Summary: H.R.7275 — 97th Congress (1981-1982)All Information (Except Text)

There is one summary for H.R.7275. Bill summaries are authored by CRS.

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Introduced in House (10/01/1982)

Federal Employees Health Benefits Reform Act of 1982 - Increases the amount of the Government's contribution for an employee enrolled in a employee health benefits plan from 60 to 75 percent of the average subscription charge for such plan. Increases the maximum Government contribution for an enrollee from 75 to 100 percent of such subscription charge.

Requires payment of a Government differential equal to five percent of the average subscription charge, in addition to the Government's contribution, for any enrollee who is over 65 years of age and not entitled to medicare benefits. Excludes such differential in determining the amount to be paid by the enrollee.

Permits the following persons to elect to continue coverage under a Federal employees' health benefits plan for a specified period: (1) an employee who is involuntarily separated from the civil service due to a reduction in force; (2) the spouse of an enrollee whose marriage is dissolved by divorce or annulment, if the enrollee was enrolled for self and family; (3) an individual who elects to receive the lump-sum credit for civil service retirement benefits; and (4) an individual 22 years of age or older whose enrollment was based on such individual's being an unmarried child who was incapable of self-support because of a mental or physical disability which existed and did not terminate before the individual attained the age of 22. Requires such persons who elect to continue coverage to pay into the Employees Health Benefits Fund an amount equal to the sum of employee and agency contributions paid for the same level of benefits. Allows such a person to: (1) change to a lower level of benefits; (2) change coverage within 60 days after a change in family status; and (3) transfer enrollment to another plan under conditions prescribed by the Office of Personnel Management (OPM). Provides a temporary extension of coverage to allow persons who elected not to continue coverage or whose continued coverage is terminated to convert to a nongroup contract providing health benefits.

Allows annuitants whose annuity is less than the amount required to be withheld for enrollment in a health benefits plan to pay the amount of any deficiency required for enrollment.

Requires contracts for employee organization plans and comprehensive medical plans to require carriers to reinsure with other participants.

Requires the service benefit plan and the indemnity benefit plan to provide, in addition to all currently authorized benefits: (1) nervous and mental disorder benefits; and (2) alcoholism and substance abuse treatment and rehabilitation benefits. Prohibits the OPM from entering into a contract for any service benefit, indemnity benefit, or employee organization plan which does not provide for 50 outpatient visits and 60 inpatient days of nervous and mental disorder benefits and two 28-day alcoholism treatment and rehabilitation benefits. Requires any limits on nervous and mental disorder benefits to be exceeded on a case by case basis only to the extent that a peer review mechanism determines such treatment to be necessary. Requires 80 percent of such excessive benefit claims to be paid from the balance of one percent of all contributions to the Employees Health Benefits Fund remaining after the expenses of administering provisions governing Federal employees health benefit plans are paid.

Prohibits the OPM from entering into a contract with a carrier for any health benefits plan which does not provide 95 percent of the benefits that such plan or the most similar plan provided during the preceding year, unless the carrier and the OPM mutually agree to waive such requirement.

Directs the OPM to: (1) provide a three week period during which enrollees in health benefits plans may change or cancel their enrollments before any contract term in which the rates or benefits of a plan will change, a new plan will be offered, or an existing plan will be terminated; and (2) make available to such enrollees information on such plans at least four weeks before such open enrollment period.

Prohibits the OPM from entering into a contract for a health benefits plan which excludes anyone because of nonactive employee status.

Eliminates the requirement that the group of physicians under a group-practice prepayment plan include physicians representing at least three major medical specialties.