```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 57 Introduced in Senate (IS)]

106th CONGRESS
  1st Session
                                 S. 57

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 SENATE OF THE UNITED STATES

                            January 19, 1999

  Ms. Mikulski (for herself, Mr. Sarbanes, Mr. Robb, and Mr. Warner) 
introduced the following bill; which was read twice and referred to the 
                   Committee on Governmental Affairs

_______________________________________________________________________

                                 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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Federal Employees Group Long-Term 
Care Insurance Act of 1999''.

SEC. 2. LONG-TERM CARE INSURANCE.

    Subpart G of part III of title 5, United States Code, is amended by 
adding at the end the following new chapter:

                 ``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.
``Sec. 9001. Definitions
    ``For the purpose of this chapter, the term--
            ``(1) `annuitant' means an individual referred to in 
        section 8901(3);
            ``(2) `employee' means an individual referred to in 
        subparagraphs (A) through (D), and (F) through (I) of section 
        8901(1); but does not include an employee excluded by 
        regulation of the Office under section 9011;
            ``(3) `Office' means the Office of Personnel Management;
            ``(4) `other eligible individual' means the spouse, former 
        spouse, parent or parent-in-law of an employee or annuitant, or 
        other individual specified by the Office;
            ``(5) `qualified carrier' means an insurer licensed to do 
        business in each of the States and meeting the requirements of 
        a qualified insurer in each of the States;
            ``(6) `qualified contract' means a contract meeting the 
        conditions prescribed in section 9002; and
            ``(7) `State' means a State or territory or possession of 
        the United States, and includes the District of Columbia.
``Sec. 9002. Contracting authority
    ``(a) The Office may, without regard to section 3709 of the Revised 
Statutes (41 U.S.C. 5) or any other statute requiring competitive 
bidding, purchase from 1 or more qualified carriers a policy or 
policies of group long-term care insurance to provide benefits as 
specified by this chapter. The Office shall ensure that each resulting 
contract is awarded on the basis of contractor qualifications, price, 
and reasonable competition to the maximum extent practicable.
    ``(b) The Office may design a benefits package or packages and 
negotiate final offerings with qualified carriers.
    ``(c) Each contract shall be for a uniform term of 5 years, unless 
terminated earlier by the Office.
    ``(d) Premium rates charged under a contract entered into under 
this section shall reasonably reflect the cost of the benefits provided 
under that contract as determined by the Office.
    ``(e) The coverage and benefits made available to individuals under 
a contract entered into under this section are guaranteed to be 
renewable and may not be canceled by the carrier except for nonpayment 
of premium.
    ``(f) The Office may withdraw an offering under this section based 
on open season participation rates, the composition of the risk pool, 
or both.
``Sec. 9003. Minimum standards for contractors
    ``At the minimum, to be a qualified carrier under this chapter, a 
company shall--
            ``(1) be licensed as an insurance company and approved to 
        issue group long-term care insurance in all States and to do 
        business in each of the States; and
            ``(2) be in compliance with the requirements imposed on 
        issuers of qualified long-term care contracts by section 4980C 
        of the Internal Revenue Code of 1986.
``Sec. 9004. Long-term care benefits
    ``The benefits provided under this chapter shall be long-term care 
benefits which, at a minimum, shall be compliant with the most recent 
standards recommended by the National Association of Insurance 
Commissioners.
``Sec. 9005. Financing
    ``(a) The amount necessary to pay the premium for enrollment of an 
enrolled employee shall be withheld from the pay of each enrolled 
employee.
    ``(b) Except as provided under subsection (d), the amount necessary 
to pay the premium for enrollment of an enrolled annuitant shall be 
withheld from the annuity of each enrolled annuitant.
    ``(c) The amount necessary to pay the premium for enrollment of a 
spouse may be withheld from pay or annuity, as appropriate.
    ``(d) An employee, annuitant, or other eligible individual, whose 
pay or annuity is insufficient to cover the withholding required for 
enrollment, shall, at the discretion of the Office, pay the premium for 
enrollment directly to the carrier.
    ``(e) Each carrier participating in the program established under 
chapter shall maintain the funds related to this program separate and 
apart from funds related to other contracts and other lines of 
business.
    ``(f) The costs of the Office in adjudicating a claims dispute 
under section 9008, including costs related to an inquiry not 
culminating in a dispute, shall be reimbursed by the carrier involved 
in the dispute or inquiry. Such funds shall be available to the Office 
for the administration of this chapter.
``Sec. 9006. Preemption
    ``This chapter shall supersede and preempt any State or local law 
which is determined by the Office to be inconsistent with--
            ``(1) the provisions of this chapter; or
            ``(2) after consultation with the National Association of 
        Insurance Commissioners, the efficient provision of a 
        nationwide long-term care insurance program for Federal 
        employees.
``Sec. 9007. Studies, reports, and audits
    ``(a) Each qualified carrier entering into a contract under this 
chapter shall--
            ``(1) furnish such reasonable reports as the Office 
        determines to be necessary to enable the carrier to carry out 
        the functions under this chapter; and
            ``(2) permit the Office and representatives of the General 
        Accounting Office to examine such records of the carrier 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 carrier, or both, with such 
information and reports as the Office may require.
``Sec. 9008. Claims for benefits
    ``(a) A claim for benefits under this chapter shall be filed within 
4 years after the date on which the reimbursable cost was incurred or 
the service was provided.
    ``(b) The Office shall adjudicate a claims dispute arising under 
this chapter and shall require the contractor to pay for any benefit or 
provide any service the Office determines appropriate under the 
applicable contract.
    ``(c)(1) Except as provided under paragraph (2), benefits payable 
under this chapter for any reimbursable cost incurred or service 
provided are secondary to any other benefit payable for such cost or 
service. No payment may be made where there is no legal obligation for 
such payment.
    ``(2)(A) Benefits payable under the programs described under 
subparagraph (B) shall be secondary to benefits payable under this 
chapter.
    ``(B) The programs referred to under subparagraph (A) are--
            ``(i) the program of medical assistance under title XIX of 
        the Social Security Act (42 U.S.C. 1396); and
            ``(ii) any other Federal or State programs that the Office 
        may specify in regulations that provide health benefit coverage 
        designed to be secondary to other insurance coverage.
``Sec. 9009. Jurisdiction of courts
    ``A claimant under this chapter may file suit against the carrier 
of the long-term care insurance policy covering such claimant in the 
district courts of the United States, after exhausting all available 
administrative remedies.
``Sec. 9010. Regulations
    ``(a) The Office shall prescribe regulations necessary to carry out 
this chapter.
    ``(b) The regulations of the Office may prescribe the time at which 
and the conditions under which an eligible individual may enroll in the 
program established under this chapter.
    ``(c) The Office may not exclude--
            ``(1) an employee or group of employees solely on the basis 
        of the hazardous nature of employment; or
            ``(2) an employee who is occupying a position on a part-
        time career employment basis, as defined in section 3401(2).
    ``(d) The regulations of the Office shall provide for the beginning 
and ending dates of coverage of employees, annuitants, former spouses, 
and other eligible individuals under this chapter, and any requirements 
for continuation or conversion of coverage.
``Sec. 9011. Authorization of appropriations
    ``There are authorized to be appropriated such sums as may be 
necessary for the purposes of carrying out sections 9002 and 9010.''.

SEC. 3. EFFECTIVE DATE.

    The amendments made by this Act shall take effect on the date of 
enactment of this Act, except that no coverage may be effective until 
the first day of the first applicable pay period in October, which 
occurs more than 1 year after the date of enactment of this Act.
                                 <all>
```