I
105TH CONGRESS
1ST SESSION
H. R. 1397
To provide health insurance benefits to certain former employees at defense
nuclear facilities of the Department of Energy for injuries caused by
exposure to ionizing radiation.
IN THE HOUSE OF REPRESENTATIVES
APRIL 17, 1997
Mr. SKAGGS (for himself, Mr. EVANS, and Mr. SANDERS) introduced the
following bill; which was referred to the Committee on Commerce
A BILL
To provide health insurance benefits to certain former em-
ployees at defense nuclear facilities of the Department
of Energy for injuries caused by exposure to ionizing
radiation.
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 ‘‘Defense Nuclear Work-
ers’ Health Insurance Act of 1997’’.
SEC. 2. HEALTH INSURANCE PROGRAM FOR CERTAIN
FORMER DEPARTMENT OF ENERGY EMPLOY-
EES EXPOSED TO IONIZING RADIATION.
(a) ESTABLISHMENT OF PROGRAM.—The Secretary
of Energy shall provide in accordance with this section for
payment to (or on behalf of) certain former Department
of Energy employees (described in subsection (b)) for all
reasonable expenses for certain health care services (de-
scribed in subsection (c)) incurred (whether through insur-
ance or out-of-pocket) above the threshold dollar amount
specified in subsection (d).
(b) FORMER EMPLOYEES COVERED.—An employee
described in this section is an individual who—
(1) was (but is no longer) employed at a De-
partment of Energy defense nuclear facility (as de-
fined in subsection (g)(3));
(2) while employed at that facility—
(A) received 10 REM or more total expo-
sure to ionizing radiation or 10 percent or more
of the maximum permissible body burden expo-
sure to ionizing radiation, or
(B) was employed for 5 years or more in
a building or facility in which radioactive mate-
rials were regularly stored, handled, processed,
or disposed of; and
(3) is not entitled to benefits under the Medi-
care Program.
(c) REASONABLE EXPENSES FOR CERTAIN HEALTH
CARE SERVICES COVERED.—
(1) IN GENERAL.—Reasonable expenses for cer-
tain health care services described in this subsection
are expenses in a reasonable amount for health care
services which are medically reasonable and nec-
essary for treatment of—
(A)(i) leukemia or cancer of the blood-
forming tissues (excluding chronic lymphocytic
leukemia),
(ii) multiple myeloma or muscle cancer af-
fecting the spinal cord, or lymphoma (other
than Hodgkin’s disease),
(iii) cancer of the thyroid, lung, breast,
brain or nervous system, bone, skin, prostate,
parathyroid glands, stomach, colon or rectum,
esophagus, bladder, urinary tract, pharynx,
pancreas, small intestine, bile ducts, gall blad-
der, or liver (except if cirrhosis or hepatitis B
is indicated); or
(iv) berylliosis; or
(B) another disease if the Secretary of En-
ergy (in consultation with the Secretary of
Health and Human Services) determines that
there is a reasonable medical certainty that
such disease could have been directly or indi-
rectly caused by an illness referred to in sub-
paragraph (A).
(2) 
DETERMINATION
OF
REASONABLE
AMOUNT.—In applying paragraph (1)—
(A) health care expenses shall be treated
as being ‘‘in a reasonable amount’’ based on a
typical 
payment 
methodology 
used 
under
FEHBP plans, and
(B) treatment of an illness shall be consid-
ered to be medically reasonable and necessary if
payment for such treatment can be expected to
be made under either an FEHBP plan or under
the Medicare Program.
(3) HEALTH
SERVICES
DEFINED.—In para-
graph (1), the term ‘‘health care services’’ means
health care items and services that are the type of
items and services for which benefits are made avail-
able either under an FEHBP plan or under the
Medicare Program and includes hospital services,
physicians services, outpatient prescription drugs,
hospice care, home health services, skilled nursing
facility services, and rehabilitation (inpatient and
outpatient) services.
(d) THRESHOLD DOLLAR AMOUNT.—The threshold
dollar amount specified in this subsection is $25,000 with
respect to any individual during the individual’s lifetime,
not counting expenses incurred before the date of the en-
actment of this Act.
(e) ADMINISTRATION.—The Secretary of Energy may
carry out this section directly, through a memorandum of
understanding with an appropriate Federal department or
agency, or through a contract with an appropriate health
insurance carrier or administrator.
(f) EFFECTIVE DATE.—The Secretary of Energy
shall establish the insurance program under this section
by not later than 6 months after the date of the enactment
of this Act. The program shall apply to expenses incurred
for services furnished on or after the date the program
first becomes effective.
(g) DEFINITIONS.—In this section:
(1) The term ‘‘FEHBP plan’’ means a health
plan typical of the health plans offered to Federal
employees and annuitants under chapter 89 of title
5, United States Code.