U.S. Code » Title 5 » Part PART III— EMPLOYEES › Subpart Subpart G— Insurance and Annuities › Chapter CHAPTER 89— HEALTH INSURANCE

5 U.S.C. § 8907

Information to individuals eligible to enroll

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(a) The Office of Personnel Management shall make available to each individual eligible to enroll in a health benefits plan under this chapter such information, in a form acceptable to the Office after consultation with the carrier, as may be necessary to enable the individual to exercise an informed choice among the types of plans described by sections 8903 and 8903a of this title.(b) Each enrollee in a health benefits plan shall be issued an appropriate document setting forth or summarizing the—(1) services or benefits, including maximums, limitations, and exclusions, to which the enrollee or the enrollee and any eligible family members are entitled thereunder;(2) procedure for obtaining benefits; and(3) principal provisions of the plan affecting the enrollee and any eligible family members.(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(5), Nov. 8, 1984, 98 Stat. 3204; Pub. L. 99–53, § 2(d), June 17, 1985, 99 Stat. 94.)

Historical and Revision Notes

Derivation

U.S. Code

Revised Statutes and

Statutes at Large

 

5 U.S.C. 3009(d).

Sept. 28, 1959, Pub. L. 86–382, § 10(d), 73 Stat. 715.

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 NotesAmendments

1985—Subsec. (a). Pub. L. 99–53 inserted reference to section 8903a of this title.

1984—Pub. L. 98–615, § 3(5)(C), substituted “individuals eligible to enroll” for “employees” in section catchline.

Subsec. (a). Pub. L. 98–615, § 3(5)(A), substituted “individual” for “employee” in two places.

Subsec. (b). Pub. L. 98–615, § 3(5)(B)(i), substituted “enrollee” for “employee enrolled” in provisions preceding par. (1).

Subsec. (b)(1). Pub. L. 98–615, § 3(5)(B)(ii), substituted “enrollee or the enrollee and any eligible family members” for “employee or the employee and members of his family”.

Subsec. (b)(3). Pub. L. 98–615, § 3(5)(B)(iii), substituted “the enrollee and any eligible family members” for “the employee or members of his family”.

1978—Subsec. (a). Pub. L. 95–454 substituted “Office of Personnel Management” and “Office” for “Civil Service Commission” and “Commission”, respectively.

Statutory Notes and Related SubsidiariesEffective Date of 1984 Amendment

Amendment by Pub. L. 98–615 effective May 7, 1985, with enumerated exceptions, and applicable to any individual who is married to an employee or annuitant on or after that date, see section 4(a)(2) of Pub. L. 98–615, as amended, set out as a note under section 8341 of this title.

Effective Date of 1978 Amendment

Amendment by Pub. L. 95–454 effective 90 days after Oct. 13, 1978, see section 907 of Pub. L. 95–454, set out as a note under section 1101 of this title.

Notes of Decisions
Cited in 17 cases (1 in the last 5 years), 1977–2024 · leading case: Empire Healthchoice Assurance, Inc. v. McVeigh
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Empire Healthchoice Assurance, Inc. v. McVeigh (2006) scotus · cites it 2× “5 U. S. C. § 8907 (b). Concerning reimbursement and subrogation, matters FEHBA itself does not address, the BCBSA Plan's statement of benefits reads in part: "If another person or entity .”
Van Vactor v. Blue Cross Association (1977) illappct · cites it 2× “Defendant questions whether the court properly construed the insurance contract and the brochure issued to policyholders pursuant to the contract and Federal statute ( 5 U.S.C. §8907 (1970)). Defendant also questions whether the proof and pleadings support the judgment and…”
Berry v. Blue Cross of Washington and Alaska (1993) wawd · cites it 2× “5 U.S.C. § 8907 (b). Analogy in this dispute to ERISA cases regarding plan summaries is appropriate.”
Bridges v. Blue Cross and Blue Shield Ass'n (1996) dcd “§§ 8902 (i), 8906, distributes information on the available health plans to federal employees, 5 U.S.C. § 8907 , and makes determinations on claim disputes when they arise, 5 U.”
Zeigan v. Blue Cross & Blue Shield of Greater New York (1985) nysd · cites it 2× “The fourth claim alleges that BCBS violated 5 U.S.C. § 8907 by not supplying to the United States Office of Personnel Management (“OPM”) information relating to refusal to make reimbursements for long-term mental illness hospitalization, and that federal employees were thereby…”
Arnold Ex Rel. Arnold v. Blue Cross & Blue Shield of Texas, Inc. (1997) txsd “5 U.S.C. § 8907 (b). Orange Affidavit, ¶ 13.”
St. Mary's Hospital v. Carefirst of Maryland, Inc. (2002) mdd “” 5 U.S.C. § 8907 (b). The Statement of Benefits for the SBP is incorporated by reference into the contract between OPM and the Blue Cross Blue Shield association, and is the official description of benefits terms.”
Matter of Succession of Sims (1985) lactapp “" 5 U.S.C.A. § 8907 , as amended. The parties stipulated that the marriage between Marcella and Winston Sims was dissolved on November 19, 1975.”
Hanson v. Blue Cross Blue Shield of Iowa (1996) iand “5 U.S.C.A. § 8907 (b)(2), (3). The Statement of Benefits sets forth for each plan the “benefits, including máximums, limitations, and exclusions,”, the “procedure for obtaining benefits,” and the “principal provisions of the plan affecting the enrollee and any eligible family…”
Smith v. United States Office of Personnel Management (2014) paed “The MHPAEA applies to health insurance plans that cover “both medical and surgical benefits” and “mental health or substance use disorder benefits.”
Garvey v. Prudential Insurance Co. of America (1984) paed “Employees are notified of changes in benefits by means of a brochure published annually by OPM for each health benefits plan, see Title 5 U.S.C. § 8907 . 5 Each year, during an “open season” after benefit changes and premium rates are announced, federal employees are permitted…”
National Ass'n of Postal Supervisors v. United States (1990) cc “5 U.S.C. § 8907 . OPM may contract for four types of health benefits plans — service benefit, indemnity benefit, employee organization, and comprehensive medical.”
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