,,ii  #aac? ,,congress  #a/ ,session    
,s4 #adfi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #a1 #bjac ,mr4  
,paul introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to provide         
high]-quality1 l[]-co/ heal? c>e to     
s5iors4  #a4 ,%ort title ,?is ,act may  
be cit$ z ! ,congressional ,heal? ,c>e =
 ,s5iors ,act ( #bjac4  #b4 ,enroll+    
s5iors 9 ! same heal? c>e plans z       
,memb]s ( ,congress  7a7 ,9 g5]al ,*apt]
 #hi ( title #e1 ,unit$ ,/ates ,code1 is
 am5d$--  7#a7 9 section #hija--  7,a7 9
 p>agraph 7#aj71 by /rik+ & at ! end2   
7,b7 9 p>agraph 7#aa71 by /rik+ ! p]iod 
at ! end & ins]t+ 2 &2 &  7,c7 by add+  
at ! end ! foll[+3  7#ab7 ! t]m cov]$   
individual means an individual :o1 tak+ 
into acc\nt section #bbf7k7 ( ! ,social 
,security ,act1 w\ld h be5 entitl$ to1  
or c\ld h enroll$ =1 b5efits "u "p ,a ( 
title ,,xviii ( su* ,act or c\ld h      
enroll$ "u "p ,b ( su* title if section 
#ahii;,b _h n be5 enact$4  2  7#b7 by   

ins]t+ aft] section #hija ! foll[+3  ,i 
,f$]al employees  2  7#c7 9 section     
#hijb--  7,a7 9 subsection 7a7--  7i7 by
 ins]t+ 7#a7 aft] 7a72 &  7ii7 by add+  
at ! end ! foll[+3  7#b7 7,a7 ,9 ?is    
p>agraph1 ! t]m equival5t heal? b5efits 
plan means a heal? b5efits plan propos$ 
to be provid$ t (f]s b5efits t !        
,director ( ! ,(fice ( ,p]sonnel        
,managem5t det]m9es are sub/antially    
equival5t or sup]ior to b5efits (f]$ "u1
 & does n impose requirem5ts t are      
sub/antially diff]5t ?an requirem5ts "u1
 a heal? b5efits plan 9 :i* an employee 
c\ld enroll on ! date ( enactm5t ( !    
,congressional ,heal? ,c>e = ,s5iors    
,act ( #bjac if ! employee resid$--  7i7
 any:]e 9 ! ,unit$ ,/ates2 or  7ii7 9 ! 
same region ( ! ,unit$ ,/ates z ! heal? 
b5efits plan propos$ to be provid$4     
7,b7 ,= contract ye>s beg9n+ on or aft] 
,janu>y #a1 #bjae1 if a c>ri] (f]s to   
provide an equival5t heal? b5efits plan1
 ! ,director %all ent] into a contract )
 ! c>ri] to provide ! equival5t heal?   

b5efits plan4  2  7,b7 9 subsection 7e71
 by /rik+ ,! ,(fice may prescribe &     
ins]t+ ,subject to subsection 7a77#b71 !
 ,(fice may prescribe2 &  7,c7 by add+  
at ! end ! foll[+3  7p7 ,a contract "u  
?is *apt] = a contract ye> beg9n+ on or 
aft] ,janu>y #a1 #bjae1 %all (f] b5efits
 = employees1 annuitants1 memb]s ( _!   
families1 =m] sp\ses1 p]sons hav+       
cont9u$ cov]age "u section #hije;a ( ?is
 title1 & cov]$ individuals4 ,9 adm9i/]+
 ?is sub*apt] & sub*apt] ,,ii1          
employees1 annuitants1 memb]s ( _!      
families1 =m] sp\ses1 p]sons hav+       
cont9u$ cov]age "u section #hije;a ( ?is
 title1 & cov]$ individuals %all be 9 ! 
same risk pool4  2  7#d7 9 section      
#hijd--  7,a7 by /rik+ 7a7 ,! b5efits & 
ins]t+ ,! b5efits2  7,b7 by /rik+ ?is   
subsection ea* place x appe>s & ins]t+  
?is section2 &  7,c7 by /rik+ subsection
 7b72  7#e7 9 section #hiji7;a77#a71 by 
ins]t+ & = all paym5ts "u section       
#hiba7;d7 be=e ! semicolon2  7#f7 9     
section #hiaj1 by /rik+ subsection 7d72 

&  7#g7 by add+ at ! end ! foll[+3  ,,ii
 ,cov]$ individuals  #hiba4 ,heal?      
insurance = cov]$ individuals  7a7 ,=   
contract ye>s beg9n+ on or aft] ,janu>y 
#a1 #bjae1 & except z o!rwise provid$ 9 
?is sub*apt]1 ! ,director ( ! ,(fice (  
,p]sonnel ,managem5t %all ensure t to ! 
greate/ ext5t possible heal? b5efits    
plans provide b5efits = cov]$           
individuals to ! same ext5t & 9 ! same  
mann] z provid$ "u sub*apt] ,i =        
employees1 annuitants1 memb]s ( _!      
families1 =m] sp\ses1 & p]sons hav+     
cont9u$ cov]age "u section #hije;a ( ?is
 title4  7b7 7#a7 ,! ,director %all     
e/abli% ! deadl9e by :i* a cov]$        
individual %all elect to--  7,a7 enroll 
9 a heal? b5efits plan "u ?is *apt] bas$
 on ! /atus ( ! individual z a cov]$    
individual2  7,b7 ) ! concurr5ce ( !    
employ] or =m] employ] ( ! cov]$        
individual1 receive paym5ts "u          
subsection 7d7 to assi/ 9 pay+ = heal?  
insurance provid$ ?r\gh ! employ] or =m]
 employ] ( ! cov]$ individual2 or  7,c7 

n enroll 9 a heal? b5efits plan or      
receive paym5ts "u ?is *apt]4  7#b7     
,failure to make a timely election "u   
?is subsection %all be deem$ z an       
election to n enroll 9 a heal? b5efits  
plan or receive paym5t "u ?is *apt]4    
7#c7 ,a cov]$ individual--  7,a7 may    
elect to enroll 9 a heal? b5efits plan z
 an individual2 &  7,b7 may n enroll 9 a
 heal? b5efits plan = self & family4    
7#d7 7,a7 ,a cov]$ individual :o elects 
n to enroll1 or :o elects n to cont9ue  
enrollm5t1 9 a heal? b5efits plan "u ?is
 *apt] 7includ+ a cov]$ individual :o   
elects to receive paym5ts "u subsection 
7d77 may subsequ5tly enroll 9 a heal?   
b5efits plan "u ?is *apt] bas$ on !     
/atus ( ! cov]$ individual z a cov]$    
individual 9 accordance ) su* proc$ures1
 & aft] pay+ su* fees1 z ! ,director ( !
 ,(fice ( ,p]sonnel ,managem5t may      
e/abli%4  7,b7 ,! fact t a cov]$        
individual elects n to enroll1 or elects
 n to cont9ue enrollm5t1 9 a heal?      
b5efits plan "u ?is *apt] %all n affect 

! eligibility ( ! cov]$ individual =    
b5efits "u title ,,ii ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #dja et   
seq474  7c7 7#a7 7,a7 ,a cov]$          
individual :o elects to enroll 9 a heal?
 b5efits plan "u ?is *apt] bas$ on !    
/atus ( ! cov]$ individual z a cov]$    
individual %all pay a mon?ly individual 
premium paym5t det]m9$ 9 accordance )   
subp>agraph 7,b74  7,b7 ,! individual   
premium paym5t "u subp>agraph 7,a7 %all 
be det]m9$ bas$ on income1 z foll[s3    
7i7 ,= an individual ) an adju/$ gross  
income 7z def9$ "u section #fb ( !      
,int]nal ,rev5ue ,code ( #aihf7 ( n m   
?an #he1jjj1 ! individual premium paym5t
 %all be 9 an am\nt equal to ! employee 
contribution = ! heal? b5efits plan1 z  
det]m9$ "u section #hijf4  7ii7 ,= an   
individual ) an adju/$ gross income ( m 
?an #he1jjj & n m ?an #ajg1jjj1 !       
individual premium paym5t %all be 9 an  
am\nt equal to ! sum (--  7,i7 !        
employee contribution = ! heal? b5efits 
plan1 z det]m9$ "u section #hijf2 &     

7,,ii7 ! product obta9$ by multiply+--  
7aa7 ! ,gov]nm5t contribution 7z det]m9$
 "u section #hijf7;b772 by  7bb7 #j4je4 
7iii7 ,= an individual ) an adju/$ gross
 income ( m ?an #ajg1jjj & n m ?an      
#afj1jjj1 ! individual premium paym5t   
%all be 9 an am\nt equal to ! sum (--   
7,i7 ! employee contribution = ! heal?  
b5efits plan1 z det]m9$ "u section      
#hijf2 &  7,,ii7 ! product obta9$ by    
multiply+--  7aa7 ! ,gov]nm5t           
contribution 7z det]m9$ "u section      
#hijf7;b772 by  7bb7 #j4a4  7iv7 ,= an  
individual ) an adju/$ gross income ( m 
?an #afj1jjj & n m ?an #bej1jjj1 !      
individual premium paym5t %all be 9 an  
am\nt equal to ! sum (--  7,i7 !        
employee contribution = ! heal? b5efits 
plan1 z det]m9$ "u section #hijf2 &     
7,,ii7 ! product obta9$ by multiply+--  
7aa7 ! ,gov]nm5t contribution 7z det]m9$
 "u section #hijf7;b772 by  7bb7 #j4ae4 
7v7 ,= an individual ) an adju/$ gross  
income ( m ?an #bej1jjj & n m ?an       
#a1jjj1jjj1 ! individual premium paym5t 

%all be 9 an am\nt equal to ! sum (--   
7,i7 ! employee contribution = ! heal?  
b5efits plan1 z det]m9$ "u section      
#hijf2 &  7,,ii7 ! product obta9$ by    
multiply+--  7aa7 ! ,gov]nm5t           
contribution 7z det]m9$ "u section      
#hijf7;b772 by  7bb7 #j4e4  7vi7 ,= an  
individual ) an adju/$ gross income ( m 
?an #a1jjj1jjj1 ! individual premium    
paym5t %all be 9 an am\nt equal to ! sum
 (--  7,i7 ! employee contribution = !  
heal? b5efits plan1 z det]m9$ "u section
 #hijf2 &  7,,ii7 ! ,gov]nm5t           
contribution 7z det]m9$ "u section      
#hijf7;b774  7,c7 ,! ,director ( !      
,(fice ( ,p]sonnel ,managem5t %all adju/
 ! income am\nts "u subp>agraph 7,b7    
annually to reflect *anges 9 ! ,consum] 
,price ,index = all ,urban ,consum]s    
publi%$ by ! ,dep>tm5t ( ,labor4  7#b7  
7,a7 ,= a cov]$ individual :o is entitl$
 to mon?ly b5efits "u section #bjb or   
#bbc ( ! ,social ,security ,act 7#db    
,u4,s4,c4 #djb & #dbc71 ! mon?ly        
premiums ( ! cov]$ individual "u ?is    

sub*apt] %all 7except z provid$ 9       
subp>agraph 7,b7 or 7,c77 be collect$ by
 d$uct+ ! am\nt ( ! premium f ! am\nt ( 
su* mon?ly b5efits4  7,b7 ,= a cov]$    
individual :o is entitl$ to receive = a 
mon? an annuity "u ! ,railroad          
,retirem5t ,act ( #aigd 7:e!r or n !    
cov]$ individual is also entitl$ = su*  
mon? to a mon?ly insurance b5efit "u    
section #bjb ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #djb771 ! mon?ly premiums
 ( ! cov]$ individual "u ?is sub*apt]   
%all 7except z provid$ 9 subp>agraph    
7,c77 be collect$ by d$uct+ ! am\nt !re(
 f su* annuity or p5sion4  7,c7 ,if a   
cov]$ individual to :om subp>agraph 7,a7
 or 7,b7 applies e/imates t ! am\nt :i* 
w be available = d$uction "u su*        
subp>agraph = any premium paym5t p]iod w
 be less ?an ! am\nt ( ! mon?ly premiums
 = su* p]iod1 ! cov]$ individual may pay
 to ! ,director ( ! ,(fice ( ,p]sonnel  
,managem5t su* portion ( ! mon?ly       
premiums = su* p]iod z ! cov]$          
individual desires4  7,d7 ,= a cov]$    

individual :o is n describ$ 9           
subp>agraph 7,a7 or 7,b7 & :o elects to 
enroll 9 a heal? b5efits plan "u ?is    
*apt]1 or ) respect to :om subp>agraph  
7,c7 applies1 ! cov]$ individual %all   
pay mon?ly premiums to ! ,director ( !  
,(fice ( ,p]sonnel ,managem5t at su*    
times1 & 9 su* mann]1 z ! ,director %all
 by regulations prescribe4  7,e7 ,am\nts
 d$uct$ or paid "u ?is p>agraph %all be 
deposit$ 9 ! ,treasury to ! cr$it ( !   
,employees ,heal? ,b5efits ,fund        
e/abli%$ "u section #hiji4  7,f7 ,aft]  
consultation ) ! ,director ( ! ,(fice ( 
,p]sonnel ,managem5t1 ! ,secret>y (     
,heal? & ,human ,s]vices %all e/abli%   
proc$ures = mak+ & deposit+ d$uctions "u
 ?is p>agraph4  7#c7 ,! ,director ( !   
,(fice ( ,p]sonnel ,managem5t %all      
e/abli% proc$ures = t]m9at+ ! enrollm5t 
( a cov]$ individual 9 a heal? b5efits  
plan if ! cov]$ individual fails to make
 timely paym5t ( premiums1 :i* %all all[
 su* a cov]$ individual to re5roll 9 a  
heal? b5efits plan "u su* t]ms &        

conditions z ! ,director may prescribe4 
7d7 ,! ,director ( ! ,(fice ( ,p]sonnel 
,managem5t %all make p]iodic paym5ts to 
! employ] or =m] employ] provid+ heal?  
insurance to a cov]$ individual :o makes
 an election "u subsection 7b77#a77;,b7 
9 a total am\nt n to exce$ ! less] (--  
7#a7 ! co/ to ! employ] or =m] employ] (
 provid+ heal? insurance to ! cov]$     
individual2 &  7#b7 ! av]age ,gov]nm5t  
contribution = an individual enroll$ 9 a
 heal? b5efits plan "u ?is *apt] t is   
available to individuals resid+ any:]e 9
 ! ,unit$ ,/ates4  7e7 ,= fiscal ye>    
#bjae & ea* fiscal ye> !reaft]1 !re are 
appropriat$ to ! ,employees ,heal?      
,b5efits ,fund e/abli%$ "u section      
#hiji1 out ( any funds 9 ! ,treasury n  
o!rwise appropriat$--  7#a7 an am\nt    
equal to--  7,a7 ! taxes impos$ by      
sections #caja7;b7 & #caaa7;b7 ( !      
,int]nal ,rev5ue ,code ( #aihf ) respect
 to wages report$ to ! ,secret>y ( !    
,treasury pursuant to subtitle ,f ( su* 
,code aft] ,decemb] #ca1 #bjad1 z       

det]m9$ by ! ,secret>y ( ! ,treasury by 
apply+ ! applicable rates ( tax "u su*  
sections to su* wages1 :i* wages %all be
 c]tifi$ by ! ,commission] ( ,social    
,security on ! basis ( records ( wages  
e/abli%$ & ma9ta9$ by ! ,commission] (  
,social ,security 9 accordance ) su*    
reports2  7,b7 ! taxes impos$ by section
 #adja7;b7 ( ! ,int]nal ,rev5ue ,code ( 
#aihf ) respect to self-employm5t income
 report$ to ! ,secret>y ( ! ,treasury on
 tax returns "u subtitle ,f ( su* ,code1
 z det]m9$ by ! ,secret>y ( ! ,treasury 
by apply+ ! applicable rate ( tax "u su*
 section to su* self-employm5t income1  
:i* self-employm5t income %all be       
c]tifi$ by ! ,commission] ( ,social     
,security on ! basis ( records (        
self-employm5t e/abli%$ & ma9ta9$ by !  
,commission] ( ,social ,security 9      
accordance ) su* returns2 &  7,c7 any   
am\nts t1 on or aft] ,janu>y #a1 #bjae1 
are to be deposit$ 9 ! ,f$]al ,hospital 
,insurance ,tru/ ,fund e/abli%$ "u      
section #ahag ( ! ,social ,security ,act

 7#db ,u4,s4,c4 #acie;i7 "u any o!r     
provision ( law2 &  7#b7 a ,gov]nm5t    
contribution equal to ! diff]5ce obta9$ 
by subtract+--  7,a7 ! sum (--  7i7 !   
total am\nt ( premiums paid by cov]$    
individuals "u subsection 7c77#b7 = !   
fiscal ye>2 &  7ii7 ! am\nt appropriat$ 
"u p>agraph 7#a72 f  7,b7 ! sum (--  7i7
 ! total co/ = ! fiscal ye> (           
subscription *>ges = heal? b5efits plans
 = cov]$ individuals enroll$ 9 a heal?  
b5efits plan bas$ on ! /atus ( ! cov]$  
individuals z cov]$ individuals2 &  7ii7
 ! total am\nt ( paym5ts = ! fiscal ye> 
"u subsection 7d74  7f7 ,! ,director ( !
 ,(fice ( ,p]sonnel ,managem5t %all     
e/abli%1 9 consultation ) ! ,secret>y ( 
,heal? & ,human ,s]vices act+ ?r\gh !   
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 proc$ures to ensure t
 heal? b5efits plans coord9ate ) ,/ate  
,m$icaid programs ) respect to !        
provision ( co/-%>+ & o!r m$ical        
assi/ance = cov]$ individuals enroll$ 9 
heal? b5efit plans :o are also eligible 

= m$ical assi/ance & enroll$ 9 a ,/ate  
,m$icaid program4  ,,iii ,cov]age ( high
 risk individuals  #hida4 ,reimbursem5t 
( co/s = high risk individuals  7a7 ,9  
?is section1 ! t]m high risk individual 
means an individual id5tifi$ "u         
subsection 7b77#a74  7b7 ,aft] ! end (  
ea* contract ye> beg9n+ on or aft]      
,janu>y #a1 #bjae1 ! ,director ( !      
,(fice ( ,p]sonnel ,managem5t %all--    
7#a7 id5tify1 = ! contract ye>1         
individuals :o--  7,a7 enroll$ 9 a heal?
 b5efits plan "u ?is *apt] = a contract 
ye>2 &  7,b7 :o1 ( all individuals      
enroll$ 9 a heal? b5efits plan "u ?is   
*apt] = ! contract ye>1 are 9 ! highe/  
#e p]c5t 9 t]ms ( b5efits paid by a     
c>ri] "u a heal? b5efits plan relat+ to 
! contract ye>2 &  7#b7 pay to a c>ri]  
contract+ to provide a heal? b5efits    
plan to a high risk individual = !      
contract ye> #ij p]c5t ( ! b5efits paid 
by ! c>ri] relat+ to ! high risk        
individual4  7c7 7#a7 ,= fiscal ye>     
#bjae & ea* fiscal ye> !reaft]1 !re are 

appropriat$ to ! ,director ( ! ,(fice ( 
,p]sonnel ,managem5t f ! ,f$]al         
,hospital ,insurance ,tru/ ,fund        
e/abli%$ "u section #ahag ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie;i7  
su* sums z are necess>y to c>ry out ?is 
section4  7#b7 ,if ! am\nts appropriat$ 
"u p>agraph 7#a7 are insuffici5t to c>ry
 out ?is section1 = fiscal ye> #bjae &  
ea* fiscal ye> !reaft]1 !re are         
appropriat$ to ! ,director ( ! ,(fice ( 
,p]sonnel ,managem5t1 out ( any funds 9 
! ,treasury n o!rwise appropriat$1 su*  
sums z are necess>y to c>ry out ?is     
section4  4  7b7 ,exemption f insurance 
requirem5ts  7#a7 ,am5dm5t to title #e  
,*apt] #hi ( title #e1 ,unit$ ,/ates    
,code1 is am5d$ by ins]t+ aft] section  
#hija ! foll[+3  #hija;,a4 ,exemption f 
insurance requirem5ts ,title ,i ( !     
,pati5t ,protection & ,af=dable ,c>e    
,act1 subtitle ,a ( title ,x ( su* ,act1
 & ! am5dm5ts made by su* title ,i &    
subtitle ,a %all n apply to heal?       
b5efits plans4  4  7#b7 ,con=m+ am5dm5t 

,section #bgji ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h7 
7z add$ by section #ajajc ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act7 is   
am5d$--  7,a7 by /rik+ subsection 7g72 &
  7,b7 by r$esignat+ subsection 7h7 z   
subsection 7g74  7c7 ,te*nical & con=m+ 
am5dm5ts ,*apt] #hi ( title #e1 ,unit$  
,/ates ,code1 is am5d$--  7#a7 9 ! table
 ( sections--  7,a7 by ins]t+ aft] !    
item relat+ to section #hija ! foll[+3  
#hija;,a4 ,exemption f insurance        
requirem5ts4 ,,sub*apt] ,i--,f$]al      
employees  2  &  7,b7 by add+ at ! end !
 foll[+3  ,,sub*apt] ,,ii--,cov]$       
individuals #hiba4 ,heal? insurance =   
cov]$ individuals4 ,,sub*apt]           
,,iii--,cov]age ( high risk individuals 
#hida4 ,reimbursem5t ( co/s = high risk 
individuals4  2  7#b7 9 section         
#hijb;a7d77#a7--  7,a7 9 subp>agraph    
7,a71 by add+ or at ! end2  7,b7 by     
/rik+ subp>agraph 7,b72 &  7,c7 by      
r$esignat+ subp>agraph 7,c7 z           
subp>agraph 7,b72 &  7#c7 by /rik+      

section #hiaj7;d74  7d7 ,effective date2
 applicability ,! am5dm5ts made by ?is  
section %all take effect on ! date (    
enactm5t ( ?is ,act & apply on & aft]   
,janu>y #a1 #bjae4  #c4 ,transition+    
,m$ic>e pati5ts to cov]age "u ! ,f$]al  
,employees ,heal? ,b5efits ,program  7a7
 ,increase 9 ,m$ic>e eligibility age    
,section #bbf ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #dbf7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7k7  
,increas+ ,m$ic>e qualify+ age  7#a7 ,9 
g5]al ,not)/&+ any o!r provision ( law1 
any ref]5ce 9 ?is section1 title        
,,xviii1 or title ,,xix 7ins(> z x      
relates to ! eligibility age = ,m$ic>e  
b5efits "u title ,,xviii7 to age #fe    
%all be deem$ a ref]5ce to ! ,m$ic>e    
qualify+ age specifi$ 9 p>agraph 7#b74  
7#b7 ,m$ic>e qualify+ age specifi$ ,!   
,m$ic>e qualify+ age specifi$ 9 ?is     
p>agraph is det]m9$ z foll[s3  7,a7 ,9 !
 case ( an individual :o atta9s #fe ye>s
 ( age be=e ,janu>y #a1 #bjae1 ! ,m$ic>e
 qualify+ age is #fe ye>s ( age4  7,b7  

,9 ! case ( an individual :o atta9s #fe 
ye>s ( age 9 a ye> aft] #bjad1 & be=e   
#bjce1 ! ,m$ic>e qualify+ age is !      
,m$ic>e qualify+ age specifi$ 9 ?is     
p>agraph = ! previ\s ye> increas$ by #c 
mon?s4  7,c7 ,9 ! case ( an individual  
:o atta9s #fe ye>s ( age 9 a ye> aft]   
#bjcd1 ! ,m$ic>e qualify+ age is #gj    
ye>s ( age plus ! numb] ( mon?s 9 ! age 
increase factor 7z det]m9$ "u p>agraph  
7#c774  7#c7 ,age increase factor ,!    
,commission] ( ,social ,security %all   
det]m9e 7us+ reasonable actu>ial        
assumptions7 & publi% on or be=e        
,novemb] #a ( ea* cal5d> ye> aft] #bjcc 
! numb] ( mon?s 7r\nd$1 if n a multiple 
( "o mon?1 to ! next l[] multiple ( "o  
mon?7 by :i* life expectancy z ( ,octob]
 #a ( su* cal5d> ye> ( an individual    
atta9+ age #fe on su* ,octob] #a exce$s 
! life expectancy z ( ,octob] #a1 #bjcd1
 ( an individual atta9+ age #fe on      
,octob] #a1 #bjcd4 ,) respect to an     
individual :o atta9s age #fe 9 ! cal5d> 
ye> foll[+ any cal5d> ye> 9 :i* a       

det]m9ation is made "u ?is p>agraph1 !  
age increase factor %all be ! numb] (   
mon?s det]m9$ "u ?is p>agraph z (       
,octob] #a ( su* cal5d> ye> 9 :i* su*   
det]m9ation is made4  4  7b7 ,sunset    
,title ,,xviii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie et seq47 is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #ahii;,b4 ,sunset ( ,m$ic>e   
program ) transition to cov]age "u !    
,f$]al ,employees ,heal? ,b5efits       
,program ,not)/&+ any o!r provision (   
law1 on & aft] ,janu>y #a1 #bjae1 !     
foll[+ rules %all apply3  7#a7 ,! prec$+
 provisions ( ?is title %all n apply4   
7#b7 ,no paym5ts = items & s]vices      
furni%$ "u ?is title aft] su* date %all 
be made4 ,no additional1 bonus1 or      
inc5tive paym5ts "u ?is title1 su* z    
graduate m$ical education paym5ts1 may  
be made4  7#c7 ,paym5ts = items &       
s]vices furni%$ "u ?is title prior to   
su* date %all be made 9 ! same mann] z  
if ?is section _h n be5 enact$4  7#d7   
,all ,m$ic>e supplem5tal policies "u    

section #ahhb are t]m9at$4  7#e7 ,all   
demon/ration projects conduct$ "u ?is   
title are t]m9at$4  7#f7 ,entitlem5t to 
heal? b5efits = individuals :o1 b = ?is 
section 7& tak+ into acc\nt section     
#bbf7k771 w\ld h be5 entitl$ to1 or c\ld
 h enroll$ =1 b5efits "u "p ,a or c\ld h
 enroll$ "u "p ,b %all be ?r\gh         
enrollm5t 9 a heal? b5efits plan "u     
*apt] #hi ( title #e1 ,unit$ ,/ates     
,code4  7#g7 ,at a date det]m9$         
appropriate by ! ,secret>y 7aft] paym5ts
 describ$ 9 p>agraph 7#c7 h be5 made71  
am\nts 9 ! ,f$]al ,hospital ,insurance  
,tru/ ,fund & ! ,f$]al ,supplem5t>y     
,m$ical ,insurance ,tru/ ,fund 7includ+ 
! ,m$ic>e ,prescription ,drug ,acc\nt )9
 su* ,tru/ ,fund7 %all be transf]r$ to !
 ,employees ,heal? ,b5efits ,fund       
e/abli%$ "u section #hiji ( *apt] #e1   
,unit$ ,/ates ,code4  7#h7 ,any         
det]m9ation "u ,f$]al law 7o!r ?an ?is  
title & title ,,ii7 relat+ to ,m$ic>e   
eligibility %all be made bas$ on :e!r an
 individual is a cov]$ individual1 z    

def9$ 9 section #hija ( title #e1 ,unit$
 ,/ates ,code4  4  7c7 ,con=m+ am5dm5t  
7#a7 ,section #bbf ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #dbf71 z am5d$ by  
subsection 7a71 is am5d$ by add+ at !   
end ! foll[+ new subsection3  7l7       
,not)/&+ ! prec$+ provisions ( ?is      
section1 on & aft] ,janu>y #a1 #bjae1   
entitlem5t to heal? b5efits to          
individuals :o1 b = ?is subsection &    
section #ahii;,b1 w\ld h be5 entitl$ to 
b5efits "u "p ,a & eligible to enroll "u
 "p ,b ( title ,,xviii pursuant to ?is  
section %all be ?r\gh enrollm5t 9 a     
heal? b5efits plan "u *apt] #hi ( title 
#e1 ,unit$ ,/ates ,code1 r ?an "u title 
,,xviii ( ?is ,act4  4  7#b7 ,section   
#bbf;,a ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #dbf7 is am5d$ by add+ at !   
end ! foll[+ new subsection3  7d7       
,not)/&+ ! prec$+ provisions ( ?is      
section1 on & aft] ,janu>y #a1 #bjae1   
entitlem5t to heal? b5efits to          
individuals :o1 b = ?is subsection &    
section #ahii;,b1 w\ld h be5 entitl$ to 

b5efits "u "p ,a & eligible to enroll "u
 "p ,b ( title ,,xviii pursuant to ?is  
section %all be ?r\gh enrollm5t 9 a     
heal? b5efits plan "u *apt] #hi ( title 
#e1 ,unit$ ,/ates ,code1 r ?an "u title 
,,xviii ( ?is ,act4  4  7d7             
,recomm5dations to ,/ates ,n lat] ?an #a
 ye> aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all make available to ,/ates  
recomm5dations ) respect to requirem5ts 
= heal? c>e entities & individuals "u ! 
,m$ic>e program t1 by reason ( section  
#ahii;,b ( ! ,social ,security ,act1 z  
add$ by subsection 7b71 w no long] apply
 b t %\ld be consid]$ on ! ,/ate level4