S4035-118

1. Short title This Act may be cited as the FEHB Protection Act.

2. FEHB improvements In this section: The term Director means the Director of the Office of Personnel Management. The term employing office has the meaning given the term in section 890.101(a) of title 5, Code of Federal Regulations, or any successor regulation. The terms health benefits plan and member of family have the meanings given those terms in section 8901 of title 5, United States Code. The term open season means an open season described in section 890.301(f) of title 5, Code of Federal Regulations, or any successor regulation. The term Program means the health insurance program carried out under chapter 89 of title 5, United States Code, including the program carried out under section 8903c of that title. The term qualifying life event has the meaning given the term in section 892.101 of title 5, Code of Federal Regulations, or any successor regulation. Beginning on the date that is 180 days after the date of enactment of this Act, the Director shall require each employing office to verify— the veracity of any qualifying life event through which an enrollee in the Program seeks to add a member of family with respect to the enrollee to a health benefits plan under the Program; and that, when an enrollee in the Program seeks to add a member of family with respect to the enrollee to the health benefits plan of the enrollee under the Program during any open season, the individual so added is actually a member of family with respect to the enrollee. In any fraud risk assessment conducted with respect to the Program on or after the date of enactment of this Act, the Director shall include an assessment of individuals who are enrolled in, or covered under, a health benefits plan under the Program even though those individuals are not eligible to be so enrolled or covered. During the 5-year period beginning on the date of enactment of this Act, the Director shall conduct a comprehensive audit regarding members of family— who are covered under an enrollment in a health benefits plan under the Program; and with respect to whom the basis for the eligibility for the coverage described in subparagraph (A) has not been verified. In conducting the audit required under paragraph (1), the Director shall review marriage certificates, birth certificates, and other appropriate documents that are necessary to determine eligibility to enroll in a health benefits plan under the Program. Beginning on the date of enactment of this Act, the Director may disenroll or remove from enrollment any individual enrolled in, or covered under, a health benefits plan under the Program if the Director determines that such individual is not eligible to be so enrolled or covered.