Page:United States Statutes at Large Volume 80 Part 1.djvu/639

 80 STAT. ]

PUBLIC LAW 89-554-SEPT. 6, 1966

tions, 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.—Group-practice

prepayment plans which offer health benefits of the types referred to by section 8904(4) of this title, 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 physicians representing at least three major medical specialties who receive all or a substantial part of their professional income from the prepaid funds. (B)

INDIVIDUAL-PRACTICE PREPAYMENT PLANS.—Individ-

ual-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 Commission, 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 Commission of the plan in which employees may enroll. § 8904. Types of benefits The benefits to be provided under plans described by section 8903 of this title may be of the following types: (1)

SERVICE BENEFIT P L A N. —

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

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

(2) INDEMNITY BENEFIT P L A N. —

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

Hospital care. Surgical 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 named under paragraph (1) or (2) of this section or both. (4) COMPREHENSIVE MEDICAL PLANS.—Benefits of the types named under paragraph (1) or (2) of this section or both. All plans contracted for under paragraphs (1) and (2) of this section shall include benefits both for costs associated with care in a general hospital and for other health services of a catastrophic nature. § 8905. Election of coverage (a) A n employee may enroll in an approved health benefits plan described by section 8903 of this title either as an individual or for self and family.

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