this title for items and services furnished 
on or after January 1, 2010. 
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(c) NON-PREEMPTION
OF EXISTING COLLECTIVE 
BARGAINING AGREEMENTS.—Nothing in this Act shall be 
construed as preempting any collective bargaining agree-
ment that is in effect as of the date of the enactment of 
this Act, during the period in which such agreement is 
in effect (without regard to any extension of such agree-
ment effected as such date of enactment). 
SEC. 3. ELIGIBILITY; ENROLLMENT. 
(a) ELIGIBILITY.— 
(1) IN GENERAL.—Each CCHBP-eligible indi-
vidual (as defined in paragraph (2)) is eligible to en-
roll in accordance with this title in a qualified health 
plan offered under this title. 
(2) CCHBP-ELIGIBLE INDIVIDUAL DEFINED.— 
For purposes of this title, the term ‘‘CCHBP-eligible 
individual’’ means elected Federal officials (including 
the President, Vice President, and Members of Con-
gress) and any other individual residing in the 
United States who— 
(A) is a citizen or national of the United 
States; and 
(B) is not enrolled under the Federal em-
ployees health benefits program under chapter 
89 of title 5, United States Code. 
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(3) CONFORMING ELIMINATION OF FEHBP ELI-
GIBILITY FOR FEDERAL ELECTED OFFICIALS.—Ef-
fective for benefits for items and services furnished 
on or after January 1, 2010, section 8901 of title 
5, United States Code, is amended— 
(A) by striking subparagraphs (B) and 
(D); and 
(B) in the matter following subparagraph 
(J)— 
(i) by striking ‘‘or’’ at the end of 
clause (iii); 
(ii) by striking the period at the end 
of clause (iv) and inserting ‘‘; or’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(v) the President, the Vice President, or 
a Member of Congress as defined in section 
2106 of this title.’’. 
(b) ENROLLMENT.— 
(1) IN GENERAL.—The Director shall establish 
a process for CCHBP-eligible individuals to enroll in 
qualified health plans. Such process shall be based 
on the enrollment process used under FEHBP and 
shall provide for the dissemination of information to 
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CCHBP-eligible individuals on qualified health plans 
being offered. 
(2) CHANGES IN ENROLLMENT.—The Director 
shall establish enrollment procedures that include an 
annual open season and permit changes in enroll-
ment with qualified health plans at other times 
(such as by reason of changes in marital or depend-
ent status or eligibility). Such procedures shall be 
based on the enrollment procedures established 
under FEHBP. 
(3) LIMITATIONS.—CCHBP-eligible individuals 
may be enrolled in a qualified health plan under this 
title only during enrollment periods specified by the 
Director. 
(c) TREATMENT OF FAMILY MEMBERS.—Enrollment 
under this title includes both individual and family enroll-
ment, in a manner similar to that provided under 
FEHBP. To the extent consistent with eligibility under 
subsection (a), the Director shall provide rules similar to 
the rules under FEHBP for the enrollment of family 
members who are CCHBP-eligible individuals in the same 
plan. 
(d) CHANGES IN PLAN ENROLLMENT.—The Director 
shall provide for and permit changes in the qualified 
health plan in which an individual or family is enrolled 
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under this section in a manner similar to the manner in 
which such changes are provided or permitted under 
FEHBP. The Director shall provide for termination of 
such enrollment for an individual at the time the indi-
vidual is no longer an CCHBP-eligible individual. 
(e) ENROLLMENT GUIDES.—The Director shall pro-
vide for the broad dissemination of information on quali-
fied health plans offered under this title. Such information 
shall be provided in a comparative manner, similar to that 
used under FEHBP, and shall include information, col-
lected through surveys of enrollees, on measures of en-
rollee satisfaction with the different plans. 
SEC. 4. QUALIFIED HEALTH PLANS; BENEFITS; PREMIUMS. 
(a) OFFERING OF PLANS.— 
(1) CONTRACTS.—The Director shall enter into 
contracts with entities for the offering of qualified 
health plans in accordance with this title. Such con-
tracts shall be entered into in a manner similar to 
the process by which the Director is authorized to 
enter into contracts with health benefits plans under 
FEHBP. 
(2) REQUIREMENTS FOR ENTITIES OFFERING 
PLANS.—No such contract shall be entered into with 
an entity for the offering of a qualified health plan 
in a region unless the entity— 
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(A) is licensed as a health maintenance or-
ganization in that State or is licensed to sell 
group health insurance coverage in that State; 
and 
(B) meets such requirements, similar to re-
quirements under FEHBP, as the Director may 
establish relating to solvency, organization, 
structure, governance, access, quality, and min-
imum loss-ratios. 
(b) FEHBP SCOPE OF BENEFITS.— 
(1) 
COMPREHENSIVE
BENEFITS.—Qualified 
health plans shall provide for the same scope and 
type of comprehensive benefits that have been pro-
vided under FEHBP, including the types of benefits 
described in section 8904 of title 5, United States 
Code and including benefits previously required by 
regulation or direction (such as preventive benefits, 
including childhood immunization and cancer screen-
ing, and mental health parity) under FEHBP. 
(2) NO EXCLUSION FOR PRE-EXISTING CONDI-
TIONS.—Qualified health plans shall not impose pre- 
existing condition exclusions or otherwise discrimi-
nate against any enrollee based on the health status 
of such enrollee (including genetic information relat-
ing to such enrollee). 
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(3) OTHER CONSUMER PROTECTIONS.—Quali-
fied health plans also shall meet consumer and pa-
tient protection requirements that the Director es-
tablishes, based on similar requirements previously 
imposed under FEHBP, including protections of pa-
tients’ rights previously effected pursuant to Execu-
tive Memorandum. 
(4) COLLECTIVE BARGAINING AGREEMENTS.— 
Nothing in this Act shall be construed as preventing 
a collectively bargained agreement from providing 
coverage that is additional to, or supplementary of, 
benefits provided under this Act. 
(c) COMMUNITY-RATED PREMIUMS.— 
(1) APPLICATION.—The premiums established 
for a qualified health plan under this title for indi-
vidual or family coverage shall be community-rated 
and shall not vary based on gender, health status 
(including genetic information), or other factors. 
(2) COLLECTION PROCESS.—The Director shall 
establish a process for the timely and accurate col-
lection of premiums owed by enrollees, taking into 
account any Government contribution under section 
5(a). Such process shall include methods for pay-
ment through payroll withholding, as well as pay-
ment through automatic debiting of accounts with fi-
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nancial institutions, and shall be coordinated with 
the application of section 59B of the Internal Rev-
enue Code of 1986. 
(d) MARKETING PRACTICES AND COSTS.—The Di-
rector shall monitor marketing practices with respect to 
qualified health plans in order to assure— 
(1) the accuracy of the information dissemi-
nated regarding such plans; and 
(2) that costs of marketing are reasonable and 
do not exceed a percentage of total costs that is 
specified by the Director and that takes into account 
costs of market entry for new qualified health plans. 
SEC. 5. GOVERNMENT CONTRIBUTION. 
(a) AMOUNT ESTABLISHED BIANNUALLY BY CON-
GRESS.—The Director shall provide each year (beginning 
with 2010) for a contribution under this subsection to-
wards the coverage provided under this title for CCHBP- 
eligible individuals. The amount of such contribution shall 
be determined biannually by Congress 
(b) PLAN PAYMENT.— 
(1) IN GENERAL.—The Director shall provide 
for payment of qualified health plans of the pre-
miums for such plans, as adjusted under this sub-
section. 
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(2) RISK ADJUSTED PAYMENT.—The payment 
to a qualified health plan under this subsection shall 
be adjusted in a budget-neutral manner specified by 
the Director to reflect the actuarial risk of the en-
rollees in the plan compared to an average actuarial 
risk. 
(3) REDUCTION
FOR
ADMINISTRATIVE
EX-
PENSES AND CONTINGENCY RESERVE.—The Direc-
tor may provide for a uniform percentage reduction 
in payment otherwise made to a qualified health 
plan under this subsection in order to provide for a 
contingency reserve and for Federal administrative 
costs in carrying out this title. 
SEC. 6. ADMINISTRATION. 
(a) APPLICATION OF FEHBP RULES.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this title, the program under this title shall 
be administered in the same manner as FEHBP. 
(2) SPECIFIC PROVISIONS.—In carrying out this 
title, the Director pursuant to paragraph (1) shall 
provide for the following: 
(A) Approval and disapproval of plans as 
qualified health plans. 
(B) Negotiation of plan benefits (including 
cost-sharing) and plan premiums. 
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(b) DUTIES.— 
(1) IN GENERAL.—The Director shall admin-
ister the program under this title. 
(2) ESTABLISHMENT OF CCHBP REGIONS.—For 
purposes of carrying out this title, the Director shall 
divide the United States into, and establish, CCHBP 
regions. 
(c) RULEMAKING.—The Director is authorized to 
issue such regulations as may be required to carry out this 
title. 
(d) USE OF REGIONAL AND FIELD OFFICES.—The 
Director shall establish such regional and field offices as 
may be appropriate for the convenient and efficient admin-
istration of this title. 
(e) COVERAGE
OF ADMINISTRATION COSTS.—The 
Director shall provide for the collection of administrative 
costs of offering coverage under this title from entities of-
fering qualified health plans in the same manner as 
FEHBP provides for coverage of its administrative costs. 
(f) CONTINGENCY RESERVES.— 
(1) CCHBP CONTINGENCY RESERVE.—The Di-
rector is authorized to establish and maintain a con-
tingency reserve for purposes of carrying out this 
title and is authorized to impose under section 
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5(b)(3)(A) a premium surcharge of up to three per-
cent in order to provide financing for such reserve. 
(2) PLAN RESERVES.—A qualified health plan 
may establish contingency reserves, that are in addi-
tion to the reserve described in paragraph (1), in a 
manner similar to that permitted under FEHBP. 
SEC. 7. DEFINITIONS. 
For purposes of this Act: 
(1) The term ‘‘CCHBP-eligible individual’’ 
means an individual described in section 3(a)(2). 
(2) The term ‘‘CCHBP region’’ means a region 
as specified by the Director under section 6(c)(2). 
(3) The term ‘‘Director’’ means the Director of 
the Office of Personnel Management. 
(4) The term ‘‘FEHBP’’ means the program 
under chapter 89 of title 5, United States Code. 
(5) The term ‘‘qualified health plan’’ means 
such a plan offered under this title. 
Æ 
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