§ 1108. Health care coverage through Federal Employees Health Benefits program: demonstration project
(a)
FEHBP Option Demonstration.—
The Secretary of Defense, after consulting with the other administering Secretaries, shall enter into an agreement with the Office of Personnel Management to conduct a demonstration project (in this section referred to as the “demonstration project”) under which eligible beneficiaries described in subsection (b) and residing within one of the areas covered by the demonstration project may enroll in health benefits plans offered through the Federal Employees Health Benefits program under chapter
89 of title
5. The number of eligible beneficiaries and family members of such beneficiaries under subsection (b)(2) who may be enrolled in health benefits plans during the enrollment period under subsection (d)(2) may not exceed 66,000.
(b)
Eligible Beneficiaries; Coverage.—
(1)
An eligible beneficiary under this subsection is—
(A)
a member or former member of the uniformed services described in section
1074
(b) of this title who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.);
(B)
an individual who is an unremarried former spouse of a member or former member described in section
1072
(2)(F) or
1072
(2)(G));
(C)
an individual who is—
(D)
an individual who is—
(i)
a dependent of a living member or former member described in section
1076
(b)(1) of this title who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act, regardless of the member’s or former member’s eligibility for such hospital insurance benefits; and
(2)
Eligible beneficiaries may enroll in a Federal Employees Health Benefit plan under chapter
89 of title
5 under this section for self-only coverage or for self and family coverage which includes any dependent of the member or former member who is a family member for purposes of such chapter.
(3)
A person eligible for coverage under this subsection shall not be required to satisfy any eligibility criteria specified in chapter
89 of title
5 (except as provided in paragraph (1)(C) or (1)(D)) as a condition for enrollment in health benefits plans offered through the Federal Employees Health Benefits program under the demonstration project.
(4)
For purposes of determining whether an individual is a member of family under paragraph (5) of section
8901 of title
5 for purposes of paragraph (1)(C) or (1)(D), a member or former member described in section
1076
(b) or
1076
(a)(2)(B) of this title shall be deemed to be an employee under such section.
(c)
Area of Demonstration Project.—
The Secretary of Defense and the Director of the Office of Personnel Management shall jointly identify and select the geographic areas in which the demonstration project will be conducted. The Secretary and the Director shall establish at least six, but not more than ten, such demonstration areas. In establishing the areas, the Secretary and Director shall include—
(d)
Duration of Demonstration Project.—
(e)
Prohibition Against Use of MTFs and Enrollment Under TRICARE.—
Covered beneficiaries under this chapter who are provided coverage under the demonstration project shall not be eligible to receive care at a military medical treatment facility or to enroll in a health care plan under the TRICARE program.
(f)
Term of Enrollment in Project.—
(1)
Subject to paragraphs (2) and (3), the period of enrollment of an eligible beneficiary who enrolls in the demonstration project during the open enrollment period for the year 2000 shall be three years unless the beneficiary disenrolls before the termination of the project.
(g)
Effect of Cancellation.—
The cancellation by an eligible beneficiary of coverage under the Federal Employee Health Benefits program shall be irrevocable during the term of the demonstration project.
(h)
Separate Risk Pools; Charges.—
(1)
The Director of the Office of Personnel Management shall require health benefits plans under chapter
89 of title
5 that participate in the demonstration project to maintain a separate risk pool for purposes of establishing premium rates for eligible beneficiaries who enroll in such a plan in accordance with this section.
(2)
The Director shall determine total subscription charges for self only or for family coverage for eligible beneficiaries who enroll in a health benefits plan under chapter
89 of title
5 in accordance with this section. The subscription charges shall include premium charges paid to the plan and amounts described in section
8906
(c) of title
5 for administrative expenses and contingency reserves.
(i)
Government Contributions.—
The Secretary of Defense shall be responsible for the Government contribution for an eligible beneficiary who enrolls in a health benefits plan under chapter
89 of title
5 in accordance with this section, except that the amount of the contribution may not exceed the amount of the Government contribution which would be payable if the electing beneficiary were an employee (as defined for purposes of such chapter) enrolled in the same health benefits plan and level of benefits.
(j)
Report Requirements.—
(1)
The Secretary of Defense and the Director of the Office of Personnel Management shall jointly submit to Congress two reports containing the information described in paragraph (2). The first report shall be submitted not later than the date that is 15 months after the date that the Secretary begins to implement the demonstration project. The second report shall be submitted not later than December 31, 2002.
(2)
The reports required by paragraph (1) shall include the following:
(A)
Information on the number of eligible beneficiaries who elect to participate in the demonstration project.
(B)
An analysis of the percentage of eligible beneficiaries who participate in the demonstration project as compared to the percentage of covered beneficiaries under this chapter who elect to enroll in a health care plan under such chapter.
(C)
Information on eligible beneficiaries who elect to participate in the demonstration project and did not have Medicare Part B coverage before electing to participate in the project.
(D)
An analysis of the enrollment rates and cost of health services provided to eligible beneficiaries who elect to participate in the demonstration project as compared with similarly situated enrollees in the Federal Employees Health Benefits program under chapter
89 of title
5.
(E)
An analysis of how the demonstration project affects the accessibility of health care in military medical treatment facilities, and a description of any unintended effects on the treatment priorities in those facilities in the demonstration area.
(F)
An analysis of any problems experienced by the Department of Defense in managing the demonstration project.
(G)
A description of the effects of the demonstration project on medical readiness and training of the Armed Forces at military medical treatment facilities located in the demonstration area, and a description of the probable effects that making the project permanent would have on the medical readiness and training.
(H)
An examination of the effects that the demonstration project, if made permanent, would be expected to have on the overall budget of the Department of Defense, the budget of the Office of Personnel Management, and the budgets of individual military medical treatment facilities.
(I)
An analysis of whether the demonstration project affects the cost to the Department of Defense of prescription drugs or the accessibility, availability, and cost of such drugs to eligible beneficiaries.
(J)
Any additional information that the Secretary of Defense or the Director of the Office of Personnel Management considers appropriate to assist Congress in determining the viability of expanding the project to all Medicare-eligible members of the uniformed services and their dependents.
(k)
Comptroller General Report.—
Not later than December 31, 2002, the Comptroller General shall submit to Congress a report addressing the same matters required to be addressed under subsection (j)(2). The report shall describe any limitations with respect to the data contained in the report as a result of the size and design of the demonstration project.
(l)
Application of Medigap Protections to Demonstration Project Enrollees.—
(1)
Subject to paragraph (2), the provisions of section
1882
(s)(3) (other than clauses (i) through (iv) of subparagraph (B)) and 1882(s)(4) of the Social Security Act shall apply to enrollment (and termination of enrollment) in the demonstration project under this section, in the same manner as they apply to enrollment (and termination of enrollment) with a Medicare+Choice [2] organization in a Medicare+Choice [2] plan.
[1] See References in Text note below.
[2] See Change of Name note below.