[Federal Register Volume 73, Number 197 (Thursday, October 9, 2008)]
[Rules and Regulations]
[Pages 59504-59505]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-24001]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD-2008-HA-0035]
RIN 0720-AA69
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Voluntary Disenrollment From the TRICARE Retiree Dental
Program (TRDP)
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule implements section 726 of the Floyd D. Spence
National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2001,
which amended 10 U.S.C. 1076c to allow for voluntary disenrollment from
the TRICARE Retiree Dental Program (TRDP) in certain circumstances.
DATES: Effective Date: This rule is effective November 10, 2008.
FOR FURTHER INFORMATION CONTACT: Colonel Gary Martin, TMA, TRICARE
Policy and Operations, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Summary of Final Rule Provisions
Section 726 of the Floyd D. Spence NDAA for FY 2001 (Pub. L. 106-
398), amended 10 U.S.C. 1076c by directing the Department to allow an
enrollee to the TRDP to disenroll at the beginning of the prescribed
enrollment period and to permit disenrollment thereafter under limited
circumstances providing that the fiscal integrity of the dental program
is not jeopardized. The amendment specifies the inclusion of the
following circumstances: a period of up to 30 days at the beginning of
the prescribed minimum enrollment period during which an enrollee may
disenroll; assignment of Federal employment outside dental plan
jurisdiction that prevents utilization of the plan's benefits; a
serious medical condition that prevents utilization of the plan's
benefits; and, severe financial hardship. The final rule expands the
voluntary termination provision of the TRDP provided by the Department
and originally contained in a final rule published in the Federal
Register on January 30, 2002 (67 FR 4353). Under the statutory mandate
for voluntary enrollment required by section 704 of the NDAA for FY
2000 (Pub. L. 106-65), that provision implemented a grace period in
which a new enrollee could voluntarily disenroll during the first 30
days following the beginning date of coverage on the condition that no
benefits had been used and, effectively, nullify the enrollment. It
also designated the TRDP contractor as the authority for grace period
disenrollment decisions.
This final rule provides another opportunity for voluntary
disenrollment from the TRDP during the enrollment lock-in period that
could occur upon an enrollee's request without any penalty and is based
on the extenuating circumstances specified in the Floyd D. Spence NDAA
for FY 2001. The TRDP contractor continues as the authority for
voluntary disenrollment decisions but only at the initial level. The
final rule allows a process for enrollees to appeal to the TMA all
adverse decisions made by the contractor in response to requests for
voluntary disenrollment.
The final rule also makes administrative corrections.
II. Review of Public Comments
We published the proposed rule on January 30, 2002 (67 FR 4375) and
provided a 60-day comment period. We received no public comments.
III. Regulating Procedures
Executive Order 12866 requires that a comprehensive regulatory
impact analysis be performed on any economically significant regulatory
action, defined as one that would result in an annual effect of $100
million or more on the national economy or which would have other
substantial impacts. The Regulatory Flexibility Act (RFA) requires that
each Federal agency prepare, and make available for public comment, a
regulatory flexibility analysis when the agency issues a regulation
which would have a significant impact on a substantial number of small
entities. This rule is not an economically significant regulatory
action and will not have a significant impact on a substantial number
of small entities for purposes of the RFA, thus this final rule is not
subject to any of these requirements.
This rule does not contain a Federal mandate that may result in the
expenditure by State, local and tribunal governments, in aggregate, or
by the private sector, of $100 million or more in any one year.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(Title 44, U.S.C., 3501-3511).
We have examined the impact(s) of the final rule under Executive
Order 13132 and it does not have policies that have federalism
implications that would have substantial direct effects on the States,
on the relationship between the National Government and the States, or
on the distribution of power and responsibilities among the various
levels of government, therefore, consultation with State and local
officials is not required.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health insurance, Individuals with
disabilities, Military personnel.
0
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for 32 CFR part 199 continues to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
0
2. Section 199.22 is amended by revising paragraph (b)(4); the first
two sentences of paragraph (d)(1)(iv) introductory text; and paragraphs
(d)(4)(ii), (d)(5)(ii), (e)(2) and (k) to read as follows:
Sec. 199.22 TRICARE Retiree Dental Program (TRDP).
* * * * *
(b) * * *
(4) Except as otherwise provided in this section or by the
Assistant Secretary of Defense (Health Affairs) or designee, the TRDP
is administered in a manner similar to the TRICARE Dental Program under
Sec. 199.13 of this part.
* * * * *
[[Page 59505]]
(d) * * *
(1) * * *
(iv) Eligible dependents of a member described in paragraph
(d)(1)(i) or paragraph (d)(1)(ii) of this section when the member is
not enrolled in the program and the member meets at least one of the
conditions in paragraphs (d)(1)(iv)(A) through (C) of this section.
Already enrolled members must satisfy any remaining enrollment
commitment prior to enrollment of dependents becoming effective under
this paragraph, at which time the dependent-only enrollment will
continue on a voluntary basis as specified in paragraph (d)(4) of this
section. * * *
* * * * *
(4) * * *
(ii) Enrollment period for enhanced benefits. The initial
enrollment period for enhanced benefit coverage described in paragraph
(f)(2) of this section shall be established by the Director, TMA, or
designee, to be a period of not less than 12 months and not more than
24 months. The initial enrollment period shall be followed by renewal
enrollment periods of up to 12 months as long as the enrollee chooses
to continue enrollment and remains eligible. An enrollee who chooses
not to continue enrollment upon completion of an enrollment period may
re-enroll at any time. However, an enrollee who is disenrolled from the
TRDP before completion of an initial or subsequent enrollment period
for reasons other than those in paragraphs in (d)(5)(ii)(A) and (B) of
this section shall incur a lockout period of 12 months before re-
enrollment can occur. Former enrollees who re-enroll following a
lockout period or following a period of disenrollment after completion
of an enrollment period must comply with all provisions that apply to
new enrollees, including a new enrollment commitment.
(5) * * *
(ii) Voluntary termination. All enrollee requests for termination
of TRDP coverage before the completion of an enrollment period shall be
submitted to the TRDP contractor for determination of whether the
enrollee qualifies to be disenrolled under paragraphs (d)(5)(ii)(A) or
(B) of this section.
(A) Enrollment grace period. Regardless of the reason, TRDP
coverage shall be cancelled, or otherwise terminated, upon request from
an enrollee if the request is received by the TRDP contractor within 30
calendar days following the enrollment effective date and there has
been no use of TRDP benefits under the enrollment during that period.
If such is the case, the enrollment is voided and all premium payments
are refunded. However, use of benefits during this 30-day enrollment
grace period constitutes acceptance by the enrollee of the enrollment
and the enrollment period commitment. In this case, a request for
termination of enrollment under paragraph (d)(5)(ii)(A) of this section
will not be honored, and premiums will not be refunded.
(B) Extenuating circumstances. Under limited circumstances, TRDP
enrollees shall be disenrolled by the contractor before the completion
of an enrollment period commitment upon request by an enrollee if the
enrollee submits written, factual documentation that independently
verifies that one of the following extenuating circumstances occurred
during the enrollment period. In general, the circumstances must be
unforeseen and long-term and must have originated after the effective
date of TRDP coverage.
(1) The enrollee is prevented by a serious medical condition from
being able to utilize TRDP benefits,
(2) The enrollee would suffer severe financial hardship by
continuing TRDP enrollment; or
(3) Any other circumstances which the Secretary considers
appropriate.
(C) Effective date of voluntary termination. For cases determined
to qualify for disenrollment under the grace period provisions in
paragraph (d)(5)(ii)(A) of this section, enrollment is completely
nullified effective from the beginning date of coverage. For cases
determined to qualify for disenrollment under the extenuating
circumstances provisions in paragraph (d)(5)(ii)(B) of this section,
the effective date of disenrollment is the first of the month following
the contractor's initial determination on the disenrollment request or
the first of the month following the last use of TRDP benefits under
the enrollment, whichever is later.
(D) Appeal process for denied voluntary enrollment termination. An
enrollee has the right to appeal the contractor's determination that a
disenrollment request does not qualify under paragraphs (d)(5)(ii)(A)
or (B) of this section. The enrollee may appeal that determination by
submitting a written appeal to the TMA, Office of Appeals and Hearings,
with a copy of the contractor's determination notice and relevant
documentation supporting the disenrollment request. This appeal must be
received by TMA within 60 days of the date on the contractor's
determination notice. The burden of proof is on the enrollee to
establish affirmatively by substantial evidence that the enrollee
qualifies to be disenrolled under paragraphs (d)(5)(ii)(A) or (B) of
this section. TMA will issue written notification to the enrollee and
the contractor of its appeal determination within 60 days from the date
of receipt of the appeal request. That determination is final.
* * * * *
(e) * * *
(2) Effects of failure to make premium payments. Failure to make
premium payments will result in the enrollee's disenrollment from the
TRDP and a lockout period of 12 months. Following this period of time,
eligible individuals will be able to re-enroll.
* * * * *
(k) Appeal procedures. All levels of appeal established by the
contractor shall be exhausted prior to an appeal being filed with the
TMA. Procedures comparable to those established for appeal of benefit
determinations under Sec. 199.10 of this part shall apply together
with the procedures for appeal of voluntary disenrollment
determinations described in paragraph (d)(5)(ii)(D) of this section.
* * * * *
Dated: September 30, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-24001 Filed 10-8-08; 8:45 am]
BILLING CODE 5001-06-P