Page:United States Statutes at Large Volume 73.djvu/750

 712

PUBLIC LAW 86-382-SEPT. 28, 1959

[73 S T A T.

TYPES OF BENEFITS

SEC. 5. The benefits to be provided under plans described in section 4 may be of the following types: (1) SERVICE BENEFIT PLAN.—

(A^ (B) ^C) (D) (E) (F)

Hospital benefits. Surgical benefits. In-hospital medical benefits. Ambulatory patient benefits. Supplemental benefits. Obstetrical benefits.

(2) INDEMNITY BENEFIT PLAN.—

(A) (B) 'C) D) E) ,^F)

Hospital care. Surreal care and treatment. Medical care and treatment. Obstetrical benefits. Prescribed drugs, medicines, and prosthetic devices. Other medical supplies and services. (3] EMPLOYEE ORGANIZATION PLANS.—Benefits of the types specified in this section under paragraph (1) or (2) or both. (4) COMPREHENSIVE MEDICAL PLANS.—Benefits of the types specified in this section under paragraph (1) or (2) or both. All plans contracted for under paragraphs (1) and (2) shall include benefits both for costs associated with care in a general hospital and for other health service costs of a catastrophic nature. CONTRACTING AUTHORITY

SEC. 6. (a) The Commission is authorized, without regard to section 41 USC 5. 3709 of the Revised Statutes or any other provision of law requiring competitive bidding, to enter into contracts with qualified carriers offering plans described in section 4. Each such contract shall be for a uniform term of at least one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. (b)(1) To be eligible as the carrier for the plan described in section 4(2), a company must be licensed to issue group health insurance in all the States of the United States and the District of Columbia. (2) Each contract for a plan described in paragraph (1) or (2) of section 4 shall rec[uire the carrier— (A) to reinsure with such other companies as may elect to participate, in accordance with an equitable formula based on the total amount of their group health insurance benefit payments in the United States during the latest year for which such information is available, to be determined by the carrier and approved by the Commissionj or (B) to allocate its rights and obligations under the contract among such of its affiliates as may elect to participate, in accordance with an equitable formula to be determined by the carrier and such affiliates and approved by the Commission. (c) Each contract under this Act shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits as the Commission may deem necessary or desirable. (d) The Commission is authorized to prescribe regulations fixing reasonable minimum standards for health benefits plans described in section 4 and for carriers offering such plans. Approval of such a plan shall not be withdrawn except after notice, and opportunity for 5° u^s'c^ioo 1 hearing without regard to the Administrative Procedure Act, to the "otecarrier or carriers concerned.

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