5 U.S.C. § 8956 — Election of coverage

Page 1277 TITLE 5—GOVERNMENT ORGANIZATION AND EMPLOYEES § 8956 1 So in original. Probably should be followed by a comma. Office. The Office shall require qualified compa- nies 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.) 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. § 8955. Information to individuals eligible to en- roll (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 nec- essary to enable the individual to make an in- formed decision about electing coverage. (b) The Office shall make available to each in- dividual eligible to enroll in a dental benefits plan, information on services and benefits pro- vided by qualified companies participating under chapter 89. (Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004.) 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. § 8956. Election of coverage (a) An eligible individual may enroll in a den- tal 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 en- rolled 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 den- tal benefits plan; and (2) an enrolled individual may change the self-only, self plus one, or self and family cov- erage of that individual. (c)(1) Regulations under subsection (b) shall permit an eligible individual to cancel or trans- fer 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 of- fered, or in which an existing plan is termi- nated; or (B) during other times and under other cir- cumstances specified by the Office. (2) A transfer under paragraph (1) shall be sub- ject to waiting periods provided under a new plan. (d) Coverage under a dental benefits plan under this chapter for any employee or a cov- ered TRICARE-eligible individual enrolled in such a plan and who, as a result of a lapse in ap- propriations, is furloughed or excepted from fur- lough and working without pay shall continue during such lapse and may not be cancelled as a result of nonpayment of premiums or other peri- odic charges due to such lapse. (Added Pub. L. 108–496, § 2, Dec. 23, 2004, 118 Stat. 4004; amended Pub. L. 116–92, div. A, title XI, § 1111(a)(1), Dec. 20, 2019, 133 Stat. 1600.) Editorial Notes AMENDMENTS 2019—Subsec. (d). Pub. L. 116–92 added subsec. (d) Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2019 AMENDMENT Pub. L. 116–92, div. A, title XI, § 1111(c), Dec. 20, 2019, 133 Stat. 1601, provided that: ‘‘The amendments made by subsection (a) [amending this section and sections 8986 and 9003 of this title] shall apply to any contract for supplemental dental, supplemental vision, or long- term care insurance under chapter 89A, 89B, or 90 (re- spectively) of title 5, United States Code, entered into before, on, or after the date of enactment of this Act [Dec. 20, 2019].’’ 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. REGULATIONS Pub. L. 116–92, div. A, title XI, § 1111(b), Dec. 20, 2019, 133 Stat. 1601, provided that: ‘‘(1) IN GENERAL.—Consistent with paragraph (2), the Director of the Office of Personnel Management shall prescribe regulations under which premiums for supple- mental dental, supplemental vision, or long-term care insurance under chapter 89A, 89B, or 90 (respectively) of title 5, United States Code, (as amended by subsection (a)) that are unpaid by an employee, a covered TRICARE-eligible individual, or a member of the uni- formed services (as the case may be), as a result of that employee, covered TRICARE-eligible individual, or member being furloughed or excepted from furlough and working without pay as a result of a lapse in appro- priations, are paid to the applicable carrier from back pay made available to the employee or member as soon as practicable upon the end of such lapse. ‘‘(2) LONG-TERM CARE PREMIUMS FROM SOURCE OTHER THAN BACKPAY.—The regulations promulgated under paragraph (1) for the amendments made by subsection (a)(3) [amending section 9003 of this title] may provide, with respect to any individual who elected under sec- tion 9004(d) of title 5, United States Code, to pay pre- miums directly to the carrier, that such individual may continue to pay premiums pursuant to such election in- stead of from back pay made available to such indi- vidual.’’ Page 1278 TITLE 5—GOVERNMENT ORGANIZATION AND EMPLOYEES § 8957 § 8957. Coverage of restored survivor or dis- ability 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.) 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. § 8958. Premiums (a) Each eligible individual obtaining supple- mental 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 pre- miums for enrollment may— (1) in the case of an employee, be withheld from the pay of such an employee; (2) in the case of an annuitant, be withheld from the annuity of such an annuitant; (3) in the case of a covered TRICARE-eligible individual who receives pay from the Federal Government or an annuity from the Federal Government due to the death of a member of the uniformed services (as defined in section 101 of title 10), and is not a former spouse of a member of the uniformed services, be withheld from— (A) the pay (including retired pay) of such individual; or (B) the annuity paid to such individual; or (4) in the case of a covered TRICARE-eligible individual who is not described in paragraph (3), be billed to such individual directly. (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 re- quire. (f)(1) The Employee Health Benefits Fund is available, without fiscal year limitation, for reasonable expenses incurred by the Office in ad- ministering 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 Admin- istrative Account, which shall be available to the Office, without fiscal year limitation, to de- fray 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 Bene- fits Administrative Account as necessary to en- sure 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; amended Pub. L. 114–328, div. A, title VII, § 715(b)(1), Dec. 23, 2016, 130 Stat. 2222.) Editorial Notes AMENDMENTS 2016—Subsec. (c)(3), (4). Pub. L. 114–328 added pars. (3) and (4). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2016 AMENDMENT Amendment by Pub. L. 114–328 applicable with re- spect to the first contract year for chapter 89A or 89B of this title, as applicable, that begins on or after Jan. 1, 2018, see section 715(c) of Pub. L. 114–328, set out as a note under section 8951 of this title. 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. § 8959. Preemption The terms of any contract that relate to the nature, provision, or extent of coverage or bene- fits (including payments with respect to bene- fits) 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.) 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. § 8960. Studies, reports, and audits (a) Each contract shall contain provisions re- quiring the qualified company to— (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 Government Accountability Office to ex- amine 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 compari- son of the dental benefits available under chap- ter 89, to ensure the competitiveness of plans under this chapter. The Office shall cooperate