5 U.S.C. § 8903c Postal Service Health Benefits Program

• Library: United States Statutes
• Edition: 2023
• Currency: Current through P.L. 118-34 (published on www.congress.gov on 12/26/2023), except for [P. L. 118-31]
• Year: 2023
• Citation: 5 U.S.C. § 8903c

(a) DEFINITIONS.-In this section-

(1) the term "covered Medicare individual" means an individual who is entitled to benefits under Medicare part A, 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 );

(2) the term "initial contract year" means the contract year beginning in January of 2025;

(3) the term "initial participating carrier" means a carrier that enters into a contract with the Office to participate in the Program during the initial contract year;

(4) the term "Medicare part A" means part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.);

(5) the term "Medicare part B" means part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq.);

(6) the term "Office" means the Office of Personnel Management;

(7) the term "Postal Service" means the United States Postal Service;

(8) the term "Postal Service annuitant" means an annuitant enrolled in a health benefits plan under this chapter whose Government contribution is required to be paid under section 8906(g)(2);

(9) 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;

(10) the term "Postal Service Medicare covered annuitant" means an individual who-

(A) is a Postal Service annuitant; and

(B) is a covered Medicare individual;

(11) the term "Program" means the Postal Service Health Benefits Program established under subsection (c) within the Federal Employees Health Benefits Program;

(12) the term "Program plan" means a health benefits plan offered under the Program; and

(13) the definitions set forth in section 8901 shall apply, and for the purposes of applying such definitions in carrying out this section, a Postal Service employee and Postal Service annuitant shall be treated in the same manner as an employee and an annuitant (as those terms are defined in paragraphs (1) and (3), respectively, of section 8901), consistent with the requirements of this section.

(b) APPLICATION.-The requirements under this section shall-

(1) apply to the initial contract year and each contract year thereafter; and

(2) supersede any other provision of this chapter inconsistent with such requirements, as determined by the Office.

(c) ESTABLISHMENT OF THE POSTAL SERVICE HEALTH BENEFITS PROGRAM.-

(1) IN GENERAL.-

(A) ESTABLISHMENT.-The Office shall establish the Postal Service Health Benefits Program within the Federal Employees Health Benefits Program under this chapter, under which the Office may contract with carriers to offer health benefits plans as described under this section.

(B) APPLICABILITY OF CHAPTER REQUIREMENTS TO CONTRACTS.-Except as otherwise provided in this section, any contract described in subparagraph (A) 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.

(C) PROGRAM PLANS AND PARTICIPATION.-The Program shall-

(i) to the greatest extent practicable-

(I) with respect to each plan provided by a carrier under this subchapter in which the total enrollment includes, in the contract year beginning in January 2023, 1,500 or more enrollees who are Postal Service employees or Postal Service annuitants, include a plan offered by that carrier with equivalent benefits and cost-sharing requirements as provided under paragraph (2), except that the Director of the Office may exempt any comprehensive medical plan from this requirement; and

(II) include plans offered by any other carrier determined appropriate by the Office;

(ii) provide for enrollment in Program plans of Postal Service employees and Postal Service annuitants, in accordance with subsection (d);

(iii) provide for enrollment in a Program plan as an individual, for self plus one, or for self and family; and

(iv) not provide for enrollment in a Program plan of an individual who is not a Postal Service employee or Postal Service annuitant (except as a member of family of such an employee or annuitant or as provided under paragraph (4)).

(2) COVERAGE WITH EQUIVALENT BENEFITS AND COST-SHARING.-In the initial contract year, the Office shall ensure that each carrier participating in the Program provides under the Program plans offered by the carrier benefits and cost-sharing requirements that are equivalent to the benefits and cost-sharing requirements under the health benefits plans offered by the carrier under this chapter that are not Program plans, except that prescription drug benefits and cost-sharing requirements may differ between the Program plans and other health benefits plans offered by the carrier under this chapter to the extent needed to integrate the Medicare part D prescription drug benefits coverage required under subsection (h)(2).

(3) APPLICABILITY OF FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM REQUIREMENTS.-Except as otherwise set forth in this section, the provisions of this chapter applicable to health benefits plans offered by carriers under section 8903 or 8903a shall apply to plans offered under the Program.