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10 U.S.C. § 1108 — Health care coverage through Federal Employees Health Benefits program: demonstration project

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

10 U.S.C. § 1108 — Health care coverage through Federal Employees Health Benefits program: demonstration project

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Stable record: federal_law:legal_authorities:record_usc_2127a01424bed2c30efaf199
Source file: Laws/federal/codes/united-states-code/title-10/section-1108-health-care-coverage-through-federal-employees-health-benefits-program-d--1f1f305892.md
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Source location: Title 10, Chapter 55, § 1108; chapter-055-medical-and-dental-care.md

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**(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1074/b&num=0&edition=prelim) who is entitled to hospital 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.); (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— (i) a dependent of a deceased member or former member described in section 1076(b) or 1076(a)(2)(B) of this title or of a member who died while on active duty for a period of more than 30 days; and (ii) a member of family as defined in [section 8901(5) of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8901/5&num=0&edition=prelim); or (D) an individual who is— (i) a dependent of a living member or former member described in [section 1076(b)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1076/b/1&num=0&edition=prelim) 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 (ii) a member of family as defined in [section 8901(5) of title 5](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8901/5&num=0&edition=prelim). (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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8901&num=0&edition=prelim) 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. (5) An eligible beneficiary who is eligible to enroll in the Federal Employees Health Benefits program as an employee under chapter 89 of title 5 is not eligible to enroll in a Federal Employees Health Benefits plan under this 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— (1) an area that includes the catchment area of one or more military medical treatment facilities; (2) an area that is not located in the catchment area of a military medical treatment facility; (3) an area in which there is a Medicare Subvention Demonstration project area under section 1896 11 See References in Text note below. of title XVIII of the Social Security Act ([42 U.S.C. 1395ggg](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ggg&num=0&edition=prelim)); and (4) not more than one area for each TRICARE region. **(d) Duration of Demonstration Project.—** (1) The Secretary of Defense shall conduct the demonstration project during three contract years under the Federal Employees Health Benefits program. (2) Eligible beneficiaries shall, as provided under the agreement pursuant to subsection (a), be permitted to enroll in the demonstration project during an open enrollment period for the year 2000 (conducted in the fall of 1999). The demonstration project shall terminate on December 31, 2002. **(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. (2) A beneficiary who elects to enroll in the project, and who subsequently discontinues enrollment in the project before the end of the period described in paragraph (1), shall not be eligible to reenroll in the project. (3) An eligible beneficiary enrolled in a Federal Employees Health Benefits plan under this section may change health benefits plans and coverage in the same manner as any other Federal Employees Health Benefits program beneficiary may change such plans. **(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8906/c&num=0&edition=prelim) 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) 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 22 See Change of Name note below. organization in a Medicare+Choice 2 plan. (2) In applying paragraph (1)— (A) any reference in clause (v) or (vi) of section 1882(s)(3)(B) of such Act to 12 months is deemed a reference to 36 months; and (B) the notification required under section 1882(s)(3)(D) of such Act shall be provided in a manner specified by the Secretary of Defense in consultation with the Director of the Office of Personnel Management.

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

10 U.S.C. § 1073 — Administration of this chapter

**(a) Responsible Officials.—** (1) Except as otherwise provided in this chapter, the Secretary of Defense shall administer this chapter for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy, and the Secretary of Health and Human Services shall administer this chapter for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997 ([42 U.S.C. 14401](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section14401&num=0&edition=prelim) et seq.). (2) Except as otherwise provided in this chapter, the Secretary of Defense shall have responsibility for administering the TRICARE program and making any decision affecting such program. **(b) Stability in Program of Benefits.—** The Secretary of Defense shall, to the maximum extent practicable, provide a stable program of benefits under this chapter throughout each fiscal year. To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense may implement any such change prior to the next fiscal quarter if the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter.

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42 U.S.C. § 1395ss — Application of certain provisions of subchapter II

The provisions of sections 406 and 416(j) of this title, and of subsections (a), (d), (e), (h), (i), (j), (k), and (l) of [section 405 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section405&num=0&edition=prelim), shall also apply with respect to this subchapter to the same extent as they are applicable with respect to subchapter II, except that, in applying such provisions with respect to this subchapter, any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary or the Department of Health and Human Services, respectively.

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

42 U.S.C. § 1395w–21 — Federal Supplementary Medical Insurance Trust Fund

**(a) Creation; deposits; fund transfers** There is hereby created on the books of the Treasury of the United States a trust fund to be known as the “Federal Supplementary Medical Insurance Trust Fund” (hereinafter in this section referred to as the “Trust Fund”). The Trust Fund shall consist of such gifts and bequests as may be made as provided in [section 401(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section401/i/1&num=0&edition=prelim), such amounts as may be deposited in, or appropriated to, such fund as provided in this part or section 9008(c) 11 See References in Text note below. of the Patient Protection and Affordable Care Act of 2009, and such amounts as may be deposited in, or appropriated to, the Medicare Prescription Drug Account established by [section 1395w–116 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w-116&num=0&edition=prelim) or the Transitional Assistance Account established by [section 1395w–141(k)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–141/k/1&num=0&edition=prelim). **(b) Board of Trustees; composition; meetings; duties** With respect to the Trust Fund, there is hereby created a body to be known as the Board of Trustees of the Trust Fund (hereinafter in this section referred to as the “Board of Trustees”) composed of the Commissioner of Social Security, the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services, all ex officio, and of two members of the public (both of whom may not be from the same political party), who shall be nominated by the President for a term of four years and subject to confirmation by the Senate. A member of the Board of

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42 U.S.C. § 1395c — Prohibition against any Federal interference

Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

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5 U.S.C. § 8901 — Definitions

For the purpose of this chapter— (1) “employee” means— (A) an employee as defined by [section 2105 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section2105&num=0&edition=prelim); (B) a Member of Congress as defined by [section 2106 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section2106&num=0&edition=prelim); (C) a Congressional employee as defined by [section 2107 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section2107&num=0&edition=prelim); (D) the President; (E) an individual first employed by the government of the District of Columbia before October 1, 1987; (F) an individual employed by Gallaudet College; 11 See Change of Name note below. (G) an individual employed by a county committee established under [section 590h(b) of title 16](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title16-section590h/b&num=0&edition=prelim); (H) an individual appointed to a position on the office staff of a former President under section 1(b) of the Act of August 25, 1958 (72 Stat. 838); (I) an individual appointed to a position on the office staff of a former President, or a former Vice President under section 5 of the Presidential Transition Act of 1963, as amended (78 Stat. 153), who immediately before the date of such appointment was an employee as defined under any other subparagraph of this paragraph; and (J) an individual who is employed by the Roosevelt Campobello International Park Commission and is a citizen of the United States, but does not include— (i) an employee of a corporation supervised by the Farm Credit Administration if private interests elect or appoint a member of the board of directors; (ii) a

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42 U.S.C. § 1305 — Short title of chapter

This chapter may be cited as the “Social Security Act”.

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42 U.S.C. § 1395ggg — Payments to promote closing or conversion of underutilized hospital facilities

**(a) Transitional allowances; procedures applicable** Any hospital may file an application with the Secretary (in such form and including such data and information as the Secretary may require) for establishment of a transitional allowance under this subchapter with respect to the closing or conversion of an underutilized hospital facility. The Secretary also may establish procedures, consistent with this section, by which a hospital, before undergoing an actual closure or conversion of a hospital facility, can have a determination made as to whether or not it will be eligible for a transitional allowance under this section with respect to such closure or conversion. **(b) Allowable costs as transitional allowances; findings and determinations** If the Secretary finds, after consideration of an application under subsection (a), that— (1) the hospital’s closure or conversion— (A) is formally initiated after September 30, 1981, (B) is expected to benefit the program under this subchapter by (i) eliminating excess bed capacity, (ii) discontinuing an underutilized service for which there are adequate alternative sources, or (iii) substituting for the underutilized service some other service which is needed in the area, and (C) is consistent with the findings of an appropriate health planning agency and with any applicable State program for reduction in the number of hospital beds in the State, and (2) in the case of a complete closure of a hospital— (A) the hospital is a private nonprofit hospital or a local governmental hospital, and (B) the closure is not for replacement of the hospital, the Secretary may include as an allowable cost in the hospital’s reasonable cost (for the purpose of making payments to the hospital under this subchapter) an amount (i

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5 U.S.C. § 8905 — Election of coverage

**(a)** An employee may enroll in an approved health benefits plan described in section 8903 or 8903a— (1) as an individual; (2) for self plus one; or (3) for self and family. **(b)** An annuitant who at the time he becomes an annuitant was enrolled in a health benefits plan under this chapter— (1) as an employee for a period of not less than— (A) the 5 years of service immediately before retirement; (B) the full period or periods of service between the last day of the first period, as prescribed by regulations of the Office of Personnel Management, in which he is eligible to enroll in the plan and the date on which he becomes an annuitant; or (C) the full period or periods of service beginning with the enrollment which became effective before January 1, 1965, and ending with the date on which he becomes an annuitant; whichever is shortest; or (2) as a member of the family of an employee or annuitant; may continue his enrollment under the conditions of eligibility prescribed by regulations of the Office. The Office may, in its sole discretion, waive the requirements of this subsection in the case of an individual who fails to satisfy such requirements if the Office determines that, due to exceptional circumstances, it would be against equity and good conscience not to allow such individual to be enrolled as an annuitant in a health benefits plan under this chapter 11 So in original. Probably should be followed by a period. **(c)** (1) A former spouse may— (A) within 60 days after the dissolution of the marriage, or (B) in the case of a former spouse of a former employee whose marriage was dissolved after the employee’s retirement, within 60 days after the dissolution of the marriage or, if later, within 60 days after an election is made under se

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

5 U.S.C. § 8906 — Contributions

**(a)** (1) Not later than October 1 of each year, the Office of Personnel Management shall determine the weighted average of the subscription charges that will be in effect during the following contract year with respect to— (A) enrollments under this chapter for self alone; (B) enrollments under this chapter for self plus one; and (C) enrollments under this chapter for self and family. (2) In determining each weighted average under paragraph (1), the weight to be given to a particular subscription charge shall, with respect to each plan (and option) to which it is to apply, be commensurate with the number of enrollees enrolled in such plan (and option) as of March 31 of the year in which the determination is being made. (3) For purposes of paragraph (2), the term “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. **(b)** (1) Except as provided in paragraphs (2), (3), and (4), the biweekly Government contribution for health benefits for an employee or annuitant enrolled in a health benefits plan under this chapter is adjusted to an amount equal to 72 percent of the weighted average under subsection (a)(1)(A) or (B), as applicable. For an employee, the adjustment begins on the first day of the employee’s first pay period of each year. For an annuitant, the adjustment begins on the first day of the first period of each year for which an annuity payment is made. (2) The biweekly Government contribution for an employee or annuitant enrolled in a plan under this chapter shall not exceed 75 percent of the subscription charge. (3) In the case of an employee who is occupying a position on a part-time career employment b

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

5 U.S.C. § 8909 — Employees Health Benefits Fund

**(a)** There is in the Treasury of the United States an Employees Health Benefits Fund which is administered by the Office of Personnel Management. The contributions of enrollees and the Government described by [section 8906 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8906&num=0&edition=prelim) shall be paid into the Fund. The Fund is available— (1) without fiscal year limitation for all payments to approved health benefits plans; and (2) to pay expenses for administering this chapter within the limitations that may be specified annually by Congress, except that the amounts required to be set aside under subsection (b)(2) shall not be subject to the limitations that may be specified annually by Congress. Payments from the Fund to a plan participating in a letter-of-credit arrangement under this chapter shall, in connection with any payment or reimbursement to be made by such plan for a health service or supply, be made, to the maximum extent practicable, on a checks-presented basis (as defined under regulations of the Department of the Treasury). **(b)** Portions of the contributions made by enrollees and the Government shall be regularly set aside in the Fund as follows: (1) A percentage, not to exceed 1 percent of all contributions, determined by the Office to be reasonably adequate to pay the administrative expenses made available by subsection (a) of this section. (2) In fiscal year 2026, $66,000,000, to be derived from all contributions, and to remain available until the end of fiscal year 2035, for the Director of the Office to carry out subsections (c) through (f) of the FEHB Protection Act of 2025. (3) For each health benefits plan, a percentage, not to exceed 3 percent of the contributions toward the plan, de

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