108th CONGRESS
2d Session
H. R. 4844
To amend part III of title 5, United States Code, to provide for
the establishment of programs under which supplemental dental and vision benefits
are made available to Federal employees, retirees, and their dependents, to
expand the contracting authority of the Office of Personnel Management, and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
July 15, 2004
Mrs. JO ANN DAVIS of Virginia (for herself and Mr. TOM DAVIS of Virginia)
introduced the following bill; which was referred to the Committee on Government
Reform
A BILL
To amend part III of title 5, United States Code, to provide for
the establishment of programs under which supplemental dental and vision benefits
are made available to Federal employees, retirees, and their dependents, to
expand the contracting authority of the Office of Personnel Management, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Federal Employee Dental and Vision Benefits
Enhancement Act of 2004'.
SEC. 2. ENHANCED DENTAL BENEFITS FOR FEDERAL EMPLOYEES.
(a) In General- Subpart G of part III of title 5, United States Code, is amended
by inserting after chapter 89 the following:
`CHAPTER 89A--ENHANCED DENTAL BENEFITS
`8952. Availability of dental benefits.
`8953. Contracting authority.
`8955. Information to individuals eligible to enroll.
`8956. Election of coverage.
`8957. Coverage of restored survivor or disability annuitants.
`8960. Studies, reports, and audits.
`8961. Jurisdiction of courts.
`8962. Administrative functions.
`Sec. 8951. Definitions
`(1) The term `employee' means an employee defined under section 8901(1).
`(2) The terms `annuitant', `member of family', and `dependent' have the
meanings as such terms are defined under paragraphs (3), (5), and (9), respectively,
of section 8901.
`(3) The term `eligible individual' refers to an individual described in
paragraph (1) or (2), without regard to whether the individual is enrolled
in a health benefits plan under chapter 89.
`(4) The term `Office' means the Office of Personnel Management.
`(5) The term `qualified company' means a company (or consortium of companies)
that offers indemnity, preferred provider organization, health maintenance
organization, or discount dental programs and if required is licensed to
issue applicable coverage in any number of States, taking any subsidiaries
of such a company into account (and, in the case of a consortium, considering
the member companies and any subsidiaries thereof, collectively).
`(6) The term `employee organization' means an association or other organization
of employees which is national in scope, or in which membership is open
to all employees of a Government agency who are eligible to enroll in a
health benefits plan under chapter 89.
`(7) The term `State' includes the District of Columbia.
`Sec. 8952. Availability of dental benefits
`(a) The Office shall establish and administer a program through which an
eligible individual may obtain dental coverage to supplement coverage available
through chapter 89.
`(b) The Office shall determine, in the exercise of its reasonable discretion,
the financial requirements for qualified companies to participate in the program.
`(c) Nothing in this chapter shall be construed to prohibit the availability
of dental benefits provided by health benefits plans under chapter 89.
`Sec. 8953. Contracting authority
`(a)(1) The Office shall contract with a reasonable number of qualified companies
for a policy or policies of benefits described under section 8954 without
regard to section 5 of title 41 or any other statute requiring competitive
bidding. An employee organization may contract with a qualified company for
the purpose of participating with that qualified company in any contract between
the Office and that qualified company.
`(2) The Office shall ensure that each resulting contract is awarded on the
basis of contractor qualifications, price, and reasonable competition.
`(b) Each contract under this section shall contain--
`(1) the requirements under section 8902 (d), (f), and (i) made applicable
to contracts under this section by regulations prescribed by the Office;
`(2) the terms of the enrollment period; and
`(3) such other terms and conditions as may be mutually agreed to by the
Office and the qualified company involved, consistent with the requirements
of this chapter and regulations prescribed by the Office.
`(c) Nothing in this chapter shall, in the case of an individual electing
dental supplemental benefit coverage under this chapter after the expiration
of such individual's first opportunity to enroll, preclude the application
of waiting periods more stringent than those that would have applied if that
opportunity had not yet expired.
`(d)(1) Each contract under this chapter shall require the qualified company
to agree--
`(A) to provide payments or benefits to an eligible individual if such individual
is entitled thereto under the terms of the contract; and
`(B) with respect to disputes regarding claims for payments or benefits
under the terms of the contract--
`(i) to establish internal procedures designed to expeditiously resolve
such disputes; and
`(ii) to establish, for disputes not resolved through procedures under
clause (i), procedures for 1 or more alternative means of dispute resolution
involving independent third-party review under appropriate circumstances
by entities mutually acceptable to the Office and the qualified company.
`(2) A determination by a qualified company as to whether or not a particular
individual is eligible to obtain coverage under this chapter shall be subject
to review only to the extent and in the manner provided in the applicable
contract.
`(3) For purposes of applying the Contract Disputes Act of 1978 to disputes
arising under this chapter between a qualified company and the Office--
`(A) the agency board having jurisdiction to decide an appeal relative to
such a dispute shall be such board of contract appeals as the Director of
the Office of Personnel Management shall specify in writing (after appropriate
arrangements, as described in section 8(c) of such Act); and
`(B) the district courts of the United States shall have original jurisdiction,
concurrent with the United States Court of Federal Claims, of any action
described in section 10(a)(1) of such Act relative to such a dispute.
`(e) Nothing in this section shall be considered to grant authority for the
Office or third-party reviewer to change the terms of any contract under this
chapter.
`(f) Contracts under this chapter shall be for a uniform term of 7 years and
may not be renewed automatically.
`Sec. 8954. Benefits
`(a) The Office may prescribe reasonable minimum standards for enhanced dental
benefits plans offered under this chapter and for qualified companies offering
the plans.
`(b) Each contract may include more than 1 level of benefits that shall be
made available to all eligible individuals.
`(c) The benefits to be provided under enhanced dental benefits plans under
this chapter may be of the following types:
`(5) Oral and maxillofacial surgery.
`(d) A contract approved under this chapter shall require the qualified company
to cover the geographic service delivery specified by the Office. The Office
shall require qualified companies to include dentally underserved areas in
their service delivery areas.
`(e) If an individual has dental coverage under a health benefits plan under
chapter 89 and also has coverage under a plan under this chapter, the health
benefits plan under chapter 89 shall be the first payor of any benefit payments.
`Sec. 8955. Information to individuals eligible to enroll
`(a) The qualified companies at the direction and with the approval of the
Office, shall make available to each individual eligible to enroll in a dental
benefits plan information on services and benefits (including maximums, limitations,
and exclusions), that the Office considers necessary to enable the individual
to make an informed decision about electing coverage.
`(b) The Office shall make available to each individual eligible to enroll
in a dental benefits plan, information on services and benefits provided by
qualified companies participating under chapter 89.
`Sec. 8956. Election of coverage
`(a) An eligible individual may enroll in a dental benefits plan for self-only,
self plus one, or for self and family. If an eligible individual has a spouse
who is also eligible to enroll, either spouse, but not both, may enroll for
self plus one or self and family. An individual may not be enrolled both as
an employee, annuitant, or other individual eligible to enroll and as a member
of the family.
`(b) The Office shall prescribe regulations under which--
`(1) an eligible individual may enroll in a dental benefits plan; and
`(2) an enrolled individual may change the self-only, self plus one, or
self and family coverage of that individual.
`(c)(1) Regulations under subsection (b) shall permit an eligible individual
to cancel or transfer the enrollment of that individual to another dental
benefits plan--
`(A) before the start of any contract term in which there is a change in
rates charged or benefits provided, in which a new plan is offered, or in
which an existing plan is terminated; or
`(B) during other times and under other circumstances specified by the Office.
`(2) A transfer under paragraph (1) shall be subject to waiting periods provided
under a new plan.
`Sec. 8957. Coverage of restored survivor or disability annuitants
`A surviving spouse, disability annuitant, or surviving child whose annuity
is terminated and is later restored, may continue enrollment in a dental benefits
plan subject to the terms and conditions prescribed in regulations issued
by the Office.
`Sec. 8958. Premiums
`(a) Each eligible individual obtaining supplemental dental coverage under
this chapter shall be responsible for 100 percent of the premiums for such
coverage.
`(b) The Office shall prescribe regulations specifying the terms and conditions
under which individuals are required to pay the premiums for enrollment.
`(c) The amount necessary to pay the premiums for enrollment may--
`(1) in the case of an employee, be withheld from the pay of such an employee;
or
`(2) in the case of an annuitant, be withheld from the annuity of such an
annuitant.
`(d) All amounts withheld under this section shall be paid directly to the
qualified company.
`(e) Each participating qualified company shall maintain accounting records
that contain such information and reports as the Office may require.
`(f)(1) The Employee Health Benefits Fund is available, without fiscal year
limitation, for reasonable expenses incurred by the Office in administering
this chapter before the first day of the first contract period, including
reasonable implementation costs.
`(2)(A) There is established in the Employees Health Benefits Fund a Dental
Benefits Administrative Account, which shall be available to the Office, without
fiscal year limitation, to defray reasonable expenses incurred by the Office
in administering this chapter after the start of the first contract year.
`(B) A contract under this chapter shall include appropriate provisions under
which the qualified company involved shall, during each year, make such periodic
contributions to the Dental Benefits Administrative Account as necessary to
ensure that the reasonable anticipated expenses of the Office in administering
this chapter during such year are defrayed.
`Sec. 8959. Preemption
`The terms of any contract that relate to the nature, provision, or extent
of coverage or benefits (including payments with respect to benefits) shall
supersede and preempt any State or local law, or any regulation issued thereunder,
which relates to dental benefits, insurance, plans, or contracts.
`Sec. 8960. Studies, reports, and audits
`(a) Each contract shall contain provisions requiring the qualified company
to--
`(1) furnish such reasonable reports as the Office determines to be necessary
to enable it to carry out its functions under this chapter; and
`(2) permit the Office and representatives of the General Accounting Office
to examine such records of the qualified company as may be necessary to
carry out the purposes of this chapter.
`(b) Each Federal agency shall keep such records, make such certifications,
and furnish the Office, the qualified company, or both, with such information
and reports as the Office may require.
`(c) The Office shall conduct periodic reviews of plans under this chapter,
including a comparison of the dental benefits available under chapter 89,
to ensure the competitiveness of plans under this chapter. The Office shall
cooperate with the General Accounting Office to provide periodic evaluations
of the program.
`Sec. 8961. Jurisdiction of courts
`The district courts of the United States have original jurisdiction, concurrent
with the United States Court of Federal Claims, of a civil action or claim
against the United States under this chapter after such administrative remedies
as required under section 8953(d) have been exhausted, but only to the extent
judicial review is not precluded by any dispute resolution or other remedy
under this chapter.
`Sec. 8962. Administrative functions
`(a) The Office shall prescribe regulations to carry out this chapter. The
regulations may exclude an employee on the basis of the nature and type of
employment or conditions pertaining to it.
`(b) The Office shall, as appropriate, provide for coordinated enrollment,
promotion, and education efforts as appropriate in consultation with each
qualified company. The information under this subsection shall include information
relating to the dental benefits available under chapter 89, including the
advantages and disadvantages of obtaining additional coverage under this chapter.'.
SEC. 3. ENHANCED VISION BENEFITS FOR FEDERAL EMPLOYEES.
Subpart G of part III of title 5, United States Code, is amended by inserting
after chapter 89A (as added by section 2 of this Act) the following:
`CHAPTER 89B--ENHANCED VISION BENEFITS
`8982. Availability of vision benefits.
`8983. Contracting authority.
`8985. Information to individuals eligible to enroll.
`8986. Election of coverage.
`8987. Coverage of restored survivor or disability annuitants.
`8990. Studies, reports, and audits.
`8991. Jurisdiction of courts.
`8992. Administrative functions.
`Sec. 8981. Definitions
`(1) The term `employee' means an employee defined under section 8901(1).
`(2) The terms `annuitant', `member of family', and `dependent' have the
meanings as such terms are defined under paragraphs (3), (5), and (9), respectively,
of section 8901.
`(3) The term `eligible individual' refers to an individual described in
paragraph (1) or (2), without regard to whether the individual is enrolled
in a health benefits plan under chapter 89.
`(4) The term `Office' means the Office of Personnel Management.
`(5) The term `qualified company' means a company (or consortium of companies)
that offers indemnity, preferred provider organization, health maintenance
organization, or discount vision programs and if required is licensed to
issue applicable coverage in any number of States, taking any subsidiaries
of such a company into account (and, in the case of a consortium, considering
the member companies and any subsidiaries thereof, collectively).
`(6) The term `employee organization' means an association or other organization
of employees which is national in scope, or in which membership is open
to all employees of a Government agency who are eligible to enroll in a
health benefits plan under chapter 89.
`(7) The term `State' includes the District of Columbia.
`Sec. 8982. Availability of vision benefits
`(a) The Office shall establish and administer a program through which an
eligible individual may obtain vision coverage to supplement coverage available
through chapter 89.
`(b) The Office shall determine, in the exercise of its reasonable discretion,
the financial requirements for qualified companies to participate in the program.
`(c) Nothing in this chapter shall be construed to prohibit the availability
of vision benefits provided by health benefits plans under chapter 89.
`Sec. 8983. Contracting authority
`(a)(1) The Office shall contract with a reasonable number of qualified companies
for a policy or policies of benefits described under section 8984 without
regard to section 5 of title 41 or any other statute requiring competitive
bidding. An employee organization may contract with a qualified company for
the purpose of participating with that qualified company in any contract between
the Office and that qualified company.
`(2) The Office shall ensure that each resulting contract is awarded on the
basis of contractor qualifications, price, and reasonable competition.
`(b) Each contract under this section shall contain--
`(1) the requirements under section 8902 (d), (f), and (i) made applicable
to contracts under this section by regulations prescribed by the Office;
`(2) the terms of the enrollment period; and
`(3) such other terms and conditions as may be mutually agreed to by the
Office and the qualified company involved, consistent with the requirements
of this chapter and regulations prescribed by the Office.
`(c) Nothing in this chapter shall, in the case of an individual electing
vision supplemental benefit coverage under this chapter after the expiration
of such individual's first opportunity to enroll, preclude the application
of waiting periods more stringent than those that would have applied if that
opportunity had not yet expired.
`(d)(1) Each contract under this chapter shall require the qualified company
to agree--
`(A) to provide payments or benefits to an eligible individual if such individual
is entitled thereto under the terms of the contract; and
`(B) with respect to disputes regarding claims for payments or benefits
under the terms of the contract--
`(i) to establish internal procedures designed to expeditiously resolve
such disputes; and
`(ii) to establish, for disputes not resolved through procedures under
clause (i), procedures for 1 or more alternative means of dispute resolution
involving independent third-party review under appropriate circumstances
by entities mutually acceptable to the Office and the qualified company.
`(2) A determination by a qualified company as to whether or not a particular
individual is eligible to obtain coverage under this chapter shall be subject
to review only to the extent and in the manner provided in the applicable
contract.
`(3) For purposes of applying the Contract Disputes Act of 1978 to disputes
arising under this chapter between a qualified company and the Office--
`(A) the agency board having jurisdiction to decide an appeal relative to
such a dispute shall be such board of contract appeals as the Director of
the Office of Personnel Management shall specify in writing (after appropriate
arrangements, as described in section 8(c) of such Act); and
`(B) the district courts of the United States shall have original jurisdiction,
concurrent with the United States Court of Federal Claims, of any action
described in section 10(a)(1) of such Act relative to such a dispute.
`(e) Nothing in this section shall be considered to grant authority for the
Office or third-party reviewer to change the terms of any contract under this
chapter.
`(f) Contracts under this chapter shall be for a uniform term of 7 years and
may not be renewed automatically.
`Sec. 8984. Benefits
`(a) The Office may prescribe reasonable minimum standards for enhanced vision
benefits plans offered under this chapter and for qualified companies offering
the plans.
`(b) Each contract may include more than 1 level of benefits that shall be
made available to all eligible individuals.
`(c) The benefits to be provided under enhanced vision benefits plans under
this chapter may be of the following types:
`(1) Diagnostic (to include refractive services).
`(d) A contract approved under this chapter shall require the qualified company
to cover the geographic service delivery specified by the Office. The Office
shall require qualified companies to include visually underserved areas in
their service delivery areas.
`(e) If an individual has vision coverage under a health benefits plan under
chapter 89 and also has coverage under a plan under this chapter, the health
benefits plan under chapter 89 shall be the first payor of any benefit payments.
`Sec. 8985. Information to individuals eligible to enroll
`(a) The qualified companies at the direction and with the approval of the
Office, shall make available to each individual eligible to enroll in a vision
benefits plan information on services and benefits (including maximums, limitations,
and exclusions), that the Office considers necessary to enable the individual
to make an informed decision about electing coverage.
`(b) The Office shall make available to each individual eligible to enroll
in a vision benefits plan, information on services and benefits provided by
qualified companies participating under chapter 89.
`Sec. 8986. Election of coverage
`(a) An eligible individual may enroll in a vision benefits plan for self-only,
self plus one, or for self and family. If an eligible individual has a spouse
who is also eligible to enroll, either spouse, but not both, may enroll for
self plus one or self and family. An individual may not be enrolled both as
an employee, annuitant, or other individual eligible to enroll and as a member
of the family.
`(b) The Office shall prescribe regulations under which--
`(1) an eligible individual may enroll in a vision benefits plan; and
`(2) an enrolled individual may change the self-only, self plus one, or
self and family coverage of that individual.
`(c)(1) Regulations under subsection (b) shall permit an eligible individual
to cancel or transfer the enrollment of that individual to another vision
benefits plan--
`(A) before the start of any contract term in which there is a change in
rates charged or benefits provided, in which a new plan is offered, or in
which an existing plan is terminated; or
`(B) during other times and under other circumstances specified by the Office.
`(2) A transfer under paragraph (1) shall be subject to waiting periods provided
under a new plan.
`Sec. 8987. Coverage of restored survivor or disability annuitants
`A surviving spouse, disability annuitant, or surviving child whose annuity
is terminated and is later restored, may continue enrollment in a vision benefits
plan subject to the terms and conditions prescribed in regulations issued
by the Office.
`Sec. 8988. Premiums
`(a) Each eligible individual obtaining supplemental vision coverage under
this chapter shall be responsible for 100 percent of the premiums for such
coverage.
`(b) The Office shall prescribe regulations specifying the terms and conditions
under which individuals are required to pay the premiums for enrollment.
`(c) The amount necessary to pay the premiums for enrollment may--
`(1) in the case of an employee, be withheld from the pay of such an employee;
or
`(2) in the case of an annuitant, be withheld from the annuity of such an
annuitant.
`(d) All amounts withheld under this section shall be paid directly to the
qualified company.
`(e) Each participating qualified company shall maintain accounting records
that contain such information and reports as the Office may require.
`(f)(1) The Employee Health Benefits Fund is available, without fiscal year
limitation, for reasonable expenses incurred by the Office in administering
this chapter before the first day of the first contract period, including
reasonable implementation costs.
`(2)(A) There is established in the Employees Health Benefits Fund a Vision
Benefits Administrative Account, which shall be available to the Office, without
fiscal year limitation, to defray reasonable expenses incurred by the Office
in administering this chapter after the start of the first contract year.
`(B) A contract under this chapter shall include appropriate provisions under
which the qualified company involved shall, during each year, make such periodic
contributions to the Vision Benefits Administrative Account as necessary to
ensure that the reasonable anticipated expenses of the Office in administering
this chapter during such year are defrayed.
`Sec. 8989. Preemption
`The terms of any contract that relate to the nature, provision, or extent
of coverage or benefits (including payments with respect to benefits) shall
supersede and preempt any State or local law, or any regulation issued thereunder,
which relates to vision benefits, insurance, plans, or contracts.
`Sec. 8990. Studies, reports, and audits
`(a) Each contract shall contain provisions requiring the qualified company
to--
`(1) furnish such reasonable reports as the Office determines to be necessary
to enable it to carry out its functions under this chapter; and
`(2) permit the Office and representatives of the General Accounting Office
to examine such records of the qualified company as may be necessary to
carry out the purposes of this chapter.
`(b) Each Federal agency shall keep such records, make such certifications,
and furnish the Office, the qualified company, or both, with such information
and reports as the Office may require.
`(c) The Office shall conduct periodic reviews of plans under this chapter,
including a comparison of the vision benefits available under chapter 89,
to ensure the competitiveness of plans under this chapter. The Office shall
cooperate with the General Accounting Office to provide periodic evaluations
of the program.
`Sec. 8991. Jurisdiction of courts
`The district courts of the United States have original jurisdiction, concurrent
with the United States Court of Federal Claims, of a civil action or claim
against the United States under this chapter after such administrative remedies
as required under section 8983(d) have been exhausted, but only to the extent
judicial review is not precluded by any dispute resolution or other remedy
under this chapter.
`Sec. 8992. Administrative functions
`(a) The Office shall prescribe regulations to carry out this chapter. The
regulations may exclude an employee on the basis of the nature and type of
employment or conditions pertaining to it.
`(b) The Office shall, as appropriate, provide for coordinated enrollment,
promotion, and education efforts as appropriate in consultation with each
qualified company. The information under this subsection shall include information
relating to the vision benefits available under chapter 89, including the
advantages and disadvantages of obtaining additional coverage under this chapter.'.
SEC. 4. TECHNICAL AND CONFORMING AMENDMENT.
The table of chapters for part III of title 5, United States Code, is amended
by inserting after the item relating to chapter 89 the following:
--8951
--8981.'.
SEC. 5. APPLICATION TO POSTAL SERVICE EMPLOYEES.
Section 1005(f) of title 39, United States Code, is amended in the second
sentence by striking `chapters 87 and 89' and inserting `chapters 87, 89,
89A, and 89B'.
SEC. 6. SENSE OF CONGRESS.
(a) Findings- Congress finds that--
(1) oral and vision health and general health and well-being are inseparable
and access to dental and vision services is an essential factor in maintaining
good health;
(2) Federal employees and their families deserve and desire additional coverage
options and place value on maintaining good oral and vision health; and
(3) it is in the interest of the Federal Government to remain competitive
in attracting and retaining highly skilled employees and taking reasonable
steps to ensure the health and well-being of its employees.
(b) Sense of Congress- It is the sense of Congress that health insurance benefits
available to Federal employees should be sufficient to promote the health
and productivity of all Federal workers and to support the recruitment and
retention of a highly qualified workforce. To help achieve these goals, Congress
should evaluate the supplemental plans established under the Federal Employee
Dental and Vision Benefits Enhancement Act of 2004 to determine the options
for and feasibility of providing an employer contribution.
SEC. 7. REQUIREMENT TO STUDY HEALTH BENEFITS COVERAGE FOR DEPENDENT CHILDREN
WHO ARE FULL-TIME STUDENTS.
Not later than 6 months after the date of enactment of this Act, the Office
of Personnel Management shall submit to Congress a report describing and evaluating
options whereby benefits under chapter 89 of title 5, United States Code,
could be made available to an unmarried dependent child under 25 years of
age who is enrolled as a full-time student at an institution of higher education
as defined under section 101 of the Higher Education Act of 1965 (20 U.S.C.
1001).
SEC. 8. EFFECTIVE DATE.
The amendments made by this Act shall take effect on the date of enactment
of this Act and shall apply to contracts that take effect with respect to
the calendar year 2006.
END
