Federal Employee Short-Term Disability Insurance Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4493 To provide a short-term disability insurance program for Federal employees for disabilities that are not work-related, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 25, 2019 Ms. NORTON introduced the following bill; which was referred to the Committee on Oversight and Reform A BILL To provide a short-term disability insurance program for Federal employees for disabilities that are not work- related, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Federal Employee 4 Short-Term Disability Insurance Act of 2019’’. 5 SEC. 2. PURPOSE. 6 The purpose of this Act is to offer voluntary insur- 7 ance to Federal employees for protection against the loss 8 of pay resulting from— 9 (1) short-term injury or disability; 10 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 2 •HR 4493 IH (2) short-term leave taken for the purpose of 1 caring for a family member; 2 (3) the birth of a child of such an employee; or 3 (4) making arrangements to adopt a child or to 4 become a foster parent. 5 SEC. 3. NON-WORK RELATED DISABILITY INSURANCE. 6 (a) IN GENERAL.—Title 5, United States Code, is 7 amended by inserting after chapter 87 the following: 8 ‘‘CHAPTER 88—NON-WORK RELATED 9 SHORT-TERM DISABILITY INSURANCE 10 ‘‘Sec. ‘‘8801. Definitions. ‘‘8802. Availability of insurance. ‘‘8803. Contracting authority. ‘‘8804. Benefits. ‘‘8805. Premiums. ‘‘8806. Preemption. ‘‘8807. Studies, reports, and audits. ‘‘8808. Jurisdiction of courts. ‘‘8809. Administrative functions. ‘‘8810. Cost accounting standards. ‘‘§ 8801. Definitions 11 ‘‘For purposes of this chapter— 12 ‘‘(1) the term ‘Director’ means the Director of 13 the Office of Personnel Management; 14 ‘‘(2) the term ‘employee’ means— 15 ‘‘(A) an employee defined in section 16 8901(1); and 17 ‘‘(B) an officer or employee of the United 18 States Postal Service or of the Postal Regu- 19 latory Commission; 20 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 3 •HR 4493 IH ‘‘(3) the term ‘injury or disability’, with respect 1 to an employee, means that such employee is unable 2 to perform the essential functions of such employee’s 3 position of employment with the Federal Govern- 4 ment; 5 ‘‘(4) the term ‘member of family’ has the mean- 6 ing given such term in section 8901(5); 7 ‘‘(5) the term ‘carrier’ means an insurance 8 company that is licensed to issue disability insurance 9 in all States, taking into account any subsidiaries or 10 affiliates of such a company; and 11 ‘‘(6) the term ‘State’ includes the District of 12 Columbia. 13 ‘‘§ 8802. Availability of insurance 14 ‘‘(a) The Director shall establish and administer a 15 program to make insurance coverage available under this 16 chapter— 17 ‘‘(1) for an injury or disability not covered 18 under chapter 81; 19 ‘‘(2) for leave to care for, or leave to make ar- 20 rangements to care for, a member of family, includ- 21 ing the birth of a son or a daughter; and 22 ‘‘(3) for leave to make arrangements— 23 ‘‘(A) to become a foster parent; or 24 ‘‘(B) to adopt a child. 25 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 4 •HR 4493 IH ‘‘(b) Insurance shall not be available under this chap- 1 ter if the injury or disability of an employee is— 2 ‘‘(1) caused by willful misconduct of such em- 3 ployee; 4 ‘‘(2) caused by such employee’s intention to 5 bring about such injury or disability to himself or to 6 another individual; or 7 ‘‘(3) proximately caused by the intoxication of 8 such employee. 9 ‘‘(c) In addition to the requirements otherwise appli- 10 cable under section 8801(5), an insurance contract under 11 this chapter must be fully insured, whether through rein- 12 surance with other carriers or otherwise. 13 ‘‘§ 8803. Contracting authority 14 ‘‘(a) The Director shall, without regard to any statute 15 requiring competitive bidding, contract with one or more 16 carriers for a policy or policies of disability insurance as 17 described under this chapter. The Director shall ensure 18 that each resulting contract is awarded on the basis of 19 contractor qualifications, price, and reasonable competi- 20 tion. 21 ‘‘(b)(1) Each contract under this section shall con- 22 tain— 23 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 5 •HR 4493 IH ‘‘(A) a detailed statement of the benefits of- 1 fered (including any maximums, limitations, exclu- 2 sions, and other definitions of benefits); 3 ‘‘(B) the premiums charged (including any limi- 4 tations or other conditions on their subsequent ad- 5 justment); 6 ‘‘(C) the duration of the enrollment period; and 7 ‘‘(D) such other terms and conditions (includ- 8 ing procedures for establishing eligibility for insur- 9 ance under this chapter) as may be determined by 10 the Director, consistent with the requirements of 11 this chapter. 12 ‘‘(2) Premiums charged under a contract under this 13 section shall reasonably and equitably reflect the cost of 14 the benefits provided, as determined by the Director. 15 ‘‘(c)(1) Each contract under this section shall require 16 the carrier— 17 ‘‘(A) to provide payments or benefits described 18 in section 8804(c) to an employee if such employee 19 is entitled thereto under the terms of the contract; 20 and 21 ‘‘(B) with respect to disputes regarding claims 22 for payments or benefits under the terms of the con- 23 tract— 24 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 6 •HR 4493 IH ‘‘(i) to establish internal procedures de- 1 signed to resolve such disputes expeditiously; 2 and 3 ‘‘(ii) to establish, for disputes not resolved 4 through procedures under clause (i), procedures 5 for one or more alternative means of dispute 6 resolution involving independent third-party re- 7 view under circumstances acceptable to the Di- 8 rector. 9 ‘‘(2) The carrier’s determination as to whether or not 10 a particular employee is eligible to obtain insurance cov- 11 erage under this chapter shall be subject to review to the 12 extent and in the manner provided in the applicable con- 13 tract. 14 ‘‘(3) Nothing in this chapter shall be considered to 15 grant authority for a third-party reviewer to change the 16 terms of any contract under this chapter. 17 ‘‘(d)(1) Each contract under this section shall be for 18 a term of not less than 3 years and not greater than 7 19 years, and may be terminated earlier than the termination 20 date of such contract by the Director in accordance with 21 the terms of such contract. However, the rights and re- 22 sponsibilities of the enrolled employee, the insurer, and the 23 Director under each contract shall continue with respect 24 to such employee until the termination of coverage of the 25 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 7 •HR 4493 IH enrolled employee or the effective date of a successor con- 1 tract. 2 ‘‘(2) A contract described in paragraph (1) may be 3 made automatically renewable, for a term of 1 year each 4 January 1, unless written notice of non-renewal is given 5 either by the Director or the carrier not less than 180 6 days before the renewal date, or unless modified by mutual 7 agreement. 8 ‘‘(3) A contract described in paragraph (1) shall in- 9 clude such provisions as may be necessary to ensure that, 10 once an employee becomes duly enrolled, insurance cov- 11 erage pursuant to that enrollment shall be terminated only 12 if the individual is separated from Federal service or, 13 where appropriate, for non-payment of premiums. 14 ‘‘§ 8804. Benefits 15 ‘‘(a) The Director may prescribe reasonable minimum 16 standards for benefit plans offered under this chapter. 17 ‘‘(b)(1) Benefits provided to an employee under this 18 chapter shall offset other benefits received by such em- 19 ployee for the same injury or disability, leave to care for 20 or make arrangements to care for a member of family (in- 21 cluding the birth of a son or a daughter), or leave to make 22 arrangements to adopt a child or become a foster parent 23 including worker’s compensation and disability retirement 24 income. 25 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 8 •HR 4493 IH ‘‘(2) A contract providing benefits under this chap- 1 ter— 2 ‘‘(A) shall not provide for a preexisting condi- 3 tion exclusion; and 4 ‘‘(B) shall not charge higher premiums, deny 5 coverage, or drop coverage of an employee with a 6 preexisting condition. 7 ‘‘(3) A contract providing benefits under this chapter 8 shall provide incentives for an employee who is receiving 9 benefits under such contract to return to work. 10 ‘‘(c)(1) For each instance that such employee suffers 11 an injury or disability, takes leave to care for or make 12 arrangements to care for a member of family (including 13 the birth of a son or a daughter), or takes leave to make 14 arrangements to adopt a child or become a foster parent, 15 and is eligible for benefits under this chapter, such em- 16 ployee may receive benefits under this chapter for a period 17 not to exceed 12 months beginning on the date on which 18 such employee qualifies for such benefits. An employee 19 shall receive such benefits after the expiration of the wait- 20 ing period selected by such employee under paragraph 21 (2)(A). The amount of benefits shall be equal to the lesser 22 of— 23 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 9 •HR 4493 IH ‘‘(A) 70 percent of the annual rate of pay, ex- 1 cluding bonuses, of an employee at the time of the 2 injury or disability of such employee occurs; or 3 ‘‘(B) 70 percent of the maximum rate of basic 4 pay provided for grade GS–15 of the General Sched- 5 ule. 6 ‘‘(2)(A) The period for which benefits are payable to 7 an employee under this subsection shall begin after the 8 completion of a waiting period, subject to the requirement 9 in subparagraph (C). An employee shall elect one of the 10 following waiting period options: 11 ‘‘(i) On the 8th day of continuous injury or dis- 12 ability, leave to care for or to make arrangements to 13 care for a member of family (including the birth of 14 a son or a daughter), or leave to make arrangements 15 to adopt a child or become a foster parent. 16 ‘‘(ii) On the 31st day of continuous disability, 17 leave to care for or to make arrangements to care 18 for a member of family (including the birth of a son 19 or a daughter), or leave to make arrangements to 20 adopt a child or become a foster parent. 21 ‘‘(iii) On the 91st day of continuous disability, 22 leave to care for or to make arrangements to care 23 for a member of family (including the birth of a son 24 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 10 •HR 4493 IH or a daughter), or leave to make arrangements to 1 adopt a child or become a foster parent. 2 ‘‘(iv) On the 181st day of continuous disability, 3 leave to care for or to make arrangements to care 4 for a member of family (including the birth of a son 5 or a daughter), or leave to make arrangements to 6 adopt a child or become a foster parent. 7 ‘‘(B) An employee who elects to receive benefits ear- 8 lier shall pay a higher premium. 9 ‘‘(C) A waiting period selected under subparagraph 10 (A) shall begin on the first day of an employee’s injury 11 or disability. 12 ‘‘§ 8805. Premiums 13 ‘‘(a) Each eligible individual obtaining insurance cov- 14 erage under this chapter shall be responsible for 100 per- 15 cent of the premiums for such coverage. 16 ‘‘(b) The amount necessary to pay the premiums for 17 enrollment shall be withheld from the pay of the enrolled 18 individual. 19 ‘‘(c) The carrier participating under this chapter 20 shall maintain records that permit it to account for all 21 amounts received under this chapter (including investment 22 earnings on those amounts) separate and apart from all 23 other funds. 24 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 11 •HR 4493 IH ‘‘(d)(1)(A) The Employees’ Life Insurance Fund is 1 available, without fiscal year limitation, for reasonable ex- 2 penses incurred in administering this chapter before the 3 start of the first term described in section 8803(d)(1), in- 4 cluding reasonable implementation costs. 5 ‘‘(B) Such Fund shall be reimbursed, before the end 6 of the first year of a contract described in section 7 8803(d)(1), for all amounts obligated or expended under 8 subparagraph (A) (including lost investment income). Re- 9 imbursement under this subparagraph shall be made by 10 the carrier in accordance with applicable provisions in- 11 cluded in the relevant contract. 12 ‘‘(C)(i) There is hereby established in the Employees’ 13 Life Insurance Fund a Non-Work Related Disability In- 14 surance Administrative Account, which shall be available 15 to the Office of Personnel Management, without fiscal 16 year limitation, to defray reasonable expenses incurred by 17 the Office in administering this chapter after the start of 18 the first term described in section 8803(d)(1). 19 ‘‘(ii) A contract under this chapter shall include ap- 20 propriate provisions under which the carrier involved shall, 21 during each year, make such periodic contributions to the 22 Non-Work Related Disability Insurance Administrative 23 Account as necessary to ensure that the reasonable antici- 24 pated expenses of the Office of Personnel Management in 25 VerDate Sep 11 2014 03:03 Oct 01, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4493.IH H4493 kjohnson on DSK79L0C42 with BILLS 12 •HR 4493 IH administering this chapter during such year (adjusted to 1 reconcile for any earlier overestimates or underestimates 2 under this subparagraph) are defrayed. 3 ‘‘(e) Nothing in this chapter shall, in the case of an 4 enrolled individual applying for an extension of insurance 5 coverage under this chapte [Text truncated for display. 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