- 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.