[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1384 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                S. 1384

  To amend title 5, United States Code, to make the Federal Employees 
Health Benefits Program available to the general public, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 6, 1997

  Mr. Daschle introduced the following bill; which was read twice and 
           referred to the Committee on Governmental Affairs

_______________________________________________________________________

                                 A BILL


 
  To amend title 5, United States Code, to make the Federal Employees 
Health Benefits Program available to the general public, and for other 
                               purposes.

    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 ``Accessible Health Coverage Act''.

SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE GENERAL PUBLIC.

    (a) In General.--Chapter 89 of title 5, United States Code, is 
amended by adding at the end the following:
``Sec. 8915. Individual access to coverage
    ``(a) In General.--A contract may not be made or a plan approved 
unless the carrier agrees to offer to eligible individuals, throughout 
each term for which the contract or approval remains effective, the 
same benefits (subject to the same maximums, limitations, exclusions, 
and other similar terms or conditions) as would be offered under such 
contract or plan to employees and annuitants and their family members.
    ``(b) Eligible Individuals.--An individual shall be eligible to 
enroll under a plan or contract under this chapter if such individual--
            ``(1) is not eligible to be enrolled in a group health plan 
        (as such term is defined in section 2791(a) of the Public 
        Health Service Act (42 U.S.C. 300gg-1(a));
            ``(2) provides the Office with documentation that such 
        individual has been denied individual health insurance coverage 
        (as such term is defined in section 2791(b)(5) of the Public 
        Health Service Act (42 U.S.C. 300gg-1(b)(5));
            ``(3) during the 6-month period prior to the date on which 
        such individual attempts to enroll under such plan or contract, 
        was not eligible for coverage through a State high-risk health 
        insurance pool or coverage through a health insurer of last 
        resort;
            ``(4) is not eligible for medical assistance under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and
            ``(5) meets such other requirements as the Office, by 
        regulation, may impose.
    ``(c) Enrollment.--The Office shall provide for the implementation 
of procedures to provide for an annual open enrollment period during 
which individuals may enroll with a plan or contract for coverage under 
this section.
    ``(d) Premiums.--
            ``(1) In general.--Premiums for coverage under this section 
        shall be established in conformance with such requirements as 
        the Office shall by regulation prescribe, including provisions 
        to ensure conformance with generally accepted standards and 
        practices associated with community rating.
            ``(2) Limitation.--With respect to coverage under a health 
        plan or contract under this section, the Office, in 
        establishing premiums under paragraph (1), shall ensure that 
        the monthly premium for coverage under this section does not 
        exceed 200 percent of the monthly premium otherwise applicable 
        for the coverage of employees and annuitants and their family 
members under such health plan or contract under this chapter.
    ``(e) Adjustment in Agency Contributions.--
            ``(1) Annual reporting.--Each carrier shall maintain 
        separate records with respect to individuals covered under this 
        section and employees and annuitants (and their family members) 
        otherwise covered under this chapter, and shall annually report 
        to the Office the amount which the carrier paid (including 
        claims and administrative costs) with respect to coverage 
        provided to individuals under this section.
            ``(2) Determination by office.--If, based on the reports 
        received under paragraph (1), the Office determines that the 
        average cost of providing coverage to individuals under this 
        section exceeds 200 percent of the premiums paid by such 
        individuals for such coverage, the Office shall increase the 
        biweekly Government contribution for coverage otherwise 
        provided under this chapter by an amount equal to such excess 
        amount.
    ``(f) Contributions and Benefits.--
            ``(1) In general.--In no event shall the enactment of this 
        section result in--
                    ``(A) any increase in the level of individual 
                contributions by employees or annuitants as required 
                under section 8906 or under any other provision of this 
                chapter, including copayments or deductibles;
                    ``(B) the payment by the Government of any premiums 
                associated with coverage under this section except for 
                the increase described in subsection (e)(2);
                    ``(C) any decrease in the types of benefits offered 
                under this chapter; or
                    ``(D) any other change that would adversely affect 
                the coverage afforded under this chapter to employees 
                and annuitants and their family members.
            ``(2) Limitation.--Coverage under this section shall be 
        provided on an individual, not a family basis.
    ``(g) Individuals Eligible for Medicare.--Benefits under this 
section shall, with respect to an individual who is entitled to 
benefits under part A of title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), be offered (for use in coordination with those 
Social Security benefits) to the same extent and in the same manner as 
if coverage were under the preceding provisions of this chapter, rather 
than under this section.
    ``(h) Exclusion of Certain Carriers.--
            ``(1) In general.--A carrier may file an application with 
        the Office setting forth reasons why such carrier, or a plan 
        provided by such carrier, should be excluded from the 
        requirements of this section.
            ``(2) Consideration of factors.--In reviewing an 
        application under paragraph (1), the Office may consider such 
        factors as--
                    ``(A) any bona fide enrollment restrictions which 
                would make the application of this section 
                inappropriate, including those common to plans which 
                are limited to individuals having a past or current 
                employment relationship with a particular agency or 
                other authority of the Government;
                    ``(B) whether compliance with this section would 
                jeopardize the financial solvency of the plan or 
                carrier, or otherwise compromise its ability to offer 
                health benefits under the preceding provisions of this 
                chapter; and
                    ``(C) the anticipated duration of the requested 
                exclusion, and what efforts the plan or carrier 
                proposes to take in order to be able to comply with 
                this section.
    ``(i) Application of Section.--Except as the Office may by 
regulation prescribe, any reference to this chapter (or any requirement 
of this chapter), made in any provision of law, shall not be considered 
to include this section (or any requirement of this section).
    ``(j) Termination.--This section shall terminate on the date that 
is 10 years after the date of enactment of this section.''.
    (b) Conforming Amendment.--The table of sections for chapter 89 of 
title 5, United States Code, is amended by adding at the end the 
following:

``8915. Individual access to coverage.''.
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