5 U.S.C. § 8909 — Employees Health Benefits Fund
submitted 60 years ago by Pub. L. 89-554 to r/title-5-GOVERNMENT-ORGANIZATION-AND-EMPLOYEES · 1,008 words · no verdicts yet
The Employees Health Benefits Fund, run by OPM, holds employee and government contributions and pays approved health plans without a yearly spending limit. Portions of the money are set aside for administration, a special 2026-2035 fund for enforcing the FEHB Protection Act of 2025, and contingency reserves for each plan. The Fund also covers costs for a related demonstration project.
(a) The Fund exists in the U.S. Treasury and is run by OPM. It holds all the contributions from enrollees and the government described in section 8906. It can pay approved health plans with no yearly limit, and pay administrative costs within limits Congress sets each year — except money set aside under (b)(2), which is not subject to that yearly limit. When the Fund pays a plan that uses a "letter-of-credit" payment setup, it must, as much as practical, pay only when the plan has actually presented checks, following Treasury Department rules.
(b) OPM must regularly set aside parts of the contributions:
(1) A percentage — no more than 1% of all contributions — that OPM decides is enough to cover administrative costs.
(2) In fiscal year 2026, exactly $66,000,000, available through the end of fiscal year 2035, so OPM's Director can carry out parts (c) through (f) of the FEHB Protection Act of 2025.
(3) For each health plan, a percentage — no more than 3% of that plan's contributions — that OPM decides is enough for a contingency (backup) reserve. OPM may also move unused administrative money into these plan reserves; each plan's reserve then gets credited based on how much that plan was paid in the previous contract term. Any dividends, rate adjustments, or refunds from a plan go into that plan's reserve. Reserves can be used to soften future rate increases, lower what enrollees and the government pay, or increase benefits — OPM decides how.
(c) The Treasury Secretary may invest Fund money in interest-paying U.S. government securities and sell them when needed; the interest and sale proceeds go back into the Fund.
(d) If employee organizations that sponsor health plans merge, the merged plan's assets (including reserves) and debts transfer to the new combined organization's plan, starting the next contract term after the merger. People covered under the old plans — employees, annuitants, former spouses, and others with continued coverage — move to the new plan automatically, unless they choose a different plan. If the surviving organization is the type described in section 8901(8)(B), transferred people cannot stay enrolled past that contract term unless they are full members of that organization.
(e)
(1) Except in a merger under (d), when a plan is discontinued, its contingency reserve is divided among the remaining plans for the next contract term, based on how much each plan was paid during the year the discontinued plan ended.
(2) This division must be finished by the end of the second contract year after the plan is discontinued.
(3) OPM will write rules for how this works if a plan is dropped before it finishes receiving its own full share from an earlier plan's discontinuation.
(f)
(1) No state, the District of Columbia, Puerto Rico, or any of their local governments may tax, charge a fee to, or otherwise take money — directly or indirectly — from a carrier or subcontractor of an approved health plan because of a payment made from the Fund.
(2) But this does not stop a state or similar government from taxing the net income or profit a carrier or subcontractor earns from this business, as long as that kind of tax applies broadly to many kinds of business, not just this one.
(g) The Fund can also pay costs OPM has for running the demonstration project described in section 1108 of title 10.
There is in the Treasury of the United States an Employees Health Benefits Fund which is administered by the Office of Personnel Management. The contributions of enrollees and the Government described by section 8906 of this title shall be paid into the Fund. The Fund is available—
without fiscal year limitation for all payments to approved health benefits plans; and
to pay expenses for administering this chapter within the limitations that may be specified annually by Congress, except that the amounts required to be set aside under subsection (b)(2) shall not be subject to the limitations that may be specified annually by Congress.
Payments from the Fund to a plan participating in a letter-of-credit arrangement under this chapter shall, in connection with any payment or reimbursement to be made by such plan for a health service or supply, be made, to the maximum extent practicable, on a checks-presented basis (as defined under regulations of the Department of the Treasury).
Portions of the contributions made by enrollees and the Government shall be regularly set aside in the Fund as follows:
A percentage, not to exceed 1 percent of all contributions, determined by the Office to be reasonably adequate to pay the administrative expenses made available by subsection (a) of this section.
In fiscal year 2026, $66,000,000, to be derived from all contributions, and to remain available until the end of fiscal year 2035, for the Director of the Office to carry out subsections (c) through (f) of the FEHB Protection Act of 2025.
For each health benefits plan, a percentage, not to exceed 3 percent of the contributions toward the plan, determined by the Office to be reasonably adequate to provide a contingency reserve.
The Office, from time to time and in amounts it considers appropriate, may transfer unused funds for administrative expenses to the contingency reserves of the plans then under contract with the Office. When funds are so transferred, each contingency reserve shall be credited in proportion to the total amount of the subscription charges paid and accrued to the plan for the contract term immediately before the contract term in which the transfer is made. The income derived from dividends, rate adjustments, or other refunds made by a plan shall be credited to its contingency reserve. The contingency reserves may be used to defray increases in future rates, or may be applied to reduce the contributions of enrollees and the Government to, or to increase the benefits provided by, the plan from which the reserves are derived, as the Office from time to time shall determine.
The Secretary of the Treasury may invest and reinvest any of the money in the Fund in interest-bearing obligations of the United States, and may sell these obligations for the purposes of the Fund. The interest on and the proceeds from the sale of these obligations become a part of the Fund.
When the assets, liabilities, and membership of employee organizations sponsoring or underwriting plans approved under section 8903(3) or 8903a of this title are merged, the assets (including contingency reserves) and liabilities of the plans sponsored or underwritten by the merged organizations shall be transferred at the beginning of the contract term next following the date of the merger to the plan sponsored or underwritten by the successor organization. Each employee, annuitant, former spouse, or person having continued coverage under section 8905a of this title affected by a merger shall be transferred to the plan sponsored or underwritten by the successor organization unless he enrolls in another plan under this chapter. If the successor organization is an organization described in section 8901(8)(B) of this title, any employee, annuitant, former spouse, or person having continued coverage under section 8905a of this title so transferred may not remain enrolled in the plan after the end of the contract term in which the merger occurs unless that individual is a full member of such organization (as determined under section 8903a(d) of this title).
Except as provided by subsection (d) of this section, when a plan described by section 8903(3) or (4) or 8903a of this title is discontinued under this chapter, the contingency reserve of that plan shall be credited to the contingency reserves of the plans continuing under this chapter for the contract term following that in which termination occurs, each reserve to be credited in proportion to the amount of the subscription charges paid and accrued to the plan for the year of termination.
Any crediting required under paragraph (1) pursuant to the discontinuation of any plan under this chapter shall be completed by the end of the second contract year beginning after such plan is so discontinued.
The Office shall prescribe regulations in accordance with which this subsection shall be applied in the case of any plan which is discontinued before being credited with the full amount to which it would otherwise be entitled based on the discontinuation of any other plan.
No tax, fee, or other monetary payment may be imposed, directly or indirectly, on a carrier or an underwriting or plan administration subcontractor of an approved health benefits plan by any State, the District of Columbia, or the Commonwealth of Puerto Rico, or by any political subdivision or other governmental authority thereof, with respect to any payment made from the Fund.
Paragraph (1) shall not be construed to exempt any carrier or underwriting or plan administration subcontractor of an approved health benefits plan from the imposition, payment, or collection of a tax, fee, or other monetary payment on the net income or profit accruing to or realized by such carrier or underwriting or plan administration subcontractor from business conducted under this chapter, if that tax, fee, or payment is applicable to a broad range of business activity.
The fund described in subsection (a) is available to pay costs that the Office incurs for activities associated with implementation of the demonstration project under section 1108 of title 10.
Source credit: (Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 605; Pub. L. 95–454, title IX, § 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 98–615, § 3(6), Nov. 8, 1984, 98 Stat. 3204; Pub. L. 99–53, § 2(e), (f), June 17, 1985, 99 Stat. 94; Pub. L. 99–251, title I, § 101, Feb. 27, 1986, 100 Stat. 14; Pub. L. 100–654, title II, § 202(a), Nov. 14, 1988, 102 Stat. 3845; Pub. L. 101–508, title VII, § 7002(b), (c), Nov. 5, 1990, 104 Stat. 1388–330; Pub. L. 105–261, div. A, title VII, § 721(b)(4), Oct. 17, 1998, 112 Stat. 2065; Pub. L. 105–266, § 6(b)(1), Oct. 19, 1998, 112 Stat. 2369; Pub. L. 119–21, title IX, § 90101(g), July 4, 2025, 139 Stat. 363.)
- 1966Enacted · Pub. L. 89-554 · 80 Stat. 605
- 1978Amended · Pub. L. 95-454 · 92 Stat. 1224
- 1984Amended · Pub. L. 98-615 · 98 Stat. 3204
- 1985Amended · Pub. L. 99-53 · 99 Stat. 94
- 1986Amended · Pub. L. 99-251 · 100 Stat. 14
- 1988Amended · Pub. L. 100-654 · 102 Stat. 3845
- 1990Amended · Pub. L. 101-508 · 104 Stat. 1388
- 1998Amended · Pub. L. 105-261 · 112 Stat. 2065
- 1998Amended · Pub. L. 105-266 · 112 Stat. 2369
- 2025Amended · Pub. L. 119-21 · 139 Stat. 363
A history note hasn’t been published yet. The record shows enactment by Pub. L. 89-554 on 1966-09-06.
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