I

104TH CONGRESS

1ST SESSION H. R. 1903

To provide health insurance benefits to certain former employees at defense

nuclear facilities of the Department of Energy for injuries caused by

exposure to ionizing radiation.

IN THE HOUSE OF REPRESENTATIVES

JUNE 20, 1995

Mr. SKAGGS (for himself, Mr. STARK, Mr. EVANS, and Mr. SANDERS) introduced the following bill; which was referred to the Committee on

Commerce

A BILL

To provide health insurance benefits to certain former employees at defense nuclear facilities of the Department

of Energy for injuries caused by exposure to ionizing

radiation.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Defense Nuclear Work5 ers’ Health Insurance Act of 1995’’.
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1 SEC. 2. HEALTH INSURANCE PROGRAM FOR CERTAIN

2 FORMER DEPARTMENT OF ENERGY EMPLOY3 EES EXPOSED TO IONIZING RADIATION.

4 (a) ESTABLISHMENT OF PROGRAM.—The Secretary

5 of Energy shall provide in accordance with this section for

6 payment to (or on behalf of) certain former Department

7 of Energy employees (described in subsection (b)) for all

8 reasonable expenses for certain health care services (de9 scribed in subsection (c)) incurred (whether through insur10 ance or out-of-pocket) above the threshold dollar amount

11 specified in subsection (d).

12 (b) FORMER EMPLOYEES COVERED.—An employee

13 described in this section is an individual who—

14 (1) was (but is no longer) employed at a De15 partment of Energy defense nuclear facility (as de16 fined in subsection (g)(3));

17 (2) while employed at that facility—

18 (A) received 10 REM or more total expo19 sure to ionizing radiation or 10 percent or more

20 of the maximum permissible body burden expo21 sure to ionizing radiation, or

22 (B) was employed for 5 years or more in

23 a building or facility in which radioactive mate24 rials were regularly stored, handled, processed,

25 or disposed of; and
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1 (3) is not entitled to benefits under the Medi2 care Program.

3 (c) REASONABLE EXPENSES FOR CERTAIN HEALTH

4 CARE SERVICES COVERED.—

5 (1) IN GENERAL.—Reasonable expenses for cer6 tain health care services described in this subsection

7 are expenses in a reasonable amount for health care

8 services which are medically reasonable and nec9 essary for treatment of—

10 (A)(i) leukemia or cancer of the blood11 forming tissues (excluding chronic lymphocytic

12 leukemia),

13 (ii) multiple myeloma or muscle cancer af14 fecting the spinal cord, or lymphoma (other

15 than Hodgkin’s disease),

16 (iii) cancer of the thyroid, lung, breast,

17 brain or nervous system, bone, skin, prostate,

18 parathyroid glands, stomach, colon or rectum,

19 esophagus, bladder, urinary tract, pharynx,

20 pancreas, small intestine, bile ducts, gall blad21 der, or liver (except if cirrhosis or hepatitis B

22 is indicated); or

23 (iv) berylliosis; or

24 (B) another disease if the Secretary of En25 ergy (in consultation with the Secretary of
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1 Health and Human Services) determines that

2 there is a reasonable medical certainty that

3 such disease could have been directly or indi4 rectly caused by an illness referred to in sub5 paragraph (A).

6 (2) DETERMINATION OF REASONABLE

7 AMOUNT.—In applying paragraph (1)—

8 (A) health care expenses shall be treated

9 as being ‘‘in a reasonable amount’’ based on a

10 typical payment methodology used under

11 FEHBP plans, and

12 (B) treatment of an illness shall be consid13 ered to be medically reasonable and necessary if

14 payment for such treatment can be expected to

15 be made under either an FEHBP plan or under

16 the Medicare Program.

17 (3) HEALTH SERVICES DEFINED.—In para18 graph (1), the term ‘‘health care services’’ means

19 health care items and services that are the type of

20 items and services for which benefits are made avail21 able either under an FEHBP plan or under the

22 Medicare Program and includes hospital services,

23 physicians services, outpatient prescription drugs,

24 hospice care, home health services, skilled nursing
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1 facility services, and rehabilitation (inpatient and

2 outpatient) services.

3 (d) THRESHOLD DOLLAR AMOUNT.—The threshold

4 dollar amount specified in this subsection is $25,000 with

5 respect to any individual during the individual’s lifetime,

6 not counting expenses incurred before the date of the en7 actment of this Act.

8 (e) ADMINISTRATION.—The Secretary of Energy may

9 carry out this section directly, through a memorandum of

10 understanding with an appropriate Federal department or

11 agency, or through a contract with an appropriate health

12 insurance carrier or administrator.

13 (f) EFFECTIVE DATE.—The Secretary of Energy

14 shall establish the insurance program under this section

15 by not later than 6 months after the date of the enactment

16 of this Act. The program shall apply to expenses incurred

17 for services furnished on or after the date the program

18 first becomes effective.

19 (g) DEFINITIONS.—In this section:

20 (1) The term ‘‘FEHBP plan’’ means a health

21 plan typical of the health plans offered to Federal

22 employees and annuitants under chapter 89 of title

23 5, United States Code.
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1 (2) The term ‘‘medicare program’’ means the

2 program under title XVIII of the Social Security

3 Act.

4 (3) The term ‘‘Department of Energy defense

5 nuclear facility’’ means—

6 (A) a production facility or utilization fa7 cility (as defined in section 11 of the Atomic

8 Energy Act of 1954 (42 U.S.C. 2014)) that is

9 under the control or jurisdiction of the Sec10 retary of Energy and that is operated for na11 tional security purposes (including the tritium

12 loading facility at Savannah River, South Caro13 lina; the 236 H facility at Savannah River,

14 South Carolina; and the Mound Laboratory,

15 Ohio), but the term does not include any facil16 ity that does not conduct atomic energy defense

17 activities;

18 (B) a nuclear waste storage or disposal fa19 cility that is under the control or jurisdiction of

20 the Secretary of Energy;

21 (C) a testing and assembly facility that is

22 under the control or jurisdiction of the Sec23 retary of Energy and that is operated for na24 tional security purposes (including the test site
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1 facility in Nevada; the Pinnellas Plant, Florida;

2 and the Pantex facility, Texas);

3 (D) a nuclear weapons research facility

4 that is under the control or jurisdiction of the

5 Secretary of Energy (including the Lawrence

6 Livermore, Los Alamos, and Sandia National

7 Laboratories); or

8 (E) any facility described in subparagraphs

9 (A) through (D) that—

10 (i) is no longer in operation;

11 (ii) was under the control or jurisdic12 tion of the Department of Defense, the

13 Atomic Energy Commission, or the Energy

14 Research and Development Administration;

15 and

16 (iii) was operated for national security

17 purposes.

Æ