[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3937 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3937
To establish a health benefits program, based on the Federal employees
health benefits program, to provide health insurance coverage for the
President, Vice President, and Members of Congress, and citizens not
eligible for coverage under the Federal employees health benefits
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 27, 2009
Mr. Terry introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Oversight and Government Reform, Education and Labor, and Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish a health benefits program, based on the Federal employees
health benefits program, to provide health insurance coverage for the
President, Vice President, and Members of Congress, and citizens not
eligible for coverage under the Federal employees health benefits
program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Simple Universal
Healthcare Act of 2009''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Citizens Congressional Health Benefits Program
(CCHBP).
Sec. 3. Contracts with entities to offer qualified CCHBP health plans.
Sec. 4. Scope of benefits and coverage.
Sec. 5. Eligibility.
Sec. 6. Enrollment.
Sec. 7. Premiums.
Sec. 8. High-risk reinsurance fund.
Sec. 9. Definitions.
Sec. 10. Effective date and treatment of collective bargaining
agreements.
SEC. 2. ESTABLISHMENT OF CITIZENS CONGRESSIONAL HEALTH BENEFITS PROGRAM
(CCHBP).
(a) In General.--The Director of the Office of Personnel Management
shall establish a program (to be known as the ``Citizen's Congressional
Health Benefits Program'') to provide comprehensive health insurance
coverage to--
(1) Federal elected officials (including the President,
Vice President, and Members of Congress); and
(2) residents of the United States who are not covered
under the Federal Employees Health Benefits Program (FEHBP).
(b) Similar to FEHBP.--The coverage shall be provided in a manner
similar to the manner in which coverage has been provided to Members of
Congress and Federal Government employees and retirees and their
dependents under the Federal Employees Health Benefits Program (FEHBP).
SEC. 3. CONTRACTS WITH ENTITIES TO OFFER QUALIFIED CCHBP HEALTH PLANS.
(a) In General.--The Director shall enter into contracts with
entities for the offering of qualified CCHBP health plans in accordance
with this Act. Such contracts shall be entered into in a manner similar
to the process by which the Director is authorized to enter into
contracts with entities offering health benefits plans under FEHBP.
(b) Requirements for Entities Offering Plans.--The Director may
only enter into a contract under subsection (a) with an entity that
is--
(1) licensed--
(A) as a health maintenance organization in the
State in which the entity will offer the qualified
CCHBP health plan; or
(B) to sell group health insurance coverage in such
State;
(2) meets such requirements, similar to requirements under
FEHBP, as the Director may establish, relating to solvency,
adequacy of plan benefits (subject to section 4), organization,
structure, governance, access, and quality; and
(3) agrees to participate in the high-risk reinsurance fund
described in section 8.
(c) FEHBP Plans.--Any health plan offered under FEHBP shall be
treated as a qualified CCHBP health plan for purposes of this Act.
(d) Preemption of State Law.--The requirements of section 4, with
respect to the scope and type of benefits required to be provided by a
CCHBP health plan, shall supersede any and all State laws.
SEC. 4. SCOPE OF BENEFITS AND COVERAGE.
(a) Comprehensive Benefits.--
(1) In general.--Subject to paragraph (2), qualified CCHBP
health plans shall provide for the same scope and type of
benefits that are provided under FEHBP, including--
(A) the types of benefits described in section 8904
of title 5, United States Code; and
(B) benefits required by regulation or guidance
under FEHBP.
(2) Preventive benefits and mental health parity.--
Qualified CCHBP health plans shall provide a minimum level of
preventive benefits determined by the Director, in consultation
with the U.S. Preventive Service Task Force, which shall
include vaccines for both children and adults, an annual
physical, cancer screening (including mammographies for women
of an appropriate age), and mental health parity.
(b) No Exclusion for Pre-Existing Conditions.--Subject to section
6(b)(2), qualified CCHBP health plans shall not impose pre-existing
condition exclusions or otherwise discriminate against any individual
based on the health status of such individual (including genetic
information relating to such enrollee, or any disease or condition).
(c) Annual and Lifetime Out-Of-Pocket Limit Information.--An entity
offering a qualified CCHBP health plan must provide notice to any
individual covered by such plan of any benefit or service that is not
included in the calculation of the annual or lifetime out-of-pocket
limit under such plan.
SEC. 5. ELIGIBILITY.
(a) In General.--An individual is eligible to enroll in a qualified
CCHBP health plan if--
(1) the individual resides in the United States; and
(2) the individual is--
(A) a citizen or national of the United States;
(B) an alien lawfully admitted to the United States
for permanent residence;
(C) an alien admitted into the United States under
section 207 of the Immigration and Nationality Act
(relating to refugees);
(D) an alien otherwise permanently residing in the
United States under color of law (as specified by the
Director); or
(E) an alien with the status of a nonimmigrant who
is within a class of long-term nonimmigrants under
section 101(a)(15) of the Immigration and Nationality
Act that the Director determines, in consultation with
the Secretary of Homeland Security, to be appropriate.
(b) Exceptions.--The following individuals are not eligible to
enroll in a qualified CCHBP health plan:
(1) Individuals enrolled under public health insurance
programs.--An individual who is enrolled under the Federal
employees health benefits program under chapter 89 of title 5,
United States Code (except for a member of Congress, as defined
by section 2106 of title 5, United States Code; or the
President); the Medicare program under title XVIII of the
Social Security Act; the Medicaid program under title XIX of
such Act; the Children's Health Insurance Program under title
XXI of such Act; or Tricare under chapter 55 of title 10,
United States Code.
(2) Incarcerated individuals.--An individual who is
incarcerated (as specified by the Director).
(c) Treatment of Elected Officials.--A member of Congress (as
defined under section 2106 of title 5, United States Code) or the
President may enroll in either a qualified CCHBP health plan under this
Act or an FEHBP plan under title 5, United States Code, but may not be
enrolled in both types of plans at the same time.
(d) Confirmation of Immigration Status.--The Director, in
consultation with each entity offering a qualified CCHBP plan, shall
promulgate regulations for the use of the automated system known as the
Systematic Alien Verification for Entitlements, as provided for by
section 404 of the Illegal Immigrations Reform and Immigrant
Responsibility Act of 1996 (110 Stat. 3009-664) to verify the legal
presence of the status of an individual, other than a United States
citizen, who seeks to enroll in a qualified CCHBP plan.
(e) Employer Option.--
(1) In general.--An employer may choose to participate in
CCHBP and offer qualified CCHBP health plans to employees of
such employer as employer-sponsored health insurance.
(2) Notice.--The employer shall inform the Director that
the employer is taking such option in a form and manner
determined by the Director.
(3) Maintenance of effort required.--An employer who
provides notice under paragraph (2) must pay the percentage of
the cost of the premium, as determined under section 7, for
each employee that enrolls in a qualified CCHBP health plan,
that is the same as the percentage of the cost of the premium
of the health insurance plan that such employer offered to its
employees before the employer provided notice under paragraph
(2).
(4) Tax treatment.--For purposes of the Internal Revenue
Code of 1986, a qualified CCHBP health plan offered by an
employer under this subsection shall not fail to be treated as
employer-provided coverage solely because such employer
provides such plan through the CCHBP.
SEC. 6. ENROLLMENT.
(a) Enrollment Process.--The Director shall establish a process to
enroll eligible individuals and their families in qualified CCHBP
health plans. Such process shall be conducted in a manner that is
similar to the manner enrollment is conducted under FEHBP. To the
extent consistent with eligibility under section 3, the Director shall
provide rules similar to the rules under FEHBP for the enrollment of
family members who are CCHBP-eligible individuals in the same plan.
(b) Enrollment Period.--
(1) Enrollment upon initial eligibility.--
(A) In general.--An eligible individual may enroll
in a qualified CCHBP health plan--
(i) at any time during the 1-year period
beginning on the date that the Citizen's
Congressional Health Benefits Program begins to
operate; or, if later,
(ii) at any time during the 3-month period
beginning on the date that such individual
becomes eligible to enroll in any qualified
CCHBP health plan.
(B) Treatment of preexisting conditions.--An
individual who enrolls during the periods under
paragraph (1) shall not be subject to exclusions or
additional costs due to any preexisting conditions that
such individual developed before the date such
individual enrolled in a qualified CCHBP plan.
(2) Annual enrollment.--
(A) In general.--An eligible individual who does
not enroll in a qualified CCHBP health plan under
paragraph (1) may enroll in such a plan during an
annual enrollment period of not more than 1 month, as
determined by the Director.
(B) Treatment of preexisting conditions.--Subject
to rules developed by the Director, the entity offering
the qualified CCHBP health plan may exclude such
individual from enrolling in such a plan under this
paragraph due to any preexisting condition which such
individual develops before the date of such annual
enrollment period. Upon excluding such individual, the
entity offering the qualified CCHBP health plan shall
provide such individual with notice of such exclusion
and information about enrolling in a high risk pool.
(c) Changes in Enrollment.--The Director shall establish enrollment
procedures that include an annual open season of at least 1 month and
permit changes in enrollment with qualified health plans at other times
(such as by reason of changes in marital or dependent status or
eligibility). Such procedures shall be based on the enrollment
procedures established under FEHBP. The Director shall provide for
termination of such enrollment for an individual at the time the
individual is no longer an eligible individual.
(d) Enrollment of Employees.--Notwithstanding subsection (b)(2),
the employees of an employer that provides notice to the Director under
section 5(e)(2) may enroll in a qualified CCHBP health plan during
either the 3-month period beginning on the date that such employer
provides such notice or the 3-month period beginning on the date that
such employee begins working for such employer, whichever is later.
Such employee shall not be subject to any costs related to such
employee's pre-existing conditions if so enrolled during such period.
(e) Enrollment Guides.--The Director shall provide for the broad
dissemination of information on qualified CCHBP health plans offered
under this title. Such information shall be provided in a comparative
manner, similar to that used under FEHBP, and shall include
information, collected through surveys of enrollees, on measures of
enrollee satisfaction with the different plans.
SEC. 7. PREMIUMS.
The premiums established for a qualified CCHBP health plan under
this Act for individual or family coverage--
(1) based on the rating system used under FEHBP; and
(2) shall not vary based on age, gender, health status
(including genetic information), or other factors.
SEC. 8. HIGH-RISK REINSURANCE FUND.
The Director shall establish an arrangement among the entities
offering qualified health plans under which such entities contribute in
an equitable manner (as determined by the Director) into a fund that
provides payment to plans for a percentage (specified by the Director
and not to exceed 90 percent) of the costs that they incur for
enrollees beyond a predetermined threshold specified by the Director.
Such fund shall be funded exclusively by such entities.
SEC. 9. DEFINITIONS.
For purposes of this Act:
(1) The term ``CCHBP-eligible individual'' means an
individual described in section 5.
(2) The term ``Director'' means the Director of the Office
of Personnel Management.
(3) The term ``FEHBP'' means the program under chapter 89
of title 5, United States Code.
(4) The term ``qualified CCHBP health plan'' means a fee-
for-service plan, health maintenance organization plan, high
deductible health insurance plan, or other health insurance
plan that meets the requirements for a health insurance plan
under FEHBP and is offered through the CCHBP under this Act by
an entity that is qualified to offer such plans.
SEC. 10. EFFECTIVE DATE AND TREATMENT OF COLLECTIVE BARGAINING
AGREEMENTS.
(a) Effective Date.--Benefits shall first be made available under
this title for items and services furnished on or after the last day of
the 9-month period beginning on the date of the enactment of this Act.
(b) Non-Preemption of Existing Collective Bargaining Agreements.--
Nothing in this Act shall be construed as preempting any collective
bargaining agreement that is in effect as of the date of the enactment
of this Act, during the period in which such agreement is in effect
(without regard to any extension of such agreement effected as of such
date of enactment).
<all>