5 U.S.C. § 8952 — Availability of dental benefits

Page 1275 TITLE 5—GOVERNMENT ORGANIZATION AND EMPLOYEES § 8952 for any such coverage or benefit shall not apply with respect to any individual appointed, trans- ferred, 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.) CHAPTER 89A—ENHANCED DENTAL BENEFITS Sec. 8951. Definitions. 8952. Availability of dental benefits. 8953. Contracting authority. 8954. Benefits. 8955. Information to individuals eligible to enroll. 8956. Election of coverage. 8957. Coverage of restored survivor or disability annuitants. 8958. Premiums. 8959. Preemption. 8960. Studies, reports, and audits. 8961. Jurisdiction of courts. 8962. Administrative functions. § 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 fam- ily’’, 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), (2), or (8), 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 pro- vider organization, health maintenance orga- nization, or discount dental programs and if required is licensed to issue applicable cov- erage 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 en- roll in a health benefits plan under chapter 89. (7) The term ‘‘State’’ includes the District of Columbia. (8) The term ‘‘covered TRICARE-eligible in- dividual’’ means an individual entitled to den- tal care under chapter 55 of title 10, pursuant to section 1076c of such title, who the Sec- retary of Defense determines should be an eli- gible individual for purposes of this chapter. (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; Pub. L. 114–328, div. A, title VII, § 715(a)(1), Dec. 23, 2016, 130 Stat. 2221; Pub. L. 115–232, div. A, title VII, § 713(a), Aug. 13, 2018, 132 Stat. 1811; Pub. L. 116–283, div. A, title VII, § 711(a), (c), Jan. 1, 2021, 134 Stat. 3691.) Editorial Notes AMENDMENTS 2021—Par. (8). Pub. L. 116–283, § 711(c), repealed Pub. L. 115–232, § 713(a). See 2018 Amendment note below. Pub. L. 116–283, § 711(a), struck out ‘‘1076a or’’ before ‘‘1076c’’. 2018—Par. (8). Pub. L. 115–232, § 713(a), which sub- stituted ‘‘1076a or 1076c’’ for ‘‘1076c’’, was repealed by Pub. L. 116–283, § 711(c). 2016—Par. (3). Pub. L. 114–328, § 715(a)(1)(A), sub- stituted ‘‘paragraph (1), (2), or (8)’’ for ‘‘paragraph (1) or (2)’’. Par. (8). Pub. L. 114–328, § 715(a)(1)(B), added par. (8). 2006—Par. (1). Pub. L. 109–356, which directed inser- tion 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 in- tent of Congress. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2018 AMENDMENT Pub. L. 115–232, div. A, title VII, § 713(c), Aug. 13, 2018, 132 Stat. 1812, which provided that the amendments made by this section (amending this section and sec- tion 1076a of Title 10, Armed Forces) applied with re- spect to the first contract year for chapter 89A of title 5, United States Code, that began on or after January 1, 2022, was repealed by Pub. L. 116–283, div. A, title VII, § 711(c), Jan. 1, 2021, 134 Stat. 3691. EFFECTIVE DATE OF 2016 AMENDMENT Pub. L. 114–328, div. A, title VII, § 715(c), Dec. 23, 2016, 130 Stat. 2223, provided that: ‘‘The amendments made by this section [amending this section, sections 8958, 8981, and 8988 of this title and section 1076c of Title 10, Armed Forces] shall apply with respect to the first con- tract year for chapter 89A or 89B of title 5, United States Code, as applicable, that begins on or after Jan- uary 1, 2018.’’ EFFECTIVE DATE Pub. L. 108–496, § 7, Dec. 23, 2004, 118 Stat. 4011, pro- vided that: ‘‘The amendments made by this Act [enact- ing 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.’’ § 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 cov- erage available through chapter 89. (b) The Office shall determine, in the exercise of its reasonable discretion, the financial re- quirements for qualified companies to partici- pate 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.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective Dec. 23, 2004, and applicable to con- tracts that take effect with respect to the calendar Page 1276 TITLE 5—GOVERNMENT ORGANIZATION AND EMPLOYEES § 8953 1 See References in Text note below. year 2006, see section 7 of Pub. L. 108–496, set out as a note under section 8951 of this title. § 8953. Contracting authority (a)(1) The Office shall contract with a reason- able number of qualified companies for a policy or policies of benefits described under section 8954 without regard to section 6101(b) to (d) of title 41 or any other statute requiring competi- tive bidding. An employee organization may contract with a qualified company for the pur- pose of participating with that qualified com- pany in any contract between the Office and that qualified company. (2) The Office shall ensure that each resulting contract is awarded on the basis of contractor qualifications, price, and reasonable competi- tion. (b) Each contract under this section shall con- tain— (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 regula- tions prescribed by the Office. (c) Nothing in this chapter shall, in the case of an individual electing dental supplemental ben- efit coverage under this chapter after the expi- ration of such individual’s first opportunity to enroll, preclude the application of waiting peri- ods more stringent than those that would have applied if that opportunity had not yet expired. (d)(1) Each contract under this chapter shall require the qualified company to agree— (A) to provide payments or benefits to an el- igible 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 dis- putes; and (ii) to establish, for disputes not resolved through procedures under clause (i), proce- dures for 1 or more alternative means of dis- pute resolution involving independent third- party review under appropriate cir- cumstances by entities mutually acceptable to the Office and the qualified company. (2) A determination by a qualified company as to whether or not a particular individual is eli- gible 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 Dis- putes Act of 1978 1 to disputes arising under this chapter between a qualified company and the Of- fice— (A) the agency board having jurisdiction to decide an appeal relative to such a dispute shall be such board of contract appeals as the Director of the Office of Personnel Manage- ment shall specify in writing (after appro- priate arrangements, as described in section 8(c) 1 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 action described in section 10(a)(1) 1 of such Act relative 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 uniform term of 7 years and may not be renewed automatically. (Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4002; amended Pub. L. 111–350, § 5(a)(16), Jan. 4, 2011, 124 Stat. 3842.) Editorial Notes REFERENCES IN TEXT The Contract Disputes Act of 1978, referred to in sub- sec. (d)(3), is Pub. L. 95–563, Nov. 1, 1978, 92 Stat. 2383, which was classified principally to chapter 9 (§ 601 et seq.) of former Title 41, Public Contracts, and was sub- stantially repealed and restated as chapter 71 (§ 7101 et seq.) of Title 41, Public Contracts, by Pub. L. 111–350, §§ 3, 7(b), Jan. 4, 2011, 124 Stat. 3677, 3855. Sections 8(c) and 10(a)(1) of the Act, which were classified to sections 607(c) and 609(a)(1), respectively, of former Title 41, were repealed and restated as section 7105(d), (e)(1)(C) and section 7104(b)(1), respectively, of Title 41. For complete classification of this Act to the Code, see Ta- bles. For disposition of sections of former Title 41, see Disposition Table preceding section 101 of Title 41. AMENDMENTS 2011—Subsec. (a)(1). Pub. L. 111–350 substituted ‘‘sec- tion 6101(b) to (d) of title 41’’ for ‘‘section 5 of title 41’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective Dec. 23, 2004, and applicable to con- tracts that take effect with respect to the calendar year 2006, see section 7 of Pub. L. 108–496, set out as a note under section 8951 of this title. § 8954. Benefits (a) The Office may prescribe reasonable min- imum standards for enhanced dental benefits plans offered under this chapter and for quali- fied 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