Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Federal Employees
Dental and Vision Benefits Enhancement Act of 2004’’.
SEC. 2. ENHANCED DENTAL BENEFITS.
Subpart G of part III of title 5, United States Code,
is amended by inserting after chapter 89 the following:
‘‘CHAPTER 89A—ENHANCED DENTAL
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.
‘‘§ 8921. Definitions
‘‘In this chapter:
‘‘(1) The term ‘employee’ means an employee,
as defined by section 8901(1).
‘‘(2) The terms ‘annuitant’, ‘member of family’,
and ‘dependent’ have the meanings given such terms
by section 8901.
‘‘(3) The term ‘eligible individual’ refers to an
individual described in paragraph (1) or (2), without
regard to whether the individual is enrolled in a
health benefits plan under chapter 89.
‘‘(4) The term ‘Office’ means the Office of Per-
sonnel Management.
‘‘(5) The term ‘qualified company’ means a
company (or consortium of companies) that offers
indemnity, preferred provider organization, health
maintenance organization, or discount dental pro-
grams, and, if required, is licensed to issue applica-
ble coverage in any number of States, taking any
subsidiaries of such a company into account (and, in
the case of a consortium, considering the member
companies and any subsidiaries thereof, collectively).
‘‘(6) The term ‘employee organization’ means
an association or other organization of employees
which is national in scope, or in which membership
is open to all employees of a Government agency
who are eligible to enroll in a health benefits plan
under chapter 89.
‘‘(7) The term ‘State’ includes the District of
Columbia.
‘‘§ 8922. Availability of dental benefits
‘‘(a) The Office shall establish and administer a pro-
gram through which an eligible individual may obtain den-
tal coverage to supplement coverage available through
chapter 89.
‘‘(b) The Office shall determine, in the exercise of its
reasonable discretion, the financial requirements for quali-
fied companies to participate in the program.
‘‘(c) Nothing in this chapter shall be construed to
prohibit the availability of dental benefits provided by
health benefits plans under chapter 89.
‘‘§ 8923. Contracting authority
‘‘(a)(1) The Office shall contract with a reasonable
number of qualified companies for a policy or policies of
benefits described under section 8924, without regard to
section 5 of title 41 or any other statute requiring com-
petitive bidding. An employee organization may contract
with a qualified company for the purpose of participating
with that qualified company in any contract between the
Office and that qualified company.
‘‘(2) The Office shall ensure that each resulting con-
tract is awarded on the basis of contractor qualifications,
price, and reasonable competition.
‘‘(b) Each contract under this section shall contain—
‘‘(1) the requirements under section 8902 (d),
(f), and (i) made applicable to contracts under this
section by regulations prescribed by the Office;
‘‘(2) the terms of the enrollment period; and
‘‘(3) such other terms and conditions as may be
mutually agreed to by the Office and the qualified
company involved, consistent with the requirements
of this chapter and regulations prescribed by the Of-
fice.
‘‘(c) Nothing in this chapter shall, in the case of an
individual electing dental supplemental benefit coverage
under this chapter after the expiration of such individual’s
first opportunity to enroll, preclude the application of
waiting periods more stringent than those that would have
applied if that opportunity had not yet expired.
‘‘(d)(1) Each contract under this chapter shall re-
quire the qualified company to agree—
‘‘(A) to provide payments or benefits to an eli-
gible individual if such individual is entitled thereto
under the terms of the contract; and
‘‘(B) with respect to disputes regarding claims
for payments or benefits under the terms of the
contract—
‘‘(i) to establish internal procedures de-
signed to expeditiously resolve such disputes;
and
‘‘(ii) to establish, for disputes not resolved
through procedures under clause (i), procedures
for 1 or more alternative means of dispute reso-
lution involving independent third-party review
under appropriate circumstances by entities
mutually acceptable to the Office and the quali-
fied company.
‘‘(2) A determination by a qualified company as to
whether or not a particular individual is eligible to obtain
coverage under this chapter shall be subject to review only
to the extent and in the manner provided in the applicable
contract.
‘‘(3) For purposes of applying the Contract Disputes
Act of 1978 to disputes arising under this chapter between
a qualified company and the Office—
‘‘(A) the agency board having jurisdiction to de-
cide an appeal relative to such a dispute shall be
such board of contract appeals as the Director of the
Office of Personnel Management shall specify in
writing (after appropriate arrangements, as de-
scribed in section 8(c) of such Act); and
‘‘(B) the district courts of the United States
shall have original jurisdiction, concurrent with the
United States Court of Federal Claims, of any ac-
tion described in section 10(a)(1) of such Act rel-
ative to such a dispute.
‘‘(e) Nothing in this section shall be considered to
grant authority for the Office or third-party reviewer to
change the terms of any contract under this chapter.
‘‘(f) Contracts under this chapter shall be for a uni-
form term of 7 years and may not be renewed automati-
cally.
‘‘§ 8924. Benefits
‘‘(a) The Office may prescribe reasonable minimum
standards for enhanced dental benefits plans offered
under this chapter and for qualified companies offering
the plans.
‘‘(b) Each contract may include more than 1 level of
benefits that shall be made available to all eligible individ-
uals.
‘‘(c) The benefits to be provided under enhanced den-
tal benefits plans under this chapter may be of the fol-
lowing types:
‘‘(1) Diagnostic.
‘‘(2) Preventive.
‘‘(3) Emergency care.
‘‘(4) Restorative.
‘‘(5) Oral and maxillofacial surgery.
‘‘(6) Endodontics.
‘‘(7) Periodontics.
‘‘(8) Prosthodontics.
‘‘(9) Orthodontics.
‘‘(d) A contract approved under this chapter shall re-
quire the qualified company to cover the geographic serv-
ice delivery specified by the Office. The Office shall require
qualified companies to include underserved areas (with re-
spect to dental services) in their service delivery areas.
‘‘(e) If an individual has dental coverage under a
health benefits plan under chapter 89 and also has cov-
erage under a plan under this chapter, the health benefits
plan under chapter 89 shall be the first payor of any ben-
efit payments.
‘‘§ 8925. Information to individuals eligible to enroll
‘‘(a) The qualified companies, at the direction and
with the approval of the Office, shall make available to
each individual eligible to enroll in a dental benefits plan
information on services and benefits (including maxi-
mums, limitations, and exclusions) that the Office con-
siders necessary to enable the individual to make an in-
formed decision about electing coverage.
‘‘(b) The Office shall make available to each indi-
vidual eligible to enroll in a dental benefits plan, informa-
tion on services and benefits provided by qualified compa-
nies participating under chapter 89.
‘‘§ 8930. Studies, reports, and audits
‘‘(a) Each contract shall contain provisions requiring
the qualified company—
‘‘(1) to furnish such reasonable reports as the
Office determines to be necessary to enable it to
carry out its functions under this chapter; and
‘‘(2) to permit the Office and representatives of
the Government Accountability Office to examine
such records of the qualified company as may be
necessary to carry out the purposes of this chapter.
‘‘(b) Each Government agency shall keep such
records, make such certifications, and furnish the Office,
the qualified company, or both, with such information and
reports as the Office may require.
‘‘(c) The Office shall conduct periodic reviews of
plans under this chapter, including a comparison of the
dental benefits available under chapter 89, to ensure the
competitiveness of plans under this chapter. The Office
shall cooperate with the Government Accountability Office
to provide periodic evaluations of the program.
‘‘§ 8931. Jurisdiction of courts
‘‘The district courts of the United States have origi-
nal jurisdiction, concurrent with the United States Court
of Federal Claims, of a civil action or claim against the
United States under this chapter after such administrative
remedies as required under section 8923(d) have been ex-
hausted, but only to the extent judicial review is not pre-
cluded by any dispute resolution or other remedy under
this chapter.
‘‘§ 8932. Administrative functions
‘‘(a) The Office shall prescribe regulations to carry
out this chapter. The regulations may exclude an employee
on the basis of the nature and type of employment or con-
ditions pertaining to it.
‘‘(b) The Office shall, as appropriate, provide for co-
ordinated enrollment, promotion, and education efforts as
appropriate in consultation with each qualified company.
The information under this subsection shall include infor-
mation relating to the dental benefits available under
chapter 89, including the advantages and disadvantages
of obtaining additional coverage under this chapter.’’.
SEC. 3. ENHANCED VISION BENEFITS.
Subpart G of part III of title 5, United States Code,
is amended by inserting after chapter 89A (as added by
section 2) the following:
‘‘CHAPTER 89B—ENHANCED VISION
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.
‘‘8948. Premiums.
‘‘8949. Preemption.
‘‘8950. Studies, reports, and audits.
‘‘8951. Jurisdiction of courts.
‘‘8952. Administrative functions.
‘‘§ 8941. Definitions
‘‘In this chapter:
‘‘(1) The term ‘employee’ means an employee,
as defined by section 8901(1).
‘‘(2) The terms ‘annuitant’, ‘member of family’,
and ‘dependent’ have the meanings given such terms
by section 8901.
‘‘(3) The term ‘eligible individual’ refers to an
individual described in paragraph (1) or (2), without
regard to whether the individual is enrolled in a
health benefits plan under chapter 89.
‘‘(4) The term ‘Office’ means the Office of Per-
sonnel Management.
‘‘(5) The term ‘qualified company’ means a
company (or consortium of companies) that offers
indemnity, preferred provider organization, health
maintenance organization, or discount vision pro-
grams, and, if required, is licensed to issue applica-
ble coverage in any number of States, taking any
subsidiaries of such a company into account (and, in
the case of a consortium, considering the member
companies and any subsidiaries thereof, collectively).
‘‘(6) The term ‘employee organization’ means
an association or other organization of employees
which is national in scope, or in which membership
is open to all employees of a Government agency
who are eligible to enroll in a health benefits plan
under chapter 89.
‘‘(7) The term ‘State’ includes the District of
Columbia.
‘‘§ 8942. Availability of vision benefits
‘‘(a) The Office shall establish and administer a pro-
gram through which an eligible individual may obtain vi-
sion coverage to supplement coverage available through
chapter 89.
‘‘(b) The Office shall determine, in the exercise of its
reasonable discretion, the financial requirements for quali-
fied companies to participate in the program.
‘‘(c) Nothing in this chapter shall be construed to
prohibit the availability of vision benefits provided by
health benefits plans under chapter 89.
‘‘§ 8943. Contracting authority
‘‘(a)(1) The Office shall contract with a reasonable
number of qualified companies for a policy or policies of
benefits described under section 8944, without regard to
section 5 of title 41 or any other statute requiring com-
petitive bidding. An employee organization may contract
with a qualified company for the purpose of participating
with that qualified company in any contract between the
Office and that qualified company.
‘‘(2) The Office shall ensure that each resulting con-
tract is awarded on the basis of contractor qualifications,
price, and reasonable competition.
‘‘(b) Each contract under this section shall contain—
‘‘(1) the requirements under section 8902 (d),
(f), and (i) made applicable to contracts under this
section by regulations prescribed by the Office;
‘‘(2) the terms of the enrollment period; and
‘‘(3) such other terms and conditions as may be
mutually agreed to by the Office and the qualified
company involved, consistent with the requirements
of this chapter and regulations prescribed by the Of-
fice.
‘‘(c) Nothing in this chapter shall, in the case of an
individual electing vision supplemental benefit coverage
under this chapter after the expiration of such individual’s
first opportunity to enroll, preclude the application of
waiting periods more stringent than those that would have
applied if that opportunity had not yet expired.
‘‘(d)(1) Each contract under this chapter shall re-
quire the qualified company to agree—
‘‘(A) to provide payments or benefits to an eli-
gible individual if such individual is entitled thereto
under the terms of the contract; and
‘‘(B) with respect to disputes regarding claims
for payments or benefits under the terms of the
contract—
‘‘(i) to establish internal procedures de-
signed to expeditiously resolve such disputes;
and
‘‘(ii) to establish, for disputes not resolved
through procedures under clause (i), procedures
for 1 or more alternative means of dispute reso-
lution involving independent third-party review
under appropriate circumstances by entities
mutually acceptable to the Office and the quali-
fied company.
‘‘(2) A determination by a qualified company as to
whether or not a particular individual is eligible to obtain
coverage under this chapter shall be subject to review only
to the extent and in the manner provided in the applicable
contract.
‘‘(3) For purposes of applying the Contract Disputes
Act of 1978 to disputes arising under this chapter between
a qualified company and the Office—
‘‘(A) the agency board having jurisdiction to de-
cide an appeal relative to such a dispute shall be
such board of contract appeals as the Director of the
Office of Personnel Management shall specify in
writing (after appropriate arrangements, as de-
scribed in section 8(c) of such Act); and
‘‘(B) the district courts of the United States
shall have original jurisdiction, concurrent with the
United States Court of Federal Claims, of any ac-
tion described in section 10(a)(1) of such Act rel-
ative to such a dispute.
‘‘(e) Nothing in this section shall be considered to
grant authority for the Office or third-party reviewer to
change the terms of any contract under this chapter.
‘‘(f) Contracts under this chapter shall be for a uni-
form term of 7 years and may not be renewed automati-
cally.
‘‘§ 8944. Benefits
‘‘(a) The Office may prescribe reasonable minimum
standards for enhanced vision benefits plans offered under
this chapter and for qualified companies offering the
plans.
‘‘(b) Each contract may include more than 1 level of
benefits that shall be made available to all eligible individ-
uals.
‘‘(2) in the case of an annuitant, be withheld
from the annuity of such an annuitant.
‘‘(d) All amounts withheld under this section shall be
paid directly to the qualified company.
‘‘(e) Each participating qualified company shall
maintain accounting records that contain such informa-
tion and reports as the Office may require.
‘‘(f)(1) The Employees Health Benefits Fund is
available, without fiscal year limitation, for reasonable ex-
penses incurred by the Office in administering this chapter
before the first day of the first contract period, including
reasonable implementation costs.
‘‘(2)(A) There is established in the Employees Health
Benefits Fund a Vision Benefits Administrative Account,
which shall be available to the Office, without fiscal year
limitation, to defray reasonable expenses incurred by the
Office in administering this chapter after the start of the
first contract year.
‘‘(B) A contract under this chapter shall include ap-
propriate provisions under which the qualified company in-
volved shall, during each year, make such periodic con-
tributions to the Vision Benefits Administrative Account
as necessary to ensure that the reasonable anticipated ex-
penses of the Office in administering this chapter during
such year are defrayed.
‘‘§ 8949. Preemption
‘‘The terms of any contract that relate to the nature,
provision, or extent of coverage or benefits (including pay-
ments with respect to benefits) shall supersede and pre-
empt any State or local law, or any regulation issued
thereunder, which relates to vision benefits, insurance,
plans, or contracts.
‘‘§ 8950. Studies, reports, and audits
‘‘(a) Each contract shall contain provisions requiring
the qualified company—
‘‘(1) to furnish such reasonable reports as the
Office determines to be necessary to enable it to
carry out its functions under this chapter; and
‘‘(2) to permit the Office and representatives of
the Government Accountability Office to examine
such records of the qualified company as may be
necessary to carry out the purposes of this chapter.
‘‘(b) Each Government agency shall keep such
records, make such certifications, and furnish the Office,
the qualified company, or both, with such information and
reports as the Office may require.
‘‘(c) The Office shall conduct periodic reviews of
plans under this chapter, including a comparison of the
vision benefits available under chapter 89, to ensure the
competitiveness of plans under this chapter. The Office
shall cooperate with the Government Accountability Office
to provide periodic evaluations of the program.
‘‘§ 8951. Jurisdiction of courts
‘‘The district courts of the United States have origi-
nal jurisdiction, concurrent with the United States Court
of Federal Claims, of a civil action or claim against the
United States under this chapter after such administrative
remedies as required under section 8943(d) have been ex-
hausted, but only to the extent judicial review is not pre-
cluded by any dispute resolution or other remedy under
this chapter.
‘‘§ 8952. Administrative functions
‘‘(a) The Office shall prescribe regulations to carry
out this chapter. The regulations may exclude an employee
on the basis of the nature and type of employment or con-
ditions pertaining to it.
‘‘(b) The Office shall, as appropriate, provide for co-
ordinated enrollment, promotion, and education efforts as
appropriate in consultation with each qualified company.
The information under this subsection shall include infor-
mation relating to the vision benefits available under chap-
ter 89, including the advantages and disadvantages of ob-
taining additional coverage under this chapter.’’.
SEC. 4. TECHNICAL AND CONFORMING AMENDMENT.
The table of chapters for part III of title 5, United
States Code, is amended by inserting after the item relat-
ing to chapter 89 the following:
‘‘89A. Enhanced Dental Benefits .............................................................
8921
‘‘89B. Enhanced Vision Benefits .............................................................. 8941’’.
SEC. 5. APPLICATION TO POSTAL SERVICE EMPLOYEES.
Section 1005(f) of title 39, United States Code, is
amended in the second sentence by striking ‘‘chapters 87
and 89’’ and inserting ‘‘chapters 87, 89, 89A, and 89B’’.
SEC. 6. SENSE OF CONGRESS.
(a) FINDINGS.—Congress finds that—
(1) oral and vision health and general health
and well-being are inseparable, and access to dental
and vision services is an essential factor in maintain-
ing good health;
(2) Federal employees and their families de-
serve and desire additional coverage options and
place value on maintaining good oral and vision
health; and
(3) it is in the interest of the Federal Govern-
ment to remain competitive in attracting and retain-
ing highly skilled employees and taking reasonable
steps to ensure the health and well-being of its em-
ployees.
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that health insurance benefits available to Federal
employees should be sufficient to promote the health and
productivity of all Federal workers and to support the re-
cruitment and retention of a highly qualified workforce.
To help achieve these goals, Congress should evaluate the
supplemental plans established under the this Act to de-
termine the options for and feasibility of providing an em-
ployer contribution.
SEC. 7. REQUIREMENT TO STUDY HEALTH BENEFITS COV-
ERAGE FOR DEPENDENT CHILDREN WHO
ARE FULL-TIME STUDENTS.
Not later than 6 months after the date of enactment
of this Act, the Office of Personnel Management shall sub-
mit to Congress a report describing and evaluating options
whereby benefits under chapter 89 of title 5, United
States Code, could be made available to an unmarried de-
pendent child under 25 years of age who is enrolled as
a full-time student at an institution of higher education,
as defined under section 101 of the Higher Education Act
of 1965 (20 U.S.C. 1001).
SEC. 8. HEARING BENEFITS REPORTING REQUIREMENT.
(a) IN GENERAL.—Not later than 6 months after the
date of enactment of this Act, the Office of Personnel
Management shall submit to Congress a report describing
and evaluating options whereby additional hearing benefits
could be made available to—
(1) Federal employees and annuitants;
(2) qualified relatives of Federal employees and
annuitants; and
(3) other appropriate classes of individuals.
(b) 
REQUIRED
CONTENT.—The 
report 
shall
include—
(1) a description of the hearing benefits cur-
rently available under the Federal employees health
benefits program;
(2) a description of any hearing plans currently
offered by carriers participating in the Federal em-
ployees health benefits program;
(3) a description of specific hearing benefits
that could be offered in addition to those described
in paragraphs (1) and (2), including any maximums,
limitations, exclusions, and definitions that might be
relevant;
(4) a description of the specific classes of indi-
viduals (as referred to generally in paragraphs (1)
through (3) of subsection (a)) to whom those addi-
tional benefits should be made available, including
any definitions and other terms or conditions that
might be relevant;
(A) the relative cost effectiveness and effi-
ciency of each;
(B) the likely impact of each alternative on
the overall attractiveness of the Federal employ-
ees health benefits program to individuals eligi-
ble to enroll, particularly Federal employees
and annuitants; and
(C) the extent to which each alternative
might affect the relative competitiveness of the
various carriers and plans currently partici-
pating in the Federal employees health benefits
program (including as a provider of supple-
mental benefits);
(9) a recommendation from the Office as to its
preferred method or methods for providing those ad-
ditional benefits; and
(10) any proposed legislation or other measures
the Office considers necessary in order to implement
any of the foregoing.
SEC. 9. EFFECTIVE DATE.
The amendments made by this Act shall take effect
on the date of enactment of this Act and shall apply to
contracts that take effect in any year beginning after De-
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,
to provide for the establishment of programs
under which supplemental dental and vision ben-
efits are made available to Federal employees, re-
tirees, and their dependents, to expand the con-
tracting authority of the Office of Personnel
Management, and for other purposes.