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5 U.S.C. § 8903a (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8903a. Additional health benefits plans
(a) In addition to any plan under section 8903 of this title, the Office of Personnel Management may contract for or approve one or more health benefits plans under this section.
(b) A plan under this section may not be contracted for or approved unless it—
(1) is sponsored or underwritten, and administered, in whole or substantial part, by an employee organization described in section 8901(8)(B) of this title;
(2) offers benefits of the types named by paragraph (1) or (2) of section 8904 of this title or both;
(3) provides for benefits only by paying for, or providing reimbursement for, the cost of such benefits (as provided for under paragraph (1) or (2) of section 8903 of this title) or a combination thereof; and
(4) is available only to individuals who, at the time of enrollment, are full members of the organization and to members of their families.
(c) A contract for a plan approved under this section shall require the carrier—
(1) to enter into an agreement approved by the Office with an underwriting subcontractor licensed to issue group health insurance in all the States and the District of Columbia; or
(2) to demonstrate ability to meet reasonable minimum financial standards prescribed by the Office.
(d) For the purpose of this section, an individual shall be considered a full member of an organization if such individual is eligible to exercise all rights and privileges incident to full membership in such organization (determined without regard to the right to hold elected office).
(Added Pub. L. 99–53, § 1(b)(1), June 17, 1985, 99 Stat. 93.)
5 U.S.C. § 8903b (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8903b. Authority to readmit an employee organization plan
(a) In the event that a plan described by section 8903(3) or 8903a is discontinued under this chapter (other than in the circumstance described in section 8909(d)), that discontinuation shall be disregarded, for purposes of any determination as to that plan’s eligibility to be considered an approved plan under this chapter, but only for purposes of any contract year later than the third contract year beginning after such plan is so discontinued.
(b) A contract for a plan approved under this section shall require the carrier—
(1) to demonstrate experience in service delivery within a managed care system (including provider networks) throughout the United States; and
(2) if the carrier involved would not otherwise be subject to the requirement set forth in section 8903a(c)(1), to satisfy such requirement.
(Added Pub. L. 105–266, § 6(a)(1), Oct. 19, 1998, 112 Stat. 2368.)
heading: Effective Date
text: Pub. L. 105–266, § 6(a)(3), Oct. 19, 1998, 112 Stat. 2369, provided that:
“(A) In general.—
The amendments made by this subsection [enacting this section] shall apply as of the date of the enactment of this Act [Oct. 19, 1998], including with respect to any plan which has been discontinued as of such date.
“(B) Transition rule.—
For purposes of applying section 8903b(a) of title 5, United States Code (as amended by this subsection) with respect to any plan seeking to be readmitted for purposes of any contract year beginning before January 1, 2000, such section shall be applied by substituting ‘second contract year’ for ‘third contract year’.”
5 U.S.C. § 8906a (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8906a. Temporary employees
(a)
(1) The Office of Personnel Management shall prescribe regulations to provide for offering health benefits plans to temporary employees (who meet the requirements of paragraph (2)) under the provisions of this chapter.
(2) To be eligible to participate in a health benefits plan offered under this section a temporary employee shall have completed 1 year of current continuous employment, excluding any break in service of 5 days or less.
(b) Notwithstanding the provisions of section 8906—
(1) any temporary employee enrolled in a health benefits plan under this section shall have an amount withheld from the pay of such employee, as determined by the Office of Personnel Management, equal to—
(A) the amount withheld from the pay of an employee under the provisions of section 8906; and
(B) the amount of the Government contribution for an employee under section 8906; and
(2) the employing agency of any such temporary employee shall not pay the Government contribution under the provisions of section 8906.
(Added Pub. L. 100–654, title III, § 301(a), Nov. 14, 1988, 102 Stat. 3846.)
heading: Effective Date
text: Pub. L. 100–654, title III, § 301(d), Nov. 14, 1988, 102 Stat. 3847, provided that: “The amendments made by this section [enacting this section and amending section 8913 of this title] shall be effective 120 days after the date of enactment of this section [Nov. 14, 1988].”
5 U.S.C. § 8907 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8907. Information to individuals eligible to enroll
(a) The Office of Personnel Management shall make available to each individual eligible to enroll in a health benefits plan under this chapter such information, in a form acceptable to the Office after consultation with the carrier, as may be necessary to enable the individual to exercise an informed choice among the types of plans described by sections 8903 and 8903a of this title.
(b) Each enrollee in a health benefits plan shall be issued an appropriate document setting forth or summarizing the—
(1) services or benefits, including maximums, limitations, and exclusions, to which the enrollee or the enrollee and any eligible family members are entitled thereunder;
(2) procedure for obtaining benefits; and
(3) principal provisions of the plan affecting the enrollee and any eligible family members.
(Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 605; Pub. L. 95–454, title IX, § 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 98–615, § 3(5), Nov. 8, 1984, 98 Stat. 3204; Pub. L. 99–53, § 2(d), June 17, 1985, 99 Stat. 94.)
text: Historical and Revision Notes
Derivation
U.S. Code
Revised Statutes and
Statutes at Large
5 U.S.C. 3009(d).
Sept. 28, 1959, Pub. L. 86–382, § 10(d), 73 Stat. 715.
Standard changes are made to conform with the definitions applicable and the style of this title as outlined in the preface to the report.
heading: Amendments
text: 1985—Subsec. (a). Pub. L. 99–53 inserted reference to section 8903a of this title.
1984—Pub. L. 98–615, § 3(5)(C), substituted “individuals eligible to enroll” for “employees” in section catchline.
Subsec. (a). Pub. L. 98–615, § 3(5)(A), substituted “individual” for “employee” in two places.
Subsec. (b). Pub. L. 98–615, § 3(5)(B)(i), substituted “enrollee” for “employee enrolled” in provisions preceding par. (1).
Subsec. (b)(1). Pub. L. 98–615, § 3(5)(B)(ii), substituted “enrollee or the enrollee and any eligible family members” for “employee or the employee and members of his family”.
Subsec. (b)(3). Pub. L. 98–615, § 3(5)(B)(iii), substituted “the enrollee and any eligible family members” for “the employee or members of his family”.
1978—Subsec. (a). Pub. L. 95–454 substituted “Office of Personnel Management” and “Office” for “Civil Service Commission” and “Commission”, respectively.
heading: Effective Date of 1984 Amendment
text: Amendment by Pub. L. 98–615 effective May 7, 1985, with enumerated exceptions, and applicable to any individual who is married to an employee or annuitant on or after that date, see section 4(a)(2) of Pub. L. 98–615, as amended, set out as a note under section 8341 of this title.
heading: Effective Date of 1978 Amendment
text: Amendment by Pub. L. 95–454 effective 90 days after Oct. 13, 1978, see section 907 of Pub. L. 95–454, set out as a note under section 1101 of this title.
5 U.S.C. § 8911 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8911. Advisory committee
The Director of the Office of Personnel Management shall appoint a committee composed of five members, who serve without pay, to advise the Office regarding matters of concern to employees under this chapter. Each member of the committee shall be an employee enrolled under this chapter or an elected official of an employee organization.
(Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 95–454, title IX, § 906(a)(1), (4), Oct. 13, 1978, 92 Stat. 1224, 1225.)
text: Historical and Revision Notes
Derivation
U.S. Code
Revised Statutes and
Statutes at Large
5 U.S.C. 3012.
Sept. 28, 1959, Pub. L. 86–382, § 13, 73 Stat. 716.
Standard changes are made to conform with the definitions applicable and the style of this title as outlined in the preface to the report.
heading: Amendments
text: 1978—Pub. L. 95–454 substituted “Director of the Office of Personnel Management” for “Chairman of the Civil Service Commission” and “Office” for “Commission”.
heading: Effective Date of 1978 Amendment
text: Amendment by Pub. L. 95–454 effective 90 days after Oct. 13, 1978, see section 907 of Pub. L. 95–454, set out as a note under section 1101 of this title.
heading: Termination of Advisory Committees
text: Advisory committees in existence on Jan. 5, 1973, to terminate not later than the expiration of the 2-year period following Jan. 5, 1973, unless, in the case of a committee established by the President or an officer of the Federal Government, such committee is renewed by appropriate action prior to the expiration of such 2-year period, or in the case of a committee established by the Congress, its duration is otherwise provided by law. See section 14 of Pub. L. 92–463, Oct. 6, 1972, 86 Stat. 776, set out in the Appendix to this title.
5 U.S.C. § 8912 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8912. Jurisdiction of courts
The district courts of the United States have original jurisdiction, concurrent with the United States Court of Federal Claims, of a civil action or claim against the United States founded on this chapter.
(Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 607; Pub. L. 97–164, title I, § 160(a)(3), Apr. 2, 1982, 96 Stat. 48; Pub. L. 102–572, title IX, § 902(b)(1), Oct. 29, 1992, 106 Stat. 4516.)
text: Historical and Revision Notes
Derivation
U.S. Code
Revised Statutes and
Statutes at Large
5 U.S.C. 3014.
Sept. 28, 1959, Pub. L. 86–382, § 15, 73 Stat. 716.
Standard changes are made to conform with the definitions applicable and the style of this title as outlined in the preface to the report.
heading: Amendments
text: 1992—Pub. L. 102–572 substituted “United States Court of Federal Claims” for “United States Claims Court”.
1982—Pub. L. 97–164 substituted “United States Claims Court” for “Court of Claims”.
heading: Effective Date of 1992 Amendment
text: Amendment by Pub. L. 102–572 effective Oct. 29, 1992, see section 911 of Pub. L. 102–572, set out as a note under section 171 of Title 28, Judiciary and Judicial Procedure.
heading: Effective Date of 1982 Amendment
text: Amendment by Pub. L. 97–164 effective Oct. 1, 1982, see section 402 of Pub. L. 97–164, set out as a note under section 171 of Title 28, Judiciary and Judicial Procedure.
5 U.S.C. § 8914 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8914. Effect of other statutes
Any provision of law outside of this chapter which provides coverage or any other benefit under this chapter to any individuals who (based on their being employed by an entity other than the Government) would not otherwise be eligible for any such coverage or benefit shall not apply with respect to any individual appointed, transferred, or otherwise commencing that type of employment on or after October 1, 1988.
(Added Pub. L. 100–238, title I, § 108(a)(3)(A), Jan. 8, 1988, 101 Stat. 1747.)
5 U.S.C. § 8951 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8951. Definitions
In this chapter:
(1) The term “employee” means an employee defined under section 8901(1) and an employee of the District of Columbia courts.
(2) The terms “annuitant”, “member of family”, and “dependent” have the meanings as such terms are defined under paragraphs (3), (5), and (9), respectively, of 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 Personnel Management.
(5) The term “qualified company” means a company (or consortium of companies or an employee organization defined under section 8901(8)) that offers indemnity, preferred provider organization, health maintenance organization, or discount dental programs and if required is licensed to issue applicable 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.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4001; amended Pub. L. 109–356, title I, § 117(a)(1), Oct. 16, 2006, 120 Stat. 2027.)
heading: Amendments
text: 2006—Par. (1). Pub. L. 109–356, which directed insertion of “and an employee of the District of Columbia courts” at end of par. (1), was executed by making the insertion before the period to reflect the probable intent of Congress.
heading: Effective Date
text: Pub. L. 108–496, § 7, Dec. 23, 2004, 118 Stat. 4011, provided that: “The amendments made by this Act [enacting this chapter and chapter 89B of this title, amending section 1005 of Title 39, Postal Service, and enacting provisions set out as a note under section 101 of this title] shall take effect on the date of enactment of this Act [Dec. 23, 2004] and shall apply to contracts that take effect with respect to the calendar year 2006.”
5 U.S.C. § 8952 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8952. Availability of dental benefits
(a) The Office shall establish and administer a program through which an eligible individual may obtain dental coverage to supplement coverage available through chapter 89.
(b) The Office shall determine, in the exercise of its reasonable discretion, the financial requirements for qualified 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.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4002.)
5 U.S.C. § 8954 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8954. 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 individuals.
(c) The benefits to be provided under enhanced dental benefits plans under this chapter may be of the following 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 require the qualified company to cover the geographic service delivery area specified by the Office. The Office shall require qualified companies to include dentally underserved areas in their service delivery areas.
(e) If an individual has dental coverage under a health benefits plan under chapter 89 and also has coverage under a plan under this chapter, the health benefits plan under chapter 89 shall be the first payor of any benefit payments.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4003.)
5 U.S.C. § 8955 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8955. Information to individuals eligible to enroll
(a) The qualified companies 1 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 maximums, limitations, and exclusions), that the Office considers necessary to enable the individual to make an informed decision about electing coverage.
(b) The Office shall make available to each individual eligible to enroll in a dental benefits plan, information on services and benefits provided by qualified companies participating under chapter 89.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004.)
5 U.S.C. § 8956 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8956. Election of coverage
(a) An eligible individual may enroll in a dental benefits plan for self-only, self plus one, or for self and family. If an eligible individual has a spouse who is also eligible to enroll, either spouse, but not both, may enroll for self plus one or self and family. An individual may not be enrolled both as an employee, annuitant, or other individual eligible to enroll and as a member of the family.
(b) The Office shall prescribe regulations under which—
(1) an eligible individual may enroll in a dental benefits plan; and
(2) an enrolled individual may change the self-only, self plus one, or self and family coverage of that individual.
(c)
(1) Regulations under subsection (b) shall permit an eligible individual to cancel or transfer the enrollment of that individual to another dental benefits plan—
(A) before the start of any contract term in which there is a change in rates charged or benefits provided, in which a new plan is offered, or in which an existing plan is terminated; or
(B) during other times and under other circumstances specified by the Office.
(2) A transfer under paragraph (1) shall be subject to waiting periods provided under a new plan.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004.)
5 U.S.C. § 8957 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8957. Coverage of restored survivor or disability annuitants
A surviving spouse, disability annuitant, or surviving child whose annuity is terminated and is later restored, may continue enrollment in a dental benefits plan subject to the terms and conditions prescribed in regulations issued by the Office.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004.)
5 U.S.C. § 8958 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8958. Premiums
(a) Each eligible individual obtaining supplemental dental coverage under this chapter shall be responsible for 100 percent of the premiums for such coverage.
(b) The Office shall prescribe regulations specifying the terms and conditions under which individuals are required to pay the premiums for enrollment.
(c) The amount necessary to pay the premiums for enrollment may—
(1) in the case of an employee, be withheld from the pay of such an employee; or
(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 information and reports as the Office may require.
(f)
(1) The Employee Health Benefits Fund is available, without fiscal year limitation, for reasonable expenses 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 Dental 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 appropriate provisions under which the qualified company involved shall, during each year, make such periodic contributions to the Dental Benefits Administrative Account as necessary to ensure that the reasonable anticipated expenses of the Office in administering this chapter during such year are defrayed.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004.)
5 U.S.C. § 8959 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8959. Preemption
The terms of any contract that relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to dental benefits, insurance, plans, or contracts.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4005.)
5 U.S.C. § 8960 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8960. Studies, reports, and audits
(a) Each contract shall contain provisions requiring the qualified company to—
(1) furnish such reasonable reports as the Office determines to be necessary to enable it to carry out its functions under this chapter; and
(2) 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 Federal 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.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4005.)
5 U.S.C. § 8961 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8961. Jurisdiction of courts
The district courts of the United States have original 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 8953(d) have been exhausted, but only to the extent judicial review is not precluded by any dispute resolution or other remedy under this chapter.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4005.)
5 U.S.C. § 8962 (GOVERNMENT ORGANIZATION AND EMPLOYEES)
§ 8962. 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 conditions pertaining to it.
(b) The Office shall, as appropriate, provide for coordinated enrollment, promotion, and education efforts as appropriate in consultation with each qualified company. The information under this subsection shall include information relating to the dental benefits available under chapter 89, including the advantages and disadvantages of obtaining additional coverage under this chapter.
(Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4006.)