Sec. 101. 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 covered Medicare individual means an individual who is entitled to benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.), but excluding an individual who is eligible to enroll under such part under section 1818 or 1818A of the Social Security Act ( 42 U.S.C. 1395i–2 , 1395i–2a); the term initial contract year means the contract year beginning in January of 2019; 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 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 pursuant to the requirements of 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 whose Government contribution is paid by the Postal Service; the term Postal Service Medicare covered annuitant means an individual who— is a Postal Service annuitant; and is a covered Medicare individual; the term Program means the Postal Service Health Benefits Program established under subsection
(c)within the Federal Employees Health Benefit Program; and the term Program plan means a health benefits plan offered under the Program. The requirements under this section shall— apply to the initial contract year and each contract year thereafter; and supersede any other provision of this chapter inconsistent with such requirements, as determined by the Office. The Office shall establish the Postal Service Health Benefits Program under which the Office contracts with carriers to offer health benefits plans as described under this section. Except as otherwise provided under this section, any such contract shall be consistent with the requirements of this chapter for contracts under section 8902 with carriers to offer health benefits plans other than under this section. The Program shall— to the greatest extent practicable, include plans offered by— each carrier for which the total enrollment in the plans provided under this chapter includes, in the contract year beginning in January 2019, 1,500 or more enrollees who are Postal Service employees or Postal Service annuitants; and any other carrier determined appropriate by the Office; be available for participation by all Postal Service employees and Postal Service annuitants, in accordance with subsection (d); provide for enrollment in a plan as an individual, for self plus one, or for self and family; and 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 or as provided under paragraph (5)). The Office shall ensure that each Program plan includes rates 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 covered family members of such employees and annuitants), taking into specific account the reduction in benefits cost for the Program plan due to the Medicare enrollment requirements under subsection
(e)and any savings or subsidies resulting from subsection (f)(1). The Office shall ensure that each carrier participating in the Postal Service Health Benefits Program provides coverage under the Program plans offered by the carrier that is actuarially equivalent, as determined by the Office, to the coverage that the carrier provides under the health benefits plans offered by the carrier under this chapter that are not Program plans. Except as otherwise set forth in this section, all provisions of this chapter applicable to health benefits plans offered by the carrier under section 8903 or 8903a shall also apply to plans offered under the Program. In accordance with rules established by the Office, section 8905a shall apply to health benefits plans offered under this section in the same manner as such section applies to other health benefits plans offered under this chapter. 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 of this section; and may not enroll in any other health benefits plan offered under any other section of this chapter. A Postal Service annuitant shall not be subject to the requirements of this section if the Postal Service annuitant— is enrolled in a health benefits plan under this chapter for the contract year immediately preceding 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 Program plan; the health benefits plan in which such annuitant is enrolled for such contract year ceases to be available; or the health benefits plan in which such annuitant is enrolled for such contract year becomes available as a Program plan; or resides in a geographic area for which there is not a Program plan in which the Postal Service annuitant may enroll. If a Postal Service annuitant changes enrollment to a health benefits plan under this chapter provided by a different carrier than the health benefits plan in which such annuitant is enrolled during the previous contract year, the Postal Service annuitant may only enroll in a Program plan. A Postal Service employee who is enrolled in a health benefits plan under this chapter for the contract year immediately preceding the initial contract year that is not a health benefits plan offered by an initial participating carrier shall not be subject to the requirements of this section, except that— if the Postal Service employee changes enrollment to a different health benefits plan under this chapter during the open season for the initial contract year, or after the start of the initial contract year, the Postal Service employee may only enroll in a Program plan; if the health benefits plan in which such employee is enrolled for such contract year becomes available as a Program plan, the Postal Service employee may only enroll in a Program plan; 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 Program plan during the open season that is— being held when the Postal Service employee becomes a Postal Service annuitant; or if the date on which the Postal Service employee becomes a Postal Service annuitant falls outside of an open season, the first open season following that date; and subparagraphs (A), (B), and
(C)shall not apply to an employee who resides in a geographic area for which there is not a Program plan in which the employee may enroll. A Postal Service Medicare covered annuitant subject to the requirements of this section may not obtain coverage under this chapter unless the annuitant is enrolled in part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq.). If a family member of a Postal Service annuitant who is subject to the requirements of this section is a covered Medicare individual, the family member may not be covered under the Program as a family member of the Postal Service annuitant unless the family member is enrolled in part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq.). The Office shall establish a process under which— Postal Service annuitants and family members who are subject to the requirements of paragraph
(1)or (2)— are informed, at the time of enrollment under this chapter, of such requirement; receive requests for any additional information necessary for enrollment in writing; and as a consequence of such enrollment are deemed, for such continuous period as such annuitant or family member involved otherwise maintains eligibility for enrollment under Medicare part B, to have elected to be enrolled under Medicare part B (under section 1837(m)(1) of the Social Security Act) in connection with the enrollment in a Program plan under this chapter; and the Office provides the Secretary of Health and Human Services and the Commissioner of Social Security in a timely manner with such information respecting such annuitants and family members and such election as may be required to effect their enrollment and coverage under Medicare part B and this section in a timely manner. The Office shall require each Program plan to provide benefits for covered Medicare individuals pursuant to the standard coordination of benefits method used under this chapter, rather than the exclusion method or the carve-out method. The Office shall require each Program plan to provide prescription drug benefits for Postal Service annuitants and family members who are eligible individuals (as defined in section 1860D–1(a)(3)(A) of the Social Security Act) through an employer group waiver plan offered under subsection
(b)of section 1860D–22 of the Social Security Act. Subject to subsection (i), for purposes of applying section 8906(b) to the Postal Service, the weighted average shall be calculated in accordance with paragraphs
(2)and (3). Not later than October 1 of each year (beginning with 2019), the Office shall determine the weighted average of the rates established pursuant to subsection (c)(2) for Program 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. In determining such weighted average of the rates for the initial contract year, the Office shall take into account (for purposes of section 8906(a)(2)) the enrollment of Postal Service employees and annuitants in the health benefits plans offered by the initial participating carriers as of March 31, 2019. The Office shall ensure that each Program plan maintains separate reserves (including a separate contingency reserve) with respect to the enrollees in the Program plan in accordance with section 8909. For purposes of the 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 Program plan shall be credited with a proportionate amount of the funds in the reserves for health benefits plans offered by the carrier. In applying section 8909(e) relating to a Program 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 Program 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. Not later than 180 days after the date of enactment of this section, the Postal Service shall establish a Medicare Education Program. Under the Program, the Postal Service shall— notify annuitants and employees of the Postal Service about the Postal Service Health Benefits Program established under subsection (c)(1); provide information regarding the Postal Service Health Benefits Program to such annuitants and employees, including a description of the health care options available under such Program, the requirement that retirees be enrolled in Medicare under subsection (e)(1), and the operation of the premium transition fund to be created under section 104 of the Postal Service Reform Act of 2018 ; and respond and provide answers to any inquiry from such employees and annuitants about the Postal Service Health Benefits Program or Medicare enrollment. . 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 an individual who— is— a Postal Service Medicare covered annuitant; or an individual who is a family member of such an annuitant and is a covered Medicare individual; enrolls in a Program plan under section 8903c of title 5, United States Code; and is not enrolled under this part, the individual is deemed, in accordance with section 8903c(e)(3) of such title, to have elected to be enrolled under this part. In the case of an individual who is deemed to be enrolled under paragraph (1), the coverage period under this part shall begin on the date that the individual first has coverage under the Program plan pursuant to the enrollment described in paragraph (1)(B). The definitions in section 8903c(a) of title 5, United States Code, shall apply for purposes of this subsection. . Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) ) is amended by inserting after subsection (i)(4) or
(l)of section 1837 the following: or pursuant to subsection
(m)of such section . Section 1862(b) of the Social Security Act ( 42 U.S.C. 1395y(b) ) is amended by adding at the end the following: The previous provisions of this subsection are superseded to the extent the Secretary determines, in consultation with the Office of Personnel Management, them to be inconsistent with section 8903c(f) of title 5, United States Code. .
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- 42 USC 1395i–2
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Sec. 101
Postal Service Health Benefits Program
Cite42 USC 1395i–2
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