5 U.S.C. § 8903 : US Code - Section 8903: Health benefits plans

Search 5 U.S.C. § 8903 : US Code - Section 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).