
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 5USC8903]

 
             TITLE 5--GOVERNMENT ORGANIZATION AND EMPLOYEES
 
                           PART III--EMPLOYEES
 
                   Subpart G--Insurance and Annuities
 
                      CHAPTER 89--HEALTH INSURANCE
 
Sec. 8903. Health benefits plans

    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 two levels of benefits, 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 given to employees, 
    annuitants, members of their families, former spouses, or persons 
    having continued coverage under section 8905a of this title, 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.
        (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.
        (3) Employee Organization Plans.--Employee organization plans 
    which offer benefits of the types referred to by section 8904(3) of 
    this title, 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, 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, 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).

(Pub. L. 89-554, Sept. 6, 1966, 80 Stat. 602; Pub. L. 95-454, title IX, 
Sec. 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 98-615, 
Sec. 3(3), Nov. 8, 1984, 98 Stat. 3203; Pub. L. 99-53, Sec. 2(b), June 
17, 1985, 99 Stat. 94; Pub. L. 99-251, title I, Secs. 102, 111, Feb. 27, 
1986, 100 Stat. 14, 19; Pub. L. 100-654, title II, Sec. 202(b), Nov. 14, 
1988, 102 Stat. 3845; Pub. L. 105-266, Sec. 3(b), Oct. 19, 1998, 112 
Stat. 2366.)

                      Historical and Revision Notes
------------------------------------------------------------------------
                                                    Revised Statutes and
     Derivation                U.S. Code             Statutes at Large
------------------------------------------------------------------------
                     5 U.S.C. 3003.                Sept. 28, 1959, Pub.
                                                    L. 86-382, Sec.  4,
                                                    73 Stat. 711.
                     ............................  July 8, 1963, Pub. L.
                                                    88-59, Sec.  1(b),
                                                    77 Stat. 77.
------------------------------------------------------------------------

    Standard changes are made to conform with the definitions applicable 
and the style of this title as outlined in the preface to the report.


                               Amendments

    1998--Par. (1). Pub. L. 105-266 substituted ``plan, which may be 
underwritten by participating affiliates licensed in any number of 
States,'' for ``plan,''.
    1988--Par. (1). Pub. L. 100-654 substituted ``former spouses, or 
persons having continued coverage under section 8905a of this title,'' 
for ``or former spouses,'' and ``former spouse, or person having 
continued coverage under section 8905a of this title.'' for ``or former 
spouse.''
    1986--Par. (4)(A). Pub. L. 99-251, Sec. 102, amended second sentence 
generally, substituting ``at least 3 physicians'' for ``physicians 
representing at least three major medical specialties'' and inserted 
``and who represent 1 or more medical specialties appropriate and 
necessary for the population proposed to be served by the plan''.
    Par. (4)(C). Pub. L. 99-251, Sec. 111, added subpar. (C).
    1985--Par. (3). Pub. L. 99-53 inserted ``described in section 
8901(8)(A) of this title'' after ``employee organizations''.
    1984--Par. (1). Pub. L. 98-615, Sec. 3(3), substituted ``employees, 
annuitants, members of their families, or former spouses'' for 
``employees or annuitants, or members of their families'' and 
``employee, annuitant, family member, or former spouse'' for ``employee 
or annuitant or member of his family''.
    1978--Pub. L. 95-454 substituted ``Office of Personnel Management'' 
and ``Office'' for ``Civil Service Commission'' and ``Commission'', 
respectively, wherever appearing.


                    Effective Date of 1988 Amendment

    Amendment by Pub. L. 100-654 applicable with respect to any calendar 
year beginning, and contracts entered into or renewed for any calendar 
year beginning, after end of 9-month period beginning Nov. 14, 1988, and 
with respect to any qualifying event occurring on or after first day of 
first calendar year beginning after end of such 9-month period, see 
section 203 of Pub. L. 100-654, set out as a note under section 8902 of 
this title.


                    Effective Date of 1984 Amendment

    Amendment by Pub. L. 98-615 effective May 7, 1985, with enumerated 
exceptions, and applicable to any individual who is married to an 
employee or annuitant on or after that date, see section 4(a)(2) of Pub. 
L. 98-615, as amended, set out as a note under section 8341 of this 
title.


                    Effective Date of 1978 Amendment

    Amendment by Pub. L. 95-454 effective 90 days after Oct. 13, 1978, 
see section 907 of Pub. L. 95-454, set out as a note under section 1101 
of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 8901, 8902, 8902a, 8903a, 
8903b, 8904, 8905, 8907, 8908, 8909, 8910, 8913 of this title; title 42 
sections 1395s, 1397cc.
