I
104TH CONGRESS
1ST SESSION
H. R. 1084
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 HOUSE OF REPRESENTATIVES
FEBRUARY 28, 1995
Mrs. SCHROEDER introduced the following bill; which was referred to the
Committee on Government Reform and Oversight and, in addition, to the
Committee on Commerce, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To amend title 5, United States Code, to make the Federal
Employees Health Benefits Program available to the gen-
eral public, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Federal Employees
Health Benefits Access Act’’.
SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE
GENERAL PUBLIC.
(a) IN GENERAL.—Chapter 89 of title 5, United
States Code, is amended by adding at the end the follow-
ing:
‘‘§ 8915. Provisions to require that benefits be ex-
tended to the general public
‘‘(a) A contract may not be made or a plan approved
unless the carrier agrees to offer to the general public,
throughout each term for which the contract or approval
remains effective, the same benefits (subject to the same
maximums, limitations, exclusions, and other similar
terms or conditions) as would be offered under such con-
tract or plan to employees and annuitants and their family
members.
‘‘(b)(1) Premiums for coverage under this section
shall be established in conformance with such require-
ments as the Office of Personnel Management shall by
regulation prescribe, including provisions to ensure con-
formance with generally accepted standards and practices
associated with community rating.
‘‘(2) In no event shall the enactment of this section
result in—
‘‘(A) any increase in the level of individual or
Government contributions required under section
8906 or any other provision of this chapter, includ-
ing copayments or deductibles;
‘‘(B) any decrease in the types of benefits of-
fered under this chapter; or
‘‘(C) any other change that would adversely af-
fect the coverage afforded under this chapter to em-
ployees and annuitants and their family members.
‘‘(c) Benefits under this section shall, with respect
to an individual who is entitled to benefits under part A
of title XVIII of the Social Security Act, be offered (for
use in coordination with those Social Security benefits) to
the same extent and in the same manner as if coverage
were under the preceding provisions of this chapter, rather
than under this section.
‘‘(d)(1) A carrier may file an application with the Of-
fice setting forth reasons why it, or a plan provided by
such carrier, should be excluded from the requirements of
this section.
‘‘(2) In reviewing any such application, the Office
may consider such factors as—
‘‘(A) any bona fide enrollment restrictions
which would make the application of this section in-
appropriate, including those common to plans which
are limited to individuals having a past or current
employment relationship with a particular agency or
other authority of the Government;
‘‘(B) whether compliance with this section
would jeopardize the financial solvency of the plan or
carrier, or otherwise compromise its ability to offer
health benefits under the preceding provisions of this
chapter; and
‘‘(C) the anticipated duration of the requested
exclusion, and what efforts the plan or carrier pro-
poses to take in order to be able to comply with this
section.
‘‘(e) Except as the Office may by regulation pre-
scribe, any reference to this chapter (or any requirement
of this chapter), made in any provision of law, shall not
be considered to include this section (or any requirement
of this section).’’.
(b) CONFORMING AMENDMENT.—The table of sec-
tions for chapter 89 of title 5, United States Code, is
amended by adding at the end the following:
‘‘8915. Provisions to require that benefits be extended to the general public.’’.
SEC. 3. STANDARDIZED CLAIMS PROCESSING.
Section 8902 of title 5, United States Code, is
amended by adding at the end the following:
‘‘(o) A claim for payment or reimbursement under
this chapter (whether electronic or otherwise) shall be sub-
mitted on such a standard form or in such a standard
manner as may be required by the Office in relation to
health benefit plans. Each contract under this chapter
shall include appropriate provisions to carry out the pre-
ceding sentence.’’.
SEC. 4. ADVANCE DIRECTIVES.
Section 8907 of title 5, United States Code, is
amended by adding at the end the following:
‘‘(c) The Office shall—
‘‘(1) prepare information relating to the use of
advance directives regarding the type or intensity of
care which an individual desires in the event that
such individual becomes unable to communicate by
reason of incapacity due to illness or injury; and
‘‘(2) require, as a condition for approval of any
contract under section 8902, that appropriate provi-
sions be included so that such information may be
made available to enrollees of the plan involved.’’.
SEC. 5. DEMONSTRATION PROJECT TO EXAMINE THE FEA-
SIBILITY OF OFFERING FEHBP ENROLLEES
THE OPTION OF USING ARBITRATION IN-
STEAD OF LITIGATION TO RESOLVE MEDICAL
MALPRACTICE CLAIMS.
(a) IN GENERAL.—The Office of Personnel Manage-
ment shall conduct a demonstration project to assess the
feasibility and desirability of offering the use of arbitra-