US Code

Public Law 119-73 (01/23/2026)

5 U.S.C. § 8903

Health benefits plans

The Office of Personnel Management may contract for or approve the following health benefits plans:
(1)

Service Benefit Plan.—

section 8904(1) of this titlesection 8905a of this titlesection 8905a of this titleOne Government-wide plan, which may be underwritten by participating affiliates licensed in any number of States, offering at least 2 levels of benefits for enrollees under this chapter generally and at least 2 levels of benefits for enrollees under the Postal Service Health Benefits Program established under section 8903c, under which payment is made by a carrier under contracts with physicians, hospitals, or other providers of health services for benefits of the types described by given to employees, annuitants, members of their families, former spouses, or persons having continued coverage under , or, under certain conditions, payment is made by a carrier to the employee, annuitant, family member, former spouse, or person having continued coverage under .
(2)

Indemnity Benefit Plan.—

section 8904(2) of this titleOne Government-wide plan, offering two levels of benefits, under which a carrier agrees to pay certain sums of money, not in excess of the actual expenses incurred, for benefits of the types described by .
(3)

Employee Organization Plans.—

section 8904(3) of this titlesection 8901(8)(A) of this titleEmployee organization plans which offer benefits of the types referred to by , which are sponsored or underwritten, and are administered, in whole or substantial part, by employee organizations described in , which are available only to individuals, and members of their families, who at the time of enrollment are members of the organization.
(4)

Comprehensive Medical Plans.—

(A)

Group-practice prepayment plans.—

section 8904(4) of this titleGroup-practice prepayment plans which offer health benefits of the types referred to by , in whole or in substantial part on a prepaid basis, with professional services thereunder provided by physicians practicing as a group in a common center or centers. The group shall include at least 3 physicians who receive all or a substantial part of their professional income from the prepaid funds and who represent 1 or more medical specialties appropriate and necessary for the population proposed to be served by the plan.
(B)

Individual-practice prepayment plans.—

Individual-practice prepayment plans which offer health services in whole or substantial part on a prepaid basis, with professional services thereunder provided by individual physicians who agree, under certain conditions approved by the Office, to accept the payments provided by the plans as full payment for covered services given by them including, in addition to in-hospital services, general care given in their offices and the patients’ homes, out-of-hospital diagnostic procedures, and preventive care, and which plans are offered by organizations which have successfully operated similar plans before approval by the Office of the plan in which employees may enroll.
(C)

Mixed model prepayment plans .—

Mixed model prepayment plans which are a combination of the type of plans described in subparagraph (A) and the type of plans described in subparagraph (B).

Pub. L. 89–55480 Stat. 602Pub. L. 95–454, title IX, § 906(a)(2)92 Stat. 1224Pub. L. 98–615, § 3(3)98 Stat. 3203Pub. L. 99–53, § 2(b)99 Stat. 94Pub. L. 99–251, title I100 Stat. 14Pub. L. 100–654, title II, § 202(b)102 Stat. 3845Pub. L. 105–266, § 3(b)112 Stat. 2366Pub. L. 117–108, title I, § 101(a)(2)(A)136 Stat. 1135(, , ; , (3), , ; , , ; , , ; , §§ 102, 111, , , 19; , , ; , , ; , , .)

Historical and Revision Notes

Derivation

U.S. Code

Revised Statutes and

Statutes at Large

 

5 U.S.C. 3003.

Sept. 28, 1959, Pub. L. 86–382, § 4, 73 Stat. 711.

 

 

July 8, 1963, Pub. L. 88–59, § 1(b), 77 Stat. 77.

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

Editorial Notes

Amendments

Pub. L. 117–1082022—Par. (1). substituted “at least 2 levels of benefits for enrollees under this chapter generally and at least 2 levels of benefits for enrollees under the Postal Service Health Benefits Program established under section 8903c” for “two levels of benefits”.

Pub. L. 105–2661998—Par. (1). substituted “plan, which may be underwritten by participating affiliates licensed in any number of States,” for “plan,”.

Pub. L. 100–654section 8905a of this titlesection 8905a of this title1988—Par. (1). substituted “former spouses, or persons having continued coverage under ,” for “or former spouses,” and “former spouse, or person having continued coverage under .” for “or former spouse.”

Pub. L. 99–251, § 1021986—Par. (4)(A). , amended second sentence generally, substituting “at least 3 physicians” for “physicians representing at least three major medical specialties” and inserted “and who represent 1 or more medical specialties appropriate and necessary for the population proposed to be served by the plan”.

Pub. L. 99–251, § 111Par. (4)(C). , added subpar. (C).

Pub. L. 99–53section 8901(8)(A) of this title1985—Par. (3). inserted “described in ” after “employee organizations”.

Pub. L. 98–615, § 3(3)1984—Par. (1). , substituted “employees, annuitants, members of their families, or former spouses” for “employees or annuitants, or members of their families” and “employee, annuitant, family member, or former spouse” for “employee or annuitant or member of his family”.

Pub. L. 95–4541978— substituted “Office of Personnel Management” and “Office” for “Civil Service Commission” and “Commission”, respectively, wherever appearing.

Statutory Notes and Related Subsidiaries

Effective Date of 1988 Amendment

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

Effective Date of 1984 Amendment

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

Effective Date of 1978 Amendment

Pub. L. 95–454section 907 of Pub. L. 95–454section 1101 of this titleAmendment by effective 90 days after , see , set out as a note under .