Defense Nuclear Workers' Health Insurance Act of 1995

Summary: Defense Nuclear Workers' Health Insurance Act of 1995 - Directs the Secretary of Energy to provide for payments to certain former Department of Energy (DOE) employees who were employed at a DOE defense nuclear facility and who are not entitled to Medicare benefits for all reasonable expenses above $25,000 for certain health care services for the treatment of specified conditions related to exposure to ionizing radiation.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Defense Nuclear Workers' Health 
Insurance Act of 1995''.
SEC. 2. HEALTH INSURANCE PROGRAM FOR CERTAIN FORMER DEPARTMENT OF 
              ENERGY EMPLOYEES EXPOSED TO IONIZING RADIATION.

    (a) Establishment of Program.--The Secretary of Energy shall 
provide in accordance with this section for payment to (or on behalf 
of) certain former Department of Energy employees (described in 
subsection (b)) for all reasonable expenses for certain health care 
services (described in subsection (c)) incurred (whether through 
insurance or out-of-pocket) above the threshold dollar amount specified 
in subsection (d).
    (b) Former Employees Covered.--An employee described in this 
section is an individual who--
            (1) was (but is no longer) employed at a Department of 
        Energy defense nuclear facility (as defined in subsection 
        (g)(3));
            (2) while employed at that facility--
                    (A) received 10 REM or more total exposure to 
                ionizing radiation or 10 percent or more of the maximum 
                permissible body burden exposure to ionizing radiation, 
                or
                    (B) was employed for 5 years or more in a building 
                or facility in which radioactive materials were 
                regularly stored, handled, processed, or disposed of; 
                and
            (3) is not entitled to benefits under the Medicare Program.
    (c) Reasonable Expenses for Certain Health Care Services Covered.--
            (1) In general.--Reasonable expenses for certain health 
        care services described in this subsection are expenses in a 
        reasonable amount for health care services which are medically 
        reasonable and necessary for treatment of--
                    (A)(i) leukemia or cancer of the blood-forming 
                tissues (excluding chronic lymphocytic leukemia),
                    (ii) multiple myeloma or muscle cancer affecting 
                the spinal cord, or lymphoma (other than Hodgkin's 
                disease),
                    (iii) cancer of the thyroid, lung, breast, brain or 
                nervous system, bone, skin, prostate, parathyroid 
                glands, stomach, colon or rectum, esophagus, bladder, 
                urinary tract, pharynx, pancreas, small intestine, bile 
                ducts, gall bladder, or liver (except if cirrhosis or 
                hepatitis B is indicated); or
                    (iv) berylliosis; or
                    (B) another disease if the Secretary of Energy (in 
                consultation with the Secretary of Health and Human 
                Services) determines that there is a reasonable medical 
                certainty that such disease could have been directly or 
                indirectly caused by an illness referred to in 
                subparagraph (A).
            (2) Determination of reasonable amount.--In applying 
        paragraph (1)--
                    (A) health care expenses shall be treated as being 
                ``in a reasonable amount'' based on a typical payment 
                methodology used under FEHBP plans, and
                    (B) treatment of an illness shall be considered to 
                be medically reasonable and necessary if payment for 
                such treatment can be expected to be made under either 
                an FEHBP plan or under the Medicare Program.
            (3) Health services defined.--In paragraph (1), the term 
        ``health care services'' means health care items and services 
        that are the type of items and services for which benefits are 
        made available either under an FEHBP plan or under the Medicare 
        Program and includes hospital services, physicians services, 
        outpatient prescription drugs, hospice care, home health 
        services, skilled nursing facility services, and rehabilitation 
        (inpatient and outpatient) services.
    (d) Threshold Dollar Amount.--The threshold dollar amount specified 
in this subsection is $25,000 with respect to any individual during the 
individual's lifetime, not counting expenses incurred before the date 
of the enactment of this Act.
    (e) Administration.--The Secretary of Energy may carry out this 
section directly, through a memorandum of understanding with an 
appropriate Federal department or agency, or through a contract with an 
appropriate health insurance carrier or administrator.
    (f) Effective Date.--The Secretary of Energy shall establish the 
insurance program under this section by not later than 6 months after 
the date of the enactment of this Act. The program shall apply to 
expenses incurred for services furnished on or after the date the 
program first becomes effective.
    (g) Definitions.--In this section:
            (1) The term ``FEHBP plan'' means a health plan typical of 
        the health plans offered to Federal employees and annuitants 
        under chapter 89 of title 5, United States Code.
            (2) The term ``medicare program'' means the program under 
        title XVIII of the Social Security Act.
            (3) The term ``Department of Energy defense nuclear 
        facility'' means--
                    (A) a production facility or utilization facility 
                (as defined in section 11 of the Atomic Energy Act of 
                1954 (42 U.S.C. 2014)) that is under the control or 
                jurisdiction of the Secretary of Energy and that is 
                operated for national security purposes (including the 
                tritium loading facility at Savannah River, South 
                Carolina; the 236 H facility at Savannah River, South 
                Carolina; and the Mound Laboratory, Ohio), but the term 
                does not include any facility that does not conduct 
                atomic energy defense activities;
                    (B) a nuclear waste storage or disposal facility 
                that is under the control or jurisdiction of the 
                Secretary of Energy;
                    (C) a testing and assembly facility that is under 
                the control or jurisdiction of the Secretary of Energy 
                and that is operated for national security purposes 
                (including the test site facility in Nevada; the 
                Pinnellas Plant, Florida; and the Pantex facility, 
                Texas);
                    (D) a nuclear weapons research facility that is 
                under the control or jurisdiction of the Secretary of 
                Energy (including the Lawrence Livermore, Los Alamos, 
                and Sandia National Laboratories); or
                    (E) any facility described in subparagraphs (A) 
                through (D) that--
                            (i) is no longer in operation;
                            (ii) was under the control or jurisdiction 
                        of the Department of Defense, the Atomic Energy 
                        Commission, or the Energy Research and 
                        Development Administration; and
                            (iii) was operated for national security 
                        purposes.