Sec. 102. Postal Service Health Benefits Program

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Chapter 89 of title 5, United States Code, is amended by inserting after section 8903b the following: In this section— the term initial contract year means the contract year beginning in January of the first full year that begins not less than 7 months after the date of enactment of this section; the term initial participating carrier means a carrier that enters into a contract with the Office to participate in the Postal Service Health Benefits Program during the initial contract year; the term Medicare eligible individual means an individual who— is entitled to Medicare part A, but excluding an individual who is eligible to enroll under such part under section 1818 of the Social Security Act ( 42 U.S.C. 1395i–2 ); and is eligible to enroll in Medicare part B; the term Medicare part A means the Medicare program for hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq. ); the term Medicare part B means the Medicare program for supplementary medical insurance benefits under part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq. ); the term Medicare part D means the Medicare insurance program established under part D of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–101 et seq. ); the term Office means the Office of Personnel Management; the term Postal Service means the United States Postal Service; the term Postal Service annuitant means an annuitant enrolled in a health benefits plan under this chapter whose Government contribution is paid by the Postal Service or the Postal Service Retiree Health Benefits Fund under section 8906(g)(2); the term Postal Service employee means an employee of the Postal Service enrolled in a health benefits plan under this chapter; the term Postal Service Health Benefits Program means the program of health benefits plans established under subsection

(c)within the Federal Employees Health Benefits Program under this chapter; the term Postal Service Medicare eligible annuitant means an individual who— is a Postal Service annuitant; and is a Medicare eligible individual; the term PSHBP plan means a health benefits plan offered under the Postal Service Health Benefits Program; and the term qualified carrier means a carrier for which the total enrollment in the plans provided under this chapter includes, in the contract year beginning in January of the year before the initial contract year, a combined total of 5,000 or more enrollees who are— Postal Service employees; or Postal Service annuitants. The requirements under this section shall— apply to the initial contract year, and each contract year thereafter; and supersede other provisions of this chapter to the extent of any specific inconsistency, as determined by the Office. The Office shall establish the Postal Service Health Benefits Program, which shall— consist of health benefit plans offered under this chapter; include plans offered by— each qualified carrier; and any other carrier determined appropriate by the Office; be available for participation by all Postal Service employees, in accordance with subsection (d); be available for participation by all Postal Service annuitants, in accordance with subsection (d); not be available for participation by an individual who is not a Postal Service employee or Postal Service annuitant (except as a family member of such an employee or annuitant); and be implemented and administered by the Office. The Office shall ensure that each PSHBP plan includes rates, one for enrollment as an individual, one for enrollment for self plus one, and one for enrollment for self and family within each option in the PSHBP plan, that reasonably and equitably reflect the cost of benefits provided to a risk pool consisting solely of Postal Service employees and Postal Service annuitants (and family members of such employees and annuitants), taking into specific account the reduction in benefits cost for the PSHBP plan due to the Medicare enrollment requirements under subsection

(e)and any savings or subsidies resulting from subsection (f). The Office shall ensure that each carrier participating in the Postal Service Health Benefits Program provides coverage under the PSHBP plans offered by the carrier that is actuarially equivalent, as determined by the Director of the Office, to the coverage that the carrier provides under the health benefits plans offered by the carrier under the Federal Employee Health Benefits Program that are not PSHBP plans. Except as otherwise set forth in this section, all provisions of this chapter applicable to health benefit plans offered by a carrier under section 8903 or 8903a shall apply to PSHBP plans. Except as provided in paragraphs

(2)and (3), each Postal Service employee and Postal Service annuitant who elects to receive health benefits coverage under this chapter— shall be subject to the requirements under this section; and may only enroll in a PSHBP plan. A Postal Service annuitant shall not be subject to this section if the Postal Service annuitant— is enrolled in a health benefits plan under this chapter for the contract year before the initial contract year that is not a health benefits plan offered by an initial participating carrier, unless the Postal Service annuitant voluntarily enrolls in a PSHBP plan; or resides in a geographic area for which there is not a PSHBP plan in which the Postal Service annuitant may enroll. A Postal Service employee who is enrolled in a health benefits plan under this chapter for the contract year before the initial contract year that is not a health benefits plan offered by an initial participating carrier shall not be subject to the requirements under this section, except that— if the Postal Service employee changes enrollment to a different health benefits plan under this chapter after the start of the initial contract year, the Postal Service employee may only enroll in a PSHBP plan; and upon becoming a Postal Service annuitant, if the Postal Service employee elects to continue coverage under this chapter, the Postal Service employee shall enroll in a PSHBP plan during the first open season available after the Postal Service employee becomes a Postal Service annuitant. A Postal Service Medicare eligible annuitant subject to this section may not continue coverage under the Postal Service Health Benefits Program unless the Postal Service Medicare eligible annuitant enrolls in Medicare part A, Medicare part B, and Medicare part D (as part of a prescription drug plan described in subsection (f)). If a family member of a Postal Service annuitant who is subject to this section is a Medicare eligible individual, the family member may not be covered under the Postal Service Health Benefits Program as a family member of the Postal Service annuitant unless the family member enrolls in Medicare part A, Medicare part B, and Medicare part D (as part of a prescription drug plan described in subsection (f)). The Office shall require each PSHBP plan to provide prescription drug benefits for Postal Service annuitants and family members who are eligible for Medicare part D through a prescription drug plan offered under a waiver under section 1860D–22 of the Social Security Act ( 42 U.S.C. 1395w–132 ). Subject to subsection (i), for purposes of applying section 8906(b) to the Postal Service, the weighted average shall be calculated in accordance with paragraph (2). Not later than October 1 of each year, the Office shall determine the weighted average of the rates established pursuant to subsection (c)(2) for PSHBP plans that will be in effect during the following contract year with respect to— enrollments for self only; enrollments for self plus one; and enrollments for self and family. The Office shall ensure that each PSHBP plan maintains separate reserves (including a separate contingency reserve) with respect to the enrollees in the PSHBP plan in accordance with section 8909. For purposes of the Postal Service Health Benefits Program, each reference to the Government in section 8909 shall be deemed to be a reference to the Postal Service. The reserves (including the separate contingency reserve) maintained by each PSHBP plan shall be credited with a proportionate amount of the funds in the existing reserves for health benefits plans offered by an initial participating carrier. In applying section 8909(e) relating to a PSHBP plan that is discontinued, the Office shall credit the separate Postal Service contingency reserve maintained under paragraph

(1)for that plan only to the separate Postal Service contingency reserves of the PSHBP plans continuing under this chapter. Nothing in this section shall be construed as affecting section 1005(f) of title 39 regarding variations, additions, or substitutions to the provisions of this chapter. . Section 8903(1) of title 5, United States Code, is amended by striking two levels of benefits and inserting 2 levels of benefits for enrollees under this chapter generally and 2 levels of benefits for enrollees under the Postal Service Health Benefits Program established under section 8903c . The table of sections for chapter 89 of title 5, United States Code, is amended by inserting after the item relating to section 8903b the following: 8903c. Postal Service Health Benefits Program. . Section 1837 of the Social Security Act ( 42 U.S.C. 1395p ) is amended by adding at the end the following new subsection: In the case of any individual who is subject to the enrollment requirement of section 8903c(e) of title 5, United States Code, who has elected not to enroll (or to be deemed enrolled) during the individual’s initial enrollment period, there shall be a special enrollment period described in subparagraph (B). The special enrollment period described in this subparagraph is the 6-month period, beginning on August 1 of the year before the initial contract year and ending on January 31 of the initial contract year. In the case of any individual who— was initially not subject to the enrollment requirement of section 8903c(e) of title 5, United States Code; is eligible to enroll in a plan under chapter 89 of title 5, United States Code, because of an involuntary loss of health care coverage; upon the involuntary loss of health care coverage, becomes subject to the enrollment requirement of section 8903c(e) of title 5, United States Code, because of enrollment in a PSHBP plan; and has elected not to enroll (or to be deemed enrolled) during the individual’s initial enrollment period, there shall be a special enrollment period described in subparagraph (B). The special enrollment period described in this subparagraph is the period of time equivalent to the period of time in which the individual has the ability to enroll in a PSHBP plan due to the involuntary loss of health care coverage, pursuant to chapter 89 of title 5, United States Code, and its implementing regulations. For purposes of this subsection, the term PSHBP plan has the meaning under section 8903c(a) of title 5, United States Code. In the case of an individual who enrolls during the special enrollment period provided under paragraphs

(1)and (2), the coverage period under this part shall begin on the first day of the month in which the individual enrolls. . Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) ) is amended by striking (i)(4) or

(l)and inserting (i)(4), (l), or

(m).

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