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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.
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
Group Long-Term Care Insurance Act of 1999’’.
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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 chap-
ter:
‘‘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.
‘‘§ 9001. Definitions
‘‘For the purpose of this chapter—
‘‘(1) ‘annuitant’ means an individual referred to
in section 8901(3);
‘‘(2) ‘employee’ means an individual referred to
in subparagraphs (A)–(D), and (F)–(I) of section
8901(1); but does not include an employee excluded
by regulation of the Office under section 9011;
‘‘(3) ‘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;
‘‘(4) ‘Office’ means the Office of Personnel
Management;
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‘‘(5) ‘qualified carrier’ means an insurer li-
censed 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 meet-
ing the conditions prescribed in section 9002; and
‘‘(7) ‘State’ means a State or territory or pos-
session of the United States, and includes the Dis-
trict of Columbia.
‘‘§ 9002. Contracting authority
‘‘(a) The Office may, without regard to section 5 of
title 41 or any other statute requiring competitive bidding,
purchase from one or more qualified carriers a policy or
policies of group long-term care insurance to provide bene-
fits as specified by this chapter. The Office, however, shall
ensure that each resulting contract is awarded on the basis
of contractor qualifications, price, and reasonable competi-
tion to the maximum extent practicable.
‘‘(b) The Office may design a benefits package or
packages and negotiate final offerings with qualified car-
riers.
‘‘(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
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the benefits provided under that contract as determined
by the Office.
‘‘(e) The coverage and benefits made available to in-
dividuals 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, based on open season participa-
tion rates, the composition of the risk pool, or both, with-
draw the product.
‘‘§ 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 im-
posed on issuers of qualified long-term care con-
tracts by section 4980C of the Internal Revenue
Code of 1986.
‘‘§ 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.
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‘‘§ 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 by 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 annu-
ity, as appropriate.
‘‘(d) An employee, annuitant, or other eligible individ-
ual, whose pay or annuity is insufficient to cover the with-
holding 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 estab-
lished by this 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 administra-
tion of this chapter.
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‘‘§ 9006. Preemption
‘‘The provisions of 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 Asso-
ciation of Insurance Commissioners, the efficient
provision of a nationwide long-term care insurance
program for Federal employees.
‘‘§ 9007. Studies, reports, and audits
‘‘(a) Each qualified carrier entering into a contract
under this chapter shall—
‘‘(1) furnish such reasonable reports as the Of-
fice determines to be necessary to enable it to carry
out its 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 car-
rier, or both, with such information and reports as the
Office may require.
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‘‘§ 9008. Claims for benefits
‘‘(a) A claim for benefits under this chapter shall be
filed within 4 years of the date on which the reimbursable
cost was incurred or the service was provided.
‘‘(b) The Office shall adjudicate a claims dispute aris-
ing under this chapter and shall require the contractor to
pay for any benefit or provide any service the Office deter-
mines appropriate under the applicable contract.
‘‘(c)(1) Except as provided in paragraph (2), benefits
payable under this chapter for any reimbursable cost in-
curred or service provided are secondary to any other ben-
efit payable for such cost or service. no payment may be
made where there is no legal obligation for such payment.
‘‘(2) Benefits payable under the following programs
shall be secondary to benefits payable under this chapter:
‘‘(A) The program of medical assistance under
title XIX of the Social Security Act; and
‘‘(B) 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.
‘‘§ 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.
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erage may be effective until the first day of the first pay
period in October, which follows by more than 1 year the
date of enactment of this Act.
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