Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Voluntary Disenrollment From the TRICARE Retiree Dental Program (TRDP), 59504-59505 [E8-24001]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 73, Number 197 (Thursday, October 9, 2008)]
[Rules and Regulations]
[Pages 59504-59505]
From the Federal Register Online via the Government Printing 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