Home > 106th Congressional Bills > H.R. 5296 (ih) To amend title XVIII of the Social Security Act to revise and improve the Medicare Program. [Introduced in House] ...H.R. 5296 (ih) To amend title XVIII of the Social Security Act to revise and improve the Medicare Program. [Introduced in House] ...
108th CONGRESS
2d Session
H. R. 5295
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
October 8, 2004
Mr. Murphy (for himself, Mr. Tom Davis of Virginia, Mrs. Jo Ann Davis
of Virginia, Mr. Davis of Illinois, Mr. Hoyer, Mr. Moran of Virginia,
and Mr. Wolf) 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 Employees Dental and Vision
Benefits Enhancement Act of 2004''.
SEC. 2. ENHANCED DENTAL BENEFITS.
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
``Sec.
``8921. Definitions.
``8922. Availability of dental benefits.
``8923. Contracting authority.
``8924. Benefits.
``8925. Information to individuals eligible to enroll.
``8926. Election of coverage.
``8927. Coverage of restored survivor or disability annuitants.
``8928. Premiums.
``8929. Preemption.
``8930. Studies, reports, and audits.
``8931. Jurisdiction of courts.
``8932. Administrative functions.
``Sec. 8921. Definitions
``In this chapter:
``(1) The term `employee' means an employee, as defined by
section 8901(1).
``(2) The terms `annuitant', `member of family', and
`dependent' have the meanings given such terms by 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. 8922. 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. 8923. 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 8924, 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. 8924. 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:
``(1) Diagnostic.
``(2) Preventive.
``(3) Emergency care.
``(4) Restorative.
``(5) Oral and maxillofacial surgery.
``(6) Endodontics.
``(7) Periodontics.
``(8) Prosthodontics.
``(9) Orthodontics.
``(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
underserved areas (with respect to dental services) 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. 8925. 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. 8926. 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. 8927. Coverage of restored survivor or disability annuitants
``A surviving spouse, disability annuitant, or surviving child
whose annuity is terminated and later restored may continue enrollment
in a dental benefits plan, subject to the terms and conditions
prescribed in regulations issued by the Office.
``Sec. 8928. 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; and
``(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 Employees 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. 8929. 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. 8930. Studies, reports, and audits
``(a) Each contract shall contain provisions requiring the
qualified company--
``(1) to furnish such reasonable reports as the Office
determines to be necessary to enable it to carry out its
functions under this chapter; and
``(2) to permit the Office and representatives of the
Government Accountability Office to examine such records of the
qualified company as may be necessary to carry out the purposes
of this chapter.
``(b) Each Government 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 Government Accountability Office to
provide periodic evaluations of the program.
``Sec. 8931. 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
8923(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. 8932. 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
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