[Federal Register Volume 67, Number 20 (Wednesday, January 30, 2002)]
[Proposed Rules]
[Pages 4375-4377]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-2173]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

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, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule implements section 726 of the Floyd D. 
Spence National Defense Authorization Act for Fiscal Year 2001, which 
amended 10 U.S.C. 1076c to allow for voluntary disenrollment from the 
TRICARE Retiree Dental Program in certain circumstances.

DATES: Comments must be received on or before April 1, 2002.

ADDRESSES: TRICARE Management Activity (TMA), Special Contracts and 
Operations Office, 16401 East Centretech Parkway, Aurora, CO 80011-
9043.

FOR FURTHER INFORMATION CONTACT: Linda Winter, Special Contracts and 
Operations Office, TMA, (303) 676-3682.

SUPPLEMENTARY INFORMATION:

I. Background

    The TRICARE Retiree Dental Program (TRDP), a voluntary dental 
insurance plan completely funded by enrollees' premiums, was 
implemented in 1998 based on the authority of 10 U.S.C. 1076c. The 
enabling legislation specifies that the Secretary of Defense shall 
prescribe a minimum required period for enrollment and allows 
enrollment to be terminated only for loss of eligibility and failure to 
pay premiums. There was no provision for enrollees to voluntarily 
terminate their enrollment before the enrollment commitment was 
fulfilled. Accordingly, the implementing regulation, 32 CFR 199.22, 
allows termination of enrollment during the required enrollment period 
only for the ineligibility and premium default reasons.
    In section 726 of the Floyd D. Spence National Defense 
Authorization Act for Fiscal Year 2001, Public Law 106-398, Congress 
responded to concerns that the enabling legislation was too restrictive 
by not allowing enrollees to voluntarily terminate their enrollment 
before the completion of their enrollment commitment when continued 
enrollment would be of no benefit to them. Section 726 amended 10 
U.S.C. 1076c to direct the Secretary of Defense to allow an enrollee 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: 
assignment of Federal employment outside the 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. In addition, the amendment requires a process for 
appealing adverse decisions to OCHAMPUS.

II. Provisions to the Proposed Rule.

    This proposed rule expands the voluntary termination provision 
originally published in an interim final rule in the Federal Register 
on August 14, 2000 (65 FR 49491). Under the statutory mandate for 
voluntary enrollment, that provision implemented a grace period in 
which a new enrollee could voluntarily disenroll during the first 
thirty 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 proposed rule establishes another opportunity for voluntary 
disenrollment that is based on the extenuating circumstances specified 
in the Floyd D. Spence National Defense Authorization Act for Fiscal 
Year 2001. The TRDP contractor continues as the authority for voluntary 
disenrollment decisions but only at the initial level. The rule 
establishes a process for enrollees to appeal to OCHAMPUS all adverse 
decisions made by the contractor in response to requests for voluntary 
disenrollment.
    In addition, the proposed rule makes the following administrative 
changes: Corrects a typographical error in a reference to the Assistant 
Secretary of Defense (Health Affairs); replaces references to the 
TRICARE Active Duty Dependents Dental Plan with the name of its 
successor, the TRICARE Dental Program; removes the forwarding of 
grievances to OCHAMPUS for final

[[Page 4376]]

review; and replaces the reference to the appeals process for the 
TRICARE Dental Program at section 199.13(h) with a reference to the 
OCHAMPUS appeals process as section 199.10 as governing for the TRDP.

III. Rulemaking Procedures

    Executive Order 12866 requires certain regulatory assessments for 
any ``significant regulatory action,'' defined as one that would result 
in an annual effect on the economy of $100 million or more, or have 
other substantial impacts. The Regulatory Flexibility Act requires that 
each federal agency prepare, and make available for public comment, a 
regulatory flexibility analysis when the agency issues a regulation 
that would have a significant impact on a substantial number of small 
entities. This rule has been designated as significant and has been 
reviewed by the Office of Management and Budget as required under the 
provisions of E.O. 12866.
    Furthermore, pursuant to section 605 of the Regulatory Flexibility 
Act (5 U.S.C. 605), we hereby certify that this rule will not have a 
significant economic impact on a substantial number of small entities. 
This rule affects only the manner in which enrollment in the TRICARE 
Retiree Dental Program is administered. This rule will impact only 
enrollees in that program and the contractor responsible for 
administering the program.
    This rule will not impose additional information collection 
requirements on the public under the Paperwork Reduction Act of 1995 
(44 U.S.C. Chapter 35).

List of Subjects in 32 CFR Part 199

    Claims, Dental health, Health insurance, Individuals with 
disabilities, Military personnel.

    Accordingly, 32 CFR 199 is proposed to be amended as follows:

PART 199--[AMENDED]

    1. The authority citation for Part 199 continues to read as 
follows:

    Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.

    2. Section 199.22 is proposed to be amended by revising paragraphs 
(b)(4) and (c), the first two sentences of paragraph (d)(1)(iv) 
introductory text, and paragraphs (d)(1)(v), (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.
* * * * *
    (c) Definitions. Except as may be specifically provided in this 
section, to the extent terms defined in Sec. 199.2 and 199.13(b) are 
relevant to the administration of the TRICARE Retiree Dental Program, 
the definitions contained in Secs. 199.2 and 199.13(b) shall apply to 
the TRDP as they do to CHAMPUS and the TRICARE Dental Program.
    (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. * * *
    (v) The unremarried surviving spouse and eligible child dependents 
of a deceased member who died while in status described in paragraphs 
(d)(1)(i) or (d)(1)(ii) of this section; the unremarried surviving 
spouse and eligible child dependents who receive a surviving spouse 
annuity; or the unremarried surviving spouse and eligible child 
dependents of a deceased member who died while on active duty for a 
period of more than 30 days and whose eligible dependents are not 
eligible or no longer eligible for the TRICARE Dental Program.
* * * * *
    (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, OCHAMPUS, 
or designee, when such coverage is offered, 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 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 reason other than those in paragraphs 
(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 
thirty (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 a Federal employee who has received an 
assignment to a location outside the jurisdiction of the TRDP that 
prevents utilization of TRDP benefits,
    (2) The enrollee is prevented by a serious medical condition from 
being able to utilize TRDP benefits, or

[[Page 4377]]

    (3) The enrollee would suffer severe financial hardship by 
continuing TRDP enrollment.
    (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 to OCHAMPUS 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 request to OCHAMPUS 
with a copy of the contractor's determination notice and relevant 
documentation supporting the disenrollment request. This appeal must be 
received by OCHAMPUS within 60 days of the date of 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. OCHAMPUS 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. The decision of OCHAMPUS 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 lock-out period of 12 months. Following this period of time, 
eligible individuals will be able to re-enroll if they so choose.
* * * * *
    (k) Appeal procedures. All levels of appeal established by the 
contractor shall be exhausted prior to an appeal being filed with 
OCHAMPUS. Procedures comparable to those established for appeal of 
benefit determinations under Sec. 199.10 shall apply together with the 
procedures for appeal of voluntary disenrollment determinations 
described in paragraph (d)(5)(ii)(D) of this section.
* * * * *

    Dated: January 24, 2002.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 02-2173 Filed 1-29-02; 8:45 am]
BILLING CODE 5001-08-M