108TH CONGRESS

2D SESSION H. R. 5295

AN ACT

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.
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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 Dental and Vision Benefits Enhancement Act of 2004’’.

6 SEC. 2. ENHANCED DENTAL BENEFITS.

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

8 is amended by inserting after chapter 89 the following:

9 ‘‘CHAPTER 89A—ENHANCED DENTAL

10 BENEFITS

‘‘Sec.

‘‘8921. Definitions.

‘‘8922. Availability of dental benefits.

‘‘8923. Contracting authority.

‘‘8924. Benefits.

‘‘8925. Information to individuals eligible to enroll.

‘‘8926. Election of coverage.

‘‘8927. Coverage of restored survivor or disability annuitants.

‘‘8928. Premiums.

‘‘8929. Preemption.

‘‘8930. Studies, reports, and audits.

‘‘8931. Jurisdiction of courts.

‘‘8932. Administrative functions.

11 ‘‘§ 8921. Definitions

12 ‘‘In this chapter:

13 ‘‘(1) The term ‘employee’ means an employee,

14 as defined by section 8901(1).

15 ‘‘(2) The terms ‘annuitant’, ‘member of family’,

16 and ‘dependent’ have the meanings given such terms

17 by section 8901.

18 ‘‘(3) The term ‘eligible individual’ refers to an

19 individual described in paragraph (1) or (2), without
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1 regard to whether the individual is enrolled in a

2 health benefits plan under chapter 89.

3 ‘‘(4) The term ‘Office’ means the Office of Per4 sonnel Management.

5 ‘‘(5) The term ‘qualified company’ means a

6 company (or consortium of companies) that offers

7 indemnity, preferred provider organization, health

8 maintenance organization, or discount dental pro9 grams, and, if required, is licensed to issue applica10 ble coverage in any number of States, taking any

11 subsidiaries of such a company into account (and, in

12 the case of a consortium, considering the member

13 companies and any subsidiaries thereof, collectively).

14 ‘‘(6) The term ‘employee organization’ means

15 an association or other organization of employees

16 which is national in scope, or in which membership

17 is open to all employees of a Government agency

18 who are eligible to enroll in a health benefits plan

19 under chapter 89.

20 ‘‘(7) The term ‘State’ includes the District of

21 Columbia.

22 ‘‘§ 8922. Availability of dental benefits

23 ‘‘(a) The Office shall establish and administer a pro24 gram through which an eligible individual may obtain den-
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1 tal coverage to supplement coverage available through

2 chapter 89.

3 ‘‘(b) The Office shall determine, in the exercise of its

4 reasonable discretion, the financial requirements for quali5 fied companies to participate in the program.

6 ‘‘(c) Nothing in this chapter shall be construed to

7 prohibit the availability of dental benefits provided by

8 health benefits plans under chapter 89.

9 ‘‘§ 8923. Contracting authority

10 ‘‘(a)(1) The Office shall contract with a reasonable

11 number of qualified companies for a policy or policies of

12 benefits described under section 8924, without regard to

13 section 5 of title 41 or any other statute requiring com14 petitive bidding. An employee organization may contract

15 with a qualified company for the purpose of participating

16 with that qualified company in any contract between the

17 Office and that qualified company.

18 ‘‘(2) The Office shall ensure that each resulting con19 tract is awarded on the basis of contractor qualifications,

20 price, and reasonable competition.

21 ‘‘(b) Each contract under this section shall contain—

22 ‘‘(1) the requirements under section 8902 (d),

23 (f), and (i) made applicable to contracts under this

24 section by regulations prescribed by the Office;

25 ‘‘(2) the terms of the enrollment period; and
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1 ‘‘(3) such other terms and conditions as may be

2 mutually agreed to by the Office and the qualified

3 company involved, consistent with the requirements

4 of this chapter and regulations prescribed by the Of5 fice.

6 ‘‘(c) Nothing in this chapter shall, in the case of an

7 individual electing dental supplemental benefit coverage

8 under this chapter after the expiration of such individual’s

9 first opportunity to enroll, preclude the application of

10 waiting periods more stringent than those that would have

11 applied if that opportunity had not yet expired.

12 ‘‘(d)(1) Each contract under this chapter shall re13 quire the qualified company to agree—

14 ‘‘(A) to provide payments or benefits to an eli15 gible individual if such individual is entitled thereto

16 under the terms of the contract; and

17 ‘‘(B) with respect to disputes regarding claims

18 for payments or benefits under the terms of the

19 contract—

20 ‘‘(i) to establish internal procedures de21 signed to expeditiously resolve such disputes;

22 and

23 ‘‘(ii) to establish, for disputes not resolved

24 through procedures under clause (i), procedures

25 for 1 or more alternative means of dispute reso-
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1 lution involving independent third-party review

2 under appropriate circumstances by entities

3 mutually acceptable to the Office and the quali4 fied company.

5 ‘‘(2) A determination by a qualified company as to

6 whether or not a particular individual is eligible to obtain

7 coverage under this chapter shall be subject to review only

8 to the extent and in the manner provided in the applicable

9 contract.

10 ‘‘(3) For purposes of applying the Contract Disputes

11 Act of 1978 to disputes arising under this chapter between

12 a qualified company and the Office—

13 ‘‘(A) the agency board having jurisdiction to de14 cide an appeal relative to such a dispute shall be

15 such board of contract appeals as the Director of the

16 Office of Personnel Management shall specify in

17 writing (after appropriate arrangements, as de18 scribed in section 8(c) of such Act); and

19 ‘‘(B) the district courts of the United States

20 shall have original jurisdiction, concurrent with the

21 United States Court of Federal Claims, of any ac22 tion described in section 10(a)(1) of such Act rel23 ative to such a dispute.
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1 ‘‘(e) Nothing in this section shall be considered to

2 grant authority for the Office or third-party reviewer to

3 change the terms of any contract under this chapter.

4 ‘‘(f) Contracts under this chapter shall be for a uni5 form term of 7 years and may not be renewed automati6 cally.

7 ‘‘§ 8924. Benefits

8 ‘‘(a) The Office may prescribe reasonable minimum

9 standards for enhanced dental benefits plans offered

10 under this chapter and for qualified companies offering

11 the plans.

12 ‘‘(b) Each contract may include more than 1 level of

13 benefits that shall be made available to all eligible individ14 uals.

15 ‘‘(c) The benefits to be provided under enhanced den16 tal benefits plans under this chapter may be of the fol17 lowing types:

18 ‘‘(1) Diagnostic.

19 ‘‘(2) Preventive.

20 ‘‘(3) Emergency care.

21 ‘‘(4) Restorative.

22 ‘‘(5) Oral and maxillofacial surgery.

23 ‘‘(6) Endodontics.

24 ‘‘(7) Periodontics.

25 ‘‘(8) Prosthodontics.
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1 ‘‘(9) Orthodontics.

2 ‘‘(d) A contract approved under this chapter shall re3 quire the qualified company to cover the geographic serv4 ice delivery specified by the Office. The Office shall require

5 qualified companies to include underserved areas (with re6 spect to dental services) in their service delivery areas.

7 ‘‘(e) If an individual has dental coverage under a

8 health benefits plan under chapter 89 and also has cov9 erage under a plan under this chapter, the health benefits

10 plan under chapter 89 shall be the first payor of any ben11 efit payments.

12 ‘‘§ 8925. Information to individuals eligible to enroll

13 ‘‘(a) The qualified companies, at the direction and

14 with the approval of the Office, shall make available to

15 each individual eligible to enroll in a dental benefits plan

16 information on services and benefits (including maxi17 mums, limitations, and exclusions) that the Office con18 siders necessary to enable the individual to make an in19 formed decision about electing coverage.

20 ‘‘(b) The Office shall make available to each indi21 vidual eligible to enroll in a dental benefits plan, informa22 tion on services and benefits provided by qualified compa23 nies participating under chapter 89.
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1 ‘‘§ 8926. Election of coverage

2 ‘‘(a) An eligible individual may enroll in a dental ben3 efits plan for self-only, self plus one, or for self and family.

4 If an eligible individual has a spouse who is also eligible

5 to enroll, either spouse, but not both, may enroll for self

6 plus one or self and family. An individual may not be en7 rolled both as an employee, annuitant, or other individual

8 eligible to enroll and as a member of the family.

9 ‘‘(b) The Office shall prescribe regulations under

10 which—

11 ‘‘(1) an eligible individual may enroll in a den12 tal benefits plan; and

13 ‘‘(2) an enrolled individual may change the self14 only, self plus one, or self and family coverage of

15 that individual.

16 ‘‘(c)(1) Regulations under subsection (b) shall permit

17 an eligible individual to cancel or transfer the enrollment

18 of that individual to another dental benefits plan—

19 ‘‘(A) before the start of any contract term in

20 which there is a change in rates charged or benefits

21 provided, in which a new plan is offered, or in which

22 an existing plan is terminated; or

23 ‘‘(B) during other times and under other cir24 cumstances specified by the Office.

25 ‘‘(2) A transfer under paragraph (1) shall be subject

26 to waiting periods provided under a new plan.
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1 ‘‘§ 8927. Coverage of restored survivor or disability

2 annuitants

3 ‘‘A surviving spouse, disability annuitant, or sur4 viving child whose annuity is terminated and later restored

5 may continue enrollment in a dental benefits plan, subject

6 to the terms and conditions prescribed in regulations

7 issued by the Office.

8 ‘‘§ 8928. Premiums

9 ‘‘(a) Each eligible individual obtaining supplemental

10 dental coverage under this chapter shall be responsible for

11 100 percent of the premiums for such coverage.

12 ‘‘(b) The Office shall prescribe regulations specifying

13 the terms and conditions under which individuals are re14 quired to pay the premiums for enrollment.

15 ‘‘(c) The amount necessary to pay the premiums for

16 enrollment may—

17 ‘‘(1) in the case of an employee, be withheld

18 from the pay of such an employee; and

19 ‘‘(2) in the case of an annuitant, be withheld

20 from the annuity of such an annuitant.

21 ‘‘(d) All amounts withheld under this section shall be

22 paid directly to the qualified company.

23 ‘‘(e) Each participating qualified company shall

24 maintain accounting records that contain such informa25 tion and reports as the Office may require.
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1 ‘‘(f)(1) The Employees Health Benefits Fund is

2 available, without fiscal year limitation, for reasonable ex3 penses incurred by the Office in administering this chapter

4 before the first day of the first contract period, including

5 reasonable implementation costs.

6 ‘‘(2)(A) There is established in the Employees Health

7 Benefits Fund a Dental Benefits Administrative Account,

8 which shall be available to the Office, without fiscal year

9 limitation, to defray reasonable expenses incurred by the

10 Office in administering this chapter after the start of the

11 first contract year.

12 ‘‘(B) A contract under this chapter shall include ap13 propriate provisions under which the qualified company in14 volved shall, during each year, make such periodic con15 tributions to the Dental Benefits Administrative Account

16 as necessary to ensure that the reasonable anticipated ex17 penses of the Office in administering this chapter during

18 such year are defrayed.

19 ‘‘§ 8929. Preemption

20 ‘‘The terms of any contract that relate to the nature,

21 provision, or extent of coverage or benefits (including pay22 ments with respect to benefits) shall supersede and pre23 empt any State or local law, or any regulation issued

24 thereunder, which relates to dental benefits, insurance,

25 plans, or contracts.
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1 ‘‘§ 8930. Studies, reports, and audits

2 ‘‘(a) Each contract shall contain provisions requiring

3 the qualified company—

4 ‘‘(1) to furnish such reasonable reports as the

5 Office determines to be necessary to enable it to

6 carry out its functions under this chapter; and

7 ‘‘(2) to permit the Office and representatives of

8 the Government Accountability Office to examine

9 such records of the qualified company as may be

10 necessary to carry out the purposes of this chapter.

11 ‘‘(b) Each Government agency shall keep such

12 records, make such certifications, and furnish the Office,

13 the qualified company, or both, with such information and

14 reports as the Office may require.

15 ‘‘(c) The Office shall conduct periodic reviews of

16 plans under this chapter, including a comparison of the

17 dental benefits available under chapter 89, to ensure the

18 competitiveness of plans under this chapter. The Office

19 shall cooperate with the Government Accountability Office

20 to provide periodic evaluations of the program.

21 ‘‘§ 8931. Jurisdiction of courts

22 ‘‘The district courts of the United States have origi23 nal jurisdiction, concurrent with the United States Court

24 of Federal Claims, of a civil action or claim against the

25 United States under this chapter after such administrative

26 remedies as required under section 8923(d) have been ex-
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1 hausted, but only to the extent judicial review is not pre2 cluded by any dispute resolution or other remedy under

3 this chapter.

4 ‘‘§ 8932. Administrative functions

5 ‘‘(a) The Office shall prescribe regulations to carry

6 out this chapter. The regulations may exclude an employee

7 on the basis of the nature and type of employment or con8 ditions pertaining to it.

9 ‘‘(b) The Office shall, as appropriate, provide for co10 ordinated enrollment, promotion, and education efforts as

11 appropriate in consultation with each qualified company.

12 The information under this subsection shall include infor13 mation relating to the dental benefits available under

14 chapter 89, including the advantages and disadvantages

15 of obtaining additional coverage under this chapter.’’.

16 SEC. 3. ENHANCED VISION BENEFITS.

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

18 is amended by inserting after chapter 89A (as added by

19 section 2) the following:

20 ‘‘CHAPTER 89B—ENHANCED VISION

21 BENEFITS

‘‘Sec.

‘‘8941. Definitions.

‘‘8942. Availability of vision benefits.

‘‘8943. Contracting authority.

‘‘8944. Benefits.

‘‘8945. Information to individuals eligible to enroll.

‘‘8946. Election of coverage.

‘‘8947. Coverage of restored survivor or disability annuitants.
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‘‘8948. Premiums.

‘‘8949. Preemption.

‘‘8950. Studies, reports, and audits.

‘‘8951. Jurisdiction of courts.

‘‘8952. Administrative functions.

1 ‘‘§ 8941. Definitions

2 ‘‘In this chapter:

3 ‘‘(1) The term ‘employee’ means an employee,

4 as defined by section 8901(1).

5 ‘‘(2) The terms ‘annuitant’, ‘member of family’,

6 and ‘dependent’ have the meanings given such terms

7 by section 8901.

8 ‘‘(3) The term ‘eligible individual’ refers to an

9 individual described in paragraph (1) or (2), without

10 regard to whether the individual is enrolled in a

11 health benefits plan under chapter 89.

12 ‘‘(4) The term ‘Office’ means the Office of Per13 sonnel Management.

14 ‘‘(5) The term ‘qualified company’ means a

15 company (or consortium of companies) that offers

16 indemnity, preferred provider organization, health

17 maintenance organization, or discount vision pro18 grams, and, if required, is licensed to issue applica19 ble coverage in any number of States, taking any

20 subsidiaries of such a company into account (and, in

21 the case of a consortium, considering the member

22 companies and any subsidiaries thereof, collectively).
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1 ‘‘(6) The term ‘employee organization’ means

2 an association or other organization of employees

3 which is national in scope, or in which membership

4 is open to all employees of a Government agency

5 who are eligible to enroll in a health benefits plan

6 under chapter 89.

7 ‘‘(7) The term ‘State’ includes the District of

8 Columbia.

9 ‘‘§ 8942. Availability of vision benefits

10 ‘‘(a) The Office shall establish and administer a pro11 gram through which an eligible individual may obtain vi12 sion coverage to supplement coverage available through

13 chapter 89.

14 ‘‘(b) The Office shall determine, in the exercise of its

15 reasonable discretion, the financial requirements for quali16 fied companies to participate in the program.

17 ‘‘(c) Nothing in this chapter shall be construed to

18 prohibit the availability of vision benefits provided by

19 health benefits plans under chapter 89.

20 ‘‘§ 8943. Contracting authority

21 ‘‘(a)(1) The Office shall contract with a reasonable

22 number of qualified companies for a policy or policies of

23 benefits described under section 8944, without regard to

24 section 5 of title 41 or any other statute requiring com25 petitive bidding. An employee organization may contract
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1 with a qualified company for the purpose of participating

2 with that qualified company in any contract between the

3 Office and that qualified company.

4 ‘‘(2) The Office shall ensure that each resulting con5 tract is awarded on the basis of contractor qualifications,

6 price, and reasonable competition.

7 ‘‘(b) Each contract under this section shall contain—

8 ‘‘(1) the requirements under section 8902 (d),

9 (f), and (i) made applicable to contracts under this

10 section by regulations prescribed by the Office;

11 ‘‘(2) the terms of the enrollment period; and

12 ‘‘(3) such other terms and conditions as may be

13 mutually agreed to by the Office and the qualified

14 company involved, consistent with the requirements

15 of this chapter and regulations prescribed by the Of16 fice.

17 ‘‘(c) Nothing in this chapter shall, in the case of an

18 individual electing vision supplemental benefit coverage

19 under this chapter after the expiration of such individual’s

20 first opportunity to enroll, preclude the application of

21 waiting periods more stringent than those that would have

22 applied if that opportunity had not yet expired.

23 ‘‘(d)(1) Each contract under this chapter shall re24 quire the qualified company to agree—
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1 ‘‘(A) to provide payments or benefits to an eli2 gible individual if such individual is entitled thereto

3 under the terms of the contract; and

4 ‘‘(B) with respect to disputes regarding claims

5 for payments or benefits under the terms of the

6 contract—

7 ‘‘(i) to establish internal procedures de8 signed to expeditiously resolve such disputes;

9 and

10 ‘‘(ii) to establish, for disputes not resolved

11 through procedures under clause (i), procedures

12 for 1 or more alternative means of dispute reso13 lution involving independent third-party review

14 under appropriate circumstances by entities

15 mutually acceptable to the Office and the quali16 fied company.

17 ‘‘(2) A determination by a qualified company as to

18 whether or not a particular individual is eligible to obtain

19 coverage under this chapter shall be subject to review only

20 to the extent and in the manner provided in the applicable

21 contract.

22 ‘‘(3) For purposes of applying the Contract Disputes

23 Act of 1978 to disputes arising under this chapter between

24 a qualified company and the Office—
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1 ‘‘(A) the agency board having jurisdiction to de2 cide an appeal relative to such a dispute shall be

3 such board of contract appeals as the Director of the

4 Office of Personnel Management shall specify in

5 writing (after appropriate arrangements, as de6 scribed in section 8(c) of such Act); and

7 ‘‘(B) the district courts of the United States

8 shall have original jurisdiction, concurrent with the

9 United States Court of Federal Claims, of any ac10 tion described in section 10(a)(1) of such Act rel11 ative to such a dispute.

12 ‘‘(e) Nothing in this section shall be considered to

13 grant authority for the Office or third-party reviewer to

14 change the terms of any contract under this chapter.

15 ‘‘(f) Contracts under this chapter shall be for a uni16 form term of 7 years and may not be renewed automati17 cally.

18 ‘‘§ 8944. Benefits

19 ‘‘(a) The Office may prescribe reasonable minimum

20 standards for enhanced vision benefits plans offered under

21 this chapter and for qualified companies offering the

22 plans.

23 ‘‘(b) Each contract may include more than 1 level of

24 benefits that shall be made available to all eligible individ25 uals.
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1 ‘‘(c) The benefits to be provided under enhanced vi2 sion benefits plans under this chapter may be of the fol3 lowing types:

4 ‘‘(1) Diagnostic (to include refractive services).

5 ‘‘(2) Preventive.

6 ‘‘(3) Eyewear.

7 ‘‘(d) A contract approved under this chapter shall re8 quire the qualified company to cover the geographic serv9 ice delivery specified by the Office. The Office shall require

10 qualified companies to include underserved areas (with re11 spect to vision services) in their service delivery areas.

12 ‘‘(e) If an individual has vision coverage under a

13 health benefits plan under chapter 89 and also has cov14 erage under a plan under this chapter, the health benefits

15 plan under chapter 89 shall be the first payor of any ben16 efit payments.

17 ‘‘§ 8945. Information to individuals eligible to enroll

18 ‘‘(a) The qualified companies, at the direction and

19 with the approval of the Office, shall make available to

20 each individual eligible to enroll in a vision benefits plan

21 information on services and benefits (including maxi22 mums, limitations, and exclusions) that the Office con23 siders necessary to enable the individual to make an in24 formed decision about electing coverage.
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1 ‘‘(b) The Office shall make available to each indi2 vidual eligible to enroll in a vision benefits plan, informa3 tion on services and benefits provided by qualified compa4 nies participating under chapter 89.

5 ‘‘§ 8946. Election of coverage

6 ‘‘(a) An eligible individual may enroll in a vision bene7 fits plan for self-only, self plus one, or for self and family.

8 If an eligible individual has a spouse who is also eligible

9 to enroll, either spouse, but not both, may enroll for self

10 plus one or self and family. An individual may not be en11 rolled both as an employee, annuitant, or other individual

12 eligible to enroll and as a member of the family.

13 ‘‘(b) The Office shall prescribe regulations under

14 which—

15 ‘‘(1) an eligible individual may enroll in a vision

16 benefits plan; and

17 ‘‘(2) an enrolled individual may change the self18 only, self plus one, or self and family coverage of

19 that individual.

20 ‘‘(c)(1) Regulations under subsection (b) shall permit

21 an eligible individual to cancel or transfer the enrollment

22 of that individual to another vision benefits plan—

23 ‘‘(A) before the start of any contract term in

24 which there is a change in rates charged or benefits
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1 provided, in which a new plan is offered, or in which

2 an existing plan is terminated; or

3 ‘‘(B) during other times and under other cir4 cumstances specified by the Office.

5 ‘‘(2) A transfer under paragraph (1) shall be subject

6 to waiting periods provided under a new plan.

7 ‘‘§ 8947. Coverage of restored survivor or disability

8 annuitants

9 ‘‘A surviving spouse, disability annuitant, or sur10 viving child whose annuity is terminated and later restored

11 may continue enrollment in a vision benefits plan, subject

12 to the terms and conditions prescribed in regulations

13 issued by the Office.

14 ‘‘§ 8948. Premiums

15 ‘‘(a) Each eligible individual obtaining supplemental

16 vision coverage under this chapter shall be responsible for

17 100 percent of the premiums for such coverage.

18 ‘‘(b) The Office shall prescribe regulations specifying

19 the terms and conditions under which individuals are re20 quired to pay the premiums for enrollment.

21 ‘‘(c) The amount necessary to pay the premiums for

22 enrollment may—

23 ‘‘(1) in the case of an employee, be withheld

24 from the pay of such an employee; and
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1 ‘‘(2) in the case of an annuitant, be withheld

2 from the annuity of such an annuitant.

3 ‘‘(d) All amounts withheld under this section shall be

4 paid directly to the qualified company.

5 ‘‘(e) Each participating qualified company shall

6 maintain accounting records that contain such informa7 tion and reports as the Office may require.

8 ‘‘(f)(1) The Employees Health Benefits Fund is

9 available, without fiscal year limitation, for reasonable ex10 penses incurred by the Office in administering this chapter

11 before the first day of the first contract period, including

12 reasonable implementation costs.

13 ‘‘(2)(A) There is established in the Employees Health

14 Benefits Fund a Vision Benefits Administrative Account,

15 which shall be available to the Office, without fiscal year

16 limitation, to defray reasonable expenses incurred by the

17 Office in administering this chapter after the start of the

18 first contract year.

19 ‘‘(B) A contract under this chapter shall include ap20 propriate provisions under which the qualified company in21 volved shall, during each year, make such periodic con22 tributions to the Vision Benefits Administrative Account

23 as necessary to ensure that the reasonable anticipated ex24 penses of the Office in administering this chapter during

25 such year are defrayed.
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1 ‘‘§ 8949. Preemption

2 ‘‘The terms of any contract that relate to the nature,

3 provision, or extent of coverage or benefits (including pay4 ments with respect to benefits) shall supersede and pre5 empt any State or local law, or any regulation issued

6 thereunder, which relates to vision benefits, insurance,

7 plans, or contracts.

8 ‘‘§ 8950. Studies, reports, and audits

9 ‘‘(a) Each contract shall contain provisions requiring

10 the qualified company—

11 ‘‘(1) to furnish such reasonable reports as the

12 Office determines to be necessary to enable it to

13 carry out its functions under this chapter; and

14 ‘‘(2) to permit the Office and representatives of

15 the Government Accountability Office to examine

16 such records of the qualified company as may be

17 necessary to carry out the purposes of this chapter.

18 ‘‘(b) Each Government agency shall keep such

19 records, make such certifications, and furnish the Office,

20 the qualified company, or both, with such information and

21 reports as the Office may require.

22 ‘‘(c) The Office shall conduct periodic reviews of

23 plans under this chapter, including a comparison of the

24 vision benefits available under chapter 89, to ensure the

25 competitiveness of plans under this chapter. The Office
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1 shall cooperate with the Government Accountability Office

2 to provide periodic evaluations of the program.

3 ‘‘§ 8951. Jurisdiction of courts

4 ‘‘The district courts of the United States have origi5 nal jurisdiction, concurrent with the United States Court

6 of Federal Claims, of a civil action or claim against the

7 United States under this chapter after such administrative

8 remedies as required under section 8943(d) have been ex9 hausted, but only to the extent judicial review is not pre10 cluded by any dispute resolution or other remedy under

11 this chapter.

12 ‘‘§ 8952. Administrative functions

13 ‘‘(a) The Office shall prescribe regulations to carry

14 out this chapter. The regulations may exclude an employee

15 on the basis of the nature and type of employment or con16 ditions pertaining to it.

17 ‘‘(b) The Office shall, as appropriate, provide for co18 ordinated enrollment, promotion, and education efforts as

19 appropriate in consultation with each qualified company.

20 The information under this subsection shall include infor21 mation relating to the vision benefits available under chap22 ter 89, including the advantages and disadvantages of ob23 taining additional coverage under this chapter.’’.
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1 SEC. 4. TECHNICAL AND CONFORMING AMENDMENT.

2 The table of chapters for part III of title 5, United

3 States Code, is amended by inserting after the item relat4 ing to chapter 89 the following:

‘‘89A. Enhanced Dental Benefits ............................................................. 8921

‘‘89B. Enhanced Vision Benefits .............................................................. 8941’’.

5 SEC. 5. APPLICATION TO POSTAL SERVICE EMPLOYEES.

6 Section 1005(f) of title 39, United States Code, is

7 amended in the second sentence by striking ‘‘chapters 87

8 and 89’’ and inserting ‘‘chapters 87, 89, 89A, and 89B’’.

9 SEC. 6. SENSE OF CONGRESS.

10 (a) FINDINGS.—Congress finds that—

11 (1) oral and vision health and general health

12 and well-being are inseparable, and access to dental

13 and vision services is an essential factor in maintain14 ing good health;

15 (2) Federal employees and their families de16 serve and desire additional coverage options and

17 place value on maintaining good oral and vision

18 health; and

19 (3) it is in the interest of the Federal Govern20 ment to remain competitive in attracting and retain21 ing highly skilled employees and taking reasonable

22 steps to ensure the health and well-being of its em23 ployees.
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1 (b) SENSE OF CONGRESS.—It is the sense of Con2 gress that health insurance benefits available to Federal

3 employees should be sufficient to promote the health and

4 productivity of all Federal workers and to support the re5 cruitment and retention of a highly qualified workforce.

6 To help achieve these goals, Congress should evaluate the

7 supplemental plans established under the this Act to de8 termine the options for and feasibility of providing an em9 ployer contribution.

10 SEC. 7. REQUIREMENT TO STUDY HEALTH BENEFITS COV11 ERAGE FOR DEPENDENT CHILDREN WHO

12 ARE FULL-TIME STUDENTS.

13 Not later than 6 months after the date of enactment

14 of this Act, the Office of Personnel Management shall sub15 mit to Congress a report describing and evaluating options

16 whereby benefits under chapter 89 of title 5, United

17 States Code, could be made available to an unmarried de18 pendent child under 25 years of age who is enrolled as

19 a full-time student at an institution of higher education,

20 as defined under section 101 of the Higher Education Act

21 of 1965 (20 U.S.C. 1001).

22 SEC. 8. HEARING BENEFITS REPORTING REQUIREMENT.

23 (a) IN GENERAL.—Not later than 6 months after the

24 date of enactment of this Act, the Office of Personnel

25 Management shall submit to Congress a report describing
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1 and evaluating options whereby additional hearing benefits

2 could be made available to—

3 (1) Federal employees and annuitants;

4 (2) qualified relatives of Federal employees and

5 annuitants; and

6 (3) other appropriate classes of individuals.

7 (b) REQUIRED CONTENT.—The report shall

8 include—

9 (1) a description of the hearing benefits cur10 rently available under the Federal employees health

11 benefits program;

12 (2) a description of any hearing plans currently

13 offered by carriers participating in the Federal em14 ployees health benefits program;

15 (3) a description of specific hearing benefits

16 that could be offered in addition to those described

17 in paragraphs (1) and (2), including any maximums,

18 limitations, exclusions, and definitions that might be

19 relevant;

20 (4) a description of the specific classes of indi21 viduals (as referred to generally in paragraphs (1)

22 through (3) of subsection (a)) to whom those addi23 tional benefits should be made available, including

24 any definitions and other terms or conditions that

25 might be relevant;
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1 (5) a description and assessment of the various

2 contracting arrangements by which the Government

3 could make those additional benefits available, in4 cluding whether such benefits should be contracted

5 for on a regional or national basis;

6 (6) the estimated cost of those additional bene7 fits, including an analysis relating to whether any

8 regular Government contributions or allocation for

9 start-up costs might be necessary or appropriate;

10 (7) a description of how those additional bene11 fits could be made available through—

12 (A) the Federal employees health benefits

13 program;

14 (B) one or more plans outside the Federal

15 employees health benefits program, including

16 supplemental plans referred to in paragraph

17 (2);

18 (C) the program described in subpara19 graph (A) in combination with one or more of

20 the plans described in subparagraph (B); and

21 (D) any other hearing coverage delivery

22 method;

23 (8) an analysis of the advantages and disadvan24 tages associated with the alternatives described

25 under paragraph (7), including—
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1 (A) the relative cost effectiveness and effi2 ciency of each;

3 (B) the likely impact of each alternative on

4 the overall attractiveness of the Federal employ5 ees health benefits program to individuals eligi6 ble to enroll, particularly Federal employees

7 and annuitants; and

8 (C) the extent to which each alternative

9 might affect the relative competitiveness of the

10 various carriers and plans currently partici11 pating in the Federal employees health benefits

12 program (including as a provider of supple13 mental benefits);

14 (9) a recommendation from the Office as to its

15 preferred method or methods for providing those ad16 ditional benefits; and

17 (10) any proposed legislation or other measures

18 the Office considers necessary in order to implement

19 any of the foregoing.

20 SEC. 9. EFFECTIVE DATE.

21 The amendments made by this Act shall take effect

22 on the date of enactment of this Act and shall apply to
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1 contracts that take effect in any year beginning after De2 cember 31, 2005.

Passed the House of Representatives October 8,

2004.

Attest:

Clerk.
108TH CONGRESS

2D SESSION H. R. 5295

AN ACT

To amend part III of title 5, United States Code,

Management, and for other purposes.tracting authority of the Office of Personneltirees, and their dependents, to expand the conefits are made available to Federal employees, reunder which supplemental dental and vision bento provide for the establishment of programs