[Senate Report 108-393]
[From the U.S. Government Publishing Office]
108th Congress Report
SENATE
2d Session 108-393
_______________________________________________________________________
Calendar No. 783
FEDERAL EMPLOYEE DENTAL AND VISION BENEFITS ENHANCEMENT ACT OF 2004
__________
R E P O R T
of the
COMMITTEE ON GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
to accompany
S. 2657
October 8, 2004.--Ordered to be printed
COMMITTEE ON GOVERNMENTAL AFFAIRS
SUSAN M. COLLINS. Maine, Chairman
TED STEVENS, Alaska JOSEPH I. LIEBERMAN, Connecticut
GEORGE V. VOINOVICH, Ohio CARL LEVIN, Michigan
NORM COLEMAN, Minnesota DANIEL K. AKAKA, Hawaii
ARLEN SPECTER, Pennsylvania RICHARD J. DURBIN, Illinois
ROBERT F. BENNETT, Utah THOMAS R. CARPER, Delaware
PETER G. FITZGERALD, Illinois MARK DAYTON, Minnesota
JOHN E. SUNUNU, New Hampshire FRANK LAUTENBERG, New Jersey
RICHARD C. SHELBY, Alabama MARK PRYOR, Arkansas
Michael D. Bopp, Staff Director and Chief Counsel
Jennifer A. Hemingway, Professional Staff Member
Heather Hogg, Professional Staff, Subcommittee on Financial Management,
the Budget, and International Security
Joyce A. Rechtschaffen, Minority Staff Director and Counsel
Lawrence B. Novey, Minority Counsel
Nanci Langley, Minority Staff Director, Subcommittee on Financial
Management, the Budget, and International Security
Calendar No. 783
108th Congress Report
SENATE
2d Session 108-393
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FEDERAL EMPLOYEE DENTAL AND VISION BENEFITS ENHANCEMENT ACT OF 2004
_______
October 8, 2004.--Ordered to be printed
_______
Ms. Collins, from the Committee on Governmental Affairs, submitted the
following
R E P O R T
[To accompany S. 2657]
The Committee on Governmental Affairs, to which was
referred the bill (S. 2657) 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, having
considered the same, reports favorably thereon and recommends
that the bill do pass.
CONTENTS
Page
I. Purpose and Summary..............................................1
II. Background.......................................................2
III. Legislative History..............................................7
IV. Section-by-Section Analysis......................................8
V. Estimated Cost of Legislation...................................13
VI. Evaluation of Regulatory Impact.................................14
VII. Changes in Existing Law.........................................15
I. Purpose and Summary
S. 2657, the Federal Employee Dental and Vision Benefits
Enhancement Act of 2004, is a bill to provide federal
employees, annuitants, and their dependents access to
voluntary, supplemental dental and vision coverage on an
employee-paid basis. The purpose of the legislation is to grant
the Office of Personnel Management the framework and authority
to contract with qualified companies to provide the
supplemental coverage. The legislation also expresses 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, and
states that, to help achieve these goals, Congress should
evaluate the supplemental plans established under this Act to
determine the options for and feasibility of providing an
employer contribution. In addition, the legislation would
require the Office of Personnel Management to submit to
Congress a report describing and evaluating options whereby
coverage under the Federal Employees Health Benefits Program
could be made available to unmarried dependent children of
federal employees and annuitants, under 25 years of age, who
are enrolled as full-time students at institutes of higher
education.
II. Background
WHY SHOULD THE FEDERAL GOVERNMENT--AS AN EMPLOYER--OFFER ENHANCED
DENTAL AND VISION BENEFITS?
There are several important considerations that support
offering dental and vision benefits to federal employees,
including improved recruitment and retention, improved employee
health, and improved employee satisfaction.
Improved recruitment and retention
Ensuring the right people, in the right place, at the right
time--is a high priority for the federal government as an
employer. Therefore, it is important to understand the
competitive employment environment when making decisions about
benefit offerings. The overwhelming majority of both large
private and public sector employers offer some combination of
dental or vision benefits to their employees.
In 2003, 96 percent of employers with 500 or more
employees, and 98 percent of employers with 20,000 or more
employees provided dental benefits to their workforce.\1\ For
county, city, and state government entities, the survey
revealed that 95 percent of the aforementioned government
employers with over 500 employees offered dental benefits with
median deductible and maximums of $50 and $1,000,
respectively.\2\ All states, except Kentucky and Mississippi,
offer dental coverage to state employees.
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\1\ Mercer Survey of Employer-Sponsored Health Plans, December 8,
2003.
\2\ Ibid.
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Moreover, the government finds itself at a critical
juncture in its ability to carry out its work. The Government
Accountability Office has identified human capital management
as a High Risk area, calling for concerted action in addressing
the issue. Various studies have identified the likely
retirement of significant numbers of federal employees, leaving
some agencies with critical shortages of needed skills in a
variety of occupations and important areas of governmental
activity. The establishment of a program of dental and vision
insurance for the federal workforce can be a significant
component in addressing these issues.
Improved employee health
Access to dental and vision care can improve the overall
health and well-being of employees. Routine dental and vision
services can prevent diseases from developing and identify
major diseases in their early stages when they are easier and
less expensive to treat. Healthier employees are generally more
productive employees.
Oral health is an essential element of over-all health. The
2000 Surgeon General report, ``Oral Health in America,''
estimated that approximately 108 million Americans did not have
access to a dental benefit, about 2.5 times the number who do
not have medical coverage. The report found that 70.4 percent
of individuals with private dental insurance reported seeing a
dentist in the past year while only 50.7 percent of those
without benefits did.\3\ The report notes that preventive care
is essential to keeping down overall dental and medical costs
because early detection of other diseases, including oral
cancer, can be found through oral check-ups. The National
Institute of Dental and Craniofacial Research estimates that
for every dollar spent on dental disease prevention, $4 is
saved in subsequent treatment costs. Research continues to
support the association of dental disease with coronary heart
disease, stroke, and premature childbirth.\4\ In view of the
proven relationship between good oral health and good overall
health, promoting access to dental care is essential.
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\3\ Oral Health in America: A Report of the Surgeon General, U.S.
Public Health Service, May 25, 2000.
\4\ Dental and Vision Benefits for Federal Employees, hearing
before the House Subcommittee on Civil Service and Agency
Reorganization, 108th Congress, (February 24, 2004) (testimony by Jon
Seltenheim, National Association of Dental Plans).
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Dental health can be linked directly to the physical health
of employees. Each year, adults miss more than 164 million
hours (approximately 20.5 million days) of work due to oral
health problems or dental treatments.\5\ While the percentage
of adult Americans missing all of their teeth has declined
significantly over the past 20 years, today, one in every 250
young adults have lost all their teeth.\6\ There is a
developing body of medical evidence that correlates severe gum
disease in mothers to low-birth-weight babies. Obstetricians
and gynecologists are increasingly asking pregnant women about
their dental history in the first trimester of their pregnancy
to identify and treat potential infections as early as
possible. Other researchers have asserted that the link of
periodontic disease to heart disease may be as strong as the
risks of smoking and high blood lipids. In addition, there is
evidence that gum disease makes controlling insulin levels more
difficult for diabetics.\7\ Clearly the better an individual's
dental health, the better that individual's overall physical
health will be.
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\5\ Journal of Dental Education, Association Report: Trends in
Dentistry and Dental Education, June 2001.
\6\ National Center for Chronic Disease Prevention and Health
Promotion, ``Oral Health for Adults.''
\7\ Richmond Times Dispatch, ``More Reasons To Brush and Floss
Research Suggests Severe Gum Disease Can Affect Heart, Pregnancy and
Other Body Systems,'' May 2, 2002, Section F-1.
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The links between vision health and physical health are no
less strong. Routine eye exams are an ideal opportunity to
identify more significant health issues, some of which can be
life-threatening such as high blood pressure, arteriosclerosis
and diabetes. These are diseases that if left untreated can
lead to serious and expensive complications.\8\ More than 5
million Americans have vision problems that are related to
diabetes.\9\ Diabetics are 25 times more likely to lose vision
than those who do not, and yet, with early intervention,
ninety-five percent of people with significant diabetic
retinopathy can avoid significant vision loss.\10\ In addition,
with the use of computers in the workforce becoming
increasingly common, ``Computer vision syndrome'' (CVS) has
emerged as a growing issue facing many employees. CVS causes
headaches, dry eyes, and other related problems. The
availability of basic vision benefits can help minimize the
impact of CVS on employees.\11\ In addition to assuring proper
visual correction, a vision benefit can also provide the
opportunity for early detection of serious eye and systemic
conditions from glaucoma to high blood pressure and diabetes.
Early treatment is key to avoiding serious health
consequences.\12\
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\8\ Dental and Vision Benefits for Federal Employees, hearing
before the House Subcommittee on Civil Service and Agency
Reorganization, 108th Congress, (February 24, 2004) (testimony of Dr.
Howard J. Braverman, O.D., Past President, American Optometric
Association).
\9\ National Eye Institute, ``Vision Problem in the United
States,'' 2002.
\10\ American Academy of Ophthalmology, April 2004.
\11\ Dental and Vision Benefits for Federal Employees, hearing
before the House Subcommittee on Civil Service and Agency
Reorganization, 108th Congress, (February 24, 2004) (testimony of Dr.
Howard J. Braverman, O.D., Past President, American Optometric
Association).
\12\ Letter to the Honorable Susan Collins, American Optometric
Association, July 15, 2004.
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Simply put, employers can offer the advantages of group
purchasing of dental and vision benefits to their employees and
contribute to improved physical health (and corresponding
improvements in productivity) while incurring only minimal
administrative costs. Under the Federal Employees Dental and
Vision Enhancement Act of 2004, the federal government's
administrative costs would be limited to costs incurred between
the date of enactment and the initial contract agreements
between OPM and interested companies.
Improved employee satisfaction
Employees value the ability to purchase dental and vision
benefits at a group rate from their employer. In addition to
having access to these benefits, employees also appreciate
having decision tools to support them as they select providers
and make critical care decisions.
The U.S. Chamber of Commerce Annual Report on Employee
Benefits indicates that employees rank dental benefits as one
of the top 5 benefit offerings along with medical, life, long-
term disability, and 401(k)'s. Seven of 10 employees want to
have a vision plan as a part of their benefits package. One
study even suggests that two-thirds of employees would trade a
day off for vision benefits.\13\
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\13\ Dental and Vision Benefits for Federal Employees, hearing
before the House Subcommittee on Civil Service and Agency
Reorganization, 108th Congress, (February 24, 2004) (testimony of Dr.
Howard J. Braverman, O.D., Past President, American Optometric
Association).
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COMPREHENSIVE DENTAL AND VISION COVERAGE
While some federal government employees have access to
limited preventive dental and vision care through their medical
plans, many federal employees do not have coverage. By offering
an opportunity for all federal government employees to purchase
coverage, the government can be assured that all employees and
retirees will have access to comprehensive basic coverage.
Today, federal employees have access to comprehensive
medical insurance through the Federal Employees Health Benefits
Program (FEHBP); \14\ however, the FEHBP provides little in the
way of dental and vision coverage. While some of the health
insurance plans offered under the FEHBP include dental and
vision benefits, they typically provide lower levels of
coverage when compared to the array of plans available to both
the public and private sectors. For example, the Blue Cross and
Blue Shield Association plans, which provide coverage to
approximately 52 percent of the federal workforce, pays $8 of a
$24 maximum allowable charge for a periodic oral
evaluation.\15\ In testimony before the House Government Reform
Subcommittee on Civil Service and Agency Organization,
CompBenefits Corporation presented a review of dental benefits
available through the FEHBP.\16\ The review covered 150 of plan
documents of carriers participating in the FEHBP. The review
found that only one carrier offered specific preventative care
for children, approximately one-third offered preventative care
for all ages, less than one-third offered minor restorative
dental care, one-fifth offered any major restorative dental
care, and fourteen offered any orthodontic care.\17\
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\14\ Chapter 89 of title 5, United States Code.
\15\ 2004 Blue Cross and Blue Shield Service Benefit Plan Brochure,
www.fepblue.org.
\16\ ``Resource on Optional Dental/Vision Benefits for Federal
Employees,'' A Report to the House Subcommittee on Civil Service and
Agency Reorganization, CompBenefits Corporation, February 24, 2004.
\17\ Ibid.
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Customer surveys, focus groups, and other feedback indicate
the FEHBP enrollees want better dental and vision benefits
coverage than is currently available in the FEHBP. Since the
1980s, OPM has not accepted proposals from participating
companies to increase dental benefits because either coverage
for basic medical services would have to be reduced or premiums
increase significantly to cover the cost. The statutory
framework in the Federal Employee Dental and Vision Enhancement
Act of 2004 will provide federal employees, annuitants, and
their dependents with access to separate and improved dental
and vision coverage.
As the legislation was developed, some expressed concern
that the supplemental benefits created by the bill would serve
as a precedent for carving out other benefits the FEHBP
insurers provide today. Those concerned believe that
segregating core medical benefits, such as prescription drugs,
would impair the ability of FEHBP insurers to continue
providing federal employees, annuitants, and their dependents
with highest-quality health benefits at affordable premiums.
The Committee understands that concern. The Federal Employee
Dental and Vision Enhancements Act of 2004 should not be viewed
as a precedent for segregating treatments or procedures that,
unlike dental and vision, are integrally related to the
practice of medicine.
ADVANTAGES OF EMPLOYER-SPONSORED DENTAL AND VISION BENEFITS TO
EMPLOYEES
Offering employees supplemental dental and vision benefits
offers clear advantages to the federal government. But what
about advantages to the federal employee? Supplemental dental
and vision benefits offer three, clear-cut advantages to the
employee: (1) access to more comprehensive dental and vision
benefits coverage; (2) a greater sense of financial security;
and (3) tax savings.
The first two employee advantages are linked: whether or
not the individual chooses additional levels of dental or
vision coverage, the reality is that the coverage is available.
Employees feel more secure that the employer is able to provide
access to higher levels of coverage. And for those who feel
they really need that additional coverage, they feel good about
not having to look elsewhere for the coverage they feel they
need.
More tangibly, offering additional dental and vision
benefits on a pre-tax (or ``before-tax'') basis has an
immediate, positive impact on the individual: savings. Pre-tax
contributions means the individual pays the cost of coverage
before taxes are calculated on pay. Consequently, the
individual lowers his or her taxable pay by the amount they
contribute toward the cost of coverage. For the average Federal
employee earning $56,400 per year this means a savings of 25%
of premiums. In short, they save money relative to paying for
coverage after taxes are taken out.
Finally, beyond the obvious benefit of having to pay less
for coverage, pre-tax savings also means the individual has
additional dollars (not spent on coverage), that are available
for other areas--such as contributions to a flexible spending
account which can be applied to a variety of medical expenses
like co-pays, doctor visit charges, eyeglasses, etc. Since
money contributed to a spending account is also pre-tax, the
average Federal employee will have $1.25 of purchasing power
for every dollar placed into the spending account.
To ensure that employees understand the services and
benefits available under the various offerings, the bill
includes provision requiring OPM to work with the participating
companies to provide federal employees and annuitants with the
education materials necessary to evaluate the new offerings.
The Committee believes competition among carriers, group
discounts, and volumes of sales should keep premiums affordable
for federal employees. In recognition of the enormous fiscal
pressures faced by the federal government, the legislation is
designed to provide a voluntary, employee-paid dental and
vision benefit, patterned after the Federal Employees Long-Term
Care Insurance Program.
BENEFIT OFFERINGS AND BENEFIT ADMINISTRATION
In designing the future benefit packages, there are several
plan design alternatives to be considered. In addition, there
are important administration considerations as well.
Flexibility in both design and administration is critically
important for the employer and the employee. The employer needs
the flexibility to respond to the ever changing market and the
employee needs flexibility to respond to his or her changing
needs. The Federal Employee Dental and Vision Benefits
Enhancement Act of 2004 is written to mirror the prevalent
practices in the private sector. Therefore, it is important to
understand how the private sector has designed their programs
in a way that offers both cost efficiency and administrative
simplicity.
Design considerations
There are a wide variety of stand-alone dental plans on the
market that OPM could adapt in order to meet the demand for
enhanced dental coverage, including dental health maintenance
organizations, dental preferred provider organizations, dental
indemnity plans, and discount dental plans. According to the
National Association of Dental Plans, premiums range from a few
dollars a month for discount dental plans to an average of $90
a month for family indemnity plans.\18\ An array of vision
plans is available as well. The existing variety of plans will
allow the Office of Personnel Management wide flexibility in
providing employees, annuitants, and their dependents access to
a level of dental benefits appropriate for their individual
dental care needs.
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\18\ Dental and Vision Benefits for Federal Employees, hearing
before the House Subcommittee on Civil Service and Agency
Reorganization, 108th Congress, (February 24, 2004) (testimony by Jon
Seltenheim, National Association of Dental Plans).
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Administration considerations
How employers deliver benefits is often as important as the
benefits delivered. Today's employees have high expectations
for fast, high quality service delivery. Consequently,
mostlarge employers in the United States have decided to contract with
organizations whose core competencies include benefits administration
for the delivery of dental and vision benefits. Many of the nation's
largest employers have decided to contract with alternate service
administrators for the administration of their health and welfare
plans, including dental and vision benefits. In addition to managing
enrollment, claims processing and regulatory compliance, large
administrators have a wealth of decision support tools that help
employees make smart choices about how to use their benefits. Examples
of such tools include: comparison charts that allow employees to
quickly compare costs and coverages of different plans, complete with
web links to those plans if more detail is desired, personalized
provider directories that allow employees to see which local dentists
or eye doctors are aligned to the offered plans, and health content
sites that allow employees to learn more about their health conditions.
The Committee urges OPM to give strong consideration to companies with
decision support tools to assist the federal workforce and annuitant
population in becoming better consumers of their vision and dental
services.
III. Legislative History
S. 2657 was introduced by Senators Collins and Akaka on
July 14, 2004, and was referred to the Committee on
Governmental Affairs. Senator Lieberman cosponsored the
legislation on July 15, Senator Voinovich cosponsored the
legislation on July 22, and Senator Santorum cosponsored the
legislation on September 9.
The legislation was referred to the Subcommittee on
Financial Management, the Budget, and International Security on
July 15, 2004. On July 20, 2004, the Subcommittee on Financial
Management, the Budget, and International Security favorably
polled out S. 2657 to the full Committee.
On July 21, 2004, the Committee on Governmental Affairs
considered S. 2657 and ordered the bill reported by voice vote
without amendment. Senators present: Collins, Voinovich,
Specter, Fitzgerald, Lieberman, Akaka, Durbin, Carper, and
Lautenberg.
IV. Section-by-Section Analysis
Section 1. Short title
This section establishes the title of the legislation as
the ``Federal Employee Dental and Vision Benefits Enhancement
Act of 2004.''
Section 2. Enhanced dental benefits for federal employees
This section amends subpart G of part III of title 5,
United States Code, by adding a new chapter 89A to allow the
Office of Personnel Management to establish a program under
which supplemental dental insurance is made available to
federal employees, annuitants, and their dependents.
New section 8951 defines the terms used in chapter 89A,
including the definition of employee, annuitant, member of
family, dependent, eligible individual, Office, qualified
company, employee organization, and State.
New section 8952 requires OPM to establish and administer
the dental program. Subsection (a) states that OPM shall
establish and administer a program through which an eligible
individual may obtain dental coverage to supplement coverage
available through the Federal Employees Health Benefits Program
codified at chapter 89 of title 5, United States Code.
Subsection (b) states that OPM shall use reasonable discretion
to determine the financial requirements for qualified companies
to participate in the supplemental dental program. Subsection
(c) makes clear that nothing in the supplemental dental program
shall be construed to prohibit the availability of dental
benefits provided by a health benefits plan under chapter 89 of
title 5, United States Code.
New section 8953 provides the contracting framework for OPM
to use in establishing and operating the program. Subsection
(a) states that OPM shall contract with a reasonable number of
qualified companies for a policy or policies of benefits
described under new section 8954 without regard to section 5 of
title 41 or any other statute requiring competitive bidding. In
addition, this subsection states that an employee organization
may contract with a qualified company to participate with the
company in any contract between OPM and that qualified company
in order to offer a supplemental dental package under chapter
89A. Subsection (b) requires OPM to ensure that contracts are
awarded on the basis of contractor qualifications, price, and
reasonable competition. Subsection (c) allows companies to
apply additional waiting periods for benefits for individuals
who enroll after their initial enrollment opportunity.
Subsection (d) requires companies to establish internal dispute
resolution procedures as well as alternative dispute resolution
procedures involving independent third-party review. This
subsection states that the district courts of the United States
would have original jurisdiction, concurrent with the United
States Court of Federal Claims, over any action described in
section (10)(a)(1) of the Contract Disputes Act relating to
such a dispute arising under the contract. Subsection (e)
states that this section does not authorize OPM or a third-
party reviewer to change the terms of any contract under
chapter 89A. Subsection (f) states that contracts under chapter
89A shall be for seven years and may not be renewed
automatically.
New section 8954 relates to benefits. Subsection (a) grants
OPM the authority to set reasonable minimum standards for
enhanced dental benefits plans under chapter 89A and for
qualified companies offering those plans. Subsection (b)
specifies that contracts may include more than 1 level of
benefits. Subsection (c) describes categories of benefits that
may be offered under chapter 89A dental plans. Subsection (d)
requires contracts to cover geographic service delivery areas
specified by OPM, and makes clear that OPM shall require
companies to include dentally underserved areas in their
service delivery areas. Subsection (e) states that the health
benefits plans under chapter 89 of title 5, United States Code,
shall be the first payor of any benefit payments for an
individual with dental coverage under chapter 89 and chapter
89A.
New section 8955 specifies information requirements.
Subsection (a) requires companies tomake available to each
individual eligible to enroll information on services and benefits that
OPM considers necessary to enable the individual to make an informed
decision about electing coverage under chapter 89A. Subsection (b)
states that OPM shall make available to each individual eligible to
enroll in a dental benefits plan information on services and benefits
provided by companies participating in the Federal Employees Health
Benefits Program under chapter 89 of title 5, United States Code.
New section 8956 governs elections of coverage. Subsection
(a) allows eligible individuals to enroll in a dental benefits
plan for self-only, self plus one, or for self and family.
Subsection (b) requires OPM to prescribe regulations under
which eligible individuals may enroll. Subsection (c) permits
eligible individuals to cancel or transfer enrollment 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 during
other times and circumstances as specified by OPM.
New section 8957 states that a surviving spouse, disability
annuitant, or surviving child whose annuity is terminated and
is later restored, may continue enrollment in a dental benefits
plan under chapter 89A, subject to OPM regulations.
New section 8958 relates to premiums. Subsection (a) states
that each eligible individual obtaining dental coverage under
chapter 89A is responsible for 100 percent of the premiums for
such coverage. Subsection (b) requires OPM to issue regulations
specifying the terms under which individuals are required to
pay the premiums for enrollment. Subsection (c) states that the
amount necessary to pay the premiums may be withheld from an
individual's federal pay or annuity. Subsection (d) specifies
that premiums shall be paid directly to the qualified company.
Subsection (e) requires participating qualified companies to
maintain accounting records as OPM may require. Subsection (f)
makes the Employee Health Benefits Fund available for
reasonable expenses incurred by OPM in administering chapter
89A before the first day of the first contract period,
including reasonable implementation costs. In addition, this
subsection establishes a Dental Benefits Administrative Account
available to OPM to defray administrative costs after the start
of the first contract year. Contracts under chapter 89A would
include appropriate provisions for companies to reimburse the
Dental Benefits Administrative Account.
New section 8959 provides that contracts established under
chapter 89A preempt any State or local law which relates to
dental benefits, insurance, plans, or contracts.
New section 8960 imposes requirements for studies, reports,
and audits relating to the dental benefits program. Subsection
(a) requires participating companies to both furnish such
reasonable reports as OPM determines to be necessary and permit
OPM and representatives of the General Accounting Office to
examine the records of such companies as necessary. Subsection
(b) requires each federal agency to keep records, make
certifications, and furnish OPM, the company, or both, with the
information and reports OPM requires. Subsection (c) requires
OPM to conduct periodic reviews of the plans under chapter 89A,
including a comparison of the dental benefits available under
chapter 89 of title 5, United States Code, to ensure the
competitiveness of plans under new chapter 89A.
New section 8961 grants the district courts of the United
States original jurisdiction, concurrent with the United States
Court of Federal Claims, for a civil action or claim against
the United States under chapter 89A after administrative
remedies under chapter 8953(d) have been exhausted.
New section 8962 relates to administrative functions for
OPM. Subsection (a) requires OPM to prescribe regulations to
carry out new chapter 89A. Subsection (b) requires OPM to
provide for coordinated enrollment, promotion, and education
efforts as appropriate in consultation with each qualified
company. The information must include information relating to
the dental benefits available under chapter 89 of title 5,
United States Code, and the advantages and disadvantages of
additional coverage under chapter 89A.
Section 3. Enhanced vision benefits for federal employees
This section amends subpart G of part III of title 5,
United States Code, by adding a new chapter 89B to allow the
Office of Personnel Management to establish a program under
which supplemental vision insurance is made available to
federal employees, annuitants, and their dependents.
New section 8981 defines the terms used in chapter 89B,
including the definition of employee, annuitant, member of
family, dependent, eligible individual, Office, qualified
company, employee organization, and State.
New section 8982 requires OPM to establish and administer
the vision program. Subsection (a) states that OPM shall
establish and administer a program through which an eligible
individual may obtain vision coverage to supplement coverage
available through the Federal Employees Health Benefits Program
codified at chapter 89 of title 5, United States Code.
Subsection (b) states that OPM shall use reasonable discretion
to determine the financial requirements for qualified companies
to participate in the supplemental vision program. Subsection
(c) makes clear that nothing in the supplemental vision program
shall be construed to prohibit the availability of vision
benefits provided by a health benefits plan under chapter 89 of
title 5, United States Code.
New section 8983 provides the contracting framework for OPM
to use in establishing and operating the program. Subsection
(a) states that OPM shall contract with a reasonable number of
qualified companies for a policy or policies of benefits
described under new section 8984 without regard to section 5 of
title 41 or any other statute requiring competitive bidding. In
addition, this subsection states that an employee organization
may contract with a qualified company to participate with the
company in any contract between OPM and that qualified company
in order to offer a supplemental vision package under chapter
89A. Subsection (b) requires OPM to ensure that contracts are
awarded on the basis of contractor qualifications, price, and
reasonable competition. Subsection (c) allows companies to
apply additional waiting periodsfor benefits for individuals
who enroll after their initial enrollment opportunity. Subsection (d)
requires companies to establish internal dispute resolution procedures
as well as alternative dispute resolution procedures involving
independent third-party review. This subsection also states that the
district courts of the United States would have original jurisdiction,
concurrent with the United States Court of Federal Claims, over any
action described in section (10)(a)(1) of the Contract Disputes Act
relating to such a dispute arising under the contract. Subsection (e)
states that this section does not authorize OPM or a third-party
reviewer to change the terms of any contract under chapter 89A.
Subsection (f) states that contracts under chapter 89B shall be for
seven years and may not be renewed automatically.
New section 8984 relates to benefits. Subsection (a) grants
OPM the authority to set reasonable minimum standards for
enhanced vision benefits plans under chapter 89B and for
qualified companies offering those plans. Subsection (b)
specifies that contracts may include more than 1 level of
benefits. Subsection (c) describes categories of benefits that
may be offered under chapter 89B vision plans. Subsection (d)
requires contracts to cover geographic service delivery areas
specified by OPM, and makes clear that OPM shall require
companies to include underserved vision areas in their service
delivery areas. Subsection (e) states that the health benefits
plans under chapter 89 of title 5, United States Code, shall be
the first payor of any benefit payments for an individual with
vision coverage under chapter 89 and chapter 89B.
New section 8985 specifies information requirements.
Subsection (a) requires companies to make available to each
individual eligible to enroll information on services and
benefits that OPM considers necessary to enable the individual
to make an informed decision about electing coverage under
chapter 89B. Subsection (b) states that OPM shall make
available to each individual eligible to enroll in a vision
benefits plan information on services and benefits provided by
companies participating in the Federal Employees Health
Benefits Program under chapter 89 of title 5, United States
Code.
New section 8986 governs elections of coverage. Subsection
(a) allows eligible individuals to enroll in a vision benefits
plan for self-only, self plus one, or for self and family.
Subsection (b) requires OPM to prescribe regulations under
which eligible individuals may enroll. Subsection (c) permits
eligible individuals to cancel or transfer enrollment 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 during
other times and circumstances as specified by OPM.
New section 8987 states that a surviving spouse, disability
annuitant, or surviving child whose annuity is terminated and
is later restored, may continue enrollment in a vision benefits
plan under chapter 89B, subject to OPM regulations.
New section 8988 relates to premiums. Subsection (a) states
that each eligible individual obtaining vision coverage under
chapter 89B is responsible for 100 percent of the premiums for
such coverage. Subsection (b) requires OPM to issue regulations
specifying the terms under which individuals are required to
pay the premiums for enrollment. Subsection (c) states that the
amount necessary to pay the premiums may be withheld from an
individual's federal pay or annuity. Subsection (d) specifies
that premiums shall be paid directly to the qualified company.
Subsection (e) requires participating qualified companies to
maintain accounting records as OPM may require. Subsection (f)
makes the Employee Health Benefits Fund available for
reasonable expenses incurred by OPM in administering chapter
89B before the first day of the first contract period,
including reasonable implementation costs. In addition, this
subsection establishes a Vision Benefits Administrative Account
available to OPM to defray administrative costs after the start
of the first contract year. Contracts under chapter 89B would
include appropriate provisions for companies to reimburse the
Vision Benefits Administrative Account.
New section 8989 provides that contracts established under
chapter 89B preempt any State or local law which relates to
vision benefits, insurance, plans, or contracts.
New section 8990 imposes requirements for studies, reports,
and audits relating to the vision benefits program. Subsection
(a) requires participating companies to both furnish such
reasonable reports as OPM determines to be necessary and permit
OPM and representatives of the General Accounting Office to
examine the records of such companies as necessary. Subsection
(c) of new section 8990 requires OPM to conduct periodic
reviews of the plans under chapter 89B, including a comparison
of the vision benefits available under chapter 89 of title 5,
United States Code, to ensure the competitiveness of plans
under chapter 89B.
New section 8991 grants the district courts of the United
States original jurisdiction, concurrent with the United States
Court of Federal Claims, for a civil action or claim against
the United States under chapter 89B after administrative
remedies under chapter 8983 (d) have been exhausted.
New section 8992 relates to administrative functions for
OPM. Subsection (a) requires OPM to prescribe regulations to
carry out chapter 89B. Subsection (b) requires OPM to provide
for coordinated enrollment, promotion, and education efforts as
appropriate in consultation with each qualified company. The
information must include information relating to the vision
benefits available under chapter 89 of title 5, United States
Code, and the advantages and disadvantages of additional
coverage under chapter 89B.
Section 4. Technical and conforming amendment
This section makes technical and conforming amendments to
the table of chapters for part III of title 5, United States
Code, to reflect the enhanced dental and vision benefits
sections.
Section 5. Application to postal service employees
This section amends section 1005(f) of title 39, United
States Code, to make postal service employees eligible to
participate in the supplemental dental and vision benefit
programs under S. 2657.
Section 6. Sense of Congress
Subsection (a) states the finding that oral and vision and
general health and well-being are inseparable and access to
dental and vision services is an essential factor in
maintaining good health; and that it is in the interest of the
federal government to take reasonable steps to ensure the
health and well-being of its employees.
Subsection (b) expresses 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. This subsection also states that
to help achieve these goals Congress should evaluate the
supplemental plans established under S. 2657 to determine the
options for and feasibility of providing an employer
contribution.
Section 7. Requirement to study health benefits coverage for dependent
children who are full-time students
This section requires the Office of Personnel Management to
report to Congress describing and evaluating the options
whereby coverage under the Federal Employees Health Benefits
program could be made available to unmarried dependent children
under the age of 25 who are full-time students. The report is
due to Congress no later than 6 months after the date of
enactment.
Section 8. Effective date
This section applies the provisions of S. 2657 to contracts
that take effect in calendar year 2006.
V. Estimated Cost of Legislation
S. 2657--Federal Employee Dental and Vision Benefits Enhancement Act of
2004
S. 2657 would establish a voluntary program under which
federal civilian employees and annuitants would be able to
purchase supplemental insurance coverage for vision and dental
care. The coverage authorized under the bill would be available
regardless of whether eligible individuals are enrolled in the
Federal Employees Health Benefits (FEHB) program. (Plans
currently participating in the FEHB program may offer enrollees
coverage for dental or vision services, although such coverage
is often limited.)
Although the federal government would not contribute toward
enrollees' premiums for the benefit, the Office of Personnel
Management (OPM) would incur costs to implement and administer
the program. CBO estimates that implementing S. 2657 would
increase direct spending by OPM for its administrative expenses
by about $1 million in fiscal year 2005.
According to OPM, its limited administrative role would be
similar to the one it has in the federal long-term care
insurance program, in which qualifying companies are
responsible for costly marketing and enrollment activities. The
bill would authorize any administrative expenses incurred by
OPM to be paid from the federal government's Employees Health
Benefits Fund.
The bill would require companies providing the vision and
dental benefit to reimburse OPM for its future administrative
expenses after the first contract year begins. Assuming
enactment of the bill in the fall of 2004, CBO expects that
contracts would be awarded during the last quarter of fiscal
year 2005 in anticipation of coverage beginning at the start of
calendar year 2006. We assume that companies would begin to
reimburse OPM for its administrative costs once contracts are
signed.
Based on information provided by OPM, CBO estimates that
start-up costs in fiscal year 2005 would amount to about $1
million. In future years, CBO expects that reimbursements from
qualifying companies generally would cover OPM's costs to
administer the program, so net federal outlays would be zero
after the first year. S. 2657 would not affect federal
revenues.
CBO anticipates that establishing a new supplemental dental
and vision benefit program for federal civilian employees would
increase the administrative workload of federal agencies by a
negligible amount. The bill also would require OPM to conduct a
feasibility study on options to expand FEHB coverage to certain
dependents of federal employees. We estimate that preparing and
issuing the report would cost less than $500,000 in 2005.
Federal spending for such activities would be subject to the
availability of appropriated funds.
S. 2657 would preempt state and local laws that establish
coverage levels or benefit requirements that would otherwise
apply to vision or dental benefits offered under the new
benefit programs authorized by the bill. Such preemptions are
intergovernmental mandates as defined in the Unfunded Mandates
Reform Act, but CBO estimates that they would not affect the
budgets of state, local, or tribal governments. While the
preemptions would limit the application of state laws, they
would not preempt state taxing authority and would impose no
duties on states that would result in additional spending. The
bill does not contain any private-sector mandates.
The CBO staff contact for this estimate is Julia
Christensen. This estimate was approved by Robert A. Sunshine,
Assistant Director for Budget Analysis.
VI. Evaluation of Regulatory Impact
Pursuant to the requirements of paragraph 11(b) of rule
XXVI of the Standing Rules of the Senate, the Committee has
considered the regulatory impact of this bill. CBO states that
there are no intergovernmental or private-sector mandates as
defined in the Unfunded Mandates Reform Act and no costs on
state, local, or tribal governments. The legislation contains
no other regulatory impact.
VII. Changes in Existing Law
In compliance with paragraph 12 of rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic and existing law, in which no
change is proposed, is shown in roman):
TITLE 5, UNITED STATES CODE
* * * * * * *
GOVERNMENT ORGANIZATION AND EMPLOYEES
* * * * * * *
PART III--EMPLOYEES
* * * * * * *
Subpart G--Insurance and Annuities
* * * * * * *
CHAPTER 89--HEALTH INSURANCE
* * * * * * *
CHAPTER 89A--ENHANCED DENTAL BENEFITS
8951. Definitions.
8952. Availability of dental benefits.
8953. Contracting authority.
8954. Benefits.
8955. Information to individuals eligible to enroll.
8956. Election of coverage.
8957. Coverage of restored survivor or disability annuitants.
8958. Premiums.
8959. Preemption.
8960. Studies, reports, and audits.
8961. Jurisdiction of courts.
8962. Administrative functions.
SEC. 8951. DEFINITIONS.
In this chapter:
(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:
(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 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 reasonableanticipated 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.
* * * * * * *
CHAPTER 89B--ENHANCED VISION BENEFITS
8981. Definitions.
8982. Availability of vision benefits.
8983. Contracting authority.
8984. Benefits.
8985. Information to individuals eligible to enroll.
8986. Election of coverage.
8987. Coverage of restored survivor or disability annuitants.
8988. Premiums.
8989. Preemption.
8990. Studies, reports, and audits.
8991. Jurisdiction of courts.
8992. Administrative functions.
SEC. 8981. DEFINITIONS.
In this chapter:
(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).
(2) Preventive.
(3) Eyewear.
(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.
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TITLE 39, UNITED STATES CODE
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POSTAL SERVICE
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PART II--PERSONNEL
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CHAPTER 10--EMPLOYMENT WITHIN THE POSTAL SERVICE
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SEC. 1005. APPLICABILITY OF LAWS RELATING TO FEDERAL EMPLOYEES.
(f) Compensation, benefits, and other terms and conditions
of employment in effect immediately prior to the effective date
of this section, whether provided by statute or by rules and
regulations of the former Post Office Department or the
executive branch of the Government of the United States, shall
continue to apply to officers and employees of the Postal
Service, until changed by the Postal Service in accordance with
this chapter and chapter 12 of this title. Subject to the
provisions of this chapter and chapter 12 of this title, the
provisions of subchapter I of chapter 85 and [chapters 87 and
89] chapters 87, 89, 89A, and 89B of title 5 shall apply to
officers and employees of the Postal Service, unless varied,
added to, or substituted for, under this subsection. No
variation, addition, or substitution with respect to fringe
benefits shall result in a program of fringe benefits which on
the whole is less favorable to the officers and employees than
fringe benefits in effect on the effective date of this
section, and as to officers and employees for whom there is a
collective-bargaining representative, no such variation,
addition, or substitution shall be made except by agreement
between the collective-bargaining representative and the Postal
Service.
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