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 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 1,500 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 benefits 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 benefits plans offered by a carrier under section 8903 or 8903a shall apply to PSHBP plans. In accordance with rules established by the Office, section 8905a shall apply to PSHBP plans in the same manner as that 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 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; resides in a geographic area— for which there is not a PSHBP plan in which the Postal Service annuitant may enroll; or in which there is a lack of participating Medicare part B providers; or would not derive benefit from enrolling in Medicare part B because of comprehensive medical coverage provided by the Department of Veterans Affairs or other programs. 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 under 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 PSHBP plan; if the health benefits plan in which the Postal Service employee is enrolled for such contract year becomes available as a PSHBP plan, the Postal Service employee may only enroll in a PSHBP 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 PSHBP 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 PSHBP plan in which the employee may enroll. 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)(2)). 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)(2)). 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; and except as provided in paragraph (4), as a consequence of such enrollment are deemed to have elected to be enrolled under Medicare part B (under subsection (m)(1) of section 1837 of the Social Security Act ( 42 U.S.C. 1395p )) in connection with the enrollment in a PSHBP 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 Postal Service, in consultation with recognized labor organizations and management organizations, shall establish a waiver program under which the requirement to enroll in Medicare part B under paragraph

(1)or (2), as applicable, is waived for Postal Service annuitants and family members who demonstrate extreme financial hardship. If the applicable requirement described in subparagraph

(A)is waived for a Postal Service annuitant or family member— the Postal Service shall notify the Office of the waiver; and the annuitant or family member shall not be deemed to have elected to be enrolled under Medicare part B as described in paragraph (3)(A)(ii). The Office shall require each PSHBP plan to provide benefits for Medicare eligible 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 PSHBP plan to provide qualified prescription drug coverage for Postal Service annuitants and family members who are part D eligible individuals (as defined in section 1860D–1(a)(3)(A) of the Social Security Act ( 42 U.S.C. 1395w–101(a)(3)(A) ) under a prescription drug plan under Medicare part D pursuant to the provisions of section 1860D–22(b) (commonly referred to as an employer group waiver plan ). For purposes of the preceding sentence, the carrier offering the PSHBP plan shall be deemed to be the sponsor of the plan for purposes of Medicare part D. 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 the year before the initial contract 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. 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 of the year before the initial contract year. 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. Not later than 180 days after the date of enactment of this section, the Postal Service shall establish a Medicare Education Program, under which the Postal Service shall— notify annuitants and employees of the Postal Service about the Postal Service Health Benefits Program; provide information regarding the Postal Service Health Benefits Program to such annuitants and employees, including— a description of the health care options available under the Postal Service Health Benefits Program; the requirement that annuitants be enrolled in Medicare under subsection (e)(1); and the premium subsidies under section 103 of the Postal Service Reform Act of 2018 ; and respond and provide answers to any inquiry from such annuitants and employees 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 eligible annuitant, or an individual who is a family member of such an annuitant and is a Medicare eligible individual; enrolls in a PSHBP 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 have elected 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 PSHBP plan pursuant to the enrollment described in paragraph (1)(B). The provisions of section 1838(b) shall apply to an individual who is deemed to have elected to be enrolled under paragraph (1). The Secretary, the Commissioner of Social Security, the United States Postal Service, and the Office of Personnel Management shall coordinate to monitor premiums paid by individuals who are deemed to have elected to be enrolled under paragraph

(1)for purposes of determining whether those individuals are in compliance with the applicable requirements under section 8903c(e) of title 5, United States Code. 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 section 1837, the following: and not pursuant to a deemed enrollment under subsection

(m)of such section during the open season for the initial contract year (as defined in section 8903c(a) of title 5, United States Code) of the Postal Service Health Benefits Program, . Section 1862(b) of the Social Security Act ( 42 U.S.C. 1395y(b) ) is amended by adding at the end the following: Paragraphs

(1)through

(9)shall apply except to the extent that the Secretary, in consultation with the Office of Personnel Management, determines those paragraphs to be inconsistent with section 8903c(f) of title 5, United States Code. .

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