‘‘(i) to establish internal procedures de-
signed to resolve such disputes expeditiously; 
and 
‘‘(ii) to establish, for disputes not resolved 
through procedures under clause (i), procedures 
for one or more alternative means of dispute 
resolution involving independent third-party re-
view under circumstances acceptable to the Di-
rector. 
‘‘(2) The carrier’s determination as to whether or not 
a particular employee is eligible to obtain insurance cov-
erage under this chapter shall be subject to review to the 
extent and in the manner provided in the applicable con-
tract. 
‘‘(3) Nothing in this chapter shall be considered to 
grant authority for a third-party reviewer to change the 
terms of any contract under this chapter. 
‘‘(d)(1) Each contract under this section shall be for 
a term of not less than 3 years and not greater than 7 
years, and may be terminated earlier than the termination 
date of such contract by the Director in accordance with 
the terms of such contract. However, the rights and re-
sponsibilities of the enrolled employee, the insurer, and the 
Director under each contract shall continue with respect 
to such employee until the termination of coverage of the 
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enrolled employee or the effective date of a successor con-
tract. 
‘‘(2) A contract described in paragraph (1) may be 
made automatically renewable, for a term of 1 year each 
January 1, unless written notice of non-renewal is given 
either by the Director or the carrier not less than 180 
days before the renewal date, or unless modified by mutual 
agreement. 
‘‘(3) A contract described in paragraph (1) shall in-
clude such provisions as may be necessary to ensure that, 
once an employee becomes duly enrolled, insurance cov-
erage pursuant to that enrollment shall be terminated only 
if the individual is separated from Federal service or, 
where appropriate, for non-payment of premiums. 
‘‘§ 8804. Benefits 
‘‘(a) The Director may prescribe reasonable minimum 
standards for benefit plans offered under this chapter. 
‘‘(b)(1) Benefits provided to an employee under this 
chapter shall offset other benefits received by such em-
ployee for the same injury or disability, leave to care for 
or make arrangements to care for a member of family (in-
cluding the birth of a son or a daughter), or leave to make 
arrangements to adopt a child or become a foster parent 
including worker’s compensation and disability retirement 
income. 
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‘‘(2) A contract providing benefits under this chap-
ter— 
‘‘(A) shall not provide for a preexisting condi-
tion exclusion; and 
‘‘(B) shall not charge higher premiums, deny 
coverage, or drop coverage of an employee with a 
preexisting condition. 
‘‘(3) A contract providing benefits under this chapter 
shall provide incentives for an employee who is receiving 
benefits under such contract to return to work. 
‘‘(c)(1) For each instance that such employee suffers 
an injury or disability, takes leave to care for or make 
arrangements to care for a member of family (including 
the birth of a son or a daughter), or takes leave to make 
arrangements to adopt a child or become a foster parent, 
and is eligible for benefits under this chapter, such em-
ployee may receive benefits under this chapter for a period 
not to exceed 12 months beginning on the date on which 
such employee qualifies for such benefits. An employee 
shall receive such benefits after the expiration of the wait-
ing period selected by such employee under paragraph 
(2)(A). The amount of benefits shall be equal to the lesser 
of— 
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‘‘(A) 70 percent of the annual rate of pay, ex-
cluding bonuses, of an employee at the time of the 
injury or disability of such employee occurs; or 
‘‘(B) 70 percent of the maximum rate of basic 
pay provided for grade GS–15 of the General Sched-
ule. 
‘‘(2)(A) The period for which benefits are payable to 
an employee under this subsection shall begin after the 
completion of a waiting period, subject to the requirement 
in subparagraph (C). An employee shall elect one of the 
following waiting period options: 
‘‘(i) On the 8th day of continuous injury or dis-
ability, leave to care for or to make arrangements to 
care for a member of family (including the birth of 
a son or a daughter), or leave to make arrangements 
to adopt a child or become a foster parent. 
‘‘(ii) On the 31st day of continuous disability, 
leave to care for or to make arrangements to care 
for a member of family (including the birth of a son 
or a daughter), or leave to make arrangements to 
adopt a child or become a foster parent. 
‘‘(iii) On the 91st day of continuous disability, 
leave to care for or to make arrangements to care 
for a member of family (including the birth of a son 
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or a daughter), or leave to make arrangements to 
adopt a child or become a foster parent. 
‘‘(iv) On the 181st day of continuous disability, 
leave to care for or to make arrangements to care 
for a member of family (including the birth of a son 
or a daughter), or leave to make arrangements to 
adopt a child or become a foster parent. 
‘‘(B) An employee who elects to receive benefits ear-
lier shall pay a higher premium. 
‘‘(C) A waiting period selected under subparagraph 
(A) shall begin on the first day of an employee’s injury 
or disability. 
‘‘§ 8805. Premiums 
‘‘(a) Each eligible individual obtaining insurance cov-
erage under this chapter shall be responsible for 100 per-
cent of the premiums for such coverage. 
‘‘(b) The amount necessary to pay the premiums for 
enrollment shall be withheld from the pay of the enrolled 
individual. 
‘‘(c) The carrier participating under this chapter 
shall maintain records that permit it to account for all 
amounts received under this chapter (including investment 
earnings on those amounts) separate and apart from all 
other funds. 
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