Laws Affecting the Federal Employees Health
Benefits Program (FEHBP)
Annie L. Mach
Analyst in Health Care Financing
Ada S. Cornell
Information Research Specialist
February 13, 2013
Congressional Research Service
7-5700
www.crs.gov
R42741
CRS Report for Congress
Pr
epared for Members and Committees of Congress
Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Summary
The Federal Employees Health Benefits Program (FEHBP) has been in existence for over 50
years. Since its creation, it has provided private health insurance coverage to federal employees,
annuitants, and their dependents. It is the largest employer-sponsored health insurance program in
the country, covering about 8 million enrollees.
The program was created by the Federal Employees Health Benefits Act of 1959 (FEHBA, P.L.
86-382). FEHBA and its subsequent amendments established the parameters for eligibility and
the election of coverage; the types of health plans and benefits that may be offered; the level of
the government’s share of premiums; the Employees Health Benefits Fund to pay for program
expenses; and provisions for studies, reports, and audits. FEHBA also outlined the role of the
Office of Personnel Management (OPM). By law, OPM is given the authority to contract with
insurers and to prescribe regulations to manage FEHBP, among other duties.
The general model of FEHBP has not changed since its inception in 1959. FEHBP was and is a
program that allows competing private insurers to offer numerous types of coverage to enrollees
within broad federal guidelines. The federal government and the employee/annuitant have always
shared the cost of the premium, and generally, employees and annuitants have always had access
to the same plans at the same cost. However, specific features of FEHBP have been modified, in
some cases multiple times, by Congress and OPM. For example, eligibility has been expanded to
include additional types of federal employees and dependents, the formula for determining the
government’s share of premiums has changed, and the types of health benefits offered through
FEHBP plans have been broadened.
Congressional policymakers share responsibility with OPM for the program’s viability and
sustainability. Congress has financial and administrative interest in the program, as the
government pays for a share of FEHBP premiums and Congress has legislative authority to
modify FEHBP. Congressional interest in FEHBP also extends to FEHBP’s potential applicability
as a model for other health care programs or as an avenue to provide coverage, such as extending
aspects of FEHBP to Medicare, or using it as one of the models for the state exchanges under the
Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).
The purpose of the report is to provide historical and background information that helps explain
how FEHBP has evolved into the program it is today. Policymakers may use this report to
understand how Congress has interacted with FEHBP in the past, and to inform its future
interactions with FEHBP. Specifically, the report includes short discussions of how Congress has
effected and maintained policy changes to FEHBP by restricting the use of federal funds; changed
the formula for determining the government’s share of FEHBP premiums; expanded eligibility for
the program; and implemented policies that affect the relationship between Medicare and FEHBP.
The Appendix includes detailed summaries of selected laws or provisions of laws that have
directly amended or otherwise changed FEHBP.
Congressional Research Service
Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Contents
Introduction ...................................................................................................................................... 1
Interest in FEHBP ...................................................................................................................... 2
Scope of Report ......................................................................................................................... 3
Conditions on FEHBP Use of Federal Funds .................................................................................. 4
Premium Determinations ................................................................................................................. 5
Eligibility ......................................................................................................................................... 7
Medicare and FEHBP .................................................................................................................... 11
Tables
Table 1. Provisions of Laws Conditioning the Use of Federal Funds for FEHBP ........................... 5
Table 2. Provisions of Laws Related to Changes in How the Government’s Share of the
Premium Is Determined ................................................................................................................ 6
Table 3. Laws Affecting Eligibility for FEHBP ............................................................................... 8
Table 4. Provisions Related to Changing How FEHBP and Medicare Interact ............................. 12
Appendixes
Appendix. FEHBP Legislative History .......................................................................................... 13
Contacts
Author Contact Information........................................................................................................... 38
Congressional Research Service
Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Introduction
The Federal Employees Health Benefits program (FEHBP) provides private health insurance to
federal employees, retirees, and their dependents. FEHBP is the country’s largest employer-
sponsored health insurance program; in 2011 the federal government spent $30.8 billion on
FEHBP premiums for its approximately 8 million enrollees.1
Participation in FEHBP is voluntary. Enrollees can elect coverage in an approved plan for either
individual or family coverage. FEHBP offers enrollees choices among a variety of different plans
offered by private insurers. Enrollees can choose among nationally available fee-for-service plans
and locally available plans. Many plans in FEHBP offer a choice between a standard option, a
high option, and/or a high-deductible plan. The number of plans available to an enrollee varies
according to where the enrollee resides, but most enrollees typically have a choice among 6 to 15
different plans. Premiums and cost-sharing requirements vary according to plan, and both the
federal government and the enrollee contribute to the cost of premiums.
Prior to the creation of FEHBP in 1959, federal employees were not able to obtain health
insurance through the federal government; instead, federal employees who wanted health
insurance could voluntarily purchase coverage on their own or through the few union and
employee association plans that offered plans to federal employees.2 By 1950, it was common for
employers in the private sector in the United States to offer health insurance and pay at least a
portion of their employees’ health insurance premiums. As early as 1951, it was recommended
that the federal government begin following this practice.3 After debate on whether and how the
government should pursue this option, Congress passed the Federal Employees Health Benefits
Act of 1959 (FEHBA, P.L. 86-382).4
FEHBA generally established parameters for eligibility; election of coverage; the types of health
plans and benefits that may be offered; the level of the government’s share of premiums; the
establishment of an Employees Health Benefits Fund to pay for program expenses; and
provisions for studies, reports, and audits. FEHBA also outlined the role of the Office of
Personnel Management (OPM).5 By law, OPM is given the authority to contract with insurers and
to prescribe regulations to manage FEHBP, among other duties.6
FEHBA has been amended many times since its passage. The general model of FEHBP,
consisting of enrollees choosing between multiple types of coverage offered by competing private
1 Authors’ calculation based on unpublished March 2011 enrollment data from the Office of Personnel Management
(OPM).
2 U.S. Congress, House Committee on Post Office and Civil Service, The Federal Employees Health Benefits Program:
Possible Strategies for Reform, committee print, prepared by Congressional Research Service, 101st Cong., 1st sess.,
May 24, 1989, Committee Print 101-5 (Washington: GPO, 1989).
3 Odin W. Anderson and J. Joel May, The Federal Employees Health Benefits Program, 1961-1968: A Model for
National Health Insurance? (Chicago: University of Chicago, 1971).
4 Ibid.
5 Until the passage of the Civil Service Reform Act of 1978 (P.L. 95-454), the Office of Personnel Management (OPM)
was known as the Civil Service Commission. For the sake of clarity, in this report OPM is used even in the years prior
to the change.
6 For more information about OPM’s authority within FEHBP, see CRS Report RS21974, Federal Employees Health
Benefits Program (FEHBP): Available Health Insurance Options, by Annie L. Mach.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
insurers, has not changed. Employees and annuitants have always shared the cost of premiums
with the federal government, and employees and annuitants have generally always had access to
the same plans at the same cost.7
However, many other aspects of FEHBP have been modified. For example, the determination of
the government’s share of premiums has changed several times, and the government’s share of
premiums has generally increased. In addition, eligibility, services, and benefits have generally
been expanded in a number of ways. Congress, in its legislative authority, often has some part in
modifying FEHBP, either in proposing changes to FEHBP or reacting to proposed changes.
Interest in FEHBP
Since its inception, policymakers and researchers have been interested in FEHBP both as a model
for private and public health insurance programs (e.g., Medicare) and as an avenue for expanding
coverage to certain individuals (e.g., the uninsured).8 The FEHBP model consists of competing
insurers providing numerous types of coverage to enrollees with minimal intervention from OPM.
Many view this model as generally successful in giving enrollees the opportunity to make cost-
conscious choices and in constraining the program’s overall cost growth.
For this reason, some would like to export aspects of the FEHBP model to other health care
programs. For example, some policymakers and researchers believe that Medicare could benefit
from implementing aspects of the FEHBP model.9 Others are interested in expanding access to
FEHBP or creating new programs modeled after FEHBP to provide coverage to individuals who
are not federal workers or annuitants, such as small business employees or the uninsured.10 Some
policymakers have embraced these ideas, introducing legislation to create new programs or
opening FEHBP to individuals who are not federal employees or annuitants.11 In the past, it has
7 Certain plans offered in FEHBP are available only to certain types of employees and annuitants. For example, the
Foreign Service Benefit Plan is available only to employees and annuitants who are American Foreign Service
personnel. Non-postal employees and all annuitants pay the same premium for plans; however, postal employees have
collective bargaining rights, and historically, the Postal Service’s contribution to premiums for postal employees has
been higher than for all other employees and annuitants.
8 For examples of the various policymakers, including Members of Congress, Presidents, and presidential candidates,
who have expressed interest in FEHBP as a model for other programs or in expanding access to FEHBP, see the
following discussions: Walton Francis, Putting Medicare Consumers in Charge (Washington D.C.: The AEI Press,
2009), pp. 3-6; Beth C. Fuchs, Increasing Health Insurance Coverage Through An Extended Federal Employees
Health Benefits Program, The Commonwealth Fund, December 2000, pp. 6-8, http://www.commonwealthfund.org/
usr_doc/fuchs2_workable_414.pdf.
9 The extent of support among policymakers and researchers for exporting FEHBP concepts to Medicare varies. For
example, see Stuart M. Butler and Robert E. Moffit, “The FEHBP As A Model for A New Medicare Program,” Health
Affairs, vol. 14, no. 4 (Winter 1995); Karen Davis, Barbara S. Cooper, and Rose Capasso, The Federal Employee
Health Benefits Program: A Model for Workers, Not Medicare, The Commonwealth Fund, November 2003; Roger
Feldman, Kenneth E. Thorpe, and Bradley Gray, “The Federal Employees Health Benefits Plan,” Journal of Economic
Perspectives, vol. 16, no. 2 (Spring 2002); Walton Francis, Putting Medicare Consumers in Charge (Washington D.C.:
The AEI Press, 2009); Mark Merlis, The Federal Employees Health Benefits Program: Program Design, Recent
Performance, and Implications for Medicare Reform, Kaiser Family Foundation, May 2003.
10 Stan Dorn and Jack A. Meyer, Nine Billion Dollars a Year to Cover the Uninsured: Possible Common Ground for
Significant, Incremental Process, Economic and Social Research Institute, October 2002, http://www.esresearch.org/
newsletter/october/summary4.htm; Beth C. Fuchs, Increasing Health Insurance Coverage Through An Extended
Federal Employees Health Benefits Program, The Commonwealth Fund, December 2000, pp. 6-8,
http://www.commonwealthfund.org/usr_doc/fuchs2_workable_414.pdf.
11 For example, in the 112th Congress legislation was introduced to enroll Medicare beneficiaries in FEHBP and to
(continued...)
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
also been suggested that certain features of FEHBP are a good model for state-level health
insurance exchanges,12 and some would say that lessons learned from FEHBP may be instructive
for state and federal officials that are establishing health benefit exchanges as created by the
Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).13
Congressional interest in FEHBP often extends beyond FEHBP’s potential applicability as a
model for other health care programs or as an avenue to provide coverage. Congressional
policymakers have some responsibility for FEHBP’s viability and sustainability. Congress has a
financial interest in the program, as the federal government has always paid a portion of FEHBP’s
costs. In addition, Congress has the legislative authority to restructure FEHBP to maintain or
improve its function.14
Scope of Report
The purpose of the report is to provide information that helps explain how FEHBP has evolved
into the program it is today and to understand how Congress has interacted with FEHBP in the
past. The report includes short discussions of certain changes to the program. The report discusses
how Congress has conditioned the use of federal funds on policy changes being implemented in
FEHBP (Table 1); changed the formula for determining the government’s share of FEHBP
premiums (Table 2); modified eligibility for the program (Table 3); and implemented policies
that affect the relationship between Medicare and FEHBP (Table 4).
In addition, the Appendix contains a summary of the enacting FEHBP legislation and summaries
of selected laws that have since amended or otherwise affected FEHBP. The summaries are
presented in chronological order. The summaries in the Appendix provide more detailed
examination of the legislation discussed in the body of this report, as well as summaries of
additional legislation that affects FEHBP.
(...continued)
sunset the Medicare program (S. 2196) and also to open up FEHBP to individuals who are not federal employees or
annuitants (H.R. 429).
12 See, for example, Robert E. Moffit, State-Based Health Reform: A Comparison of Health Insurance Exchanges and
the Federal Employees Health Benefits Program, The Heritage Foundation, No. 1515, June 20, 2007,
http://hss.state.ak.us/hspc/files/200710_state_fedbenefit.pdf.
13 Timothy D. McBride, Abigail R. Barker, Lisa M. Pollack, et al., “Federal Employees Health Program Experiences
Lack of Competition in Some Areas, Raising Cost Concerns for Exchange Plans,” Health Affairs, vol. 31, no. 6 (June
2012), pp. 1321-1328.
14 Also, as federal employees, Members of Congress and congressional staff are currently eligible to participate in
FEHBP; however, ACA includes a provision that could affect how Members and certain congressional staff can access
health plans as a benefit of their federal employment. For more information about health benefits for Members of
Congress and changes under ACA, see CRS Report RS21982, Health Benefits for Members of Congress, by Ada S.
Cornell.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Information Not Included in This Report
This report includes summaries of laws or provisions of laws that have directly amended or otherwise caused policy
changes to FEHBP. The report does not summarize any laws or provisions of laws that may apply generally, rather
than specifically, to FEHBP. For example, the Health Insurance Portability and Accountability Act of 1996 (HIPAA, P.L.
104-191) includes provisions that apply general y to group health plans. While plans provided under FEHBP are
presumed to fal under the definition of “group health plan,” and OPM requires FEHBP plans to comply with HIPAA
provisions, HIPAA does not specifically apply to FEHBP, and it is not summarized in this report.
In addition, this report does not cover any changes made to FEHBP by OPM. Statute gives OPM broad authority to
administer FEHBP, and in exercising that authority, OPM can implement changes to FEHBP.15 For example, OPM
issues “call letters” to FEHBP plans each year, which outline its policy goals for the upcoming year. In the call letter
for the 1990 contract year, OPM used its authority to require all plans to include coverage of prescription drugs.16
Subsequent cal letters have expanded and modified OPM’s prescription drug requirements. In another example, OPM
recently published an interim final rule that extends FEHBP eligibility to temporary federal firefighters.17 OPM has
indicated that doing so was within its authority to include or exclude employees in FEHBP.18
Finally, this report does not summarize any laws or provisions of laws that provide technical clarifications, non-
substantive grammatical changes, or name changes to FEHBP.
Conditions on FEHBP Use of Federal Funds
Congress can place conditions on the use of federal funds, and it has done so to effect and
maintain policy changes in FEHBP. For example, in 1983 Congress passed a law that prohibited
using appropriated federal funds to cover abortions, except when the life of the woman was in
danger.19 This provision was renewed with few changes every year except 1994 and 1995, when
the 103rd Congress excluded the provision.20 The reinstated provision prohibited the use of funds
except when the life of the woman was in danger or in cases of rape or incest; this provision has
been included in subsequent appropriations bills each year (as of the date of this report).21
Table 1 summarizes provisions in several laws that enact policy changes in FEHBP by
conditioning the use of federal funds.
15 In at least one instance, Congress has acted to block implementation of a policy change to FEHBP that was created
by OPM, in its authority to administer FEHBP. See P.L. 102-393 in the Appendix for more details.
16 FEHB Program Carrier Letter, March 30, 1989.
17 77 Federal Register 42417, July 17, 2012.
18 Letter from John Berry, Director of the Office of Personnel Management, to The Honorable Tom Coburn, Senator,
August 3, 2012.
19 This legislative restriction on FEHBP funds followed an earlier administrative attempt by OPM to eliminate non-life-
saving abortion coverage. OPM’s actions were challenged by federal employee unions, and a federal district court later
concluded that the agency acted outside the scope of its authority. In American Federation of Government Employees
v. AFL-CIO, 525 F.Supp. 250 (1981), the court found that absent a specific congressional statutory directive, there was
no basis for OPM’s actions.
20 Table 1 and the Appendix only include descriptions of laws that introduced this provision or failed to include it.
21 For further analysis of legislation related to coverage for abortion, see CRS Report RL33467, Abortion: Judicial
History and Legislative Response, by Jon O. Shimabukuro.
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Table 1. Provisions of Laws Conditioning the Use of Federal Funds for FEHBP
Year
Authorizing Statute
Change in How Federal Funds May Be Used in FEHBP
1983
A Joint Resolution Making Further Continuing
Restricted use of funds to pay for abortions or administrative expenses
Appropriations for the Fiscal Year 1984 (P.L. 98-
for any FEHBP plan that provides benefits or coverage for abortions,
151)
except when the life of the woman is in danger
Provision has been applied to FEHBP every year except 1994 and 1995;
since 1996 the provision has included an exception for cases of rape
and incest
1993
Treasury, Postal Service, and General
Prohibited use of funds appropriated by the Act to implement changes
Government Appropriations Act, 1993 (P.L. 102-
proposed by OPM that would affect Medicare beneficiaries
393)
1997
Assisted Suicide Funding Restriction Act of 1997
Prohibited use of federal funds for benefits and services related to
(P.L. 105-12)
assisted suicide and prohibits OPM from contracting with plans that
include coverage for these benefits and services
1999
Omnibus Consolidated and Emergency
Required al FEHBP plans to cover contraceptives, with the exception
Supplemental Appropriations Act, 1999 (P.L. 105-
of certain plans that object to such coverage on the basis of religious
277)
beliefs
Provision has been applied to FEHBP every year since 1999
Source: CRS analysis of selected legislation.
Premium Determinations
Over the years, the determination of the government’s share of premiums has changed, and the
percentage of the government’s share of premiums has increased overall. In the enacting
legislation, the government’s share was set at 50% of the premium, and it had to fall within a
specified dollar range. The determination changed little until 1971, when the “big six” formula
was created. The formula was equal to the simple average of the premiums of six health plans
offered in FEHBP that met the criteria specified in statute. The government’s share was originally
set at 40% of the simple average of the big six premiums and increased to 50% in 1974.
The big six formula was in place with few changes until 1997. The passage of the Balanced
Budget Act of 1997 (P.L. 105-33) introduced the formula for determining the government’s share
of premiums that is in effect today. The government contributes 72% of the weighted average
premium of all plans, not to exceed 75% of the premium for any one plan (calculated separately
for individual and family coverage).
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Table 2. Provisions of Laws Related to Changes in How the Government’s Share of
the Premium Is Determined
Change in How the Government’s Share of the
Passed Authorizing
Statute
Premium is Determined
1959
The Federal Employees Health Benefits Act of 1959
Set the government’s share of premiums at 50% of the lowest
(P.L. 86-382)
rate charged by a carrier, and required the government’s
share to fall in a specified dollar range. The dollar range was
different depending on plan type (individual or family) and the
enrol ee’s gender and family situation
1964
To Amend the Federal Employees Health Benefits
Made the government’s share of premiums the same for all
Act of 1959 to Remove Certain Inequities in the
enrollees according to plan type (individual or family),
Application of Such Act, to Improve the
regardless of gender and family situation
Administration Thereof, and for Other Purposes
(P.L. 88-284)
1966
The Federal Salary and Fringe Benefits Act of 1966
Changed the government’s share of premiums from falling in
(P.L. 89-504)
a specified dollar range to a fixed-dollar amount
1970
An Act to Increase the Contribution by the Federal
Altered the determination of the government’s share of
Government to the Cost of Health Benefits
premiums by creating the “big six” formula, calculated
Insurance, and for Other Purposes (P.L. 91-418)
separately for individual and family plans
Set the government’s share at 40% of the simple average of
the big six premiums
1974
An Act to Increase the Contribution of the
Increased the government’s share of the FEHBP plan
Government to the Costs of Health Benefits for
premium from 40% to 50% of the simple average of the big
Federal Employees, and for Other Purposes (P.L. 93-
six premiums
246)
Set the maximum government share at 75% of the total
premium for any one plan
1989
Relating to the Method by Which Government
Adjusted the big six formula to account for the absence of
Contributions to the Federal Employees Health
one of the plan types specified in the formula
Benefits Program Shal be Computed for 1990 or
1991 if no Government-Wide Indemnity Benefit Plan
Participates in that Year (P.L. 101-76)
1990
Omnibus Budget Reconciliation Act of 1990 (P.L.
Extended the restructured big six formula for calculating the
101-508)
government’s share of premiums through 1993
1993
Omnibus Budget Reconciliation Act of 1993 (P.L.
Extended the restructured big six formula for calculating the
103-66)
government’s share of premiums through 1998 (with
modifications for contract years 1997 and 1998)
1997
Balanced Budget Act of 1997 (P.L. 105-33)
Modified the formula for determining the government’s share
of premiums by requiring that OPM determine the weighted
average premium of all plans in FEHBP each year, calculated
separately for individual and family plans
Required that the biweekly government share of a premium
is equal to 72% of this average, not to exceed 75% of any
given plan’s premium
Source: CRS analysis of selected legislation.
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Eligibility
FEHBP-eligible participants specified in the enacting legislation included current federal
employees and annuitants who retired after July 1, 1960.22 Family members of employees and
annuitants were also eligible. See the text box, “Eligibility Under the Federal Employees Health
Benefits Act (P.L. 86-382),” for a complete list of eligibility under the enacting legislation. Since
the enactment of FEHBA, eligibility to enroll in FEHBP has generally been extended to more
categories of federal employees, annuitants, and their family and ex-family members.
Eligibility Under the Federal Employees Health Benefits Act (P.L. 86-382)
Specifically, the enacting legislation provided that the following individuals were eligible for FEHBP: (1) any appointed
or elected officer or employee in the executive, judicial, or legislative branch of the federal government, including a
government-owned or control ed corporation (except any corporation under the supervision of the Farm Credit
Administration); (2) any appointed or elected officer or employee of the municipal government of the District of
Columbia; (3) employees of Gal audet Col ege; (4) annuitants who retire on an immediate annuity after 12 or more
years of service or for a disability and were enrolled in a FEHBP plan for at least five years immediately prior to
retirement, or enrolled from the earliest opportunity to do so; (5) a member of a family who receives an immediate
annuity as the survivor of an annuitant or employee who dies after completing five or more years of service; (6) an
employee who receives monthly compensation under the Federal Employees’ Compensation Act (FECA, P.L. 64-267)
as a result of a work-related injury or illness, and who is determined by the Secretary of Labor to be unable to return
to duty; (7) a member of a family who receives monthly compensation under FECA as the surviving beneficiary of an
employee who has sustained work-related injuries or illnesses; (8) an employee’s or annuitant’s spouse; (9) an
employee’s or annuitant’s unmarried child under the age of 19 years, including an adopted child, a stepchild, and a
recognized natural child who lives with the employee or annuitant in a regular parent-child relationship; (10) an
employee’s or annuitant’s unmarried child who, regardless of age, is incapable of self-support because of mental or
physical incapacity that existed prior to the child reaching the age of 19 years.
FEHBP has also been expanded in that in 1978 it was extended to part-time employees, and in
1988 it was extended to certain temporary workers. In 1988, Congress also authorized temporary
continuation of coverage (TCC), whereby employees separated from service for reasons other
than gross misconduct can continue coverage in FEHBP.23 TCC enrollees must pay the entire
FEHBP premium, both the employer’s and the employees’ share, as well as a 2% administrative
fee. In general, TCC is available to separating employees and their dependents for up to 18
months after the date of separation; however, there are exceptions, such as 36 months of available
coverage for children aging out of their parents’ plans. TCC coverage has been modified for
certain employees and dependents since originally enacted.
22 In 1960, Congress passed The Retired Federal Employees Health Benefits Act (P.L. 86-724), which authorized the
creation of a health benefits program for federal employees who retired or became disabled before July 1, 1960, and
their family members. The program, “retired FEHBP,” was patterned after the existing FEHBP. In 1974, Congress
passed An Act to Increase the Contribution of the Government to the Costs of Health Benefits for Federal Employees,
and for Other Purposes (P.L. 93-246), which allowed annuitants participating or eligible to participate in retired
FEHBP and their family members to participate in regular FEHBP. This report does not include summaries of
legislation or provisions of legislation that affect only retired FEHBP.
23 TCC mirrors coverage created under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA; P.L. 99-272), which provides similar protections for private sector employees. For more information about
COBRA, see CRS Report R40142, Health Insurance Continuation Coverage Under COBRA, by Janet Kinzer.
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Table 3. Laws Affecting Eligibility for FEHBP
Authorizing Statute
Change in Eligibility for FEHBP
1959
The Federal Employees Health Benefits Act of 1959
Authorized coverage for federal employees, annuitants who
(P.L. 86-382)
retired after July 1, 1960,a dependents of employees and
annuitants, as wel as other specified individualsb
1960
The Postal Employees Salary Increase Act of 1960
Authorized coverage for Agriculture Stabilization and
(P.L. 86-568)
Conservation County Committee employees and their
dependents
1964
To Amend the Federal Employees Health Benefits
Authorized coverage for employees receiving compensation
Act of 1959 to Remove Certain Inequities in the
because of work-related injury, foster children, and unmarried
Application of Such Act, to Improve the
children up to age 21
Administration Thereof, and for Other Purposes
(P.L. 88-284)
1964
To Amend the Federal Employees Health Benefits
Authorized coverage for certain United States Commissioners
Act of 1959 and the Federal Employees Group Life
and their dependents
Insurance Act of 1954 (P.L. 88-531)
1964
To Amend the Federal Employees Health Benefits
Authorized coverage for teachers in D.C. who had been
Act of 1959 and the Federal Employees Group Life
temporarily employed as teachers for a total of at least two
Insurance Act of 1954 (P.L. 88-631)
years
1966
To Preserve the Benefits of the Civil Service
Authorized coverage for congressional staff receiving certain
Retirement Act, the Federal Employees Group Life
congressional staff fel owships
Insurance Act of 1954, and the Federal Employees
Health Benefits Act of 1959 for Congressional
Employees Receiving Certain Congressional Staff
Fel owships (P.L. 89-379)
1966
The Federal Salary and Fringe Benefits Act of 1966
Authorized coverage for dependent children from age 21 to 22
(P.L. 89-504)
Permitted certain employees on leave without pay to continue
or acquire coverage
1968
The National Guard Technicians Act of 1968 (P.L.
Authorized coverage for National Guard technicians and their
90-486)
dependents
1968
The Federal Magistrates Act (P.L. 90-578)
Authorized coverage for United States magistrates, their clerical
and secretarial assistants, and their dependents
1969
The Foreign Assistance Act of 1969 (P.L. 91-175)
Authorized coverage for employees during a period of transfer
to employment with an international organization
1970
An Act to Increase the Contribution by the Federal
Authorized coverage for (1) family members who received an
Government to the Cost of Health Benefits
immediate annuity as the survivor of an employee or of a retired
Insurance, and for Other Purposes (P.L. 91-418)
employee in the event that the deceased had completed less
than five years of creditable service; (2) noncitizen employees
whose permanent duty station is in the Panama Canal Zone
1971
The Intergovernmental Personnel Act of 1970 (P.L.
Authorized coverage for federal employees assigned to state or
91-648)
local governments
Authorized coverage for state or local government employees
who were assigned to an executive agency in the federal
government
1973
To Extend Civil Service Federal Employees Group
Authorized coverage for otherwise eligible United States
Life Insurance and Federal Employees Health
nationals employed at permanent duty stations outside the
Benefits Coverage to United States Nationals
United States and the Panama Canal Zone
Employed by the Federal Government (P.L. 93-160)
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Authorizing Statute
Change in Eligibility for FEHBP
1976
To Amend Title 5, United States Code, to Restore
Authorized coverage for a surviving spouse when the survivor
Eligibility for Health Benefits Coverage to Certain
annuity was terminated because of remarriage to re-enrol in
Individuals Whose Survivor Annuities are Restored
FEHBP if the survivor annuity is restored
(P.L. 94-342)
1978
The Federal Employees Part Time Career
Authorized coverage for part-time career employees and their
Employment Act of 1978 (P.L. 95-437)
dependents
1978
To Amend Subchapter m of Chapter 83 of Title 5,
Reduced the length of creditable service required by a retiring
United States Code, to Provide that Employees who employee in order to retain FEHBP coverage into retirement
Retire After 5 Years of Service, in Certain Instances, from 12 years to 5 years
May be Eligible to Retain their Life and Health
Insurance Benefits, and for Other Purposes (P.L. 95-
583)
1979
To Make Certain Technical and Clerical
Redefined “employee” for the purpose of FEHBP coverage to
Amendments to Title 5, United States Code (P.L.
exclude the previous reference to United States Commissioners
96-54)
1979
The Panama Canal Act of 1979 (P.L. 96-70)
Excluded individuals from FEHBP who were not citizens or
nationals of the United States, and whose permanent duty
station was outside the United States, unless the individual was
an employee on September 30, 1979, by reason of service in
specified government agencies
1980
To Amend Provisions of Chapters 83 and 89 of
Eliminated the “lives with” requirement for a natural child to be
Title 5, United States Code, Which Relate to
covered by FEHBP and added a dependency requirement for all
Survivor Benefits for Certain Dependent Children,
children
and for Other Purposes (P.L. 96-179)
1984
The Civil Service Retirement Spouse Equity Act of
Authorized coverage for former spouses of employed, retired,
1984 (P.L. 98-615)
or separated federal employees
1985
An Act to Provide that Employee Organizations
Permitted certain disability annuitants who were later restored
Ineligible to Participate in the FEHBP Solely Because
to federal employment to enrol in a FEHBP plan if the annuitant
Applications for Approval Must be Filed Before
had been enrol ed in any such plan immediately prior to
January 1, 1980, May Apply to Become so Eligible,
termination of employment
and For Other Purposes (P.L. 99-53)
1986
The Federal Employees Benefits Improvement Act
Gave OPM the authority to waive the five years of service
of 1986 (P.L. 99-251)
requirement for individuals to have FEHBP coverage in
retirement in cases of exceptional circumstances
1986
The Federal Employees’ Retirement System Act of
Authorized coverage for individuals first employed by the
1986 (P.L. 99-335)
District of Columbia government before October 1, 1987
1986
The Intelligence Authorization Act for Fiscal Year
Authorized coverage for certain former spouses of Central
1987 (P.L. 99-569)
Intelligence Agency (CIA) employees
1987
The Foreign Relations Authorization Act, Fiscal
Authorized coverage for certain former spouses of employees
Years 1988 and 1989 (P.L. 100-204)
or former employees of the Foreign Service
1988
The Federal Employees’ Retirement System
Declared that certain nonfederal employees eligible for FEHBP
Technical Corrections Act (P.L. 100-238)
benefits are no longer entitled to such benefits after October 1,
1988
1988
Federal Employees Health Benefits Amendments
Created temporary continuation of coverage (TCC) in FEHBP
Act of 1988 (P.L. 100-654)
whereby federal employees separated from service and certain
dependents can maintain FEHBP
Directed OPM to prescribe regulations offering FEHBP to
certain temporary federal employees
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Authorizing Statute
Change in Eligibility for FEHBP
1988
Office of Federal Procurement Policy Act
Authorized coverage for certain individuals employed by former
Amendments of 1988 (P.L. 100-679)
Presidents and Vice Presidents
1990
Foreign Relations Authorization Act, Fiscal Years
Authorized coverage for former spouses of certain former
1990 and 1991 (P.L. 101-246)
Foreign Service employees in certain circumstances
1990
Foreign Operations, Export Financing, and Related
Authorized coverage for U.S. hostages in Iraq, Kuwait, and those
Programs Appropriations (P.L. 101-513)
captured in Lebanon, and their family members, while they
remained in hostage status and for 12 months thereafter
1990
Elimination of Post-1968 Service Prerequisite for
Provided that post-1968 service by National Guard technicians is
Retirement Credit and Other Benefits (P.L. 101-
not a required prerequisite for entitlement to FEHBP
530)
1991
Intelligence Authorization Act, Fiscal Year 1991 (P.L. Provided that a former spouse of a CIA employee who is not
102-88)
eligible to enrol or continue enrollment in a FEHBP plan solely
because of remarriage before age 55 may enrol in a FEHBP plan
under certain circumstances
1991
Legislative Branch Appropriations Act, 1992 (P.L.
Authorized coverage for employees of the Senate Employee
102-90)
Child Care Center
1992
National Defense Authorization Act for Fiscal Year
Provided for special rules with regard to TCC under FEHBP if
1993 (P.L. 102-484)
the basis for TCC is involuntary separation from a position in or
under the Department of Defense due to a reduction in force
1994
FEGLI Living Benefits Act, 1994 (P.L. 103-409)
Authorized coverage for employees of the Office of the
Comptrol er of the Currency and the Office of Thrift
Supervision whose health coverage, provided under their
organizations’ plans, terminates
1996
National Defense Authorization Act for Fiscal Year
Allowed individuals who separate from certain positions in or
1996 (P.L. 104-106)
under the Department of Defense or the Department of Energy,
to continue coverage under FEHBP and be liable for no more
than the employee’s share of FEHBP premiums
1996
Omnibus Consolidated Appropriations Act, 1997
Required OPM to prescribe regulations under which surviving
(P.L. 104-208)
children, whose survivor annuity was terminated because of
marriage and is later restored (because the marriage ends), may
enroll in a FEHBP plan
1998
Federal Employees Health Care Protection Act of
Authorized coverage for employees of the Federal Deposit
1998 (P.L. 105-266)
Insurance Corporation and the Board of Governors of the
Federal Reserve Board whose health coverage, provided under
their organizations’ plans, terminates
1998
District of Columbia Courts and Justice Technical
Authorized coverage for District of Columbia public defender
Corrections Act of 1998 (P.L. 105-274)
service employees
2000
Federal Employees Health Benefits Children’s Equity Mandated that federal employees legal y required to provide
Act of 2000 (P.L. 106-394)
health insurance coverage to a dependent child do so under
FEHBP, if the child does not otherwise have coverage
2000
District of Columbia Appropriations Act, 2001 (P.L.
Authorized coverage for certain employees of the District of
106-522)
Columbia
2002
To Amend Title 5, United States Code, to Al ow
Authorized coverage for employees of the Overseas Private
Certain Catch-up Contributions to the Thrift
Investment Corporation (OPIC) when OPIC-administered plans
Savings Plan to be Made by Participants Age 50 or
terminate
Over (P.L. 107-304)
2004
State Justice Institute Reauthorization Act of 2004
Authorized coverage for State Justice Institute employees who
(P.L. 108-372)
commenced employment on or after October 1, 1988
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Authorizing Statute
Change in Eligibility for FEHBP
2004
Ronald W. Reagan National Defense Authorization
Provided for special rules for TCC under FEHBP for certain
Act for Fiscal Year 2005 (P.L. 108-375)
federal employees
2007
A bill to amend chapter 89 of title 5, United States
Authorized coverage for U.S. citizens employed by the
Code, to make individuals employed by the
Roosevelt Campobello International Park Commission
Roosevelt Campobello International Park
Commission eligible to obtain Federal health
insurance (P.L. 110-74)
2008
A bill to provide for certain Federal employee
Permitted specified Senate Restaurants employees working
benefits to be continued for certain employees of
under the Architect of the Capitol to elect to continue coverage
the Senate Restaurants after operations of the
under FEHBP after operations of the Senate Restaurants are
Senate Restaurants are contracted to be performed
contracted out
by a private business concern, and for other
purposes (P.L. 110-279)
2008
National Aeronautics and Space Administration
Provided for special rules for TCC under FEHBP for employees
(NASA) Authorization Act of 2008 (P.L. 110-422)
who are terminated or separated from certain positions at
NASA
2010
Patient Protection and Affordable Care Act of 2010
Made a requirement that Members of Congress and certain
(P.L. 111-148, as amended)
congressional staff, in relation to their federal employment, may
only enrol in health plans created under ACA, or offered
through a health insurance exchange
Allowed all adult children (including married children) up to age
26 to remain/enrol on their parent’s FEHBP plan
Allowed certain Indian tribes and organizations to purchase
FEHBP for tribal employeesc
Source: CRS analysis of selected legislation.
a. In 1960, Congress passed The Retired Federal Employees Health Benefits Act (P.L. 86-724), which
authorized the creation of a health benefits program for federal employees who retired or became disabled
before July 1, 1960, and their family members. The program, “retired FEHBP,” was patterned after the
existing FEHBP. In 1974, Congress passed An Act to Increase the Contribution of the Government to the
Costs of Health benefits for Federal Employees, and for Other Purposes (P.L. 93-246), which al owed
annuitants participating or eligible to participate in retired FEHBP and their family members to participate in
regular FEHBP. This report does not include summaries of legislation or provisions of legislation that only
affect retired FEHBP.
b. For a detailed list of individuals eligible for FEHBP under the enacting legislation, see the text box “Eligibility
Under the Federal Employees Health Benefits Act (P.L. 86-382).”
c. This provision was included in the Indian Health Care Improvement Reauthorization and Extension Act of
2009 (S. 1790), which was enacted by §10221(a) of the Patient Protection and Affordable Care Act of 2010
(P.L. 111-148).
Medicare and FEHBP
FEHBP was established five years prior to Medicare, and in the early years there was little
interaction between the programs. This was largely because, in general, federal employees and
annuitants were not eligible for Medicare based on their federal employment. This changed in
1982 when Congress passed the Tax Equity and Fiscal Responsibility Act (P.L. 97-248), which
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
applied Medicare’s hospital insurance tax to federal employment, thereby enabling federal
workers to be eligible for Medicare based on their federal employment.24
Table 4. Provisions Related to Changing How FEHBP and Medicare Interact
Passed
Authorizing Statute
Change in Medicare-FEHBP Relationship
1982
The Tax Equity and Fiscal Responsibility Act of
Applied Medicare’s Hospital Insurance tax to federal
1982 (P.L. 97-248)
employment
Provided that Medicare payments are secondary for services
provided to federal employees and their spouses aged 65 to
69 if covered under FEHBP. This provision did not apply to
federal annuitants; Medicare remained the primary payer for
annuitants
1986
The Consolidated Omnibus Budget
Provided that Medicare payments are secondary for services
Reconciliation Act of 1985 (P.L. 99-272)
provided to federal employees (i.e., workers) and their
spouses aged 65 and older if covered under FEHBP
This provision did not apply to federal annuitants; Medicare
remained the primary payer for annuitants
1988
Medicare Catastrophic Coverage Act of 1988
This act was repealed,a but had it not been repealed, it would
(P.L. 100-360)
have required OPM to reduce the FEHBP premiums charged
to Medicare-eligible retirees who are also participating in
FEHBP
1990
Omnibus Budget Reconciliation Act of 1990 (P.L. Required improved coordination between Medicare and
101-508)
FEHBP
Applied certain Medicare Part A payment limits to services
provided to retired FEHBP enrol ees aged 65 and over who
are not covered by Medicare Part Ab
1992
Treasury, Postal Service, and General
Prohibited the use of funds appropriated by the Act to
Government Appropriations Act (P.L. 102-393)
implement changes proposed by OPM that would affect
Medicare beneficiaries
1993
Omnibus Budget Reconciliation Act of 1993 (P.L. Applied certain Medicare Part B payment limits to services
103-66)
provided to retired FEHBP enrollees aged 65 and older who
do not participate in Medicare Part Bb
Source: CRS analysis of selected legislation.
a. The law was repealed by the Medicare Catastrophic Coverage Repeal Act of 1989 (P.L. 101-234).
b. Medicare has specific rules for payment of covered benefits, and all Medicare beneficiaries, including those
who also have coverage under FEHBP, are subject to those rules. For more information on the rules, see
CRS Report RL30526, Medicare Payment Updates and Payment Rates, coordinated by Paulette C. Morgan.
24 While federal employment did not count toward Medicare eligibility prior to 1982, federal employees who were
employed in the private sector at one time and were subject to Medicare’s hospital insurance tax could have been
eligible for Medicare based on their prior private sector employment.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Appendix. FEHBP Legislative History
The Federal Employees Health Benefits Act of 1959 (P.L. 86-382), September 28,
1959
Effective July 1, 1960, the Act authorized the creation of the Federal Employees Health Benefits
program (FEHBP) for the federal workforce. The Act established the general parameters for
program operation, which included detailing eligibility and enrollment procedures; describing the
types of benefits that may be provided; determining the level of government’s share of premiums;
and outlining the role of the Office of Personnel Management (OPM).25
FEHBP-eligible participants specified in the enacting legislation included current federal
employees, and annuitants who retired after July 1, 1960, either on an immediate annuity with at
least 12 years of service or for a disability.26 Annuitants were also required either to be enrolled in
a FEHBP plan for at least five years immediately prior to retirement, or enrolled from the earliest
opportunity to do so. Family members of employees and annuitants were also eligible.27
OPM was allowed to contract or approve the following types of health benefit plans to participate
in FEHBP:28
• Service Benefit Plan—one government-wide plan (offering two levels of
benefits) under which payment is made by an insurer under contracts with
providers for the benefits described.
• Indemnity Benefit Plan—one government-wide plan (offering two levels of
benefits) under which an insurer agrees to pay certain sums of money for the
benefits described.29
• Employee Organization Plans—plans providing health benefits to members of
the organization as of July 1, 1959, that are sponsored or underwritten, and
administered, in whole or part, by employee organizations, and are available only
to employees and annuitants (and members of their families) who at the time of
enrollment are members of the organization.
25 Prior to the enactment of the Civil Service Reform Act of 1978 (P.L. 95-454), the Office of Personnel Management
(OPM) was called the Civil Service Commission. For the sake of clarity, this report only refers to “OPM,” even when
discussing legislation passed prior to the Civil Service Reform Act of 1978.
26 In 1960, Congress passed The Retired Federal Employees Health Benefits Act (P.L. 86-724) which authorized the
creation of a health benefits program for federal employees who retired or became disabled before July 1, 1960, and
their family members. The program, “retired FEHBP,” was patterned after the existing FEHBP. In 1974, Congress
passed An Act to Increase the Contribution of the Government to the Costs of Health benefits for Federal Employees,
and for Other Purposes (P.L. 93-246), which allowed annuitants participating or eligible to participate in retired
FEHBP and their family members to participate in regular FEHBP. This report does not include summaries of
legislation or provisions of legislation that only affect retired FEHBP.
27 See the text box, “Eligibility Under the Federal Employees Health Benefits Act (P.L. 86-382),” for a detailed list of
individuals eligible for FEHBP under the enacting legislation.
28 §4 of P.L. 86-382.
29 According to OPM, a major difference between the Service Benefit Plan and the Indemnity Benefit Plan is that the
Service Benefit Plan pays providers directly for health care services, while enrollees in the Indemnity Benefit Plan pay
the provider and the Plan reimburses the enrollee.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
• Comprehensive Medical Plans—either group-practice prepayment plans which
offer benefits on a prepaid basis provided by physicians practicing as a group in a
common center or centers, or individual-practice prepayment plans which offer
health services on a prepaid basis provided by individual physicians who agree to
accept the payments provided by the plans as full payment for covered services
rendered by them.
The government’s share of premiums in FEHBP plans was dependent on the type of plan and the
type of enrollee.30
• For the service benefit plan and the indemnity plan, the government’s share was
50% of the lowest rate charged by a carrier, and
• for an employee or annuitant with individual coverage, the biweekly
government share could not be less than $1.25 and not more than $1.75;
• for an employee or annuitant with family coverage, the biweekly government
share could not be less than $3.00 and not more than $4.25;
• for a female employee or annuitant with a nondependent husband with family
coverage, the biweekly government share could not be less than $1.75 and
not more than $2.50.
• For employees and annuitants enrolled in either employee organization plans or
comprehensive medical plans,
• the government’s share was 50% of the biweekly premium as long as the
biweekly premium was less than $2.50 for individual coverage and less than
$6.00 for family coverage;
• for a female employee or annuitant who had a nondependent husband and
family coverage, the government shared 30% of the premium (as long as the
biweekly premium was less than $6.00).
The Postal Employees Salary Increase Act of 1960 (P.L. 86-568), July 1, 1960
The Act authorized FEHBP coverage for Agriculture Stabilization and Conservation County
Committee employees and their dependents.31
To Amend the Federal Employees Health Benefits Act of 1959 to Provide
Additional Choice of Health Benefits Plans, and for Other Purposes (P.L. 88-
59), July 8, 1963
The Act extended the time period for acceptance of applications from qualified employee
organizations wanting to participate in FEHBP from December 31, 1959, to January 1, 1964. The
Act also eliminated the requirement for an employee organization to have offered health care
benefits to its members prior to submitting an application for FEHBP. Prior to the passage of the
30 §7 of P.L. 86-382.
31 §115(d) of P.L. 86-568.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
Act, for an employee organization to be approved to offer coverage under FEHBP, it had to have
been providing its members with health care benefits by July 1, 1959 (see P.L. 86-382).
To Amend the Federal Employees Health Benefits Act of 1959 to Remove
Certain Inequities in the Application of Such Act, to Improve the
Administration Thereof, and for Other Purposes (P.L. 88-284), March 17, 1964
The Act broadened FEHBP coverage to include employees concurrently receiving compensation
as the result of an on-the-job injury, foster children, and unmarried children up to age 21 (raised
from age 19). The Act also eased the requirements for employees to continue their FEHBP
coverage in retirement by allowing them to continue coverage if they were enrolled in a FEHBP
plan by December 31, 1964.32
At the request of OPM, the Act also gave OPM discretionary authority to terminate FEHBP plan
contracts with any carrier who did not enroll at least 300 employees and annuitants (excluding
family members) during the preceding two contract terms. The Act made the government’s share
of the premium the same for all enrollees, regardless of gender.33
Finally, the Act changed the government’s share of premiums for employee organization plans
and comprehensive medical plans. For an employee or annuitant enrolled in one of these plans for
which the biweekly premium was less than twice the government’s share established for service
benefit plans and indemnity plans, the government’s share was 50% of the premium (for both
individual and family plans).34
To Amend the Federal Employees Health Benefits Act of 1959 and the Federal
Employees Group Life Insurance Act of 1954 (P.L. 88-531), August 31, 1964
The Act authorized FEHBP coverage for certain United States Commissioners to whom the Civil
Service Retirement Act (P.L. 71-279) applies and their dependents.
To Amend the Federal Employees Health Benefits Act of 1959 and the Federal
Employees Group Life Insurance Act of 1954 (P.L. 88-631), October 6, 1964
The Act authorized FEHBP coverage for teachers in the District of Columbia if they had been
temporarily employed as teachers for a total of at least two years.
32 Under FEHBP’s enacting legislation (P.L. 86-382), the continuation of health benefits coverage into retirement
required an annuitant to have had at least five years of FEHBP coverage immediately prior to retirement, or had to have
been enrolled in FEHBP continuously from the first opportunity to enroll. Many employees had not realized the
importance of enrolling at their first opportunity and, without P.L. 88-284, would have been ineligible to continue their
FEHBP enrollment into retirement.
33 FEHBP’s enacting legislation (P.L. 86-382) provided for a smaller government contribution for women with
nondependent husbands who were enrolled in a family plan.
34 §7 of P.L. 88-284.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
To Preserve the Benefits of the Civil Service Retirement Act, the Federal
Employees Group Life Insurance Act of 1954, and the Federal Employees
Health Benefits Act of 1959 for Congressional Employees Receiving Certain
Congressional Staff Fellowships (P.L. 89-379), March 30, 1966
The Act extended FEHBP coverage to congressional employees receiving certain congressional
staff fellowships.
The Federal Salary and Fringe Benefits Act of 1966 (P.L. 89-504), July 18, 1966
The Act amended FEHBP to change the fixed-dollar government share of the cost of plan
premiums. The biweekly government share for all plan types for individual enrollment became
$1.62; the biweekly government share for all plan types for family enrollment became $3.94.
Neither could exceed 50% of the total premium.35
In addition, FEHBP coverage for dependent children was extended from age 21 to age 22,36 and
employees who were on leave without pay to serve as full-time officers or employees of
employee organizations37 were permitted to continue or acquire coverage.38
The National Guard Technicians Act of 1968 (P.L. 90-486), August 13, 1968
National Guard technicians were converted to federal employee status effective January 1, 1969,
and the Act authorized FEHBP coverage for them and their dependents.39
The Federal Magistrates Act (P.L. 90-578), October 17, 1968
The Act authorized FEHBP coverage for United States magistrates, their clerical and secretarial
assistants, and their dependents.40
The Foreign Assistance Act of 1969 (P.L. 91-175), December 30, 1969
The Act granted federal employees the option of continuing participation in FEHBP during a
period of transfer to employment with an international organization.41
35 §602 of P.L. 89-504.
36 §601 of P.L. 89-504.
37 An “employee organization” is defined in P.L. 86-382 as “an association or other organization of employees which is
national in scope or in which membership is open to all employees of a government department, agency, or
independent establishment who are eligible to enroll in a health benefits plan under this Act.”
38 §406 of P.L. 89-504.
39 §3 of P.L. 90-486.
40 §634 of P.L. 90-578.
41 §502 of P.L. 91-175.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
An Act to Increase the Contribution by the Federal Government to the Cost of
Health Benefits Insurance, and for Other Purposes (P.L. 91-418), September 25,
1970
The Act altered the determination of the government’s share of plan premiums in an effort to
“provide automatic indexing of the government contribution to reflect increases in medical price
inflation.”42
Beginning with the first pay period in 1971, the Act established what is commonly referred to as
the “big six” formula. The big six formula is equal to the simple average of the premiums
calculated separately for individual and family coverage, (using the high option where a high and
standard option are offered) of the two government-wide plans (the service benefit plan and the
indemnity plan), and the two employee organization plans and the two comprehensive medical
plans with the highest enrollment. The Act set the government’s share at 40% of the simple
average of the big six premiums.43
The Act permitted family members who received an immediate annuity as the survivor of an
employee or annuitant to continue enrollment in a FEHBP plan in the event that the deceased had
completed less than five years of creditable service.44 FEHBP coverage was also extended to
noncitizen employees whose permanent duty station was in the Panama Canal Zone.45
The Intergovernmental Personnel Act of 1970 (P.L. 91-648), January 5, 1971
The Act provided for the maintenance of FEHBP eligibility and coverage for federal employees
who were assigned to state or local governments, and extended FEHBP coverage to state or local
government employees who were assigned to an executive agency (where there would otherwise
have been a loss of coverage in a group health benefits plan, the premium of which was paid in
whole or in part by the state or local government).46
To Extend Civil Service Federal Employees Group Life Insurance and Federal
Employees Health Benefits Coverage to United States Nationals Employed by
the Federal Government (P.L. 93-160), November 27, 1973
The Act extended FEHBP coverage to otherwise eligible United States nationals employed by the
federal government at permanent duty stations outside the United States and the Panama Canal
Zone.
42 Towers, Perrin, Forster, and Crosby, Inc. Study of the Federal Employees Health Benefits Program. Washington,
1988. p. 29.
43 §1 of P.L. 91-418.
44 §2 of P.L. 91-418.
45 §3 of P.L. 91-418.
46 §3373 of P.L. 91-648.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
An Act to Increase the Contribution of the Government to the Costs of Health
Benefits for Federal Employees, and for Other Purposes (P.L. 93-246), January
31, 1974
The Act increased the government’s share of the FEHBP plan premium from 40% to 50% of the
simple average of the big six premiums, for pay periods commencing in 1974.47 A provision to
increase the government’s share to 60% of the big six average premiums for pay periods
commencing in 1975 was also included in the Act. A maximum was set on the government’s
share so that it does not exceed 75% of the total premium amount for any one health plan.48
Additionally, health insurance plans participating in FEHBP were required to comply with OPM’s
decision in disputes regarding whether or not an individual was entitled to a health benefit.49
To Provide Access for all Duly Licensed Clinical Psychologists and
Optometrists Without Prior Referral in the Federal Employee Health Benefits
Program (P.L. 93-363), July 30, 1974
The Act provided that if a plan covers the services of licensed or certified optometrists or clinical
psychologists, it cannot require referral or supervision by another practitioner as a condition for
payment or reimbursement.50
To Amend Title 5, United States Code, to Grant Court Leave to Federal
Employees When Called as Witnesses in Certain Judicial Proceedings, and for
Other Purposes (P.L. 94-310), June 15, 1976
The amendments provided that government’s share of health plan premiums for annuitants are to
be paid from annual appropriations authorized for that purpose and made available until
expended.51
To Amend Title 5, United States Code, to Restore Eligibility for Health
Benefits Coverage to Certain Individuals Whose Survivor Annuities are
Restored (P.L. 94-342), July 6, 1976
The Act provided that a surviving spouse covered by FEHBP who had his/her survivor annuity
terminated due to remarriage is eligible to re-enroll in FEHBP if the survivor annuity is restored.
47 The 40% government contribution rate was established by P.L. 91-418.
48 §1 of P.L. 93-246. Previously, the government contribution was not to exceed 50% of the total premium amount for
any one plan. See P.L. 89-504.
49 §2 of P.L. 93-246.
50 §1 of P.L. 93-363. The provision does not apply to group-practice prepayment plans, which are a type of
comprehensive medical plan, as defined in the enacting FEHBP legislation (P.L. 86-382).
51 §3 of P.L. 94-310.
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Laws Affecting the Federal Employees Health Benefits Program (FEHBP)
To Amend Chapter 89 of Title 5, United States Code, to Establish Uniformity
in Federal Employee Health Benefits and Coverage by Preempting Certain
State or Local Laws Which are Inconsistent with such Contracts, and for Other
Purposes (P.L. 95-368), September 17, 1978
The Act established uniformity in benefits and coverage under FEHBP by preempting certain
state and local laws that were inconsistent with FEHBP contracts.
The Act provided certain protections to members of medically underserved populations.52
Beginning January 1, 1980, and ending December 31, 1984, if a FEHBP contract provided or paid
for the cost of a certain health service, the insurance carrier would be required to pay, up to the
limits of its contract, for any health practitioner who is licensed by a state to provide that service
if the recipient is a member of a medically underserved population.53
The Act also changed the requirement that barred employee organizations from appealing to
sponsor a health benefit plan after January 1, 1964, permitting such organizations to apply
between December 31, 1978, and January 1, 1980.
The Federal Employees Part Time Career Employment Act of 1978 (P.L. 95-437),
October 10, 1978
The Act allowed part-time career employees and their dependents to access FEHBP coverage.54
According to Section 3401(2) of U.S.C. Title 5, part-time career employment is employment
consisting of a 16-32 hour work week, but does not include employment on a temporary or
intermittent basis.
To Amend Subchapter m of Chapter 83 of Title 5, United States Code, to
Provide that Employees who Retire After 5 Years of Service, in Certain
Instances, May be Eligible to Retain their Life and Health Insurance Benefits,
and for Other Purposes (P.L. 95-583), November 2, 1978
The Act reduced the length of creditable service required for an employee to continue FEHBP
coverage in retirement from 12 years to five years (the 12-year requirement was established by
P.L. 86-382). The Act did not change the requirement that in order for employees to continue
FEHBP into retirement, they must be enrolled in a FEHBP plan for at least five years
immediately prior to retirement, or enrolled from the earliest opportunity to do so (this
requirement was established by P.L. 86-382).
52 “Medically underserved population” as defined in §1302(7) of the Public Health Service Act (42 U.S.C. 300e-17).
53 This provision does not apply to comprehensive medical plans.
54 §4(c) of P.L. 95-437.
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To Make Certain Technical and Clerical Amendments to Title 5, United States
Code (P.L. 96-54), August 14, 1979
These amendments redefined “employee” for the purpose of FEHBP coverage to exclude the
previous reference to the United States Commissioners (see P.L. 88-531).55
The Panama Canal Act of 1979 (P.L. 96-70), September 27, 1979
The Act redefined the term “employee” for the purposes of FEHBP eligibility to exclude
individuals who were not citizens or nationals of the United States, and whose permanent duty
station was outside the United States, unless the individual was an employee on September 30,
1979, at an executive branch agency, the United States Postal Service (USPS), or the Smithsonian
Institution in the area which was then known as the Panama Canal Zone.56
To Amend Provisions of Chapters 83 and 89 of Title 5, United States Code,
Which Relate to Survivor Benefits for Certain Dependent Children, and for
Other Purposes (P.L. 96-179), January 2, 1980
The amendments eliminated the “lives with” requirement for a natural child to be covered by
FEHBP and added a dependency requirement for all children to be covered under FEHBP.57 It
also redefined the term “medically underserved population” for the purpose of making benefit
payments under FEHBP.58
The Tax Equity and Fiscal Responsibility Act of 1982 (P.L. 97-248), September 3,
1982
Effective January 1, 1983, the Act required federal employees to pay the Medicare hospital
insurance tax. Requiring federal employees to pay the tax enabled federal employees to count
their federal employment toward entitlement for premium-free benefits under Medicare Part A.59
Prior to passing this Act, federal employment did not count toward eligibility for premium-free
Part A, but federal employees could qualify for premium-free Part A based on private sector
employment, if they were subject to the Medicare hospital insurance tax.
55 §2(a)(52) of P.L. 96-54.
56 §1209 of P.L. 96-70.
57 §§1 and 2 of P.L. 96-179.
58 §3 of P.L. 96-179.
59 §§121 and 278 of P.L. 97-248. The hospital insurance tax is a payroll tax paid by most employees and employers,
and it is used to help fund Medicare’s Hospital Insurance Trust Fund, which pays for beneficiaries’ Medicare Part A
benefits. Individuals must pay into the system (i.e., incur the payroll tax) for 40 calendar quarters to become entitled to
premium-free Part A benefits. Prior to enactment of P.L. 97-248, federal employees did not pay the Medicare hospital
insurance tax and therefore their federal employment did not count toward the 40 calendar quarters required to obtain
premium-free Part A benefits.
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The Act also provided that Medicare payments are secondary for services provided to employees
aged 65 to 69 (and their spouses aged 65 to 69) if covered under certain employer group health
plans, including FEHBP.60
To Amend Title 5, United States Code, to Provide Training Opportunities for
Employees Under the Office of the Architect of the Capitol and the Botanic
Garden, and for Other Purposes (P.L. 97-346), October 15, 1982
The amendments required OPM to determine the difference between the amount of the
government’s share of health plan premiums for 1983 and the amount such contributions would
have been if the two employee organizations included in the 1981 big six formula were included
in the 1983 big six formula. The government was required to pay the difference into the
contingency reserves of all FEHBP plans for 1983 in proportion to the number of enrollees in
each plan.61
A Joint Resolution Making Further Continuing Appropriations for the Fiscal
Year 1984 (P.L. 98-151), November 14, 1983
Funds appropriated by the continuing resolution were prohibited from being used to pay for
abortions or administrative expenses for any FEHBP plan that provides benefits or coverage for
abortions, except where the life of the woman would be endangered if the fetus were carried to
term.62 This was the first time an abortion-related provision was applied to FEHBP in an
appropriations bill, and a similar provision has since been included in appropriations bills each
year, with the exception of bills passed in the 103rd Congress.63
The Civil Service Retirement Spouse Equity Act of 1984 (P.L. 98-615),
November 8, 1984
The Act extended eligibility for FEHBP coverage to former spouses of employed, retired, or
separated federal employees. The former spouse must pay both the employee’s and the
government’s share of the premium.64
60 §116 of P.L. 97-248.
61 §4 of P.L. 97-346. The enacting legislation (P.L. 86-382) requires that a certain percentage of the premiums paid to
each plan by employees, annuitants, and the federal government is set aside to provide plans with contingency reserve
funds. Funds from each plan’s contingency reserves can be used to defray future premium increases, may be applied to
reduce premium contributions of employees, annuitants, and the federal government, or may be used to increase the
plan’s benefits.
62 §140 of P.L. 98-151.
63 P.L. 103-123 and P.L. 103-329.
64 §3 of P.L. 98-615.
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An Act to Provide that Employee Organizations Ineligible to Participate in the
FEHBP Solely Because Applications for Approval Must be Filed Before
January 1, 1980, May Apply to Become so Eligible, and For Other Purposes
(P.L. 99-53), June 17, 1985
The Act authorized the establishment of additional employee organization plans in FEHBP if the
employee organization applied to OPM for plan approval within 90 days of enactment. It also
specified the conditions required for plan approval.65
The Act also permitted certain disability annuitants who were later reemployed to enroll in a
FEHBP plan if the annuitant had been enrolled in any such plan immediately prior to termination
of employment.66
The Federal Employees Benefits Improvement Act of 1986 (P.L. 99-251),
February 27, 1986
The Act allowed a new type of comprehensive medical plan, called a mixed model prepayment
plan, to participate in FEHBP.67 The plans are a combination of group practice prepayment plans
and individual practice prepayment plans, which are two types of comprehensive medical plans
recognized under FEHBP. Additionally, the requirement in the enacting legislation (P.L. 86-382)
that group-practice prepayment plans must include physicians representing at least three major
medical specialties was eliminated.68
The Act mandated studies to be undertaken by OPM regarding extending FEHBP contracting
authority to health practitioners who were not currently covered, such as nurse midwives and
chiropractors.69 Contracting authority was also extended to clinical social workers, although
health plans were permitted to require referral by a psychiatrist as a condition for
reimbursement.70
The Act also expressed the sense of Congress that enrollees in FEHBP should receive adequate
treatment for mental illness, alcoholism, and drug addiction.71 In addition, OPM was directed to
study the adequacy of the FEHBP information materials disseminated to employees during the
open enrollment season.72
65 §1 of P.L. 99-53.
66 §3 of P.L. 99-53.
67 §111 of P.L. 99-251.
68 §102 of P.L. 99-251. Group-practice prepayment plans are a type of comprehensive medical plans under FEHBP.
69 Section 108 of P.L. 99-251. OPM released this study, entitled, A Study Relating to Expanding the Class of Health
Practitioners Authorized to Receive Direct Payment or Reimbursement in Accordance with 5 U.S.C., 8902(k)(1) in
March 1986.
70 §105 of P.L. 99-251.
71 §107 of P.L. 99-251.
72 §109 of P.L. 99-251. OPM released this study, entitled A Study of the Adequacy of Information Materials under the
Federal Employees Health Benefits Program in May 1986.
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This Act gave OPM the authority to waive the five years of service requirement for individuals to
have FEHBP coverage in retirement in cases of exceptional circumstances.73 The Act provides for
a three-week period during which enrollees may change or cancel their enrollment in the event
that rates or benefits changed, a new plan is offered, or an existing plan is terminated. Enrollees
were authorized to transfer enrollment at other times and under such circumstances as prescribed
by OPM.74
The Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L. 99-272),
April 7, 1986
The Act required OPM to determine the minimum level of financial reserves which must be held
by each carrier in order to ensure stable and efficient operation of the health plan. The Act set
forth provisions regarding minimum amounts to be refunded, and the use of such amounts.
Reserves held in excess of such minimum levels were to be returned to the Employees Health
Benefits Fund. Beginning October 1, 1986, the United States Postal Service (USPS) was required
to pay the government’s share of the health plan premium for postal employees who first became
annuitants because of retirement.75 In addition, the Act provided that Medicare payments are
secondary for services provided to employees aged 65 and older (which includes FEHBP or other
certain employer group health plans).76
The Federal Employees’ Retirement System Act of 1986 (P.L. 99-335), June 6,
1986
The Act provided FEHBP eligibility to individuals first employed by the District of Columbia
government before October 1, 1987.77
The Intelligence Authorization Act for Fiscal Year 1987 (P.L. 99-569), October
27, 1986
The Act provided health benefits for certain former spouses of Central Intelligence Agency (CIA)
employees.78
Treasury, Postal Services and General Government Appropriations Act, 1988
(P.L. 100-202), December 22, 1987
This Act added qualified clinical social workers to the group of non-physician providers to whom
FEHBP enrollees must have direct access and who are entitled to receive payment by a FEHBP
plan.79
73 The five-year requirement was established in P.L. 95-583.
74 §104 of P.L. 99-251.
75 §15202 of P.L. 99-272.
76 §9201 of P.L. 99-272.
77 §207(c) of P.L. 99-335.
78 §303 of P.L. 99-569.
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The Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203), December 22,
1987
The Act specified the amount ($160 million in FY1988 and $270 million in FY1989) of the
contributions to be made by USPS to the Employees Health Benefits Fund to pay the
government’s share of the health plan premiums for certain USPS annuitants and survivor
annuitants.80
The Foreign Relations Authorization Act, Fiscal Years 1988 and 1989 (P.L. 100-
204), December 22, 1987
The Act provided FEHBP coverage for certain former spouses of employees or former employees
of the Foreign Service.81
The Federal Employees’ Retirement System Technical Corrections Act (P.L.
100-238), January 8, 1988
The Act declared that certain nonfederal employees who were eligible for FEHBP benefits were
no longer entitled to such benefits after October 1, 1988.82 However, the Act continued FEHBP
coverage for employees of St. Elizabeth’s Hospital who became District of Columbia employees
due to the federal government’s transfer of the hospital to the District of Columbia.83
Medicare Catastrophic Coverage Act of 1988 (P.L. 100-360), July 1, 1988
The Act included some provisions that affected FEHBP that were later repealed by the Medicare
Catastrophic Coverage Repeal Act of 1989 (P.L. 101-234). They are described here for the
purpose of providing a detailed account of Congress’s interactions with FEHBP. Had it not been
repealed, the Act would have (1) required OPM to reduce the rates charged to retirees
participating in FEHBP who were also Medicare-eligible; (2) specified that the rates were to be
reduced by the amount (prorated for each covered Medicare-eligible retiree) of the estimated cost
of medical services and supplies which would have been incurred by FEHBP had certain
provisions of the Act not been enacted;84 (3) required OPM to submit a report to Congress by
April 1, 1989, regarding changes to FEHBP that may be required in order to incorporate health
benefit plans designed specifically for Medicare-eligible individuals and to improve the
efficiency and effectiveness of the program; and (4) required OPM to submit a separate report to
Congress by April 1, 1989, on the feasibility of adopting the National Association of Insurance
(...continued)
79 §626, Title VI of P.L. 100-202. The provision does not apply to individuals enrolled in comprehensive medical plans.
80 §6003 of P.L. 100-203.
81 §832 of P.L. 100-204.
82 §108 of P.L. 100-238.
83 §109 of P.L. 100-238.
84 §422 of P.L. 100-360. According to OPM, the premium reduction for 1989 would have been $3.10 per month for
each Medicare eligible individual also participating in FEHBP had the provision related to reduced cost-sharing not
been repealed.
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Commissioners (NAIC) standards when providing Medicare supplemental health benefit plans
under FEHBP.85
Federal Employees Health Benefits Amendments Act of 1988 (P.L. 100-654),
November 14, 1988
The Act set forth provisions regarding the authority of OPM to impose debarment and other
sanctions on health care providers convicted of illegal activities, including financial misconduct;
neglect or abuse of patients; the unlawful manufacture, distribution, or dispensing of a controlled
substance; and interference with an investigation or prosecution of any criminal offenses.
The Act also set time limits for OPM to initiate a debarment proceeding and prohibited providers
without a valid license from participating in FEHBP. The Act authorized OPM to impose fines on
providers who made false charges or claims in connection with providing health services or
supplies.86
The Act created temporary continuation of FEHBP coverage (TCC) for federal employees.
Effective in the 1990 contract year, TCC allows most separating employees and their families to
maintain FEHBP coverage for up to 18 months after the date of separation.87 TCC enrollees must
pay the full premium, both the employee’s and the government’s share, for the plan they select,
plus a 2% administrative charge. TCC is only available to employees separated from service for
reasons other than gross misconduct, or for individuals no longer meeting unmarried dependent
child requirements.88
The Act directed OPM to prescribe regulations to offer health benefits coverage to temporary
federal employees who have completed one year of continuous service, with such employees
paying the total premium amount.89
Office of Federal Procurement Policy Act Amendments of 1988 (P.L. 100-679),
November 17, 1988
The Act provided that certain employees on the office staff of former Presidents or Vice
Presidents are considered federal employees and are therefore eligible for FEHBP.90
85 §424 of P.L. 100-360.
86 §101 of P.L. 100-654.
87 The Act allows some separating employees to maintain their temporary coverage for longer periods. Individuals who
cease to meet the requirements for being considered a dependent child and certain former spouses may maintain TCC
for 36 months.
88 §201 of P.L. 100-654.
89 §301 of P.L. 100-654.
90 §13 of P.L. 100-679.
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Relating to the Method by Which Government Contributions to the Federal
Employees Health Benefits Program Shall be Computed for 1990 or 1991 if no
Government-Wide Indemnity Benefit Plan Participates in that Year (P.L. 101-
76), August 11, 1989
The Act adjusted the big six formula in response to Aetna’s withdrawal from FEHBP.91 The Act
provided that for plan years 1990 and 1991, the government’s share of FEHBP plans would be
calculated by adjusting the Aetna high option premium for the previous year by the average
percentage change in the remaining five plans included in the big six formula. The provisions of
this Act would not apply if comprehensive reform legislation is enacted that amends FEHBP
financing provisions. OPM must transmit recommendations to Congress for comprehensive
FEHBP reform no later than 180 days after enactment.
Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239), December 19, 1989
The Act required the USPS to pay the employer’s (government’s) share of FEHBP premiums for
survivors of postal employees who retired on or after October 1, 1986, and survivors of postal
employees who died on or after that date.92
Foreign Relations Authorization Act, Fiscal Years 1990 and 1991 (P.L. 101-246),
February 16, 1990
The Act authorized FEHBP coverage for any former spouse who on February 14, 1981, was
married to a former Foreign Service employee of the United States Information Agency or of the
Agency for International Development if (1) the former employee retired from the Civil Service
Retirement System on a date before his employing agency could legally participate in the Foreign
Service Retirement System; (2) the marriage included at least five years during which the
employee was assigned overseas; and (3) the former spouse is otherwise qualified for FEHBP.93
91 The enacting FEHBP legislation (P.L. 86-382) provided that one of the plan types FEHBP could offer is one
government-wide indemnity plan (with two levels). The Aetna Life Insurance Company offered the indemnity plan
from the beginning of FEHBP through 1989, when Aetna decided it would no longer serve as the administrator of the
plan. At the time, the government share of each plan’s premium was the dollar amount equal to a percentage of the
average cost of six plans (the big six), which included the indemnity plan. With Aetna’s withdrawal from FEHBP and
no insurance company filling Aetna’s role as the administrator of the indemnity plan, the big six formula needed to be
restructured.
92 §4003 of P.L. 101-239.
93 §146 of P.L. 101-246.
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To Amend Title 5, United States Code, to Allow Federal Annuitants to Make
Contributions for Health Benefits Through Direct Payments Rather than
Through Annuity Withholdings if the Annuity is Insufficient to Cover the
Required Withholdings, and for Other Purposes (P.L. 101-303), May 29, 1990
The Act allowed federal annuitants to pay health benefits premiums through direct payments
rather than through annuity withholdings if the annuity is insufficient to cover the required
withholdings.94
Omnibus Budget Reconciliation Act of 1990 (P.L. 101-508), November 5, 1990
The Act included a number of FEHBP-related reforms.95 FEHBP plans must implement
hospitalization cost containment measures, and FEHBP must improve cash management related
to payments from a plan’s contingency reserves. The Act exempted FEHBP plans from state
premium taxes, and it extended the restructured big six formula created in P.L. 101-76 through
plan year 1993 (originally the formula was to be used in plan years 1990 and 1991).
OPM, in consultation with HHS, is required to improve coordination between FEHBP and
Medicare by creating a system that allows FEHBP plans to identify individuals who are entitled
to Medicare benefits. Additionally, the Act applied Medicare payment limits to services that
would be covered under Part A for retired FEHBP enrollees aged 65 and over who are not
covered by Part A. This provision limited the amount that FEHBP pays for certain services for
these individuals to the amount that Medicare would pay for the services.96
The Act also required the USPS to pay the government’s share of FEHBP premiums for
individuals who become annuitants because of retirement from employment with the USPS on or
after July 1, 1971.97 The amount paid by the USPS is prorated to reflect the total portion of
federal service performed as a postal employee after June 30, 1971.98
Foreign Operations, Export Financing, and Related Programs Appropriations
Act, 1991 (P.L. 101-513), November 5, 1990
The Act entitled U.S. hostages in Iraq, Kuwait, and those captured in Lebanon, and their family
members, to FEHBP benefits while in hostage status and for 12 months thereafter, if they did not
have other health insurance. Entitlement for these and certain other benefits (e.g., federal life
insurance and pay) was subject to the availability of funds; the Act appropriated up to $10 million
94 §1 of P.L. 101-303.
95 §7002 of P.L. 101-508.
96 The Medicare payment limits are not applied to services provided under comprehensive medical plans. Medicare has
specific rules for payment of covered benefits, and all Medicare beneficiaries, including those who are also covered
under FEHBP, are subject to the rules. For more information about the rules, see CRS Report RL30526, Medicare
Payment Updates and Payment Rates, coordinated by Paulette C. Morgan.
97 Prior to enactment of P.L. 101-508, the USPS was required to pay the government share of premiums for postal
service annuitants who retired on or after October 1, 1986.
98 §§7102 and 7103 of P.L. 101-508.
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for these benefits. The authority to obligate funds for this purpose expired six months after the
date of enactment.99
Elimination of Post-1968 Service Prerequisite for Retirement Credit and Other
Benefits (P.L. 101-530), November 6, 1990
The Act provided that post-1968 service by National Guard technicians is not a requirement for
their eligibility for FEHBP benefits.100
Intelligence Authorization Act, Fiscal Year 1991 (P.L. 102-88), August 14, 1991
The Act amended the Central Intelligence Agency (CIA) Act of 1949 (P.L. 81-110) to provide that
former spouses of certain CIA employees who are not eligible to enroll or continue enrollment in
a FEHBP plan solely because of remarriage before age 55, may have their eligibility restored on
the date such remarriage is dissolved by death, annulment, or divorce and may enroll in a FEHBP
plan under certain circumstances.101
Legislative Branch Appropriations Act, 1992 (P.L. 102-90), August 14, 1991
This Act provided that employees of the Senate Employee Child Care Center are eligible for
FEHBP coverage and may elect such coverage during the 31-day period beginning on the date of
enactment or during FEHBP open enrollment periods thereafter.102
Treasury, Postal Service, and General Government Appropriations Act, 1993
(P.L. 102-393), October 6, 1992
Funds appropriated by the Act were prohibited from being used to implement changes to FEHBP
that would affect Medicare beneficiaries.103 Specifically, the Act restricted the use of appropriated
funds to make certain changes to FEHBP. One restriction was to prevent OPM from requiring
retired FEHBP enrollees who are eligible for Medicare benefits to pay the difference in out-of-
pocket costs when using a nonparticipating Medicare provider (as compared to a participating
Medicare provider).104 The other restriction prevented OPM from eliminating the waiver of
FEHBP plan coinsurance for prescription drugs used by Medicare-covered FEHBP enrollees.
OPM intended to make both of these changes administratively for plan year 1993;105 neither
change was implemented due to the Act.
99 §599C of P.L. 101-513.
100 §§2 and 3 of P.L. 101-530. Previously, as established in P.L. 90-486, post-1968 service was a FEHBP eligibility
requirement for National Guard technicians.
101 §307 of P.L. 102-88.
102 §311 of P.L. 102-90.
103 §530 of P.L. 102-393.
104 Most providers and practitioners are subject to limits on the amounts that they can bill Medicare beneficiaries for
Medicare-covered services, and these limits are different according to a provider’s contractual agreement with
Medicare. For more information about “participating” and nonparticipating” providers within Medicare, see CRS
Report R40425, Medicare Primer, coordinated by Patricia A. Davis and Scott R. Talaga.
105 OPM administers FEHBP in accordance with the statue and its implementing regulations (5 CFR Part 89, and 48
(continued...)
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National Defense Authorization Act for Fiscal Year 1993 (P.L. 102-484), October
23, 1992
The Act provided for the continuation of FEHBP benefits if the basis for such continuation is
involuntary separation from a position in or under the Department of Defense due to a reduction
in force. This provision applies to any individual whose temporary continued coverage (TCC) is
based on a separation occurring on or after the date of enactment and before October 1, 1997, or
February 1, 1998 (if specific notice of such separation was given to such individuals before
October 1, 1997).106 The Act limits the individual’s payments for this coverage to no more than
the required employee’s share of premiums for such coverage and requires the agency that last
employed the individual to pay for the remaining portion of the coverage.107
The Act directed the Secretary of Defense to conduct a comprehensive review of FEHBP in order
to determine whether furnishing health care under a program similar to FEHBP to individuals
eligible for health care programs provided by the Department of Defense would be more efficient
and cost-effective.108
Omnibus Budget Reconciliation Act of 1993 (P.L. 103-66), August 10, 1993
The Act required most FEHBP plans to apply the Medicare Part B limitations on payments for
physician services to benefits provided to any retired FEHBP enrollees aged 65 or older who do
not participate in Medicare Part B.109 The Act also required physicians and suppliers who accept
Medicare payments to accept equivalent payment and cost-sharing from FEHBP as full payment
for the services to the enrollees as described above. Physicians and suppliers who are non-
participating physicians and suppliers in Medicare cannot impose charges that exceed the limiting
charge with respect to the enrollees described above.110
(...continued)
CFR Chapter 16). While the statute establishes basic rules for the program, OPM is given wide authority in
implementing regulations, contracting with plans, establishing benefits, and administering FEHBP. OPM’s authority to
generally administer FEHBP allows OPM to make certain changes to the program outside the legislative process. OPM
introduced these particular changes in Carrier Letter 92-04, February 20, 1992.
106 §4306 of P.L. 102-484. Subsequent laws have moved forward the dates by which a separation must occur to be
eligible for this provision. The most recent law to do so, P.L. 112-81 (§1123), changed the dates to before December
31, 2016 or February 1, 2017 (if specific notice of such separation was given to such individuals before December 31,
2016). For reference, the other laws that have moved forward the dates are: P.L. 103-337 (§341), P.L. 106-65 (§1104),
P.L. 107-314 (§1103), P.L. 109-163 (§1101), and P.L. 111-322 (§151).
107 Section 8905a of Title 5 U.S.C. generally provides for temporary continued coverage (TCC) under FEHBP for
individuals who were covered under FEHBP but no longer qualify due to either a change in employment or because the
individual ceases to be an unmarried dependent child. Typically, the cost to the individual for TCC under FEHBP is the
cost of both the employee’s and the employer’s share of benefits, in addition to an additional amount prescribed by
OPM for administrative expenses (which cannot exceed 2% of the combined total of the employee’s and the
employer’s shares).
108 §723 of P.L. 102-484. The Secretary of Defense was required to submit to the Congressional defense committees a
final report on the study no later than December 15, 1993.
109 This provision does not apply to comprehensive medical plans under FEHBP. Medicare has specific rules for
payment of covered benefits, and all Medicare beneficiaries, including those who are also covered under FEHBP, are
subject to the rules. For more information about the rules, see CRS Report RL30526, Medicare Payment Updates and
Payment Rates, coordinated by Paulette C. Morgan.
110 §11003 of P.L. 103-66. The “limiting charge” is defined in §1848(g) of the Social Security Act (SSA).
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The Act also provided for a temporary extension and modification of the restructured big six
formula in the continued absence of a government-wide indemnity benefit plan.111 The Act
extended the formula developed in P.L. 101-76 for plan years 1990 and 1991 through plan year
1998, and modified the formula for plan years 1997 and 1998.
Treasury, Postal Service, and General Government Appropriations Act, 1994
(P.L. 103-123), October 28, 1993
This was the first appropriations act since fiscal year 1984 (P.L. 98-151) not to include the
provision that restricts funding for abortion coverage in FEHBP plans.112 The restriction on
funding for abortion coverage was reinserted in the Treasury, Postal Service, and General
Government Appropriations Act, 1996 (P.L. 104-52).
FEGLI Living Benefits Act, 1994 (P.L. 103-409), October 25, 1994
The Act allowed individuals covered under health benefit plans administered by the Office of the
Comptroller of the Currency or the Office of Thrift Supervision (the Offices) to enroll in a
FEHBP plan upon termination of the Offices’ plans.113 The Act provides that any period of
enrollment under a health benefit plan administered by the Offices shall be deemed to be a period
of enrollment under FEHBP.
Agriculture, Rural Development, Food and Drug Administration, and Related
Agencies Appropriations Act, 1996 (P.L. 104-37), October 21, 1995
The Act allowed individuals covered under health benefit plans administered by the Farm Credit
Administration to enroll in a FEHBP plan for coverage effective on and after September 30,
1995.114 The Act also provided that any period of enrollment under a health benefit plan
administered by the Farm Credit Administration prior to the enactment of the Act shall be deemed
to be a period of enrollment under FEHBP.
Treasury, Postal Service, and General Government Appropriations Act, 1996
(P.L. 104-52), November 19, 1995
The Act reinstated the provision that prohibits appropriated funds from being available to pay for
an abortion or the administrative expenses in connection with any health plan under FEHBP that
111 §11005 of P.L. 103-66.
112 Additionally, the Treasury, Postal Service and General Government Appropriations Act, 1995 (P.L. 103-329),
passed September 30, 1994, did not include a provision that restricted funding for abortion coverage in FEHBP plans.
113 §5 of P.L. 103-409. Government agencies that have the authority to fix compensation (i.e., independent
establishments as defined in §104 title 5 U.S.C. and government corporations as defined in §103 title 5 U.S.C.)
generally also have the authority to offer health plans to their employees either in place of FEHBP or as an alternative
to FEHBP. Prior to the enactment of P.L. 103-409, the Office of the Comptroller of the Currency and the Office of
Thrift Supervision offered health plans as alternatives to FEHBP. For more information see GAO Report, “Independent
Agencies Offering Their Own Health Plans,” March 1989, http://www.gao.gov/assets/220/211072.pdf.
114 §601 of P.L. 104-37. See footnote 103. Prior to the enactment of P.L. 104-37, the Farm Credit Administration
offered its employees as health plan as an alternative to FEHBP.
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provides any benefits or coverage for abortions, except where the life of the woman would be
endangered if the fetus were carried to term. The provision is modified from the previous versions
to make an exception for pregnancy resulting from rape or incest.115 This provision has been
added each year to subsequent appropriations bills through the date of this report.
National Defense Authorization Act for Fiscal Year 1996 (P.L. 104-106),
February 10, 1996
The Act changed how temporary continuation of FEHBP coverage (TCC) works for certain
individuals. The Act allowed individuals who voluntarily separate from a surplus position in or
under the Department of Defense or the Department of Energy, to continue coverage under
FEHBP and be liable for no more than the employee’s share of premiums to FEHBP.116
Omnibus Consolidated Appropriations Act, 1997 (P.L. 104-208), September 30,
1996
The Act required OPM to prescribe regulations under which surviving children, whose survivor
annuity was terminated because of marriage and is later restored (because the marriage ends),
may enroll in a FEHBP plan if such surviving child was covered by a FEHBP plan immediately
before such annuity was terminated.117
The Secretary of Defense, in consultation with the HHS Secretary and the Director of OPM, was
required to write a report containing recommendations for the establishment of a demonstration
program.118 The demonstration program would allow certain beneficiaries of Department of
Defense health programs who are also entitled to Medicare Part A to enroll in a health plan
offered through FEHBP.
Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12), April 30, 1997
The Act generally prohibited the use of federal funds for benefits and services related to assisted
suicide, and it prohibited OPM from contracting with plans that include coverage for any of these
benefits and services.119
Balanced Budget Act of 1997 (P.L. 105-33), August 5, 1997
The Act modified the formula for determining the government’s share of FEHBP premiums.120
The Act required OPM to determine the weighted average premium of all plans in FEHBP every
115 §§524 and 525 of P.L. 104-52.
116 Generally under TCC, an employee is responsible for both the employee’s and the employer’s (government’s) share
of the FEHBP premium, as well as an additional amount prescribed by OPM for administrative expenses (which cannot
exceed 2% of the combined total of the employee’s and the employer’s shares). See P.L. 100-654.
117 §633 of P.L. 104-208.
118 §8129 of P.L. 104-208.
119 §3 of P.L. 105-12.
120 §7002 of P.L. 105-33.
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year by October 1st.121 This percentage is calculated separately for individual coverage and family
coverage, but the same formula is used. Under the Act, the biweekly government share of a
FEHBP plan for an employee or annuitant is equal to 72% of the weighted average premium of
all plans. (The Act maintained the provision enacted by P.L. 93-246 which provided that the
biweekly government share cannot exceed 75% of any given plan’s premium). This section of the
Act took affect the first day of the contract year that began in 1999.
The Act also mandated that individuals enrolled in FEHBP are not eligible to enroll in a Medicare
Medical Savings Account (MSA) plan122 until OPM certifies to HHS that OPM has adopted
policies that ensure that enrollment into such plans will not result in increased expenditures for
the federal government.123
Strom Thurmond National Defense Authorization Act for Fiscal Year 1999 (P.L.
105-261) October 17, 1998
The Act directed the Secretary of Defense to enter into an agreement with the Director of OPM to
conduct a demonstration project under which certain individuals eligible for Department of
Defense health benefits were able to voluntarily enroll in health plans offered through FEHBP.124
According to the Act, the demonstration project had to be conducted during three contract years
under FEHBP; eligible beneficiaries were permitted to enroll during an open enrollment period
for the year 2000; the project terminated December 31, 2002.
The Secretary of Defense and the Director of OPM were required to submit interim and final
reports to Congress on project costs, effectiveness, and the feasibility of making the program
permanent. The Comptroller General was also required to submit a report to Congress addressing
the same issues as well as any limitations with respect to the data contained in the report as a
result of the size and design of the demonstration project.
Federal Employees Health Care Protection Act of 1998 (P.L. 105-266), October
19, 1998
The Act provided for a number of largely administrative changes to FEHBP. OPM is required
(rather than permitted) to debar health care providers125 from FEHBP for certain fraudulent
practices.126 The Act modified the definition of a carrier under FEHBP from an “organization” to
an “organization and an association of organizations or other entities described in this paragraph
sponsoring a health benefits plan.” It specified that the government-wide plan offered in FEHBP
may be underwritten by participating affiliates licensed in each state. The Act also revised
121 The weight given to each plan is required to be commensurate with the number of enrollees in such plan as of March
31st of the year in which the determination is made.
122 The definition of an MSA plan in P.L. 105-33 is a type of Medicare+Choice (now called Medicare Advantage) plan
that provides reimbursement for items and services only after the enrollee incurs expenses equal to the amount of the
annual deductible.
123 §1851 of P.L. 105-33.
124 §721 of P.L. 105-261.
125 A “health care provider” is defined in §8902a of title 5 U.S.C as a “physician, hospital, or other individual or entity
which furnishes health care services or supplies.”
126 §2 of P.L. 105-266.
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preemption provisions so that the terms of contract relating to the nature, provision, or extent of
coverage or benefits under FEHBP shall supersede and preempt any state or local law, or any
regulation issued by a state or local entity, which relates to health insurance or plans.127
OPM is required to encourage carriers that enter into contractual arrangements to obtain discounts
from providers for health care services or supplies to seek assurance that the conditions for such
discounts are fully disclosed to the providers who grant them.128 The Act set forth provisions for
the readmission of certain plans that have discontinued their participation in FEHBP, and the
treatment of the contingency reserves of such discontinued plans.129 Prior to passage of the Act,
plans under FEHBP were required to provide enrollees direct access to certain types of licensed
providers (such as clinical psychologists, optometrists, and clinical social workers) if the
enrollees required services that may be performed by the provider.130 The Act clarified that plans
under FEHBP are also allowed to provide direct access, direct payment, and reimbursement to
licensed health care providers that are not specified in statute.131
The Act provided that individuals enrolled in Federal Deposit Insurance Corporation (FDIC)
health plans or health plans available to the Board of Governors of the Federal Reserve System
may enroll in FEHBP plans when the FDIC and Federal Reserve plans terminate.132 The Act also
provided that any period of enrollment in a health benefits plan administered by FDIC or the
Federal Reserve before the termination of such plan (January 2, 1999) is deemed to be a period of
enrollment in FEHBP.
District of Columbia Courts and Justice Technical Corrections Act of 1998 (P.L.
105-274), October 21, 1998
The Act provided that Public Defender Service employees should be treated as federal employees
for eligibility for health insurance under FEHBP, compensation for work injuries, retirement, and
life insurance.133
127 This Act revises language relating to preemption of state laws that was originally crafted in P.L. 95-368.
128 §5 of P.L. 105-266.
129 §6 of P.L. 105-266.
130 §8902(k)(1) of 5 U.S.C. This section only applies to enrollees in service benefit plans, indemnity benefit plans, and
employee organization plans; enrollees in comprehensive medical plans are not required to have direct access to
specified providers.
131 §8 of P.L. 105-266.
132 §4 of P.L. 105-266. Government agencies that have the authority to fix compensation (i.e., independent
establishments as defined in §104 title 5 U.S.C. and government corporations as defined in §103 title 5 U.S.C.)
generally also have the authority to offer health plans to their employees either in place of FEHBP or as an alternative
to FEHBP. Prior to the enactment of P.L. 105-266, the Federal Deposit Insurance Corporation and the Board of
Governors of the Federal Reserve System offered its employees a health plan as an alternative to FEHBP. For more
information see GAO Report, “Independent Agencies Offering Their Own Health Plans,” March 1989,
http://www.gao.gov/assets/220/211072.pdf.
133 §7 of P.L. 105-274.
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Omnibus Consolidated and Emergency Supplemental Appropriations Act,
1999 (P.L. 105-277), October 21, 1998
The Act required all FEHBP plans to cover contraceptives, with the exception of a few specified
plans134 and any other existing or future plan that objects to such coverage on the basis of
religious beliefs.135 As of the date of this report, this provision has been renewed each year in
subsequent appropriations bills.
Veterans Millennium Health Care and Benefits Act (P.L. 106-117), November,
30, 1999
The Act changed how temporary continuation of FEHBP coverage (TCC) works for certain
individuals. The Act allowed certain individuals to continue coverage under FEHBP and be liable
for no more than the employee’s share of premiums to FEHBP,136 specifically those: (1) who are
involuntarily separated from a position in or under the Department of Veteran Affairs due to a
reduction in force or certain staffing readjustments; or (2) who are voluntarily or involuntarily
separated from certain Department of Energy positions.
National Defense Authorization Act for Fiscal Year 2000 (P.L. 107-314), October
5, 1999
The Act required the Secretary of Defense to compare the case management program of the
Department of Defense and the case management coverage offered by at least 10 of the most
subscribed plans in FEHBP (five of which must be managed care organizations).137 The Act also
required the Secretary of Defense to submit a report that includes a comparison of health care
coverage under TRICARE to coverage available under FEHBP.138 The comparison must include,
but not be limited to, a comparison of cost sharing requirements, overall costs to beneficiaries,
covered benefits, and exclusions from coverage.
Federal Employees Health Benefits Children’s Equity Act of 2000 (P.L. 106-394),
October 30, 2000
The Act mandated that an employee who is required by court or administrative order to provide
health insurance coverage for a dependent child must do so under FEHBP if the employee cannot
provide documentation of other health insurance coverage for the child.139 If the employee is no
134 The plans specifically excluded from the requirement for coverage of contraceptives in the appropriations bills are:
Providence Health Plan; Personal Care’s HMO; Care Choices; OSF Health Plans, Inc.; Yellowstone Community Health
Plan. According to OPM, in contract year 2012, none of these excepted plans still participated in FEHBP, and no plan
had a religious exception from providing contraceptive coverage.
135 §656 of P.L. 105-277.
136 Generally under TCC, an employee is responsible for both the employee’s and the employer’s (government’s) share
of the FEHBP premium, as well as an additional amount prescribed by OPM for administrative expenses (which cannot
exceed 2% of the combined total of the employee’s and the employer’s shares). See P.L. 100-654.
137 §703 of P.L. 106-65.
138 §717 of P.L. 106-65.
139 §2 of P.L. 106-394.
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longer enrolled in FEHBP, the employing federal agency is directed to enroll the employee in a
family plan that provides the lower level of coverage under the Service Benefit Plan (if the
employee fails to enroll and cannot provide documentation of other coverage for the child).140 If
the employee has individual coverage under FEHBP, the employee is authorized to change to
family coverage. If the employee does not change his or her coverage, the employing federal
agency is directed to change the enrollment of the employee to family coverage either in the plan
in which the employee is currently enrolled, or the lower level of coverage under the nationally-
available Service Benefit Plan.
Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 (P.L.
106-398), October 30, 2000
The Act directed the Secretary of Defense to conduct a study comparing Department of Defense
health programs with plans under Medicare and FEHBP in the areas of coverage and
reimbursement for physical, speech, and occupational therapies.141
District of Columbia Appropriations Act, 2001 (P.L. 106-522), November 22,
2000
The Act allowed certain employees of the District of Columbia to be treated as federal employees
for purposes relating to certain federal programs, including FEHBP. These employees are eligible
for benefits under FEHBP, and the District of Columbia is required to contribute to FEHBP
premiums at the same rates as federal agencies.142
National Defense Authorization Act for Fiscal Year 2002 (P.L. 107-107),
December 28, 2001
The Act authorized employing agencies to pay both the employee’s and employer’s
(government’s) share of premiums for health care coverage under FEHBP for certain reservists
who are enrolled in a FEHBP plan and are called to active duty in support of a contingency
operation.143
The Act also directed the Comptroller General to carry out a study of the health benefit needs of
members of the reserve components of the Armed Forces and the National Guard and their
families with an assessment of the cost and effectiveness of various options, including providing
FEHBP coverage to all members of the reserve components of the Armed Forces and the National
Guard and their families.144
140 According to §8903 title 5 U.S.C., OPM may contract with one “Service Benefit Plan” under FEHBP, which is a
government-wide fee-for-service plan offering two levels of benefits. Blue Cross Blue Shield has been the Service
Benefit Plan offered in FEHBP since the program’s inception.
141 §762 of P.L. 106-398.
142 §145 of P.L. 106-522.
143 §519 of P.L. 107-107.
144 §721 of P.L. 107-107.
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To Amend Title 5, United States Code, to Allow Certain Catch-up
Contributions to the Thrift Savings Plan to be Made by Participants Age 50 or
Over (P.L. 107-304), November 27, 2002
The Act allowed beneficiaries of a health benefits plan administered by the Overseas Private
Investment Corporation (OPIC) to obtain FEHBP coverage when OPIC-administered plans
terminate.145 Any period of enrollment under an OPIC-administered plan before the effective date
of the Act is to be considered a period of enrollment in FEHBP for the purposes of administration
of FEHBP coverage.146
State Justice Institute Reauthorization Act of 2004 (P.L. 108-372), October 25,
2004
The Act extended FEHBP coverage to State Justice Institute employees who began employment
on or after October 1, 1988.147
Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005
(P.L. 108-375), October 28, 2004
The Act provided for the temporary continuation of FEHBP coverage for up to 24 months for a
federal employee who is (1) currently enrolled in the FEHBP; and (2) is a member of the reserve
component of the Armed Forces and called or ordered to active duty in support of a contingency
operation and serves on such duty for more than 30 consecutive days.148 Prior to the Act,
temporary continuation of coverage (TCC) was generally provided to employees and their family
members who voluntarily and involuntarily lost FEHBP coverage, but TCC was not explicitly
provided for federal employees who were called to active duty as members of the reserve
component of the armed forces.
Intelligence Authorization Act for Fiscal Year 2005 (P.L. 108-487), December 23,
2004
The Act authorized the Director of the Central Intelligence Agency (CIA) to take certain actions
to protect the unauthorized disclosure of intelligence operations, the identities of undercover
intelligence officers, and intelligence sources and methods. In doing this, the Director of the CIA,
among other things, may establish and administer a nonofficial cover employee health insurance
program for designated employees and their families.149 A designated employee that participates
145 §4 of P.L. 107-304.
146 Government agencies that have the authority to fix compensation (i.e., independent establishments as defined in
§104 title 5 U.S.C. and government corporations as defined in §103 title 5 U.S.C.) generally also have the authority to
offer health plans to their employees either in place of FEHBP or as an alternative to FEHBP. Prior to the enactment of
P.L. 107-304, the Overseas Private Investment Corporation offered a health plan to its employees as an alternative to
FEHBP. For more information see GAO Report, “Independent Agencies Offering Their Own Health Plans,” March
1989, http://www.gao.gov/assets/220/211072.pdf.
147 §3 of P.L. 108-372.
148 §1101 of P.L. 108-375.
149 §402(e) of P.L. 108-487.
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in this program cannot simultaneously participate in FEHBP. However, a designated employee
participating in the nonofficial program may convert to coverage under FEHBP at any time
deemed appropriate by the Director of the CIA.
Federal Employee Dental and Vision Benefits Enhancement Act of 2004 (P.L.
108-496), December 23, 2004
The Act directed OPM to submit a report to Congress describing and evaluating options whereby
health insurance coverage under FEHBP could be made available to unmarried dependent
children under 25 years of age who are enrolled as full-time students at institutions of higher
education.150
An Act to amend chapter 89 of title 5, United States Code, to make individuals
employed by the Roosevelt Campobello International Park Commission
eligible to obtain Federal health insurance (P.L. 110-74), August 9, 2007
The Act allowed U.S. citizens employed by the Roosevelt Campobello International Park
Commission to be eligible to obtain health insurance under FEHBP.151
An Act to provide for certain Federal employee benefits to be continued for
certain employees of the Senate Restaurants after operations of the Senate
Restaurants are contracted to be performed by a private business concern, and
for other purposes (P.L. 110-279), July 17, 2008
The Act authorized the continued coverage of federal benefits, including FEHBP, for certain
employees of Senate restaurants who are employees of the Architect of the Capitol after
operations of the Senate Restaurants are contracted to be performed by a private business
concern.152
National Aeronautics and Space Administration Authorization Act of 2008
(P.L. 110-422), October, 15, 2008
The Act specified requirements related to temporary continuation of coverage (TCC) under
FEHBP for NASA employees terminated from the Space Shuttle Program; involuntarily separated
from a position due to a reduction-in-force, declination of a directed reassignment, or transfer of
function; or a voluntary separation from a surplus position. The Act required that if such an
employee is receiving TCC under FEHBP, then the employee is not liable for more than the
employee’s share of the premium for the same health benefits plan and level of benefits. The Act
requires NASA to pay the remaining share of the premium required under FEHBP.153
150 §6 of P.L. 108-496.
151 §1 of P.L. 110-74.
152 §1 of P.L. 110-279.
153 §615 of P.L. 110-422. Generally, TCC enrollees pay the full premium, both the employee’s and the employer’s
share, plus a 2% administrative charge. See P.L. 100-654.
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The requirement for such TCC is applicable to individuals whose continued coverage is based on
a separation occurring on or after enactment of this section and before December 31, 2010.
Patient Protection and Affordable Care Act (P.L. 111-148, as amended), March
23, 2010
Beginning in 2014, Members of Congress and congressional staff may only enroll in health plans
created under ACA, or offered through an exchange. Congressional staff, for the purpose of this
requirement, will be limited to those part-and full-time employees who are employed by the
official office of a Member of Congress (i.e., in a “personal office”).154
The Act allowed eligible Indian tribes, tribal organizations, and urban Indian organizations to
purchase FEHBP for their tribal employees. The tribe or tribal organization is responsible for
paying the government’s share of the premium, at a minimum, with the enrollee paying the
remaining share. The Act only allows tribes and tribal organizations to purchase this coverage for
employees; coverage is not available to their annuitants.155
The Act required that adult children up to age 26 may remain/enroll on their parent’s health
insurance plan.156 This provision generally applies to all types of health insurance coverage, not
just coverage offered though FEHBP. As a result of extending dependent coverage to age 26,
temporary continued coverage (TCC) is available for three years when the child ages out of
FEHBP at age 26. Similarly, the opportunity for certain disabled children to remain on their
parent’s plan is tied to age 26. If a disability affected a child prior to age 26, the child may remain
a dependent on his/her parent’s plan indefinitely.157
Author Contact Information
Annie L. Mach
Ada S. Cornell
Analyst in Health Care Financing
Information Research Specialist
amach@crs.loc.gov, 7-7825
acornell@crs.loc.gov, 7-3742
154 §1312(d)(3)(D) of P.L. 111-148. For more information about this provision, see CRS Report RS21982, Health
Benefits for Members of Congress, by Ada S. Cornell.
155 §157 of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790) as enacted by
§10221(a) of P.L. 111-148.
156 §1001 of P.L. 111-148 adding §2714 to the Public Health Service Act, as amended by §2301 of P.L. 111-152.
157 FEHBP plans must comply with additional ACA provisions, but many of them have no meaningful effect on
FEHBP as the plans already meet the requirements of the provisions. For more information about how ACA affects
FEHBP, see CRS Report RS21974, Federal Employees Health Benefits Program (FEHBP): Available Health
Insurance Options, by Annie L. Mach.
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