§8983 — Title 5 Government Organization and Employees | U.S. Code

Summary

The Office must hire a reasonable number of qualified companies to offer the covered benefit plans. Employee groups may team up with a company to take part in those contracts. Contracts must be picked based on the companies’ qualifications, price, and fair competition. Each contract must include required legal protections, the rules for the enrollment period, and any other terms the Office and the company agree on that follow the law and Office rules. Companies must pay benefits to people who are eligible under the contract. They must have quick internal steps to handle claim disputes and, if those don’t work, offer outside review by independent third parties that both sides accept. Whether someone is eligible can only be reviewed the ways the contract allows. For disputes between a company and the Office, appeals go to a board of contract appeals chosen by the Director of OPM, and U.S. district courts share original jurisdiction with the U.S. Court of Federal Claims for certain actions under the Contract Disputes Act. The Office or a reviewer cannot change contract terms. Contracts run for 7 years and cannot be automatically renewed.

Title 5, §8983

Government Organization and Employees — Source: USLM XML via OLRC

(a)(1)The Office shall contract with a reasonable number of qualified companies for a policy or policies of benefits described under section 8984 without regard to section 6101(b) to (d) of title 41 or any other statute requiring competitive bidding. An employee organization may contract with a qualified company for the purpose of participating with that qualified company 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 competition.

(b)Each contract under this section shall contain—

(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 regulations prescribed by the Office.

(c)Nothing in this chapter shall, in the case of an individual electing vision supplemental benefit coverage under this chapter after the expiration of such individual’s first opportunity to enroll, preclude the application of waiting periods 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 eligible 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 designed to expeditiously resolve such disputes; and

(ii)to establish, for disputes not resolved through procedures under clause (i), procedures for 1 or more alternative means of dispute resolution involving independent third-party review under appropriate circumstances 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 eligible 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 Disputes Act of 1978 11 See References in Text note below. to disputes arising under this chapter between a qualified company and the Office—

(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 Management shall specify in writing (after appropriate 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.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Contract Disputes Act of 1978, referred to in subsec. (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 substantially 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. section 8(c) and 10(a)(1) of the Act, which were classified to section 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 Tables. 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 “section 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 contracts 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.

§8983 Contracting authority