I 111th CONGRESS 1st Session H. R. 3937 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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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).