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5 U.S.C. § 8903 — Health benefits plans

Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8903 — Health benefits plans

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Stable record: federal_law:legal_authorities:record_usc_1441fec717da5b5d36f5b9d0
Source file: Laws/federal/codes/united-states-code/title-5/section-8903-health-benefits-plans--43d982e45c.md
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Source location: Title 5, Chapter 89, § 8903; chapter-089-health-insurance.md

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The Office of Personnel Management may contract for or approve the following health benefits plans: (1) **Service Benefit Plan.—** — One Government-wide plan, which may be underwritten by participating affiliates licensed in any number of States, offering at least 2 levels of benefits for enrollees under this chapter generally and at least 2 levels of benefits for enrollees under the Postal Service Health Benefits Program established under section 8903c, under which payment is made by a carrier under contracts with physicians, hospitals, or other providers of health services for benefits of the types described by [section 8904(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8904/1&num=0&edition=prelim) given to employees, annuitants, members of their families, former spouses, or persons having continued coverage under [section 8905a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8905a&num=0&edition=prelim), or, under certain conditions, payment is made by a carrier to the employee, annuitant, family member, former spouse, or person having continued coverage under [section 8905a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8905a&num=0&edition=prelim). (2) **Indemnity Benefit Plan.—** — One Government-wide plan, offering two levels of benefits, under which a carrier agrees to pay certain sums of money, not in excess of the actual expenses incurred, for benefits of the types described by [section 8904(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8904/2&num=0&edition=prelim). (3) **Employee Organization Plans.—** — Employee organization plans which offer benefits of the types referred to by [section 8904(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8904/3&num=0&edition=prelim), which are sponsored or underwritten, and are administered, in whole or substantial part, by employee organizations described in [section 8901(8)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8901/8/A&num=0&edition=prelim), which are available only to individuals, and members of their families, who at the time of enrollment are members of the organization. (4) **Comprehensive Medical Plans.—** (A) *Group-practice prepayment plans.—* — Group-practice prepayment plans which offer health benefits of the types referred to by [section 8904(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8904/4&num=0&edition=prelim), in whole or in substantial part on a prepaid basis, with professional services thereunder provided by physicians practicing as a group in a common center or centers. The group shall include at least 3 physicians who receive all or a substantial part of their professional income from the prepaid funds and who represent 1 or more medical specialties appropriate and necessary for the population proposed to be served by the plan. (B) *Individual-practice prepayment plans.—* — Individual-practice prepayment plans which offer health services in whole or substantial part on a prepaid basis, with professional services thereunder provided by individual physicians who agree, under certain conditions approved by the Office, to accept the payments provided by the plans as full payment for covered services given by them including, in addition to in-hospital services, general care given in their offices and the patients’ homes, out-of-hospital diagnostic procedures, and preventive care, and which plans are offered by organizations which have successfully operated similar plans before approval by the Office of the plan in which employees may enroll. (C) *Mixed model prepayment plans.—* — Mixed model prepayment plans which are a combination of the type of plans described in subparagraph (A) and the type of plans described in subparagraph (B).

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8341 — Survivor annuities

**(a)** For the purpose of this section— (1) “widow” means the surviving wife of an employee or Member who— (A) was married to him for at least 9 months immediately before his death; or (B) is the mother of issue by that marriage; (2) “widower” means the surviving husband of an employee or Member who— (A) was married to her for at least 9 months immediately before her death; or (B) is the father of issue by that marriage; (3) “dependent”, in the case of any child, means that the employee or Member involved was, at the time of the employee or Member’s death, either living with or contributing to the support of such child, as determined in accordance with such regulations as the Office of Personnel Management shall prescribe; and (4) “child” means— (A) an unmarried dependent child under 18 years of age, including (i) an adopted child, and (ii) a stepchild but only if the stepchild lived with the employee or Member in a regular parent-child relationship, and (iii) a recognized natural child, and (iv) a child who lived with and for whom a petition of adoption was filed by an employee or Member, and who is adopted by the surviving spouse of the employee or Member after his death; (B) such unmarried dependent child regardless of age who is incapable of self-support because of mental or physical disability incurred before age 18; or (C) such unmarried dependent child between 18 and 22 years of age who is a student regularly pursuing a full-time course of study or training in residence in a high school, trade school, technical or vocational institute, junior college, college, university, or comparable recognized educational institution. For the purpose of this paragraph and subsection (e) of this section, a child whose 22nd birthday occurs before July

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8341

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8905a — Continued coverage

**(a)** Any individual described in subsection (b) may elect to continue coverage under this chapter in accordance with the provisions of this section. **(b)** This section applies with respect to— (1) any employee who— (A) is separated from service, whether voluntarily or involuntarily, except that if the separation is involuntary, this section shall not apply if the separation is for gross misconduct (as defined under regulations which the Office of Personnel Management shall prescribe); and (B) would not otherwise be eligible for any benefits under this chapter (determined without regard to any temporary extension of coverage and without regard to any benefits available under a nongroup contract); (2) any individual who— (A) ceases to meet the requirements for being considered an unmarried dependent child under this chapter; (B) on the day before so ceasing to meet the requirements referred to in subparagraph (A), was covered under a health benefits plan under this chapter as a member of the family of an employee or annuitant; and (C) would not otherwise be eligible for any benefits under this chapter (determined without regard to any temporary extension of coverage and without regard to any benefits available under a nongroup contract); and (3) any employee who— (A) is enrolled in a health benefits plan under this chapter; (B) is a member of a reserve component of the armed forces; (C) is called or ordered to active duty in support of a contingency operation (as defined in [section 101(a)(13) of title 10](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section101/a/13&num=0&edition=prelim)); (D) is placed on leave without pay or separated from service to perform active duty; and (E) serves on active duty for a p

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8905a

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8902 — Contracting authority

**(a)** The Office of Personnel Management may contract with qualified carriers offering plans described by section 8903 or 8903a of this title, without regard to section 6101(b) to (d) of title 41 or other statute requiring competitive bidding. Each contract shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. **(b)** To be eligible as a carrier for the plan described by [section 8903(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903/2&num=0&edition=prelim), a company must be licensed to issue group health insurance in all the States and the District of Columbia. **(c)** A contract for a plan described by section 8903(1) or (2) of this title shall require the carrier— (1) to reinsure with other companies which elect to participate, under an equitable formula based on the total amount of their group health insurance benefit payments in the United States during the latest year for which the information is available, to be determined by the carrier and approved by the Office; or (2) to allocate its rights and obligations under the contract among its affiliates which elect to participate, under an equitable formula to be determined by the carrier and the affiliates and approved by the Office. **(d)** Each contract under this chapter shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits as the Office considers necessary or desirable. **(e)** The Office may prescribe reasonable minimum standards for health benefits plans described by section 8903 or 8903a of this title and for carriers offering the plans. Approval of a pla

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8902

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 1101 — Office of Personnel Management

The Office of Personnel Management is an independent establishment in the executive branch. The Office shall have an official seal, which shall be judicially noticed, and shall have its principal office in the District of Columbia, and may have field offices in other appropriate locations.

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8903a — Additional health benefits plans

**(a)** In addition to any plan under [section 8903 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903&num=0&edition=prelim), the Office of Personnel Management may contract for or approve one or more health benefits plans under this section. **(b)** A plan under this section may not be contracted for or approved unless it— (1) is sponsored or underwritten, and administered, in whole or substantial part, by an employee organization described in [section 8901(8)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8901/8/B&num=0&edition=prelim); (2) offers benefits of the types named by paragraph (1) or (2) of [section 8904 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8904&num=0&edition=prelim) or both; (3) provides for benefits only by paying for, or providing reimbursement for, the cost of such benefits (as provided for under paragraph (1) or (2) of [section 8903 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903&num=0&edition=prelim)) or a combination thereof; and (4) is available only to individuals who, at the time of enrollment, are full members of the organization and to members of their families. **(c)** A contract for a plan approved under this section shall require the carrier— (1) to enter into an agreement approved by the Office with an underwriting subcontractor licensed to issue group health insurance in all the States and the District of Columbia; or (2) to demonstrate ability to meet reasonable minimum financial standards prescribed by the Office. **(d)** For the purpose of this section, an individual shall be considered a full member of an organization if such individual is e

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8903a

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8904 — Types of benefits

**(a)** The benefits to be provided under plans described by [section 8903 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903&num=0&edition=prelim) may be of the following types: (1) **Service Benefit Plan.—** (A) Hospital benefits. (B) Surgical benefits. (C) In-hospital medical benefits. (D) Ambulatory patient benefits. (E) Supplemental benefits. (F) Obstetrical benefits. (2) **Indemnity Benefit Plan.—** (A) Hospital care. (B) Surgical care and treatment. (C) Medical care and treatment. (D) Obstetrical benefits. (E) Prescribed drugs, medicines, and prosthetic devices. (F) Other medical supplies and services. (3) **Employee Organization Plans.—** — Benefits of the types named under paragraph (1) or (2) of this subsection or both. (4) **Comprehensive Medical Plans.—** — Benefits of the types named under paragraph (1) or (2) of this subsection or both. All plans contracted for under paragraphs (1) and (2) of this subsection shall include benefits both for costs associated with care in a general hospital and for other health services of a catastrophic nature. **(b)** (1) (A) A plan, other than a prepayment plan described in [section 8903(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903/4&num=0&edition=prelim), may not provide benefits, in the case of any retired enrolled individual who is age 65 or older and is not covered to receive Medicare hospital and insurance benefits under part A of title XVIII of the Social Security Act ([42 U.S.C. 1395c](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395c&num=0&edition=prelim) et seq.), to pay a charge imposed by any health care provider, for inpatient hospital serv

Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8904

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Federal law — U.S. Code and appendices · legal_authorities

5 U.S.C. § 8903 — Health benefits plans

Page 1247 TITLE 5—GOVERNMENT ORGANIZATION AND EMPLOYEES § 8903 of Pub. L. 103–355, which is set out as a note under sec- tion 6101 of Title 31, Money and Finance. AMENDMENTS 1998—Subsec. (a)(1)(D). Pub. L. 105–266, § 2(a)(1)(A), added subpar. (D). Subsec. (a)(2)(A). Pub. L. 105–266, § 2(a)(1)(B), sub- stituted ‘‘subsection (b), (c), or (d)’’ for ‘‘subsection (b) or (c)’’. Subsec. (b). Pub. L. 105–266, § 2(a)(2)(A), substituted ‘‘shall’’ for ‘‘may’’ in introductory provisions. Subsec. (b)(5). Pub. L. 105–266, § 2(a)(2)(B), amended par. (5) generally. Prior to amendment, par. (5) read as follows: ‘‘Any provider— ‘‘(A) whose license to provide health care services or supplies has been revoked, suspended, restricted, or not renewed, by a State licensing authority for reasons relating to the provider’s professional com- petence, professional performance, or financial integ- rity; or ‘‘(B) that surrendered such a license while a formal disciplinary proceeding was pending before such an authority, if the proceeding concerned the provider’s professional competence, professional performance, or financial integrity.’’ Subsec. (c). Pub. L. 105–266, § 2(a)(3), added subsec. (c). Former subsec. (c) redesignated (d). Subsec. (d). Pub. L. 105–266, § 2(a)(3), redesignated sub- sec. (c) as (d). Former subsec. (d) redesignated (e). Subsec. (d)(1). Pub. L. 105–266, § 2(a)(4), amended par. (1) generally. Prior to amendment, par. (1) read as fol- lows: ‘‘in connection with a claim presented under this chapter, that a provider of health care services or sup- plies— ‘‘(A) has charged for health care services or supplies that the provider knows or should have known were not provided as claimed; or ‘‘(B) has charged for health care services or supplies in an amount su

Source: Supplied 2024 U.S. Code historical extraction · 5 U.S.C. § 8903

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