[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 45 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                 H. R. 45

To amend title 5, United States Code, to reform the program under which 
           health benefits are provided to Federal employees.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 5, 1993

 Mr. Ackerman (for himself and Mrs. Morella) introduced the following 
  bill; which was referred to the Committee on Post Office and Civil 
                                Service

_______________________________________________________________________

                                 A BILL


 
To amend title 5, United States Code, to reform the program under which 
           health benefits are provided to Federal employees.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Federal Employees Health Benefits 
Reform Act of 1993''.

SEC. 2. REVISED PROGRAM.

    Chapter 89 of title 5, United States Code, is amended to read as 
follows:
                     ``chapter 89--health insurance
``Sec.
``8901.  Definitions.
``8902.  Eligibility requirements for individual coverage.
``8903.  General program description.
``8904.  Benefits under the Governmentwide plan.
``8905.  Contributions under the Governmentwide plan.
``8906.  Utilization review under the Governmentwide plan.
``8907.  Administration of the Governmentwide plan.
``8908.  Prepayment plans.
``8909.  Supplementary plans.
``8910.  Contract requirements.
``8911.  Automatic coverage; elections of coverage.
``8911a. Continued coverage for certain individuals.
``8911b. Coverage for certain other employees.
``8911c. Coverage of restored employees and survivor or disability 
                            annuitants.
``8911d. Double coverage; change in family status.
``8911e. Clarifying provisions.
``8912.  Flexible spending plan.
``8913.  Federal Employees Health Benefits Board.
``8914.  Employees Health Benefits Fund.
``8915.  Debarment and other sanctions against providers.
``8916.  Open enrollment periods; informational requirements.
``8917.  Studies, reports, and audits.
``8918.  Jurisdiction of courts.
``8919.  Regulations.
``8920.  Effect of other statutes.
``Sec. 8901. Definitions
    ``For the purpose of this chapter--
            ``(1) the term `employee' means--
                    ``(A) the President;
                    ``(B) a Member of Congress;
                    ``(C) a Congressional employee;
                    ``(D) an individual first employed by the 
                government of the District of Columbia before October 
                1, 1987;
                    ``(E) an individual employed by Gallaudet College;
                    ``(F) an individual employed by a county committee 
                established under section 8(b) of the Soil Conservation 
                and Domestic Allotment Act;
                    ``(G) an individual appointed to a position on the 
                office staff of a former President under section 1(b) 
                of the Act of August 25, 1958;
                    ``(H) an individual appointed to a position on the 
                office staff of a former President or a former Vice 
                President under section 4 of the Presidential 
                Transition Act of 1963 who, immediately before the date 
                of such appointment, was an employee as defined under 
                any other subparagraph of this paragraph; and
                    ``(I) an employee (as defined by section 2105) not 
                otherwise specified in any of the preceding 
                subparagraphs;
        but does not include--
                    ``(i) an employee of a corporation supervised by 
                the Farm Credit Administration if private interests 
                elect or appoint a member of the board of directors;
                    ``(ii) an individual who is not a citizen or 
                national of the United States and whose permanent duty 
                station is outside the United States, unless, on 
                September 30, 1979, the individual was an employee for 
                the purpose of this chapter (as then in effect), by 
                reason of service in an Executive agency, the United 
                States Postal Service, or the Smithsonian Institution 
                in the area which was then known as the Canal Zone;
                    ``(iii) an employee of the Tennessee Valley 
                Authority; or
                    ``(iv) an employee excluded by regulation of the 
                Office of Personnel Management under section 8919(b);
            ``(2) the term `Government' means the Government of the 
        United States and the government of the District of Columbia;
            ``(3) the term `annuitant' means--
                    ``(A) an employee who retires--
                            ``(i) on an immediate annuity under 
                        subchapter III of chapter 83, or another 
                        retirement system for employees of the 
                        Government, after 5 or more years of service;
                            ``(ii) under section 8412 or 8414; or
                            ``(iii) for disability under subchapter III 
                        of chapter 83, chapter 84, or another 
                        retirement system for employees of the 
                        Government;
                    ``(B) a family member who receives an immediate 
                annuity as the survivor of an employee (including a 
                family member entitled to an amount under section 
                8442(b)(1)(A), whether or not such family member is 
                entitled to an annuity under section 8442(b)(1)(B)) or 
                of a retired employee described by subparagraph (A);
                    ``(C) an employee who receives monthly compensation 
                under subchapter I of chapter 81 and who is determined 
                by the Secretary of Labor to be unable to return to 
                duty; and
                    ``(D) a family member who receives monthly 
                compensation under subchapter I of chapter 81 as the 
                surviving beneficiary of--
                            ``(i) an employee who dies as a result of 
                        injury or illness compensable under that 
                        subchapter; or
                            ``(ii) a former employee who is separated 
                        after having completed 5 or more years of 
                        service and who dies while receiving monthly 
                        compensation under that subchapter and who has 
                        been held by the Secretary to have been unable 
                        to return to duty;
            ``(4) the term `service', as used by paragraph (3), means 
        service which is creditable under subchapter III of chapter 83 
        or chapter 84;
            ``(5) a reference to the family, or members of the family, 
        of an individual shall be considered to be a reference to--
                    ``(A) the spouse of such individual; and
                    ``(B) each child of such individual;
            ``(6) the term `health benefits plan' means a group 
        insurance policy or contract, medical or hospital service 
        agreement, membership or subscription contract, or similar 
        group arrangements provided by a carrier for the purpose of 
        providing, paying for, or reimbursing expenses for health 
        services;
            ``(7) the term `carrier' means a voluntary association, 
        corporation, partnership, or other nongovernmental organization 
        which is lawfully engaged in providing, paying for, or 
        reimbursing the cost of, health services under group insurance 
        policies or contracts, medical or hospital service agreements, 
        membership or subscription contracts, or similar group 
        arrangements, in consideration of premiums or other periodic 
        charges payable to the carrier, including a health benefits 
        plan duly sponsored or underwritten by an employee 
        organization;
            ``(8) the term `employee organization' means any 
        association or other organization which satisfies the 
        definition given that term under the provisions of this chapter 
        (as last in effect before the date of enactment of the Federal 
        Employees Health Benefits Reform Act of 1993);
            ``(9) the term `dependent', in the case of any child, means 
        that the employee, annuitant, or other enrollee involved is 
        either living with or contributing to the support of such 
        child, as determined in accordance with regulations prescribed 
        by the Office;
            ``(10) the term `former spouse' means a former spouse of an 
        employee, former employee, or annuitant--
                    ``(A) who has not remarried before age 55 after the 
                marriage to the employee, former employee, or annuitant 
                was dissolved;
                    ``(B) who was enrolled in a basic plan under this 
                chapter (or an approved health benefits plan under this 
                chapter, as previously in effect) as a family member at 
                any time during the 18-month period before the date of 
                the dissolution of the marriage to the employee, former 
                employee, or annuitant; and
                    ``(C)(i) who is receiving any portion of an annuity 
                under section 8345(j) or 8467 or a survivor annuity 
                under section 8341(h) or 8445 (or benefits similar to 
                either of the aforementioned annuity benefits under a 
                retirement system for Government employees other than 
                the Civil Service Retirement System or the Federal 
                Employees' Retirement System);
                    ``(ii) as to whom a court order or a decree 
                referred to in section 8341(h), 8345(j), 8445, or 8467 
                (or similar provision of law under any such retirement 
                system other than the Civil Service Retirement System 
                or the Federal Employees' Retirement System) has been 
                issued, or for whom an election has been made under 
                section 8339(j)(3) or 8417(b) (or similar provision of 
                law); or
                    ``(iii) who is otherwise entitled to an annuity or 
                any portion of an annuity as a former spouse under a 
                retirement system for Government employees;
        except that such term shall not include any such unremarried 
        former spouse of a former employee whose marriage was dissolved 
        after the former employee's separation from the service (other 
        than by retirement);
            ``(11) the term `child' means--
                    ``(A) an unmarried dependent child under 22 years 
                of age, including--
                            ``(i) an adopted child or recognized 
                        natural child; and
                            ``(ii) a stepchild or foster child, but 
                        only if the child lives with the employee, 
                        annuitant, or other enrollee in a regular 
                        parent-child relationship;
                    ``(B) an unmarried dependent child, as described in 
                subparagraph (A) (except for being 22 years of age or 
                older), who is incapable of self-support because of 
                mental or physical disability which existed before age 
                22; and
                    ``(C) an unmarried dependent child, as described in 
                subparagraph (A) (except for being at least 22 but less 
                than 23 years of age, excluding any child under 
                subparagraph (B)), who is a student regularly pursuing 
                a full-time course of study or training in residence in 
                a high school, trade school, technical or vocational 
                institute, junior college, college, university, or 
                comparable recognized educational institution;
            ``(12) the term `basic health benefits plan' or `basic plan 
        under this chapter' means--
                    ``(A) the Governmentwide plan (as described in 
                sections 8904 through 8907); and
                    ``(B) an approved health benefits plan described in 
                section 8908;
            ``(13) the term `supplementary health benefits plan' or 
        `supplementary plan under this chapter' means an approved 
        health benefits plan described in section 8909;
            ``(14) the term `enrollee', as used with respect to a plan, 
        means an individual enrolled in such plan;
            ``(15) the term `covered individual', as used with respect 
        to a plan, means--
                    ``(A) an enrollee in such plan; and
                    ``(B) each individual covered by such plan as a 
                member of the enrollee's family;
            ``(16) the term `Board' means the Federal Employees Health 
        Benefits Board under section 8913;
            ``(17) the term `Fund' means the Employees Health Benefits 
        Fund under section 8914;
            ``(18) the term `provider of health care services or 
        supplies' or `provider' means a physician, hospital, or other 
        individual or entity which furnishes health care services or 
        supplies;
            ``(19) the term `administrative year' means a fiscal year;
            ``(20) the term `provider-agreement program' means a 
        program under which participating providers agree to provide 
        health services or supplies to covered individuals under terms 
        and conditions mutually agreed to by the provider and the 
        carrier involved;
            ``(21) the term `exclusive provider-agreement program', as 
        used with respect to a particular type of benefit, means a 
        program under which payment or reimbursement for health 
        services or supplies relating to that type of benefit are 
        available only if the services or supplies are obtained from a 
        provider participating in the program;
            ``(22) the term `mail order prescription drug program' 
        means a program under which a prescription for not less than a 
        21-day supply and not more than a 90-day supply of medication 
        may be filled or refilled by mail; and
            ``(23) the term `administrative year deductible', as used 
        with respect to the Governmentwide plan, means the deductible 
        which applies under section 8904(c)(2)(A)(i).
``Sec. 8902. Eligibility requirements for individual coverage
    ``An individual's eligibility for coverage under this chapter shall 
be determined under sections 8911 through 8911e.
``Sec. 8903. General program description
    ``Benefits under this chapter shall be provided under--
            ``(1) the Governmentwide plan (as described in sections 
        8904 through 8907);
            ``(2) group-practice or individual-practice prepayment 
        plans (or any combination thereof), as described in section 
        8908; and
            ``(3) supplementary health benefits plans, as described in 
        section 8909.
``Sec. 8904. Benefits under the Governmentwide plan
    ``(a) The Governmentwide plan shall offer benefits under a standard 
option and high option, respectively.
    ``(b)(1) Under the standard option, the following types of benefits 
shall be covered to the following extent (subject to any term or 
condition under this paragraph or subsection (c)):
            ``(A) Hospital benefits--80 percent (subject to a $200 per 
        admission deductible).
            ``(B) Surgical-medical benefits--80 percent.
            ``(C) X-rays and laboratory tests--80 percent.
            ``(D) Emergency and accidental benefits--100 percent.
            ``(E) Prescribed drugs--75 percent (subject to a $10 
        copayment per prescription or refill, if obtained through a 
        mail order prescription drug program under section 
        8907(b)(2)(C)(ii)(III)).
            ``(F) Well-baby benefits--80 percent.
            ``(G) Mammography--80 percent.
    ``(2)(A) Benefits under the high option shall be as set forth in 
subparagraph (B) or (C), as applicable, depending on whether or not 
they are obtained through a provider-agreement program under section 
8907(b)(2)(C)(ii)(I).
    ``(B) If not obtained through such a provider-agreement program, 
the following types of benefits shall be covered to the following 
extent (subject to any term or condition under this subparagraph or 
subsection (c)):
            ``(i) Hospital benefits--90 percent (subject to a $100 per 
        admission deductible).
            ``(ii) Surgical-medical benefits--85 percent.
            ``(iii) X-rays and laboratory tests--85 percent.
            ``(iv) Emergency and accidental benefits--100 percent.
            ``(v) Prescribed drugs--80 percent (subject to a $5 
        copayment per prescription or refill, if obtained through a 
        mail order prescription drug program under section 
        8907(b)(2)(C)(ii)(III)).
            ``(vi) Well-baby benefits--85 percent.
            ``(vii) Mammography--85 percent.
    ``(C) If obtained through such a provider-agreement program, the 
following types of benefits shall be covered to the following extent 
(subject to any term or condition under this subparagraph or subsection 
(c)):
            ``(i) Hospital benefits--100 percent.
            ``(ii) Surgical-medical benefits--100 percent.
            ``(iii) X-rays and laboratory tests--100 percent.
            ``(iv) Emergency and accidental benefits--100 percent.
            ``(v) Prescribed drugs--85 percent (subject to a $5 
        copayment per prescription or refill, if obtained through a 
        mail order prescription drug program under section 
        8907(b)(2)(C)(ii)(III)).
            ``(vi) Well-baby benefits--100 percent.
            ``(vii) Mammography--100 percent.
    ``(3)(A) In addition to the respective benefits described in 
paragraph (1) and paragraph (2) (B) and (C), mental health and 
substance abuse benefits--
            ``(i) shall be provided under the standard and high options 
        to the extent set forth in subparagraphs (B) and (C), 
        respectively (subject to clause (ii) and any term or condition 
        under subparagraph (B) or (C) or subsection (c)); and
            ``(ii) shall not be available except to the extent that the 
        benefit is received through an exclusive provider-agreement 
        program under section 8907(b)(2)(C)(ii)(II).
    ``(B) Mental health and substance abuse benefits under the standard 
option shall be as follows:
            ``(i) Inpatient basis--75 percent (subject to a $200 per 
        admission deductible).
            ``(ii) Outpatient basis--75 percent (up to 30 visits per 
        individual per administrative year).
    ``(C) Mental health and substance abuse benefits under the high 
option shall be as follows:
            ``(i) Inpatient basis--80 percent.
            ``(ii) Outpatient basis--75 percent (up to 100 visits per 
        individual per administrative year, but with any visits beyond 
        50 in an administrative year subject to a specific 
        determination under section 8906 that more than 50 visits are 
        necessary).
    ``(4) The Federal Employees Health Benefits Board may submit to 
Congress recommendations for any additional benefits, or changes in 
benefits, under the Governmentwide plan which the Board considers 
appropriate. Any such recommendations--
            ``(A) shall be consistent with the intent that the same 
        types of benefits shall be covered under both options; and
            ``(B) shall include the Board's estimate of any resulting 
        costs or savings anticipated during each of the first 5 
        administrative years of their implementation.
    ``(c)(1) Subject to paragraph (2), benefits under the 
Governmentwide plan shall be specifically defined, and shall be subject 
to such maximums, limitations, exclusions, and other terms or 
conditions as the Board, in consultation with the Office of Personnel 
Management, shall by regulation prescribe.
    ``(2) Such regulations shall provide that--
            ``(A)(i) a deductible of $250 per administrative year under 
        the standard option, and $150 per administrative year under the 
        high option, must be met by a covered individual before any 
        benefits shall be payable by the plan on such individual's 
        behalf; except that
            ``(ii) in the case of a family enrollment, once the 
        deductible is met by any 2 family members, the deductible shall 
        be waived for any other members of the family for the rest of 
        the administrative year;
            ``(B) any payment made to or on behalf of an individual for 
        a covered charge shall be based on the lesser of--
                    ``(i) the actual charge for the service or item 
                involved; or
                    ``(ii) the reasonable and customary charge for such 
                service or item, as determined by the Board in 
                consultation with the Office; and
            ``(C) if, in any administrative year, after the appropriate 
        deductible has been met, total out-of-pocket expenses 
        (excluding any to the extent that they exceed reasonable and 
        customary levels, as determined under subparagraph (B)(ii)) for 
        the individual (or, in the case of a family enrollment, for the 
        family) exceed the catastrophic limit established under 
        paragraph (3) for individual coverage (or, in the case of a 
        family enrollment, for family coverage), the plan shall pay 100 
        percent of all covered charges incurred by the individual (or, 
        in the case of a family enrollment, each covered individual in 
        such family).
    ``(3)(A) Except as provided in subparagraph (B), the catastrophic 
limit--
            ``(i) under the standard option shall be--
                    ``(I) $2,000 per administrative year for individual 
                coverage; and
                    ``(II) $4,000 per administrative year for family 
                coverage; and
            ``(ii) under the high option shall be--
                    ``(I) $1,000 per administrative year for individual 
                coverage; and
                    ``(II) $2,000 per administrative year for family 
                coverage.
    ``(B)(i) The Office shall prescribe regulations under which, in any 
case in which the enrollee is an employee, the catastrophic limit under 
this paragraph shall be established using a formula which makes the 
catastrophic limit commensurate with the rate of basic pay payable to 
such employee, except that no limit determined under this subparagraph 
may exceed the catastrophic limit which would otherwise apply under 
subparagraph (A).
    ``(ii) In the case of a family enrollment, if the employee's spouse 
is also an employee and such spouse is receiving a higher rate of basic 
pay, the formula shall instead use the spouse's rate of basic pay.
    ``(4) The following rules apply with respect to a `per admission' 
deductible under section 8904:
            ``(A) The per admission deductible shall be in addition to 
        any deductible requirement under paragraph (2)(A).
            ``(B) No amount applied toward meeting a per admission 
        deductible may be taken into account for purposes of meeting an 
        administrative year deductible.
    ``(d) A provider shall not be eligible for payments under this 
section unless it agrees to comply with the requirements of section 
8906 (if applicable), relating to utilization review.
    ``(e) Any amount payable by the Governmentwide plan for any covered 
charge shall be paid to the provider of the item or service involved, 
unless the enrollee elects to be reimbursed for such amount instead.
``Sec. 8905. Contributions under the Governmentwide plan
    ``(a)(1) The Office of Personnel Management shall determine the 
enrollment charges for coverage in the Governmentwide plan in 
accordance with this subsection.
    ``(2)(A) The enrollment charges shall reasonably and equitably 
reflect--
            ``(i) the cost of providing benefits under the 
        Governmentwide plan (taking into account any savings 
        anticipated through any provider-agreement program or any other 
        cost-control or cost-reduction measure under the plan);
            ``(ii) the cost of administering such plan; and
            ``(iii) any amounts necessary to maintain an adequate 
        contingency reserve.
Enrollment charges shall be determined on a basis which, in the 
judgment of the Office, is consistent with the lowest schedule of basic 
rates generally charged for group health benefit plans issued to large 
employers. In so determining such charges, costs under clauses (i) and 
(ii) shall be allocated to each option in a manner which is reasonable 
and equitable.
    ``(B) The enrollment charges determined for the first 
administrative year shall be continued for later administrative years, 
except that they may be readjusted for a later year, based on past 
experience and benefit adjustments taking effect in such later year. 
Any readjustment in such charges shall be made on a basis which, in the 
judgment of the Office, is consistent with the general practice of 
carriers which issue group health benefit plans to large employers.
    ``(3) Enrollment charges under this subsection--
            ``(A) shall be established not later than 6 months before 
        the beginning of the administrative year to which they apply;
            ``(B) shall be established in consultation with the Board; 
        and
            ``(C) shall, with respect to any administrative year, be 
        effective--
                    ``(i) for an employee, beginning on the first day 
                of the employee's first pay period of such 
                administrative year; and
                    ``(ii) for an annuitant, beginning on the first day 
                of the first period of such administrative year for 
                which an annuity payment is made.
    ``(4) Any enrollment charges established under this subsection 
shall be published in the Federal Register and the Code of Federal 
Regulations not later than 5 months before the beginning of the 
administrative year to which they apply.
    ``(5) In establishing enrollment charges under this subsection, 
projected administrative costs for the Governmentwide plan may not 
exceed 1 percent of the projected cost of providing benefits under such 
plan.
    ``(b)(1)(A) For the first administrative year during which the 
Governmentwide plan is in effect, the biweekly contribution required of 
an employee enrolled in such plan shall be--
            ``(i) if enrolled in the standard option--
                    ``(I) for self alone, $10 per pay period; or
                    ``(II) for self and family, $22 per pay period; or
            ``(ii) if enrolled in the high option--
                    ``(I) for self alone, $20 per pay period; or
                    ``(II) for self and family, $44 per pay period.
    ``(B) For each subsequent administrative year, the biweekly 
contribution required of an employee enrolled in the Governmentwide 
plan shall be the amount last required (under subparagraph (A) or 
pursuant to adjustment under this subparagraph, as applicable) before 
the start of such year, increased by the lesser of--
            ``(i) the percentage by which the medical care component of 
        the consumer price index (as determined by the Bureau of Labor 
        Statistics) for the last base quarter before the start of such 
        year exceeds such component of such index (as so determined) 
        for the second to last base quarter before the start of such 
        year (if at all); or
            ``(ii) the percentage by which the average of the 
        enrollment charges determined under subsection (a) for such 
        year exceeds the average of the enrollment charges determined 
        under such subsection for the previous administrative year (if 
        at all).
For purposes of this subparagraph, the term `base quarter' means the 3-
month period ending on December 31st of a year.
    ``(2) The Office shall provide for conversion of biweekly rates of 
contribution under this subsection to rates for employees paid on other 
than a biweekly basis and for annuitants, and for this purpose may 
provide for the adjustment of the converted rate to the nearest cent.
    ``(3)(A) Except as otherwise provided in subparagraph (B) or 
section 8912(3), contributions under this subsection shall be made 
through withholdings from the pay of the enrolled employee or the 
annuity of the enrolled annuitant, as the case may be.
    ``(B) An annuitant whose annuity is insufficient to cover the full 
amount of the withholdings required under this subsection may enroll 
(or remain enrolled) in the Governmentwide plan, notwithstanding any 
other provision of this section, if the annuitant elects, under 
conditions prescribed by regulations of the Office, to pay currently 
into the Fund, through the retirement system that administers the 
annuitant's health benefits enrollment, an amount equal to the 
withholdings that would otherwise be required under this subsection.
    ``(c)(1) The amount necessary to pay the total enrollment charge 
(as determined under subsection (a)), after the enrollee's contribution 
is deducted, shall be paid through Government contributions.
    ``(2) Such Government contributions, in any instance in which they 
are being made on behalf of an employee, shall be made at the same time 
as the employee contribution is made.
    ``(3) Government contributions under this subsection for an 
employee shall be paid--
            ``(A) in the case of employees generally, from the 
        appropriation or fund which is used to pay the employee;
            ``(B) in the case of an elected official, from an 
        appropriation or fund available for payment of other salaries 
        of the same office or establishment;
            ``(C) in the case of an employee of the legislative branch 
        who is paid by the Clerk of the House of Representatives, from 
        the contingent fund of the House; and
            ``(D) in the case of an employee in a leave without pay 
        status, from the appropriation or fund which would be used to 
        pay the employee if such employee were in a pay status.
    ``(4)(A) Except as provided in subparagraph (B), Government 
contributions under this subsection for an annuitant shall be paid from 
annual appropriations which are authorized to be made for that purpose 
and which may be made available until expended.
    ``(B) Government contributions under this subsection for an 
individual who first becomes an annuitant by reason of retirement from 
employment with the United States Postal Service on or after October 1, 
1986, or for a survivor of such an individual or of an individual who 
died on or after October 1, 1986, while employed by the United States 
Postal Service, shall be paid by the United States Postal Service.
    ``(5)(A) In the case of an employee holding a position on a part-
time career employment basis (as defined in section 3401(2)), the 
Government contribution shall be equal to--
            ``(i) the amount which would be payable by the Government 
        if the employee were employed on a full-time career basis, 
        multiplied by
            ``(ii) the percentage derived by--
                    ``(I) dividing the average number of hours in such 
                employee's regularly scheduled workweek by the average 
                number of hours in the regularly scheduled workweek of 
                an employee serving in a comparable position on a full-
                time career basis (as determined under regulations 
                prescribed by the Office); and
                    ``(II) multiplying the quotient under subclause (I) 
                by 100.
    ``(B) Any shortfall in Government contributions shall, to the 
extent attributable to subparagraph (A), be made up through a 
corresponding increase in the amount of the employee contribution.
``Sec. 8906. Utilization review under the Governmentwide plan
    ``(a) In order to help prevent excessive or otherwise inappropriate 
types or levels of hospital, medical, or mental-health care, and the 
costs associated therewith, the Board shall establish procedures to 
ensure that cost- and utilization-control measures (consistent with 
those common to group health benefits plans offered by large employers) 
are implemented under the Governmentwide plan.
    ``(b) Any second opinion, certification, or other form of review 
required under this section shall be obtained from the appropriate 
carrier under section 8907 (or person under contract with such carrier 
for that purpose). The Office of Personnel Management shall establish 
the qualification requirements for any person performing any such 
review for purposes of this section.
    ``(c) With respect to mental health and substance abuse benefits, a 
carrier (or other qualified reviewing entity) may, when medically 
appropriate, recommend alternatives to inpatient care.
``Sec. 8907. Administration of the Governmentwide plan
    ``(a)(1) The Governmentwide plan shall be administered on a 
regional basis. To that end, the Office of Personnel Management, in 
consultation with the Board, shall establish such number of geographic 
regions as the Office considers appropriate in order that each 
individual who is covered by the plan shall be included within the 
administrative jurisdiction of 1 of those regions.
    ``(2) The Office may modify the number or boundaries of the regions 
established under this subsection only as of the start of a contract 
term (described in subsection (b)(2)(B)) or at such other times as the 
Office may by regulation prescribe.
    ``(b)(1) The processing of claims, implementation of utilization 
review requirements, and other functions relating to the administration 
of the plan (as identified by the Office) shall be the responsibility 
of the carrier designated under paragraph (2) with respect to such 
region.
    ``(2)(A) The Office, in accordance with competitive bidding 
procedures established by the Office, may contract with a carrier to 
carry out the functions required under paragraph (1) with respect to a 
region.
    ``(B) Each contract shall be for a uniform term of at least 3 
administrative years, but may be made automatically renewable from term 
to term in the absence of notice of termination by either party.
    ``(C) To be eligible for consideration, a carrier must--
            ``(i) be licensed to issue group health insurance in each 
        State (including the District of Columbia, if applicable) which 
        is included, in whole or in part, within the region involved, 
        except that an organization which at any time during the 24-
        month period ending on the date of enactment of the Federal 
        Employees Health Benefits Reform Act of 1993 was under contract 
        with the Office under the provisions of this title then 
        designated as section 8902 for a health plan that was self-
        insured shall be eligible for consideration regardless of the 
        number of States in which it is licensed to issue group 
        insurance; and
            ``(ii) demonstrate that it has or will have (by the start 
        of the contract term)--
                    ``(I) a provider-agreement program sufficient to 
                provide the benefits described in section 
                8904(b)(2)(C);
                    ``(II) an exclusive provider-agreement program 
                relating to mental health and substance abuse benefits; 
                and
                    ``(III) a mail order prescription drug program.
    ``(D) Subsections (c), (e), and (f) of section 8910 shall apply to 
a contract under this section in the same way as if it were a contract 
under section 8908.
    ``(E) An employee organization shall not be subject to the 
requirement under subparagraph (C)(i).
    ``(3) If no carrier is selected with respect to a region, the 
Office shall carry out the functions described in paragraph (1) with 
respect to such region.
    ``(c) Notwithstanding any other provision of this section, an 
employee organization which, at any time during the 24-month period 
before the date of enactment of the Federal Employees Health Benefits 
Reform Act of 1993, was under contract with the Office under the 
provisions of this title then designated as section 8902 for a health 
benefits plan that was self-insured, may be selected to administer the 
Governmentwide plan with respect to--
            ``(1) an employee within that organization's bargaining 
        unit (as determined under applicable provisions of law);
            ``(2) an annuitant under section 8901(3) (A) or (C) who, 
        immediately before becoming such an annuitant, was an employee 
        within that organization's bargaining unit (as so determined); 
        and
            ``(3) any individual who is covered by such plan as a 
        family member of any such employee or annuitant.
Any selections under this subsection shall be made by the Office.
``Sec. 8908. Prepayment plans
    ``(a)(1) The Office of Personnel Management may contract for 
(without regard to section 5 of title 41 or other statute requiring 
competitive bidding) or approve one or more of the following health 
benefits plans:
            ``(A) Group-practice prepayment plans.--Group-practice 
        prepayment plans which offer health benefits of the types 
        referred to in paragraph (2), in whole or substantial part on a 
        prepaid basis, with professional services thereunder provided 
        by physicians practicing as a group in a common center or 
        centers. The group shall include at least 3 physicians who 
        receive all or a substantial part of their professional income 
        from the prepaid funds and who represent 1 or more medical 
        specialties appropriate and necessary for the population 
        proposed to be served by the plan.
            ``(B) Individual-practice prepayment plans.--Individual-
        practice prepayment plans which offer health benefits of the 
        types referred to in paragraph (2), in whole or substantial 
        part on a prepaid basis, with professional services thereunder 
        provided by individual physicians who agree, under certain 
        conditions approved by the Office, to accept the payments 
        provided by the plans as full payment for covered services 
        given by them including, in addition to in-hospital services, 
        general care given in their offices and the patients' homes, 
        out-of-hospital diagnostic procedures, and preventive care, and 
        which plans are offered by organizations which have 
        successfully operated similar plans before approval by the 
        Office of the plan in which employees may enroll.
            ``(C) Mixed-model prepayment plans.--Mixed-model prepayment 
        plans are a combination of the type of plans described in 
        subparagraph (A) and the type of plans described in 
        subparagraph (B).
    ``(2) The plans described in paragraph (1) shall offer, at a 
minimum, the same types of benefits as are offered under the standard 
option of the Governmentwide plan.
    ``(b)(1) The Government contribution on behalf of any individual 
enrolled in a plan under this section--
            ``(A) shall be equal to an amount which bears the same 
        relationship to the total enrollment charge for the coverage 
        involved as the ratio under paragraph (2); and
            ``(B) shall be paid from the same source as would be 
        required under paragraph (3) or (4) of section 8905(c) (as 
        applicable).
    ``(2) The ratio to be used for purposes of paragraph (1)(A) is 
equal to--
            ``(A) the sum of the biweekly Government contribution under 
        the Governmentwide plan for the standard and high options, 
        respectively (for self or self and family, as applicable), as 
        determined under section 8905(c), divided by
            ``(B) the sum of the total biweekly enrollment charge under 
        the Governmentwide plan for the standard and high options, 
        respectively (for self or self and family, as applicable), as 
        determined under section 8905(a).
    ``(c)(1) Except as otherwise provided in paragraph (2) or section 
8912(3), there shall be withheld from the pay of an enrolled employee 
or the annuity of an enrolled annuitant (as the case may be) the amount 
necessary to pay the total enrollment charge for a plan under this 
section, after taking into account the amount of the Government 
contribution.
    ``(2) In the case of an annuitant whose annuity is insufficient to 
cover the full amount of the withholding required under paragraph (1), 
the same election as provided for under section 8905(b)(3)(B) shall be 
available.
``Sec. 8909. Supplementary plans
    ``(a) The Office of Personnel Management may contract for (without 
regard to section 5 of title 41 or other statute requiring competitive 
bidding) or approve one or more health benefits plans which offer 
benefits of the types referred to in subsection (b), which are 
sponsored or underwritten, and administered, in whole or substantial 
part, by employee organizations, and which are available only to 
individuals who at the time of enrollment are members of the 
organization (and family members).
    ``(b) Any such plan may offer dental benefits, vision-care 
benefits, and any other type of benefit, mutually agreed to by the 
employee organization and the Office, not offered by the Governmentwide 
plan.
    ``(c)(1)(A) Except as provided in subparagraph (B), an individual 
shall be eligible to enroll (or remain enrolled) in any plan under this 
section during any period of time during which such individual is 
enrolled in a basic health benefits plan.
    ``(B) An individual shall not be eligible to enroll (or remain 
enrolled) in any plan under this section if--
            ``(i) such individual's eligibility for coverage in a basic 
        health benefits plan is under section 8911a; or
            ``(ii) such individual has nongroup coverage under the 
        basic health benefits plan.
    ``(2) Coverage under this section for family members may not be 
provided during any period of time during which they are not also 
covered under a basic health benefits plan.
    ``(d)(1) The enrollee shall pay the full enrollment charge for 
coverage under this section. Except as otherwise provided in paragraph 
(2) or section 8912(3), payments under this subsection shall be made 
through withholdings from the pay of the enrolled employee or the 
annuity of the enrolled annuitant (as the case may be).
    ``(2) In the case of an annuitant whose annuity is insufficient to 
cover the full amount of the withholding required under paragraph (1), 
the same election as provided for under section 8905(b)(3)(B) shall be 
available.
``Sec. 8910. Contract requirements
    ``(a) Each contract under section 8908 or 8909--
            ``(1) shall be for a uniform term of at least 1 
        administrative year, but may be made automatically renewable 
        from term to term in the absence of notice of termination by 
        either party; and
            ``(2) shall contain a detailed statement of benefits 
        offered and shall include such maximums, limitations, 
        exclusions, and other definitions of benefits as the Office 
        considers necessary or desirable.
    ``(b) The Office of Personnel Management may prescribe reasonable 
minimum standards for any plan under section 8908 or 8909 and for 
carriers offering the plans. Approval of a plan may be withdrawn only 
after notice and opportunity for hearing to the carrier concerned 
without regard to subchapter II of chapter 5 and chapter 7. The Office 
may terminate the contract of a carrier, effective at the end of the 
contract term, if the Office finds that at no time during the preceding 
two contract terms did the carrier have 300 or more employees and 
annuitants (exclusive of family members) enrolled in the plan.
    ``(c)(1) A contract may not be made, or a plan approved, under 
section 8908 or 8909 which excludes an individual because of race, sex, 
health status, annuitant status, or, at the time of the first 
opportunity to enroll, because of age.
    ``(2)(A) A contract may not be made, or a plan approved, under 
section 8908 which does not offer to each employee, annuitant, family 
member, former spouse, or person having continued coverage under 
section 8911a whose enrollment in the plan is ended, except by a 
cancellation of enrollment, a temporary extension of coverage during 
which that individual may exercise the option to convert, without 
evidence of good health, to a nongroup contract providing health 
benefits; an employee, annuitant, family member, former spouse, or 
person having continued coverage under section 8911a who exercises this 
option shall pay the full periodic charges of the nongroup contract.
    ``(B) The benefits and coverage made available under subparagraph 
(A) are noncancelable by the carrier except for fraud, over-insurance, 
or nonpayment of periodic charges.
    ``(d) With respect to any contract under section 8908 or 8909, the 
rates determined for the first contract term may be redetermined, for 
any later administrative year, in the same manner as provided for under 
section 8905(a)(2)(B).
    ``(e) Each contract under section 8908 or 8909 shall require the 
carrier to agree to pay for or provide a health service or supply in 
any case in which the Office finds that the employee, annuitant, family 
member, or other individual is entitled thereto under the terms of the 
contract.
    ``(f) The provisions of any contract under section 8908 or 8909 
which relate to the nature or extent of coverage or benefits (including 
payments with respect to benefits) shall supersede and preempt any 
State or local law, or any regulation issued thereunder, which relates 
to health insurance or plans to the extent that such law or regulation 
is inconsistent with such contractual provisions.
``Sec. 8911. Automatic coverage; elections of coverage
    ``(a)(1) Subject to paragraph (2)(A), an employee shall, as of the 
date of first becoming eligible for coverage under this chapter, be 
covered under the Governmentwide plan's standard option for self alone.
    ``(2)(A) Instead of the coverage provided for under paragraph (1), 
an employee may elect--
            ``(i) a different level or type of coverage under the 
        Governmentwide plan;
            ``(ii) coverage under a different basic health benefits 
        plan; or
            ``(iii) exclusion from coverage under this chapter.
    ``(B) In addition to or instead of any election under subparagraph 
(A), an employee (excluding any employee who makes an election under 
subparagraph (A)(iii)) may elect--
            ``(i) to be covered under a supplementary health benefits 
        plan;
            ``(ii) to participate in the flexible spending plan under 
        section 8912; or
            ``(iii) any other option which would be available to such 
        employee during an open enrollment period (described in section 
        8916).
    ``(C) Any election under subparagraph (A) or (B)--
            ``(i) must be submitted to the employing office of the 
        individual involved, in writing, in such form and within such 
        time as the Office of Personnel Management shall by regulation 
        prescribe; and
            ``(ii) shall, if it is submitted in accordance with clause 
        (i) but after coverage commences, become effective at the 
        beginning of the next applicable pay period.
    ``(3) An election of noncoverage under this subsection shall not 
prevent the employee from subsequently making any election for which 
such employee is eligible during an open enrollment period or at any 
other time otherwise allowable under this chapter.
    ``(b) An annuitant who, at the time of becoming an annuitant, was 
enrolled in a basic plan under this chapter--
            ``(1) as an employee for a period of not less than--
                    ``(A) the 5 years of service immediately before 
                retirement; or
                    ``(B) the full period or periods of service between 
                the last day of the first period, as prescribed by 
                regulations of the Office, in which that individual is 
                eligible to enroll in the plan and the date on which 
                such individual becomes an annuitant;
        whichever is shorter; or
            ``(2) as a member of the family of an employee or 
        annuitant;
may continue that individual's enrollment under the conditions of 
eligibility prescribed by regulations of the Office. The Office may, in 
its sole discretion, waive the requirements of this subsection in the 
case of an individual who fails to satisfy such requirements if the 
Office determines that, due to exceptional circumstances, it would be 
against equity and good conscience not to allow such individual to be 
enrolled as an annuitant in a basic plan under this chapter.
    ``(c)(1) A former spouse may--
            ``(A) within 60 days after the dissolution of the marriage, 
        or
            ``(B) in the case of a former spouse of a former employee 
        whose marriage was dissolved after the employee's retirement, 
        within 60 days after the dissolution of the marriage or, if 
        later, within 60 days after an election is made under section 
        8339(j)(3) or 8417(b) for such former spouse by the retired 
        employee,
enroll in a basic plan under this chapter as an individual or for self 
and family (as provided in paragraph (2)), subject to agreeing to pay 
the employee and Government contributions which would be payable in the 
case of an employee enrolled in the same plan and level of benefits. 
The former spouse shall submit an enrollment application and make 
payments to the agency which, at the time of divorce or annulment, 
employed the employee to whom the former spouse was married or, in the 
case of a former spouse who is receiving annuity payments under section 
8341(h), 8345(j), 8445, or 8467, to the Office.
    ``(2) Coverage for self and family under this subsection shall be 
limited to--
            ``(A) the former spouse; and
            ``(B) unmarried dependent natural or adopted children of 
        the former spouse and the employee who are--
                    ``(i) under 22 years of age;
                    ``(ii) 22 years of age or older, but incapable of 
                self-support because of mental or physical disability 
                which existed before age 22; or
                    ``(iii) students (as described in section 
                8901(6)(C)) at least 22 but less than 23 years of age 
                (excluding anyone under clause (ii)).
``Sec. 8911a. Continued coverage for certain individuals
    ``(a) Any individual described in paragraph (1) or (2) of 
subsection (b) may elect to continue coverage under this chapter 
(including under the Governmentwide plan) in accordance with this 
section.
    ``(b) This section applies with respect to--
            ``(1) any employee who--
                    ``(A) is separated from service either voluntarily 
                or involuntarily, excluding an employee involuntarily 
                separated for gross misconduct (as defined under 
                regulations prescribed by the Office of Personnel 
                Management); and
                    ``(B) would not otherwise be eligible for any 
                benefits under this chapter (determined without regard 
                to any temporary extension of coverage and without 
                regard to any benefits available under a nongroup 
                contract); and
            ``(2) any individual who--
                    ``(A) ceases to meet the requirements for being 
                considered an unmarried dependent child under this 
                chapter;
                    ``(B) on the day before so ceasing to meet the 
                requirements referred to in subparagraph (A), was 
                covered under a basic plan under this chapter as a 
                member of the family of an employee or annuitant; and
                    ``(C) would not otherwise be eligible for any 
                benefits under this chapter (determined without regard 
                to any temporary extension of coverage and without 
                regard to any benefits available under a nongroup 
                contract).
    ``(c)(1) The Office shall prescribe regulations and provide for the 
inclusion of appropriate terms in contracts with carriers to provide 
that--
            ``(A) with respect to an employee who becomes (or will 
        become) eligible for continued coverage under this section as a 
        result of separation from service, the separating agency shall, 
        before the end of the 30-day period beginning on the date as of 
        which coverage (including any temporary extensions of coverage) 
        would otherwise end, notify the individual of such individual's 
        rights under this section; and
            ``(B) with respect to a child of an employee or annuitant 
        who becomes eligible for continued coverage under this section 
        as a result of ceasing to meet the requirements for being 
        considered a member of the employee's or annuitant's family--
                    ``(i) the employee or annuitant may provide written 
                notice of the child's change in status (complete with 
                the child's name, address, and such other information 
                as the Office may by regulation require)--
                            ``(I) to the employee's employing agency; 
                        or
                            ``(II) in the case of an annuitant, to the 
                        Office; and
                    ``(ii) if the notice referred to in clause (i) is 
                received within 60 days after the date as of which the 
                child involved first ceases to meet the requirements 
                involved, the employing agency or the Office (as the 
                case may be) must, within 14 days after receiving such 
                notice, notify the child of such child's rights under 
                this section.
    ``(2) In order to obtain continued coverage under this section, an 
appropriate written election (submitted in such manner as the Office by 
regulation prescribes) must be made--
            ``(A) in the case of an individual seeking continued 
        coverage based on a separation from service, before the end of 
        the 60-day period beginning on the later of--
                    ``(i) the effective date of the separation; or
                    ``(ii) the date the separated individual receives 
                the notice required under paragraph (1)(A); or
            ``(B) in the case of an individual seeking continued 
        coverage based on a change in circumstances making such 
        individual ineligible for coverage as an unmarried dependent 
        child, before the end of the 60-day period beginning on the 
        later of--
                    ``(i) the date as of which such individual first 
                ceases to meet the requirements for being considered an 
                unmarried dependent child; or
                    ``(ii) the date such individual receives notice 
                under paragraph (1)(B)(ii);
        except that if a parent fails to provide the notice required 
        under paragraph (1)(B)(i) in timely fashion, the 60-day period 
        under this subparagraph shall be based on the date under clause 
        (i), irrespective of whether or not any notice under paragraph 
        (1)(B)(ii) is provided.
    ``(d)(1)(A) An individual receiving continued coverage under this 
section shall be required to pay currently into the Fund, under 
arrangements satisfactory to the Office, an amount equal to the sum 
of--
            ``(i) the employee and Government contributions which would 
        be required in the case of an employee enrolled in the same 
        plan and level of benefits; and
            ``(ii) an amount, determined under regulations prescribed 
        by the Office, necessary for administrative expenses, but not 
        to exceed 2 percent of the total amount under clause (i).
    ``(B) Payments under this section to the Fund shall--
            ``(i) in the case of an individual whose continued coverage 
        is based on such individual's separation, be made through the 
        agency which last employed such individual; or
            ``(ii) in the case of an individual whose continued 
        coverage is based on a change in circumstances referred to in 
        subsection (c)(2)(B), be made through--
                    ``(I) the Office if, at the time coverage would 
                (but for this section) otherwise have been 
                discontinued, the individual was covered as the child 
                of an annuitant; or
                    ``(II) the employee's employing agency as of the 
                time referred to in subclause (I) if the individual was 
                covered as the child of an employee at such time.
    ``(2) If an individual elects to continue coverage under this 
section before the end of the applicable period under subsection 
(c)(2), but after such individual's coverage under this chapter 
(including any temporary extensions of coverage) expires, coverage 
shall be restored retroactively, with appropriate contributions 
(determined in accordance with paragraph (1)) and claims (if any), to 
the same extent and effect as though no break in coverage had occurred.
    ``(3)(A) An individual making an election under subsection 
(c)(2)(B) may, at such individual's option, elect coverage either as an 
individual or for self and family.
    ``(B) For the purpose of this paragraph, members of an individual's 
family shall be determined in the same way as would apply under this 
chapter in the case of an enrolled employee.
    ``(C) Nothing in this paragraph shall be considered to limit an 
individual making an election under subsection (c)(2)(A) to coverage 
for self alone.
    ``(e)(1) Continued coverage under this section may not extend 
beyond--
            ``(A) in the case of an individual whose continued coverage 
        is based on separation from service, the date which is 18 
        months after the effective date of the separation; or
            ``(B) in the case of an individual whose continued coverage 
        is based on ceasing to meet the requirements for being 
        considered an unmarried dependent child, the date which is 36 
        months after the date on which the individual first ceases to 
        meet those requirements, subject to paragraph (2).
    ``(2)(A) In the case of an individual described in subparagraph 
(B), extended coverage under this section may not extend beyond the 
date which is 36 months after the separation date referred to in 
subparagraph (B)(iii).
    ``(B) This paragraph applies with respect to any individual who--
            ``(i) ceases to meet the requirements for being considered 
        an unmarried dependent child;
            ``(ii) as of the day before so ceasing to meet the 
        requirements referred to in clause (i), was covered as the 
        child of a former employee receiving continued coverage under 
        this section based on the former employee's separation from 
        service; and
            ``(iii) so ceases to meet the requirements referred to in 
        clause (i) before the end of the 18-month period beginning on 
        the date of the former employee's separation from service.
    ``(f)(1) The Office shall prescribe regulations under which, in 
addition to any individual otherwise eligible for continued coverage 
under this section, and to the extent practicable, continued coverage 
may also, upon appropriate written application, be afforded under this 
section--
            ``(A) to any individual who--
                    ``(i) if subparagraphs (A) and (C) of paragraph 
                (10) of section 8901 were disregarded, would be 
                eligible to be considered a former spouse within the 
                meaning of such paragraph; but
                    ``(ii) would not, but for this subsection, be 
                eligible to be so considered; and
            ``(B) to any individual whose coverage as a family member 
        would otherwise terminate as a result of a legal separation.
    ``(2) The terms and conditions for coverage under the regulations 
shall include--
            ``(A) consistent with subsection (c), any necessary 
        notification provisions, and provisions under which an election 
        period of at least 60 days' duration is afforded;
            ``(B) terms and conditions identical to those under 
        subsection (d), except that contributions to the Fund shall be 
        made through such agency as the Office by regulation 
        prescribes;
            ``(C) provisions relating to the termination of continued 
        coverage, except that continued coverage under this section may 
        not (subject to paragraph (3)) extend beyond the date which is 
        36 months after the date on which the qualifying event under 
        this subsection (the date of divorce, annulment, or legal 
        separation, as the case may be) occurs; and
            ``(D) provisions designed to ensure that any coverage 
        pursuant to this subsection does not adversely affect any 
        eligibility for coverage which the individual might otherwise 
        have under this chapter (including as a result of any change in 
        personal circumstances) if this subsection had not been 
        enacted.
    ``(3) In the case of an individual--
            ``(A) who becomes eligible for continued coverage under 
        this subsection based on a divorce, annulment, or legal 
        separation from a person who, as of the day before the date of 
        the divorce, annulment, or legal separation (as the case may 
        be) was receiving continued coverage under this section for 
        self and family based on such person's separation from service; 
        and
            ``(B) whose divorce, annulment, or legal separation (as the 
        case may be) occurs before the end of the 18-month period 
        beginning on the date of the separation from service referred 
        to in subparagraph (A),
extended coverage under this section may not extend beyond the date 
which is 36 months after the date of the separation from service, as 
referred to in subparagraph (A).
``Sec. 8911b. Coverage for certain other employees
    ``(a)(1) An employee enrolled in a basic plan under this chapter 
who is placed in a leave without pay status may have such employee's 
coverage and the coverage of members of such employee's family 
continued under the plan for not to exceed 12 months under regulations 
prescribed by the Office of Personnel Management. The regulations may 
provide for the waiving of contributions by the employee.
    ``(2) An employee who enters on approved leave without pay to serve 
as a full-time officer or employee of an organization composed 
primarily of employees within 60 days after entering on that leave 
without pay, may file with such employee's employing agency an election 
to continue such employee's health benefits enrollment and arrange to 
pay currently into the Fund, through such employee's employing agency, 
both employee and agency contributions from the beginning of leave 
without pay. The employing agency shall forward the enrollment charges 
so paid to the Fund. If the employee does not so elect, such employee's 
enrollment will continue during nonpay status and end as provided by 
paragraph (1) and implementing regulations.
    ``(b)(1)(A) The Office shall prescribe regulations under which 
temporary employees (who meet the requirements of paragraph (2)) may 
enroll, either as an individual or for self and family, in a basic plan 
under this chapter.
    ``(B) To be eligible to enroll under this subsection, a temporary 
employee must have completed 12 months of current continuous 
employment, excluding any break in service of 5 days or less.
    ``(2) Any temporary employee enrolled in a basic plan under this 
subsection shall be responsible for paying, through withholdings from 
pay, both employee and Government contributions.
``Sec. 8911c. Coverage of restored employees and survivor or disability 
              annuitants
    ``(a) An employee enrolled in a basic plan under this chapter who 
is removed or suspended without pay and later reinstated or restored to 
duty on the ground that the removal or suspension was unjustified or 
unwarranted may, at such employee's option, enroll as a new employee or 
have such employee's coverage restored, with appropriate adjustments 
made in contributions and claims, to the same extent and effect as 
though the removal or suspension had not taken place.
    ``(b) A surviving spouse whose survivor annuity under this title 
was terminated because of remarriage and is later restored may, under 
such regulations as the Office of Personnel Management may prescribe, 
enroll in a basic plan under this chapter if such spouse was covered by 
any such plan immediately before such annuity was terminated.
    ``(c) A disability annuitant whose disability annuity under section 
8337 was terminated and is later restored under the second or third 
sentence of subsection (e) of such section may, under regulations 
prescribed by the Office, enroll in a basic plan under this chapter if 
such annuitant was covered by any such plan immediately before such 
annuity was terminated.
``Sec. 8911d. Double coverage; change in family status
    ``(a) If an employee, annuitant, or other individual eligible to 
enroll in a basic plan under this chapter has a spouse who is also 
eligible to enroll, either spouse, but not both, may enroll for self 
and family, or each spouse may enroll as an individual. However, an 
individual may not be covered both as an enrollee and as a family 
member.
    ``(b) An employee, annuitant, or other individual enrolled in a 
basic plan under this chapter may change such individual's coverage or 
that of the individual and members of such individual's family by an 
application filed within 60 days after a change in family status or at 
other times and under conditions prescribed by regulations of the 
Office of Personnel Management.
``Sec. 8911e. Clarifying provisions
    ``The following rules shall apply in administering the provisions 
of sections 8911 through 8911d:
            ``(1) In administering a provision which requires that an 
        individual currently be, or previously have been, enrolled in 
        (or covered under) a basic health benefits plan, as a condition 
        for continued enrollment or other treatment under this chapter, 
        enrollment in (or coverage under) a plan under this chapter (as 
        previously in effect) shall be treated as if it had been under 
        a basic health benefits plan.
            ``(2) In order to compute any remaining period of 
        eligibility for continued coverage (where eligibility is 
        limited to a specific term), any period of continued coverage 
        under this chapter (as previously in effect) shall be treated 
        as a period of continued coverage under a basic health benefits 
        plan.
            ``(3) The Office of Personnel Management shall prescribe 
        rules relating to procedures for continuing the coverage of an 
        individual who is last covered (before first starting continued 
        coverage under a basic health benefits plan, as an annuitant or 
        otherwise) under a health benefits plan under this chapter (as 
        previously in effect). The rules shall include provisions to 
        provide that if continued coverage is elected, but no basic 
        plan under this chapter is indicated, coverage shall be under 
        the Governmentwide plan.
            ``(4) The Office shall prescribe any other rules which may 
        be necessary to carry out the purposes of this section.
``Sec. 8912. Flexible spending plan
    ``The Office of Personnel Management shall by regulation provide 
for the establishment of a flexible spending plan. Such plan--
            ``(1) shall be available to employees with health insurance 
        coverage under this chapter;
            ``(2) shall be designed and maintained in a manner that 
        ensures that benefits--
                    ``(A) meet the requirements for exclusion from 
                gross income under section 105(b) of the Internal 
                Revenue Code of 1986; and
                    ``(B) are provided pursuant to salary reduction 
                agreements meeting the requirements of section 125 of 
                the Internal Revenue Code of 1986 for exclusion from 
                gross income;
            ``(3) shall require, as a condition for participation, that 
        the employee agree that the amounts deducted or withheld from 
        pay under the plan--
                    ``(A) shall be sufficient to pay the full amount of 
                the employee contributions for any basic or 
                supplementary health benefits plan in which the 
                employee is enrolled; and
                    ``(B) shall be used for that purpose;
            ``(4) shall provide that any amounts in excess of those 
        required under paragraph (3) may be used for any deductible, 
        copayment, coinsurance, or other amount for which the employee 
        is liable under a basic or supplementary health benefits plan; 
        and
            ``(5) shall provide that any amounts forfeited under the 
        plan shall be transferred to a separate account--
                    ``(A) which shall be within the Employees Health 
                Benefits Fund; and
                    ``(B) which shall be used for purposes of the 
                programs under section 8919(e).
``Sec. 8913. Federal Employees Health Benefits Board
    ``(a) There shall be established a Federal Employees Health 
Benefits Board.
    ``(b)(1) The Board shall be composed of 6 members, all of whom 
shall be appointed by the President, except that--
            ``(A) 2 shall be appointed taking into consideration any 
        recommendations made by the Speaker of the House of 
        Representatives after consultation with the minority leader of 
        the House of Representatives; and
            ``(B) 2 shall be appointed taking into consideration any 
        recommendations made by the majority leader of the Senate after 
        consultation with the minority leader of the Senate.
    ``(2) A member of the Board shall be appointed for a term of 4 
years, except that of the members first appointed--
            ``(A) 2 shall be appointed for a term of 3 years; and
            ``(B) 2 shall be appointed for a term of 2 years.
Terms of the members first appointed shall be specified by the 
President at the time of appointment.
    ``(3)(A) A vacancy on the Board shall be filled in the manner in 
which the original appointment was made.
    ``(B) An individual chosen to fill a vacancy shall be appointed for 
the unexpired term of the member replaced.
    ``(4) A member may continue to serve after the expiration of such 
member's term until a successor is appointed, but for not more than 12 
months.
    ``(5) A chairman shall be elected by the members of the Board.
    ``(6) Any appointment or recommendation under this subsection shall 
be made from among individuals who--
            ``(A) represent organizations representing substantial 
        numbers of employees or annuitants; and
            ``(B) are generally recognized for their knowledge and 
        experience in the field of health insurance, health care, or 
        employee compensation.
    ``(c) In carrying out their responsibilities under this chapter, 
members of the Board shall act solely in the interest of individuals 
participating in the Governmentwide plan.
    ``(d) The Board may--
            ``(1) appoint such personnel as may be necessary; and
            ``(2) procure the services of experts or consultants in 
        accordance with section 3109.
``Sec. 8914. Employees Health Benefits Fund
    ``(a) There is in the Treasury of the United States an Employees 
Health Benefits Fund which is administered by the Office of Personnel 
Management. All contributions of enrollees and the Government made 
under this chapter shall be paid into the Fund. The Fund is available--
            ``(1) without fiscal year limitation for benefits payable 
        under the Governmentwide plan and all payments to approved 
        health benefits plans under section 8908 or 8909; and
            ``(2) to pay expenses for administering this chapter within 
        the limitations that may be specified annually by Congress.
    ``(b)(1) Portions of the contributions made by enrollees in any of 
the basic health benefits plans and by the Government on their behalf 
shall be regularly set aside in the Fund as follows:
            ``(A) From contributions for the Governmentwide plan, those 
        portions allocable to defraying the cost of administering such 
        plan and maintaining a contingency reserve for such plan, 
        respectively, as determined under section 8905(a).
            ``(B) From the contributions for each of the other basic 
        plans under this chapter, a percentage (not to exceed the 
        percentage of the total enrollment charge under the 
        Governmentwide plan allocable to defraying administrative costs 
        attributable to such plan) determined by the Office to be 
        reasonably adequate to pay the administrative costs 
        attributable to the basic plan involved.
    ``(2) The Office, from time to time and in amounts it considers 
appropriate, may transfer unused funds for administrative expenses of 
the Governmentwide plan to the contingency reserve of such plan. Such 
contingency reserve may be used to defray increases in future rates 
under, or may be applied to reduce the contributions of enrollees and 
the Government to, the Governmentwide plan, as the Office shall from 
time to time determine.
    ``(3)(A) Of any amounts paid into the Fund for administrative 
expenses, 90 percent shall be available for expenses incurred by the 
Office and 10 percent shall be available for expenses incurred by the 
Board.
    ``(B) The Office, from time to time and in amounts it considers 
appropriate, may transfer any unused funds for administrative expenses 
of the respective basic health benefits plans to the account 
established under section 8912(5) to subsidize the programs under 
section 8919(e).
    ``(c) The Secretary of the Treasury may invest and reinvest any of 
the money in the Fund in interest-bearing obligations of the United 
States, and may sell these obligations for the purposes of the Fund. 
The interest on and the proceeds from the sale of these obligations 
become a part of the Fund.
    ``(d) When the assets, liabilities, and membership of employee 
organizations sponsoring or underwriting plans approved under section 
8909 are merged, the assets and liabilities of the plans sponsored or 
underwritten by the merged organizations shall be transferred at the 
beginning of the contract term next following the date of the merger to 
the plan sponsored or underwritten by the successor organization. Each 
employee, annuitant, former spouse, or person having continued coverage 
under section 8911a affected by a merger shall be transferred to the 
plan sponsored or underwritten by the successor organization unless he 
enrolls in another supplementary plan under this chapter.
``Sec. 8915. Debarment and other sanctions against providers
    ``(a)(1) For the purpose of this section, an individual or entity 
shall be considered to have been convicted of a criminal offense if--
            ``(A) a judgment of conviction for such offense has been 
        entered against the individual or entity by a Federal, State, 
        or local court;
            ``(B) there has been a finding of guilt against the 
        individual or entity by a Federal, State, or local court with 
        respect to such offense;
            ``(C) a plea of guilty or nolo contendere by the individual 
        or entity has been accepted by a Federal, State, or local court 
        with respect to such offense; or
            ``(D) in the case of an individual, the individual has 
        entered a first offender or other program pursuant to which a 
        judgment of conviction for such offense has been withheld;
without regard to the pendency or outcome of any appeal (other than a 
judgment of acquittal based on innocence) or request for relief on 
behalf of the individual or entity.
    ``(2)(A) Notwithstanding any other provision of this chapter, if a 
provider is barred under subsection (b) or (c) from participating in 
the program under this chapter, no payment may be made by any basic or 
supplementary plan under this chapter (to such provider or by 
reimbursement) for any service or supply furnished by such provider 
during the period of the debarment.
    ``(B) Each contract under this chapter shall contain such 
provisions as may be necessary to carry out subparagraph (A) and the 
other provisions of this section.
    ``(b) The Office of Personnel Management may bar the following 
providers of health care services or supplies from participating in the 
program under this chapter:
            ``(1) Any provider that has been convicted, under Federal 
        or State law, of a criminal offense relating to fraud, 
        corruption, breach of fiduciary responsibility, or other 
        financial misconduct in connection with the delivery of a 
        health care service or supply.
            ``(2) Any provider that has been convicted, under Federal 
        or State law, of a criminal offense relating to neglect or 
        abuse of patients in connection with the delivery of a health 
        care service or supply.
            ``(3) Any provider that has been convicted, under Federal 
        or State law, in connection with the interference with or 
        obstruction of an investigation or prosecution of a criminal 
        offense described in paragraph (1) or (2).
            ``(4) Any provider that has been convicted, under Federal 
        or State law, of a criminal offense relating to the unlawful 
        manufacture, distribution, prescription, or dispensing of a 
        controlled substance.
            ``(5) Any provider--
                    ``(A) whose license to provide health care services 
                or supplies has been revoked, suspended, restricted, or 
                not renewed, by a State licensing authority for reasons 
                relating to the provider's professional competence, 
                professional performance, or financial integrity; or
                    ``(B) that surrendered such a license while a 
                formal disciplinary proceeding was pending before such 
                an authority, if the proceeding concerned the 
                provider's professional competence, professional 
                performance, or financial integrity.
    ``(c) Whenever the Office determines--
            ``(1) in connection with a claim presented under this 
        chapter, that a provider of health care services or supplies--
                    ``(A) has charged for health care services or 
                supplies that the provider knows or should have known 
                were not provided as claimed; or
                    ``(B) has charged for health care services or 
                supplies in an amount substantially in excess of such 
                provider's customary charges for such services or 
                supplies, or charged for health care services or 
                supplies which are substantially in excess of the needs 
                of the covered individual or which are of a quality 
                that fails to meet professionally recognized standards 
                for such services or supplies;
            ``(2) that a provider of health care services or supplies 
        has knowingly made, or caused to be made, any false statement 
        or misrepresentation of a material fact which is reflected in a 
        claim presented under this chapter; or
            ``(3) that a provider of health care services or supplies 
        has knowingly failed to provide any information required by the 
        Office, a carrier, or other person administering a plan under 
        this chapter to determine whether a payment or reimbursement is 
        payable under this chapter or the amount of any such payment or 
        reimbursement;
the Office may, in addition to any other penalties that may be 
prescribed by law, and after consultation with the Attorney General, 
impose a civil monetary penalty of not more than $10,000 for any item 
or service involved. In addition, such a provider shall be subject to 
an assessment of not more than twice the amount claimed for each such 
item or service. In addition, the Office may make a determination in 
the same proceeding to bar such provider from participating in the 
program under this chapter.
    ``(d) The Office--
            ``(1) may not initiate any debarment proceeding against a 
        provider, based on such provider's having been convicted of a 
        criminal offense, later than 6 years after the date on which 
        such provider is so convicted; and
            ``(2) may not initiate any action relating to a civil 
        penalty, assessment, or debarment under this section, in 
        connection with any claim, later than 6 years after the date 
        the claim is presented, as determined under regulations 
        prescribed by the Office.
    ``(e) In making a determination relating to the appropriateness of 
imposing or the period of any debarment under this section, or the 
appropriateness of imposing or the amount of any civil penalty or 
assessment under this section, the Office shall take into account--
            ``(1) the nature of any claims involved and the 
        circumstances under which they were presented;
            ``(2) the degree of culpability, history of prior offenses 
        or improper conduct of the provider involved; and
            ``(3) such other matters as justice may require.
    ``(f)(1) The debarment of a provider under subsection (b) or (c) 
shall be effective at such time and upon such reasonable notice to such 
provider, covered individuals, carriers, and other persons as may be 
specified in regulations prescribed by the Office.
    ``(2)(A) Except as provided in subparagraph (B), a debarment shall 
be effective with respect to any health care services or supplies 
furnished by a provider on or after the effective date of such 
provider's debarment.
    ``(B) A debarment shall not apply with respect to inpatient 
institutional services furnished to an individual who was admitted to 
the institution before the date the debarment would otherwise become 
effective until the passage of 30 days after such date, unless the 
Office determines that the health or safety of the individual receiving 
those services warrants that a shorter period, or that no such period, 
be afforded.
    ``(3) Any notice referred to in paragraph (1) shall specify the 
date as of which debarment becomes effective and the minimum period of 
time for which such debarment is to remain effective.
    ``(4)(A) A provider barred from participating in the program under 
this chapter may, after the expiration of the minimum period of 
debarment referred to in paragraph (3), apply to the Office, in such 
manner as the Office may by regulation prescribe, for termination of 
the debarment.
    ``(B) The Office may--
            ``(i) terminate the debarment of a provider, pursuant to an 
        application filed by such provider after the end of the minimum 
        debarment period, if the Office determines, based on the 
        conduct of the applicant, that--
                    ``(I) there is no basis under subsection (b) or (c) 
                for continuing the debarment; and
                    ``(II) there are reasonable assurances that the 
                types of actions which formed the basis for the 
                original debarment have not recurred and will not 
                recur; or
            ``(ii) notwithstanding any provision of subparagraph (A), 
        terminate the debarment of a provider, pursuant to an 
        application filed by such provider before the end of the 
        minimum debarment period, if the Office determines that--
                    ``(I) based on the conduct of the applicant, the 
                requirements of subclauses (I) and (II) of clause (i) 
                have been met; and
                    ``(II) early termination under this clause is 
                warranted based on the fact that the provider is the 
                sole community provider or the sole source of essential 
                specialized services in a community, or other similar 
                circumstances.
    ``(5) The Office shall--
            ``(A) promptly notify the appropriate State or local agency 
        or authority having responsibility for the licensing or 
        certification of a provider barred from participation in the 
        program under this chapter of the fact of the debarment, as 
        well as the reasons for such debarment;
            ``(B) request that appropriate investigations be made and 
        sanctions invoked in accordance with applicable law and policy; 
        and
            ``(C) request that the State or local agency or authority 
        keep the Office fully and currently informed with respect to 
        any actions taken in response to the request.
    ``(6) The Office shall, upon written request and payment of a 
reasonable charge to defray the cost of complying with such request, 
furnish a current list of any providers barred from participating in 
the program under this chapter, including the minimum period of time 
remaining under the terms of each provider's debarment.
    ``(g)(1) The Office may not make a determination under subsection 
(b) or (c) adverse to a provider of health care services or supplies 
until such provider has been given written notice and an opportunity 
for a hearing on the record. A provider is entitled to be represented 
by counsel, to present witnesses, and to cross-examine witnesses 
against the provider in any such hearing.
    ``(2) Notwithstanding section 8918 any person adversely affected by 
a final decision under paragraph (1) may obtain review of such decision 
in the United States Court of Appeals for the Federal Circuit. A 
written petition requesting that the decision be modified or set aside 
must be filed within 60 days after the date on which such person is 
notified of such decision.
    ``(3) Matters that were raised or that could have been raised in a 
hearing under paragraph (1) or an appeal under paragraph (2) may not be 
raised as a defense to a civil action by the United States to collect a 
penalty or assessment imposed under this section.
    ``(h) A civil action to recover civil monetary penalties or 
assessments under subsection (c) shall be brought by the Attorney 
General in the name of the United States, and may be brought in the 
United States district court for the district where the claim involved 
was presented or where the person subject to the penalty resides. 
Amounts recovered under this section shall be paid to the Office for 
deposit into the Fund.
    ``(i) The Office shall prescribe regulations under which, with 
respect to services or supplies furnished by a debarred provider to a 
covered individual during the period of such provider's debarment, 
payment or reimbursement under this chapter may be made, 
notwithstanding the fact of such debarment, if such individual did not 
know or could not reasonably be expected to have known of the 
debarment. In any such instance, the carrier or other administrative 
entity involved shall take appropriate measures to ensure that the 
individual is informed of the debarment and the minimum period of time 
remaining under the terms of the debarment.
``Sec. 8916. Open enrollment periods; informational requirements
    ``(a)(1) Under regulations which it shall prescribe, the Office of 
Personnel Management shall, before the start of each administrative 
year, provide a period of not less than 3 weeks during which--
            ``(A) any eligible individual may elect to become enrolled 
        in a basic or supplementary plan under this chapter, or begin 
        participating in the flexible spending plan under section 8912;
            ``(B) an individual enrolled in a basic or supplementary 
        plan under this chapter may elect to terminate the enrollment, 
        transfer to another such plan, or make any other change in the 
        terms or conditions of such individual's enrollment which is 
        allowable; and
            ``(C) any individual participating in the flexible spending 
        plan under section 8912 may elect to cease participating in 
        such plan or make any other change allowable with respect to 
        such plan.
    ``(2) In addition to any opportunity afforded under paragraph (1), 
an individual enrolled in a basic plan under this chapter shall be 
permitted to transfer such individual's enrollment to another such 
plan, cancel such enrollment, or make any other election allowable 
under this chapter at such other times and subject to such conditions 
as the Office may by regulation prescribe.
    ``(b)(1) The Office shall make available to each individual 
eligible to enroll in a basic plan under this chapter such information, 
in a form acceptable to the Office (after consultation with the 
carrier, if any), as may be necessary to enable the individual to make 
an informed choice with respect to such plans and supplementary plans 
under this chapter.
    ``(2) Each enrollee in a basic or supplementary health benefits 
plan shall be issued an appropriate document setting forth or 
summarizing--
            ``(A) the services or benefits, including maximums, 
        limitations, and exclusions, to which the enrollee or the 
        enrollee and any covered family members are entitled 
        thereunder;
            ``(B) the procedure for obtaining benefits; and
            ``(C) the principal provisions of the plan affecting the 
        enrollee and any eligible family members.
    ``(3)(A) In addition to any informational requirements otherwise 
provided for under this subsection, regulations prescribed by the 
Office shall include provisions to ensure that each employee eligible 
to enroll in a basic plan under this chapter (whether actually enrolled 
or not) is notified in writing as to the rights afforded under section 
8911a.
    ``(B) Notification under this paragraph shall be provided by 
employing agencies at an appropriate point in time before each period 
under subsection (b)(1), so that employees may be aware of their rights 
under section 8911a when making enrollment decisions during such 
period.
``Sec. 8917. Studies, reports, and audits
    ``(a) The Office of Personnel Management shall make a continuing 
study of the operation and administration of this chapter, including 
surveys and reports on basic and supplementary health benefits plans 
available to employees and on the experience of the plans.
    ``(b) In carrying out this section, the Office shall, on an annual 
basis, compile statistics and submit to the Board a written report 
describing--
            ``(1) the degree to which the basic and supplementary 
        health benefits plans are utilized during the period covered by 
        the report; and
            ``(2) the overall cost to the Government associated with 
        providing each of those types of benefits during that period.
    ``(c) Each contract entered into under this chapter with a carrier 
shall contain provisions requiring such carrier to--
            ``(1) furnish such reasonable reports as the Office 
        determines to be necessary to enable it to carry out its 
        functions under this chapter; and
            ``(2) permit the Office and representatives of the General 
        Accounting Office to examine records of the carrier as may be 
        necessary to carry out the purposes of this chapter.
    ``(d) Each Government agency shall keep such records, make such 
certifications, and furnish the Office with such information and 
reports as may be necessary to enable the Office to carry out its 
functions under this chapter.
``Sec. 8918. Jurisdiction of courts
    ``The district courts of the United States have original 
jurisdiction, concurrent with the United States Claims Court, of a 
civil action or claim against the United States founded on this 
chapter.
``Sec. 8919. Regulations
    ``(a) The Office of Personnel Management may prescribe regulations 
necessary to carry out this chapter, except to the extent that 
regulatory authority is specifically assigned to another agency.
    ``(b) The regulations of the Office may prescribe the time at which 
and the manner and conditions under which an employee is eligible to 
enroll in a basic or supplementary plan under this chapter. The 
regulations may exclude an employee on the basis of the nature and type 
of his employment or conditions pertaining to it, such as short-term 
appointment, seasonal or intermittent employment, and employment of 
like nature. The Office may not exclude--
            ``(1) an employee or group of employees solely on the basis 
        of the hazardous nature of employment;
            ``(2) a teacher in the employ of the Board of Education of 
        the District of Columbia, whose pay is fixed by section 1501 of 
        title 31, District of Columbia Code, on the basis of the fact 
        that the teacher is serving under a temporary appointment if 
        the teacher has been so employed by the Board for a period or 
        periods totaling not less than two school years;
            ``(3) an employee who is occupying a position on a part-
        time career employment basis (as defined in section 3401(2)); 
        or
            ``(4) an employee who is employed on a temporary basis and 
        is eligible under section 8911b(b).
    ``(c) The regulations of the Office shall provide for the beginning 
and ending dates of coverage (including for family members) under basic 
and supplementary health benefit plans. The regulations may permit the 
coverage to continue, exclusive of the temporary extension of coverage 
under section 8907(b)(3) or 8910(c)(2) and any nongroup coverage, until 
the end of the pay period in which an employee is separated from the 
service, or until the end of the month in which an annuitant or former 
spouse ceases to be entitled to annuity, and in case of the death of an 
employee or annuitant, may permit a temporary extension of the coverage 
of members of his family for not to exceed 90 days.
    ``(d) The Secretary of Agriculture shall prescribe regulations to 
effect the application and operation of this chapter to an individual 
named by section 8901(1)(F).
    ``(e) The regulations of the Office shall provide for the 
establishment of--
            ``(1) smoking-cessation and weight-control programs;
            ``(2) high-blood-pressure and cancer-screening programs; 
        and
            ``(3) other `wellness programs' for Federal employees.
    ``(f)(1) The Office shall prescribe such regulations as may be 
necessary to ensure that, for any annuitant eligible to receive 
benefits both under this chapter and under part A or B of title XVIII 
of the Social Security Act, deductibles and coinsurance or copayment 
amounts under this chapter shall be waived to the same extent as 
occurred immediately before the date of enactment of the Federal 
Employees Health Benefits Reform Act of 1993.
    ``(2) When an individual is eligible for benefits under this 
chapter which would be duplicative of benefits under part A or B of 
title XVIII of the Social Security Act, the primary payer shall be the 
same as would have been the case in those same circumstances 
immediately before the date referred to in paragraph (1).
``Sec. 8920. Effect of other statutes
    ``Any provision of law outside of this chapter which provides 
coverage or any other benefit under this chapter to any individuals who 
(based on their being employed by an entity other than the Government) 
would not otherwise be eligible for any such coverage or benefit shall 
not apply with respect to any individual appointed, transferred, or 
otherwise commencing that type of employment on or after October 1, 
1988.''.

SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS.

    (a) The last sentence of section 1840(d)(1) of the Social Security 
Act (42 U.S.C. 1395s(d)(1)) is amended--
            (1) by striking ``8903 or 8903a'' and inserting ``paragraph 
        (1) or (2) of section 8903''; and
            (2) by striking ``8906'' and inserting ``8905''.
    (b) Section 613(c) of the Alaska Railroad Transfer Act of 1982 (45 
U.S.C. 1212(c)) is repealed.
    (c)(1) Section 832 of the Foreign Service Act of 1980 (22 U.S.C. 
4069c) and section 16 of the Central Intelligence Agency Act of 1949 
(50 U.S.C. 403p) are each amended--
            (A) by amending subparagraph (B) of subsection (b)(1) to 
        read as follows:
            ``(B) arranges to pay currently into the Employees Health 
        Benefits Fund under section 8914 of title 5, United States 
        Code, an amount equal to the sum which would be required under 
        section 8911a(d)(1)(A) of such title.''; and
            (B) by amending subsection (e) to read as follows:
    ``(e) For purposes of this section, the term `health benefits plan' 
means a health benefits plan described in paragraph (1) or (2) of 
section 8903 of title 5, United States Code.''.
    (2) Section 833 of the Foreign Service Act of 1980 (22 U.S.C. 
4069c-1) is repealed.
    (d) Section 104(e) of the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450i(e)) is amended--
            (1) in the matter before paragraph (1) by striking ``8914'' 
        and inserting ``8920''; and
            (2) in paragraph (3) by striking ``8909'' and inserting 
        ``8914''.

SEC. 4. EFFECTIVE DATE; SAVINGS PROVISIONS; COORDINATION.

    (a) Effective Date.--
            (1) In general.--This Act and the amendments made by this 
        Act shall take effect at the beginning of the first fiscal year 
        beginning at least 12 months after the date of enactment of 
        this Act.
            (2) Special rule.--In order to facilitate the timely 
        implementation of the health benefits program provided for by 
        this Act, members of the Federal Employees Health Benefits 
        Board may be appointed at any time on or after the first day of 
        the ninth month preceding the effective date under paragraph 
        (1), and, once constituted, the Board may exercise any 
        authority which would be available to it if the amendments made 
        by this Act were then in effect.
    (b) Savings Provisions.--
            (1) Claims.--For purposes of determining the rights of any 
        individual covered by a health benefits plan immediately before 
        the effective date of this Act, and the obligations of the 
        carrier offering such plan, the provisions of chapter 89 of 
        title 5, United States Code, and any contract thereunder, as in 
        effect immediately before such effective date, shall continue 
        to apply in the same way as if an election to transfer coverage 
        to another such plan had been made by or with respect to such 
        individual during the period last afforded before such 
        effective date under section 8905(f)(1) of such title (as then 
        in effect).
            (2) Debarments.--
                    (A) Orders.--Any debarment order issued under 
                section 8902a of title 5, United States Code, before 
                this Act takes effect shall continue in effect, 
                according to its terms, unless modified, terminated, or 
                superseded in accordance with applicable succeeding 
                provisions of law.
                    (B) Proceedings.--Nothing in this Act shall affect 
                any administrative proceeding pending under such 
                section 8902a at the time this Act takes effect. Orders 
                shall be issued in such proceedings and appeals shall 
                be taken therefrom as if this Act had not been enacted.
    (c) Coordination.--The Office of Personnel Management shall 
prescribe regulations to ensure that, after the effective date of this 
Act, any class of individuals who would then otherwise have been 
entitled to any coverage, rights, or benefits under chapter 89 of title 
5, United States Code, but who (because of this Act) would cease to be 
so entitled, shall be allowed to participate in the program established 
by this Act.

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