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106TH CONGRESS

1ST SESSION H. R. 110

To amend title 5, United States Code, to provide for the establishment

of a program under which long-term care insurance is made available

to Federal employees and annuitants, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 6, 1999

Mr. CUMMINGS introduced the following bill; which was referred to the

Committee on Government Reform

A BILL

To amend title 5, United States Code, to provide for the

establishment of a program under which long-term care

insurance is made available to Federal employees and

annuitants, and for other purposes.

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 ‘‘Federal Employees

5 Group Long-Term Care Insurance Act of 1999’’.
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1 SEC. 2. LONG-TERM CARE INSURANCE.

2 Subpart G of part III of title 5, United States Code,

3 is amended by adding at the end the following new chap4 ter:

5 ‘‘Chapter 90—Long-Term Care Insurance

‘‘Sec.

‘‘9001. Definitions

‘‘9002. Contracting authority.

‘‘9003. Minimum standards for contractors.

‘‘9004. Long-term care benefits.

‘‘9005. Financing.

‘‘9006. Preemption.

‘‘9007. Studies, reports, and audits.

‘‘9008. Claims for benefits.

‘‘9009. Jurisdiction of courts.

‘‘9010. Regulations.

‘‘9011. Authorization of appropriations.

6 ‘‘§ 9001. Definitions

7 ‘‘For the purpose of this chapter—

8 ‘‘(1) ‘annuitant’ means an individual referred to

9 in section 8901(3);

10 ‘‘(2) ‘employee’ means an individual referred to

11 in subparagraphs (A)–(D), and (F)–(I) of section

12 8901(1); but does not include an employee excluded

13 by regulation of the Office under section 9011;

14 ‘‘(3) ‘other eligible individual’ means the

15 spouse, former spouse, parent or parent-in-law of an

16 employee or annuitant, or other individual specified

17 by the Office;

18 ‘‘(4) ‘Office’ means the Office of Personnel

19 Management;
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1 ‘‘(5) ‘qualified carrier’ means an insurer li2 censed to do business in each of the States and

3 meeting the requirements of a qualified insurer in

4 each of the States;

5 ‘‘(6) ‘qualified contract’ means a contract meet6 ing the conditions prescribed in section 9002; and

7 ‘‘(7) ‘State’ means a State or territory or pos8 session of the United States, and includes the Dis9 trict of Columbia.

10 ‘‘§ 9002. Contracting authority

11 ‘‘(a) The Office may, without regard to section 5 of

12 title 41 or any other statute requiring competitive bidding,

13 purchase from one or more qualified carriers a policy or

14 policies of group long-term care insurance to provide bene15 fits as specified by this chapter. The Office, however, shall

16 ensure that each resulting contract is awarded on the basis

17 of contractor qualifications, price, and reasonable competi18 tion to the maximum extent practicable.

19 ‘‘(b) The Office may design a benefits package or

20 packages and negotiate final offerings with qualified car21 riers.

22 ‘‘(c) Each contract shall be for a uniform term of 5

23 years, unless terminated earlier by the Office.

24 ‘‘(d) Premium rates charged under a contract entered

25 into under this section shall reasonably reflect the cost of
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1 the benefits provided under that contract as determined

2 by the Office.

3 ‘‘(e) The coverage and benefits made available to in4 dividuals under a contract entered into under this section

5 are guaranteed to be renewable and may not be canceled

6 by the carrier except for nonpayment of premium.

7 ‘‘(f) The Office may, based on open season participa8 tion rates, the composition of the risk pool, or both, with9 draw the product.

10 ‘‘§ 9003. Minimum standards for contractors

11 ‘‘At the minimum, to be a qualified carrier under this

12 chapter, a company shall—

13 ‘‘(1) be licensed as an insurance company and

14 approved to issue group long-term care insurance in

15 all States and to do business in each of the States;

16 and

17 ‘‘(2) be in compliance with the requirements im18 posed on issuers of qualified long-term care con19 tracts by section 4980C of the Internal Revenue

20 Code of 1986.

21 ‘‘§ 9004. Long-term care benefits

22 ‘‘The benefits provided under this chapter shall be

23 long-term care benefits which, at a minimum, shall be

24 compliant with the most recent standards recommended

25 by the National Association of Insurance Commissioners.
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1 ‘‘§ 9005. Financing

2 ‘‘(a) The amount necessary to pay the premium for

3 enrollment of an enrolled employee shall be withheld from

4 the pay of each enrolled employee.

5 ‘‘(b) Except as provided by subsection (d), the

6 amount necessary to pay the premium for enrollment of

7 an enrolled annuitant shall be withheld from the annuity

8 of each enrolled annuitant.

9 ‘‘(c) The amount necessary to pay the premium for

10 enrollment of a spouse may be withheld from pay or annu11 ity, as appropriate.

12 ‘‘(d) An employee, annuitant, or other eligible individ13 ual, whose pay or annuity is insufficient to cover the with14 holding required for enrollment, shall, at the discretion of

15 the Office, pay the premium for enrollment directly to the

16 carrier.

17 ‘‘(e) Each carrier participating in the Program estab18 lished by this chapter shall maintain the funds related to

19 this Program separate and apart from funds related to

20 other contracts and other lines of business.

21 ‘‘(f) The costs of the Office in adjudicating a claims

22 dispute under section 9008, including costs related to an

23 inquiry not culminating in a dispute, shall be reimbursed

24 by the carrier involved in the dispute or inquiry. Such

25 funds shall be available to the Office for the administra26 tion of this chapter.
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1 ‘‘§ 9006. Preemption

2 ‘‘The provisions of this chapter shall supersede and

3 preempt any State or local law which is determined by

4 the Office to be inconsistent with—

5 ‘‘(1) the provisions of this chapter; or

6 ‘‘(2) after consultation with the National Asso7 ciation of Insurance Commissioners, the efficient

8 provision of a nationwide long-term care insurance

9 program for Federal employees.

10 ‘‘§ 9007. Studies, reports, and audits

11 ‘‘(a) Each qualified carrier entering into a contract

12 under this chapter shall—

13 ‘‘(1) furnish such reasonable reports as the Of14 fice determines to be necessary to enable it to carry

15 out its functions under this chapter; and

16 ‘‘(2) permit the Office and representatives of

17 the General Accounting Office to examine such

18 records of the carrier as may be necessary to carry

19 out the purposes of this chapter.

20 ‘‘(b) Each Federal agency shall keep such records,

21 make such certifications, and furnish the Office, the car22 rier, or both, with such information and reports as the

23 Office may require.
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1 ‘‘§ 9008. Claims for benefits

2 ‘‘(a) A claim for benefits under this chapter shall be

3 filed within 4 years of the date on which the reimbursable

4 cost was incurred or the service was provided.

5 ‘‘(b) The Office shall adjudicate a claims dispute aris6 ing under this chapter and shall require the contractor to

7 pay for any benefit or provide any service the Office deter8 mines appropriate under the applicable contract.

9 ‘‘(c)(1) Except as provided in paragraph (2), benefits

10 payable under this chapter for any reimbursable cost in11 curred or service provided are secondary to any other ben12 efit payable for such cost or service. no payment may be

13 made where there is no legal obligation for such payment.

14 ‘‘(2) Benefits payable under the following programs

15 shall be secondary to benefits payable under this chapter:

16 ‘‘(A) The program of medical assistance under

17 title XIX of the Social Security Act; and

18 ‘‘(B) Any other Federal or State programs that

19 the Office may specify in regulations that provide

20 health benefit coverage designed to be secondary to

21 other insurance coverage.

22 ‘‘§ 9009. Jurisdiction of courts

23 ‘‘A claimant under this chapter may file suit against

24 the carrier of the long-term care insurance policy covering

25 such claimant in the district courts of the United States,

26 after exhausting all available administrative remedies.
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1 ‘‘§ 9010. Regulations

2 ‘‘(a) The Office shall prescribe regulations necessary

3 to carry out this chapter.

4 ‘‘(b) The regulations of the Office may prescribe the

5 time at which and the conditions under which an eligible

6 individual may enroll in the Program established under

7 this chapter.

8 ‘‘(c) The Office may not exclude—

9 ‘‘(1) an employee or group of employees solely

10 on the basis of the hazardous nature of employment;

11 or

12 ‘‘(2) an employee who is occupying a position

13 on a part-time career employment basis, as defined

14 in section 3401(2).

15 ‘‘(d) The regulations of the Office shall provide for

16 the beginning and ending dates of coverage of employees,

17 annuitants, former spouses, and other eligible individuals

18 under this chapter, and any requirements for continuation

19 or conversion of coverage.

20 ‘‘§ 9011. Authorization of appropriations

21 ‘‘There are authorized to be appropriated such sums

22 as may be necessary for the purposes of carrying out sec23 tions 9002, and 9010.’’.

24 SEC. 3. EFFECTIVE DATE.

25 The amendments made by this Act shall take effect

26 on the date of enactment of this act, except that no cov-
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1 erage may be effective until the first day of the first pay

2 period in October, which follows by more than 1 year the

3 date of enactment of this Act.

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