Sec. 707. Pilot program to provide health insurance to members of the reserve components of the Armed Forces
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The Secretary of Defense and the Director may jointly carry out a pilot program, at the election of the Secretary, under which the Director provides commercial health insurance coverage to eligible reserve component members who enroll in a health benefits plan under subsection
(b)as an individual, for self plus one coverage, or for self and family coverage. The pilot program shall— provide for enrollment by eligible reserve component members, at the election of the member, in a health benefits plan under subsection
(b)during an open enrollment period established by the Director for purposes of this section; include a variety of national and regional health benefits plans that— meet the requirements of this section; are broadly representative of the health benefits plans available in the commercial market; and do not contain unnecessary restrictions, as determined by the Director; and offer a sufficient number of health benefits plans in order to provide eligible reserve component beneficiaries with an ample choice of health benefits plans, as determined by the Director. If the Secretary elects to carry out the pilot program, the Secretary and the Director shall carry out the pilot program for not less than five years. In providing health insurance coverage under the pilot program, the Director shall contract with qualified carriers for a variety of health benefits plans. Health benefits plans contracted for under this subsection— may vary by type of plan design, covered benefits, geography, and price; shall include maximum limitations on out-of-pocket expenses paid by an eligible reserve component beneficiary for the health care provided; and may not exclude an eligible reserve component member who chooses to enroll. The Director shall ensure that each health benefits plan offered under this section offers a high degree of quality, as determined by criteria such as— access to an ample number of medical providers, as determined by the Director; adherence to industry-accepted quality measurements, as determined by the Director; access to benefits described in subsection (c), including ease of referral for health care services; and inclusion in the services covered by the plan of advancements in medical treatments and technology as soon as practicable in accordance with generally accepted standards of medicine. A health benefits plan offered by the Director under this section shall include, at a minimum, the following benefits: The health care benefits provided under chapter 55 of title 10, United States Code, excluding pharmaceutical, dental, and extended health care option benefits. The essential health benefits described in section 1302 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022 ), excluding pharmaceutical and dental benefits. Such other benefits as the Director determines appropriate. If an eligible reserve component beneficiary receives benefits described in subsection
(c)at a facility of the uniformed services, the health benefits plan under which the beneficiary is covered shall be treated as a third party payer under section 1095 of title 10, United States Code, and shall pay reasonable charges for such benefits. The Secretary, in consultation with the Director— may contract with qualified carriers with which the Director has contracted under subsection
(b)to provide health insurance coverage for health care services provided at military treatment facilities under this section; and may receive payments under section 1095 of title 10, United States Code, from qualified carriers for health care services provided at military treatment facilities under this section. An eligible reserve component member may not receive benefits under a health benefits plan under this section during any period in which the member is serving on active duty for more than 30 days. Paragraph
(1)does not affect the coverage under a health benefits plan of any dependent of an eligible reserve component member. An individual is not eligible to enroll in or be covered under a health benefits plan under this section if the individual is eligible to enroll in a health benefits plan under the Federal Employees Health Benefits Program. Except as provided in subparagraph (B), an eligible reserve component member shall pay an annual premium amount calculated under paragraph
(2)for coverage under a health benefits plan under this section and additional amounts described in paragraph
(3)for health care services in connection with such coverage. During any period in which an eligible reserve component member is serving on active duty for more than 30 days, the eligible reserve component member is not responsible for paying any premium amount under paragraph
(2)or additional amounts under paragraph (3). With respect to a dependent of an eligible reserve component member that is covered under a health benefits plan under this section, during any period described in clause
(i)with respect to the member, the Secretary shall, on behalf of the dependent, pay 100 percent of the total annual amount of a premium for coverage of the dependent under the plan and such cost sharing amounts as may be applicable under the plan. The annual premium calculated under this paragraph is an amount equal to 28 percent of the total annual amount of a premium under the health benefits plan selected. The premium amounts calculated under this paragraph shall include separate calculations for— coverage as an individual; self plus one coverage; and self and family coverage. The additional amounts described in this paragraph with respect to an eligible reserve component member are such cost sharing amounts as may be applicable under the health benefits plan under which the member is covered. In contracting for health benefits plans under subsection (b), the Director may contract with qualified carriers in a manner similar to the manner in which the Director contracts with carriers under section 8902 of title 5, United States Code, including that— a contract under this section shall be for a uniform term of not less than one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party; a contract under this section shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits as the Director considers necessary or desirable; a contract under this section shall ensure that an eligible reserve component member who is eligible to enroll in a health benefits plan pursuant to such contract is able to enroll in such plan; and the terms of a contract under this section relating to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any conflicting State or local law. The Director shall perform a thorough evaluation of the financial solvency of an insurance carrier before entering into a contract with the insurance carrier under paragraph (1). The Secretary of Defense, in consultation with the Secretary of Homeland Security, shall provide recommendations and data to the Director with respect to— matters involving military treatment facilities; matters unique to eligible reserve component members and their dependents; and such other strategic guidance necessary for the Director to administer this section as the Secretary of Defense, in consultation with the Secretary of Homeland Security, considers appropriate. The Director shall not implement any recommendation provided by the Secretary of Defense under paragraph
(1)if the Director determines that the implementation of the recommendation would result in eligible reserve components beneficiaries receiving less generous health benefits under this section than the health benefits commonly available to individuals under the Federal Employees Health Benefits Program during the same period. The Secretary of Defense and the Director shall jointly establish an appropriate mechanism to fund the pilot program under this section. Amounts shall be made available to the Director pursuant to the mechanism established under paragraph (1), without fiscal year limitation— for payments to health benefits plans under this section; and to pay the costs of administering this section. In this section: The term Director means the Director of the Office of Personnel Management. The term eligible reserve component beneficiary means an eligible reserve component member enrolled in, or a dependent of such a member described in subparagraph (A), (D), or
(I)of section 1072(2) of title 10, United States Code, covered under, a health benefits plan under this section. The term eligible reserve component member means a member of the Selected Reserve of the Ready Reserve of an Armed Force. The term extended health care option means the program of extended benefits under subsections
(d)and
(e)of section 1079 of title 10, United States Code. The term Federal Employees Health Benefits Program means the health insurance program under chapter 89 of title 5, United States Code. The term qualified carrier means an insurance carrier that is licensed to issue group health insurance in any State or the District of Columbia.
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Sec. 707
Pilot program to provide health insurance to members of the reserve components of the Armed Forces
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