5 U.S.C. § 8903c — Postal Service Health Benefits Program

(a) Definitions. This section defines the words it uses. A "covered Medicare individual" is someone entitled to Medicare Part A, but not someone who can only enroll in Part A under special end-stage-renal-disease rules. The "initial contract year" is the contract year that starts in January 2025. An "initial participating carrier" is a carrier that signs a contract to join the Program during that first year. "Medicare part A" and "Medicare part B" mean the hospital and medical insurance parts of Medicare under the Social Security Act. The "Office" means the Office of Personnel Management (OPM), and the "Postal Service" means the United States Postal Service. A "Postal Service annuitant" is a retiree enrolled in a chapter health plan whose government share is paid under section 8906(g)(2); a "Postal Service employee" is a current worker enrolled in a chapter plan whose government share is paid by the Postal Service. A "Postal Service Medicare covered annuitant" is a Postal Service annuitant who is also a covered Medicare individual. The "Program" is the Postal Service Health Benefits Program created by subsection (c), and a "Program plan" is a health plan offered through it. The general definitions in section 8901 also apply here, and for this section, Postal Service employees and annuitants are treated the same as regular employees and annuitants under those definitions. (b) Application. These rules apply starting with the initial contract year (2025) and every year after. If any other part of this chapter conflicts with these rules, OPM decides that these rules win. (c) Establishment of the Program. (1) OPM must create the Postal Service Health Benefits Program inside the existing Federal Employees Health Benefits Program, letting OPM contract with carriers to offer plans under this section. Except where this section says otherwise, these contracts must follow the same rules as regular chapter contracts under section 8902. As much as practical, the Program must include a matching plan (with equivalent benefits and cost-sharing) from any carrier that had 1,500 or more postal enrollees in a plan as of the 2023 contract year — though OPM's Director can exempt a comprehensive medical plan from this — plus plans from any other carrier OPM finds appropriate. People can enroll as an individual, for self plus one, or for self and family. No one who is not a Postal Service employee or annuitant may enroll, except as a family member of one, or under the special rule in paragraph (4). (2) In the first contract year, OPM must make sure each participating carrier's Program plans match its regular (non-Program) plans in benefits and cost-sharing — except prescription drug benefits and cost-sharing can differ, to the extent needed to coordinate with the Medicare Part D drug coverage required by subsection (h)(2). (3) Except where this section says otherwise, the normal chapter rules for plans offered under sections 8903 or 8903a also apply to Program plans. (4) Following OPM's rules, section 8905a (continued coverage) applies to Program plans the same way it applies to other chapter plans. (d) Election of Coverage. A Postal Service employee or annuitant who chooses chapter health coverage must follow this section's rules, and cannot enroll in any other chapter health plan. (e) Requirement of Medicare Enrollment. (1) Except for the exceptions in paragraph (3), a Postal Service Medicare covered annuitant cannot enroll in a Program plan unless they have Medicare Part A and are enrolled in Part B. (2) Except for those same exceptions, if such an annuitant's family member is also a covered Medicare individual, that family member cannot enroll under the Program unless they too have Medicare Part A and are enrolled in Part B. (3) These Medicare requirements do not apply to: (i) someone who, as of January 1, 2025, is already a Postal Service annuitant without both Medicare Part A and Part B enrollment; (ii) someone who, as of January 1, 2025, is a Postal Service employee at least 64 years old; (iii) a Postal Service Medicare covered annuitant or family member who lives outside the United States (including its territories), for any year they can show the Postal Service they live abroad, under Postal Service regulations; (iv) a Postal Service Medicare covered annuitant or family member enrolled in VA health care under title 38's chapter 17, subchapter II; and (v) a Postal Service Medicare covered annuitant or family member eligible for Indian Health Service care. OPM had to issue regulations for the VA and Indian Health Service exceptions, working with the VA Secretary, HHS Secretary, and Postmaster General, within one year of this section becoming law. The Postal Service must give OPM the list of people who qualify for the living-abroad exception. (4) The Postal Service and OPM, working with the Social Security Administration and the Centers for Medicare & Medicaid Services (CMS), must set up a way to timely tell postal employees, annuitants, and their family members about these Medicare enrollment requirements. (f) Transitional Open Season. (1) In this subsection, an individual's "current option" and "current plan" mean the plan and option they were enrolled in during the contract year right before the initial contract year. (2) If an eligible Postal Service employee or annuitant in a current plan does not pick a Program plan during the open season just before the initial contract year, OPM must automatically enroll them, starting with the initial contract year, in a Program plan from their current plan's carrier. If that carrier offers more than one Program plan or option, OPM must pick the one with benefits and cost-sharing equivalent to the person's current plan and option. If that carrier offers no Program plan at all, OPM must automatically enroll the person in the lowest-cost nationwide Program plan option that is not a high-deductible plan and does not charge an association or membership fee. (g) OPM Regulations. Within one year of enactment, OPM's Director had to issue regulations carrying out this section, consulting as needed with HHS, the VA, the Social Security Administration, and the Postmaster General. Those regulations must include: (A) whatever provisions are needed to implement this section; (B) a process to timely inform Postal Service annuitants and affected family members of the enrollment requirements, and let them request more information in writing; (C) a way for a Postal Service employee or annuitant to request a belated plan change and be enrolled going forward in the plan they wanted; and (D) a way for people to cancel Program coverage in writing, to the Postal Service, because they choose not to enroll in, or want to drop, Medicare Part B. (h) Medicare Coordination. (1) OPM must require every Program plan to coordinate its benefits with Medicare using a method OPM approves. (2) OPM must require every Program plan to give prescription drug coverage to any Postal Service annuitant and family member who qualifies as a Medicare Part D-eligible individual, through employer-based retiree drug coverage — either through (A) a Medicare Part D prescription drug plan itself, or (B) a contract between the Program plan and a Part D plan sponsor. (i) Postal Service Contribution. (1) Subject to subsection (k), the weighted average used to apply section 8906(b) to the Postal Service is figured using paragraphs (2) and (3). (2) By October 1 each year, starting in 2024, OPM must figure the weighted average of the rates set under subsection (c)(2) for Program plans that will apply the following year, separately for self-only, self-plus-one, and self-and-family enrollments. (3) For the initial contract year's weighted average, OPM must base the weighting on how postal employees and annuitants were enrolled, as of March 31, 2023, in the initial participating carriers' plans. (4) The Postal Service may direct OPM to pay any late-Medicare-enrollment penalty amounts owed under an agreement between the Postal Service and HHS — first from the Postal Service Retiree Health Benefits Fund until that Fund runs out, and after that from the Postal Service Fund. (j) Reserves. (1) OPM must make sure each Program plan keeps separate reserves, including a separate contingency reserve, for its own enrollees, following section 8909. All of section 8909's contingency-reserve rules apply to Program plans the same as to other chapter plans, except where they conflict with this subsection — and wherever section 8909 refers to "the Government," that means the Postal Service for Program purposes. Each Program plan's reserves get a proportional share of the carrier's overall health-plan reserves. (2) If a Program plan ends, its separate Postal Service contingency reserve, under section 8909(e), gets credited only to the contingency reserves of the Program plans that are continuing — not to other, non-Program plans. (k) No Effect on Existing Law. Nothing in this section changes section 1005(f) of title 39, which covers variations, additions, or substitutions to this chapter's rules. (l) Health Benefits Education Program. In this subsection, a "navigator" is a Postal Service (or Postal Service contractor) employee assigned to do the activities listed in paragraph (5). Within 18 months of enactment, the Postal Service had to set up a Health Benefits Education Program. That program must: (A) notify postal annuitants and employees about the Program set up under subsection (c)(1); (B) give them information about the Program and this section's requirements, including the available health care options, the enrollment rules in subsection (d), and the Medicare enrollment requirement in subsection (e); (C) answer their questions about the Program, consulting OPM as needed; (D) working with CMS and the Social Security Administration, give people information about Medicare enrollment and refer them to those agencies for more help; and (E) carry out, directly or by contract, the navigator activities in paragraph (5). OPM must timely give the Postal Service the information it needs to run this education program, and the Postal Service must coordinate with OPM (and, as needed, CMS and Social Security) to confirm that information is accurate. The navigator activities are: (i) educating annuitants and employees about Program plans and enrollment requirements, including the Medicare Part A and Part B requirements; (ii) giving fair, impartial enrollment information; (iii) helping people actually enroll; and (iv) presenting information in a way that fits the language and culture of the people it serves. The Postal Service must set standards for navigators to follow these activities while avoiding conflicts of interest — a navigator cannot be a health insurance carrier, and cannot take payment, directly or indirectly, from a carrier tied to enrolling someone in a Program plan. The Postal Service, consulting OPM and CMS as needed, must also set standards to make sure navigator information stays fair, accurate, and impartial. Within 18 months of enactment, the Postmaster General had to issue regulations setting up this education program, covering: (i) how to notify annuitants and employees about the Program and its options, including a process for telling newly Medicare-eligible employees and Medicare-covered annuitants about their choices; (ii) how to notify annuitants, employees, and family members about the Medicare enrollment requirement in subsection (e); and (iii) a process, developed with the Social Security Administration, CMS, and OPM, for handling questions from annuitants and employees about the Program or Medicare enrollment.