Chapter 89, Section 8905a, Subsection (d) · 5 U.S.C. Chapter 89

Contents

(d)

(1)The agreement holder shall keep the hereditament insured for the full cost of rebuilding or reinstatement and shall furnish to the Department, on demand, evidence of such insurance.

(A)Except as provided in paragraphs (4), (5), and (6), an individual receiving continued coverage under this section shall be required to pay currently into the Employees Health Benefits Fund, under arrangements satisfactory to the Office, an amount equal to the sum of—

(i)the employee and agency contributions which would be required in the case of an employee enrolled in the same health benefits plan and level of benefits; and

(ii)an amount, determined under regulations prescribed by the Office, necessary for administrative expenses, but not to exceed 2 percent of the total amount under clause (i).

(B)Payments under this section to the Fund shall—

(i)in the case of an individual whose continued coverage is based on such individual’s separation, be made through the agency which last employed such individual; or

(ii)in the case of an individual whose continued coverage is based on a change in circumstances referred to in subsection (c)(2)(B), be made through—

(I)the Office, if, at the time coverage would (but for this section) otherwise have been discontinued, the individual was covered as the child of an annuitant; or

(II)if, at the time referred to in subclause (I), the individual was covered as the child of an employee, the employee’s employing agency as of such time.

(2)If an individual elects to continue coverage under this section before the end of the applicable period under subsection (c)(2), but after such individual’s coverage under this chapter (including any temporary extensions of coverage) expires, coverage shall be restored retroactively, with appropriate contributions (determined in accordance with paragraph (1), (4), or (5), as the case may be) and claims (if any), to the same extent and effect as though no break in coverage had occurred.

(3)

(A)An individual making an election under subsection (c)(2)(B) may, at such individual’s option, elect coverage either as an individual or, if appropriate, for self plus one or for self and family.

(B)For the purpose of this paragraph, members of an individual’s family shall be determined in the same way as would apply under this chapter in the case of an enrolled employee.

(C)Nothing in this paragraph shall be considered to limit an individual making an election under subsection (c)(2)(A) to coverage for self alone.

(4)The agreement holder shall not be entitled to defer the payment of rates for a particular year if—

(A)If the basis for continued coverage under this section is an involuntary separation from a position, or a voluntary separation from a surplus position, in or under the Department of Defense due to a reduction in force, or the Department of Energy due to a reduction in force resulting from the establishment of the National Nuclear Security Administration—

(i)the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and

(ii)the agency which last employed the individual shall pay the remaining portion of the amount required under paragraph (1)(A).

(B)This paragraph shall apply with respect to any individual whose continued coverage is based on a separation occurring on or after the date of enactment of this paragraph and before—

(i)December 31, 2016; or

(ii)February 1, 2017, if specific notice of such separation was given to such individual before December 31, 2016.

(C)For the purpose of this paragraph, “surplus position” means a position which is identified in pre-reduction-in-force planning as no longer required, and which is expected to be eliminated under formal reduction-in-force procedures.

(5)

(A)If the basis for continued coverage under this section is an involuntary separation from a position in or under the Department of Veterans Affairs due to a reduction in force or a title 38 staffing readjustment, or a voluntary or involuntary separation from a Department of Energy position at a Department of Energy facility at which the Secretary is carrying out a closure project selected under section 44211 of the Atomic Energy Defense Act—

(i)the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and

(ii)the agency which last employed the individual shall pay the remaining portion of the amount required under paragraph (1)(A).

(B)This paragraph shall only apply with respect to individuals whose continued coverage is based on a separation occurring on or after the date of the enactment of this paragraph.

(6)

(A)If the basis for continued coverage under this section is, as a result of the termination of the Space Shuttle Program, an involuntary separation from a position due to a reduction-in-force or declination of a directed reassignment or transfer of function, or a voluntary separation from a surplus position in the National Aeronautics and Space Administration—

(i)the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and

(ii)the National Aeronautics and Space Administration shall pay the remaining portion of the amount required under paragraph (1)(A).

(B)This paragraph shall only apply with respect to individuals whose continued coverage is based on a separation occurring on or after the date of enactment of this paragraph and before December 31, 2010.

(C)For purposes of this paragraph, “surplus position” means a position which is—

(i)identified in pre-reduction-in-force planning as no longer required, and which is expected to be eliminated under formal reduction-in-force procedures as a result of the termination of the Space Shuttle Program; or

(ii)encumbered by an employee who has received official certification from the National Aeronautics and Space Administration consistent with the Administration’s career transition assistance program regulations that the position is being abolished as a result of the termination of the Space Shuttle Program.

United States Government work; public domain under 17 U.S.C. § 105.

Defined terms · 30

Show every defined term

annuitant
means—
carrier
means a voluntary association, corporation, partnership, or other nongovernmental organization which is lawfully engaged in providing, paying for, or reimbursing the cost of, health services under group insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the carrier, including a health benefits plan duly sponsored or underwritten by an employee organization and an association of organizations or other entities described in this paragraph sponsoring a health benefits plan;
covered individual
means an employee, annuitant, family member, or former spouse covered by a health benefits plan described by section 8903 or 8903a;
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);
employee
means— but does not include—
employee organization
means—
enrollee
means any individual who, during the contract year for which the weighted average is to be used under this section, will be eligible for a Government contribution for health benefits.
estimated net claims costs
shall mean the difference between—
former spouse
means a former spouse of an employee, former employee, or annuitant— except that such term shall not include any such unremarried former spouse of a former employee whose marriage was dissolved after the former employee’s separation from the service (other than by retirement);
Government
means the Government of the United States and the government of the District of Columbia;
health benefits plan
means a group insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar group arrangement provided by a carrier for the purpose of providing, paying for, or reimbursing expenses for health services;
initial contract year
means the contract year beginning in January of 2025;
initial participating carrier
means a carrier that enters into a contract with the Office to participate in the Program during the initial contract year;
Medicare part A
means part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.);
Medicare part B
means part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.);
Medicare program information
includes (i) the limitations on hospital charges established for Medicare purposes under section 1886 of the Social Security Act (42 U.S.C. 1395ww) and the identity of hospitals which have in force agreements with the Secretary of Health and Human Services consistent with section 1814(a) and 1866 of the Social Security Act (42 U.S.C. 1395f(a) and 1395cc), and (ii) the fee schedule amounts and limiting charges for physicians’ services established under section 1848 of such Act (42 U.S.C. 1395w–4) and the identity of participating physicians and suppliers who have in force agreements with such Secretary under section 1842(h) of such Act (42 U.S.C. 1395u(h)).
member of family
means the spouse of an employee or annuitant and an unmarried dependent child under 22 years of age, including— or such an unmarried dependent child regardless of age who is incapable of self-support because of mental or physical disability which existed before age 22;
navigator
means an employee of the Postal Service or of a contractor of the Postal Service who is designated by the Postal Service or contractor to carry out activities under paragraph (5).
Office
means the Office of Personnel Management;
Postal Service
means the United States Postal Service;
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);
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;
Postal Service Medicare covered annuitant
means an individual who—
Program
means the Postal Service Health Benefits Program established under subsection (c) within the Federal Employees Health Benefits Program;
Program plan
means a health benefits plan offered under the Program;
provider
means a physician, hospital, or other individual or entity which furnishes health care services or supplies;
qualified clinical social worker
means an individual—
qualified health maintenance carrier
means any qualified carrier which is a qualified health maintenance organization within the meaning of section 1310(d)(1) 1 of title XIII of the Public Health Service Act (42 U.S.C. 300c–9(d)).
should know
means that a person, with respect to information, acts in deliberate ignorance of, or in reckless disregard of, the truth or falsity of the information, and no proof of specific intent to defraud is required;
surplus position
means a position which is identified in pre-reduction-in-force planning as no longer required, and which is expected to be eliminated under formal reduction-in-force procedures.