[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 3173 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 3173

 To amend title 5, United States Code, to establish a national health 
  program administered by the Office of Personnel Management to offer 
   Federal employee health benefits plans to individuals who are not 
               Federal employees, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 9, 2002

  Mr. Durbin 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 establish a national health 
  program administered by the Office of Personnel Management to offer 
   Federal employee health benefits plans to individuals who are not 
               Federal employees, 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 ``Offering People True Insurance 
Options Nationwide Act of 2002''.

SEC. 2. OPTION HEALTH INSURANCE.

    Subpart G of part III of title 5, United States Code, is amended by 
adding at the end the following:

       ``CHAPTER 90A--HEALTH INSURANCE FOR NON-FEDERAL EMPLOYEES

``Sec.
``9051. Definitions.
``9052. Health insurance for non-Federal employees.
``9053. Contract requirement.
``9054. Eligibility.
``9055. Alternative conditions to Federal employee plans.
``9056. Coordination with social security benefits.
``9057. Non-Federal employer participation.
``Sec. 9051. Definitions
    ``In this chapter--
            ``(1) the terms defined under section 8901 shall have the 
        meanings given such terms under that section; and
            ``(2) the term `Office' means the Office of Personnel 
        Management.
``Sec. 9052. Health insurance for non-Federal employees
    ``(a) The Office of Personnel Management shall administer a health 
insurance program for non-Federal employees in accordance with this 
chapter.
    ``(b) Except as provided under this chapter, the Office shall 
prescribe regulations to apply the provisions of chapter 89 to the 
greatest extent practicable to eligible individuals covered under this 
chapter.
    ``(c) In no event shall the enactment of this chapter result in--
            ``(1) any increase in the level of individual or Government 
        contributions required under chapter 89, including copayments 
        or deductibles;
            ``(2) any decrease in the types of benefits offered under 
        chapter 89; or
            ``(3) any other change that would adversely affect the 
        coverage afforded under chapter 89 to employees and annuitants 
        and members of family under that chapter.
    ``(d) The Office shall develop methods to facilitate enrollment 
under this chapter, including the use of the Internet.
    ``(e) The Office may enter into contracts for the performance of 
appropriate administrative functions under this chapter.
``Sec. 9053. Contract requirement
    ``(a) Each contract entered into under section 8902 shall require a 
carrier to offer to eligible individuals under this chapter, throughout 
each term for which the contract 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 
applicable health benefits plan to employees, annuitants, and members 
of family.
    ``(b)(1) The Office may waive the requirements of this section, if 
the Office determines, based on a petition submitted by a carrier 
that--
            ``(A) the carrier is unable to offer the applicable health 
        benefits plan because of a limitation in the capacity of the 
        plan to deliver services or assure financial solvency;
            ``(B) the applicable health benefits plan is not sponsored 
        by a carrier licensed under applicable State law; or
            ``(C) bona fide enrollment restrictions make the 
        application of this chapter inappropriate, including 
        restrictions 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.
    ``(2) The Office may require a petition under this subsection to 
include--
                    ``(A) a description of the efforts the carrier 
                proposes to take in order to offer the applicable 
                health benefits plan under this chapter; and
                    ``(B) the proposed date for offering such a health 
                benefits plan.
    ``(3) A waiver under this subsection may be for any period 
determined by the Office. The Office may grant subsequent waivers under 
this section.
``Sec. 9054. Eligibility
    ``An individual shall be eligible to enroll in a plan under this 
chapter, unless the individual is enrolled or eligible to enroll in a 
plan under chapter 89.
``Sec. 9055. Alternative conditions to Federal employee plans
    ``(a) For purposes of enrollment in a health benefits plan under 
this chapter, an individual who had coverage under a health insurance 
plan and is not a qualified beneficiary as defined under section 
4980B(g)(1) of the Internal Revenue Code of 1986 shall be treated in a 
similar manner as an individual who begins employment as an employee 
under chapter 89.
    ``(b) In the administration of this chapter, covered individuals 
under this chapter shall be in a risk pool separate from covered 
individuals under chapter 89.
    ``(c)(1) Each contract under this chapter may include a preexisting 
condition exclusion as defined under section 9801(b)(1) of the Internal 
Revenue Code of 1986.
    ``(2)(A) The preexisting condition exclusion under this subsection 
shall provide for coverage of a preexisting condition to begin not more 
than 1 year after the date of coverage of an individual under a health 
benefits plan, reduced by 1 month for each month that individual was 
covered under a health insurance plan immediately preceding the date 
the individual submitted an application for coverage under this 
chapter.
    ``(B) For purposes of this paragraph, a lapse in coverage of not 
more than 63 days immediately preceding the date of the submission of 
an application for coverage shall not be considered a lapse in 
continuous coverage.
    ``(d)(1) Rates charged and premiums paid for a health benefits plan 
under this chapter--
            ``(A) may be adjusted and differ from such rates charged 
        and premiums paid for the same health benefits plan offered 
        under chapter 89;
            ``(B) shall be negotiated in the same manner as negotiated 
        under chapter 89; and
            ``(C) shall be adjusted to cover the administrative costs 
        of this chapter.
    ``(2) In determining rates and premiums under this chapter--
            ``(A) the age of covered individuals may be considered; and
            ``(B) rebates or lower rates and premiums shall be set to 
        encourage longevity of coverage.
    ``(e) No Government contribution shall be made for any covered 
individual under this chapter.
    ``(f) If an individual who is enrolled in a health benefits plan 
under this chapter terminates the enrollment, the individual shall not 
be eligible for reenrollment until the first open enrollment period 
following 6 months after the date of such termination.
``Sec. 9056. Coordination with social security benefits
    ``Benefits under this chapter shall, with respect to an individual 
who is entitled to benefits under part A of title XVIII of the Social 
Security Act, be offered (for use in coordination with those social 
security benefits) to the same extent and in the same manner as if 
coverage were under chapter 89.
``Sec. 9057. Non-Federal employer participation
    ``(a) In this section the term--
            ``(1) `employee', notwithstanding section 9051, means an 
        employee of a non-Federal employer;
            ``(2) `non-Federal employer' means an employer that is not 
        the Federal Government; and
            ``(3) `total premium amount' means the total premiums for 
        individual coverage for the health benefits plan under which 
        the employee is enrolled, regardless of whether the employee is 
        enrolled as an individual or for self and family.
    ``(b)(1) The Office shall prescribe regulations under which non-
Federal employers may participate under this chapter, including--
            ``(A) the offering of health benefits plans under this 
        chapter to employees through participating non-Federal 
        employers; and
            ``(B) a requirement for participating non-Federal employer 
        contributions to the payment of premiums for employees who 
        enroll in a health benefits plan under this chapter.
    ``(2) A participating non-Federal employer shall pay an employer 
contribution for the premiums of an employee or other applicable 
covered individual as follows:
            ``(A) A non-Federal employer that employs not more than 2 
        employees shall not be required to pay an employer 
        contribution.
            ``(B) A non-Federal employer that employs more than 2 and 
        not more than 25 employees shall pay not less than 40 percent 
        of the total premium amount.
            ``(C) A non-Federal employer that employs more than 25 and 
        not more than 50 employees shall pay not less than 50 percent 
        of the total premium amount.
            ``(D) A non-Federal employer that employs more than 50 
        employees shall pay not less than 60 percent of the total 
        premium amount.
    ``(3) Notwithstanding paragraph (2) (B), (C), or (D), a non-Federal 
employer that employs more than 2 employees shall pay not less than 20 
percent of the total premium amount with respect to the first year in 
which that employer participates under this chapter.
    ``(c)(1) A participating non-Federal employer shall ensure that 
each eligible full-time employee may enroll in a plan under this 
chapter.
    ``(2)(A) A participating non-Federal employer may not offer a 
health insurance plan to employees (other than a health benefits plan 
under this chapter) unless such health insurance plan is offered 
continuously on and after the date of enactment of this chapter.
    ``(B) If a participating non-Federal employer offers coverage under 
this chapter and under another plan as provided under subparagraph (A), 
the non-Federal employer--
            ``(i) shall treat all employees in the same manner with 
        respect to such offerings; and
            ``(ii) may not use financial incentives or disincentives to 
        encourage an employee or class of employees to enroll in the 
        health insurance plan not offered under this chapter.''.

SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS.

    (a) Contract Requirement Under Chapter 89.--Section 8902 of title 
5, United States Code, is amended by adding after subsection (o) the 
following:
    ``(p) Each contract under this chapter shall include a provision 
that the carrier shall offer any health benefits plan as required under 
chapter 90A.''.
    (b) Table of Chapters.--The table of chapters for part III of title 
5, United States Code, is amended by inserting after the item relating 
to chapter 90 the following:

``90A. Health Insurance for Non-Federal Employees...........    9051''.

SEC. 4. EFFECTIVE DATE.

    This Act and the amendments made by this Act shall take effect on 
the date of enactment of this Act and shall apply to contracts that 
take effect with respect to calendar year 2003 and each calendar year 
thereafter.
                                 <all>