Sec. 90004. FEHB protection

1,086 words·~5 min read·/bill/119/hr/1/pcs/section-90004

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In this subsection: The term Director means the Director of the Office of Personnel Management. The term employing office has the meaning given the term in section 890.101(a) of title 5, Code of Federal Regulations, or any successor regulation. The terms health benefits plan and member of family have the meanings given those terms in section 8901 of title 5, United States Code. The term Inspector General means the Inspector General of the Office of Personnel Management. The term open season means an open season described in section 890.301(f) of title 5, Code of Federal Regulations, or any successor regulation.

The term Program means the health insurance programs carried out under chapter 89 of title 5, United States Code, including the program carried out under section 8903c of that title. The term qualifying life event has the meaning given the term in section 892.101 of title 5, Code of Federal Regulations, or any successor regulation. Not later than 1 year after the date of the enactment of this Act, the Director shall issue regulations and implement a process to verify— the veracity of any qualifying life event through which an enrollee in the Program seeks to add a member of family with respect to the enrollee to a health benefits plan under the Program; and that, when an enrollee in the Program seeks to add a member of family with respect to the enrollee to the health benefits plan of the enrollee under the Program, including during any open season, the individual so added is a qualifying member of family with respect to the enrollee.

The process implemented under subparagraph

(A)shall require the records used for a verification described in such subparagraph under such process with respect to an individual enrolled in a health benefits plan under the Program to be provided to the Office of Personnel Management and retained by the Office of Personnel Management until the expiration of a six-year period beginning after the date of such verification in which such individual is not enrolled in a health benefits plan under the Program. In any fraud risk assessment conducted with respect to the Program on or after the date of the enactment of this Act, the Director shall include an assessment of individuals who are enrolled in, or covered under, a health benefits plan under the Program even though those individuals are not eligible to be so enrolled or covered. During the 5-year period beginning 1 year after the date of the enactment of this Act, the Director shall conduct a comprehensive audit regarding members of family who are covered under an enrollment in a health benefits plan under the Program. In conducting an audit required by subparagraph (A), the Director shall review marriage certificates, birth certificates, and other appropriate documents that are necessary to determine eligibility to enroll in a health benefits plan under the Program. All records pertaining to the eligibility of an individual to be enrolled in, or covered under, a health benefits plan under the Program obtained by the Director in the audit required by subparagraph

(A)shall be retained by the Office of Personnel Management until the expiration of a six-year period beginning after the date of such audit in which such individual is not enrolled in, or covered under, a health benefits plan under the Program. The Director shall refer any instances of individuals enrolled in, or covered under, a health benefits plan under the Program who are not eligible to be so enrolled or covered that are identified in the audit required by subparagraph

(A)to the Inspector General. Not later than 6 months after the date of the enactment of this Act, the Director shall develop a process by which any individual enrolled in, or covered under, a health benefits plan under the Program who is not eligible to be so enrolled or covered shall be disenrolled or removed from enrollment in a health benefits plan under the Program. The Director shall notify the Inspector General of each individual disenrolled or removed from enrollment in a health benefits plan under the Program under the process developed under subparagraph (A). Section 8909(a)(2) of title 5, United States Code, is amended by striking Congress. and inserting Congress, except that the amounts authorized under subsection (b)(2) for the Office shall not be subject to the limitations that may be specified annually by Congress. . Section 8909(b) of title 5, United States Code, is amended— by redesignating paragraph

(2)as paragraph (5); and by inserting after paragraph

(1)the following: In addition to the funds provided under paragraph (1), amounts of all contributions shall be available for the Office to develop, maintain, and conduct ongoing eligibility verification and oversight over the enrollment and eligibility systems with respect to benefits under this chapter, including the Postal Service Health Benefits Program under section 8903c. Amounts for the Office under this paragraph shall not be available in excess of the following amounts in the following fiscal years: In fiscal year 2026, $36,792,000. In fiscal year 2027, $44,733,161. In fiscal year 2028, $50,930,778. In fiscal year 2029, $54,198,238. In fiscal year 2030, $54,855,425. In fiscal year 2031, $56,062,244. In fiscal year 2032, $57,295,613. In fiscal year 2033, $58,556,117. In fiscal year 2034, $59,844,351. In fiscal year 2035 and each fiscal year thereafter, the amount equal to the dollar limit for the immediately preceding fiscal year, increased by 2.2. percent. In fiscal year 2026, $80,000,000, to be derived from all contributions and to remain available until expended, shall be available for the Office to conduct the audit required under section 90004(a)(4) of the Act titled ‘An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14’. Amounts of all contributions shall be available for the Office of Personnel Management Office of the Inspector General to conduct oversight associated with activities under this chapter (including the Postal Service Health Benefits Program under section 8903c), including activities associated with enrollment and eligibility in these programs and any associated audit activities as required under section 90004 of the Act titled ‘An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14’. Amounts for the Office of the Inspector General under this paragraph shall not be available in excess of the following amounts in the following fiscal years: In fiscal year 2026, $5,090,278. In fiscal year 2027 and each fiscal year thereafter, the amount equal to the dollar limit for the immediately preceding fiscal year, increased by 2.2 percent. .