Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Prime Enrollment Procedures

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA48

Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS); TRICARE Prime Enrollment Procedures

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: This final rule modifies the TRICARE Prime enrollment

procedures for active duty families by specifying that enrollment will

be automatically renewed upon the expiration of the annual enrollment

period, unless the renewal is declined. It also allows for monthly

installment payments of enrollment fees via allotment or electronic

funds transfer for those beneficiaries required to pay an annual

TRICARE Prime enrollment fee.

EFFECTIVE DATE: April 22, 1999.

ADDRESSES: TRICARE Management Activity, Program Development Branch,

Aurora, CO 80045-6900.

FOR FURTHER INFORMATION CONTACT: Kathleen Larkin, Office of the

Assistant Secretary of Defense (Health Affairs)/TRICARE Management

Activity, telephone (703) 681-1745.

SUPPLEMENTARY INFORMATION:

Introduction and Background

A. Congressional Action

This final rule implements section 712 of the FY 1999 National

Defense Authorization Act, which modified 10 U.S.C. 1097a to provide

for automatic renewal of TRICARE Prime enrollments and additional

payment options for retirees.

B. Public Comments

The proposed rule was published in the Federal Register on July 7,

1998 (63 FR 36651). We received no public comments.

II. Provisions of the Rule

1. TRICARE Prime Enrollment Renewals (revision to section 199.17(o)(2))

Provisions of the Proposed Rule

This paragraph explained that we proposed a change to the TRICARE

Prime enrollment period from a 12-month enrollment period to continuous

enrollment until such time as the enrollee opted to disenroll from

TRICARE Prime. TRICARE Prime was originally designed so that enrollees

would be required to take positive action to continue their enrollment

in TRICARE Prime at or before their 12-month anniversary date. Positive

action to reenroll was required because TRICARE implementation was not

available in all regions of the country and overseas locations.

Subsequent to our notice of proposed rulemaking, section 712 of the FY

1999 National Defense Authorization Act modified 10 U.S.C. 1097a to

require annual enrollment periods but required that TRICARE Prime

enrollment be automatically renewed upon the expiration of the

enrollment unless the renewal is declined. The Act also requires that

the enrollee, or the sponsor in the case of an enrolled family member,

be notified in writing no later than 15 days before the enrollment

expiration date and afforded the opportunity to decline enrollment.

Provisions of the Final Rule

The final rule has been modified to implement the statutory

direction given in the FY 1999 National Defense Authorization Act.

2. Changes to Installment Payments of Enrollment Fees (revision to

section 199.17(o)(3))

Provisions of the Proposed Rule

When we first instituted the requirement for annual TRICARE Prime

enrollment fees for certain beneficiary categories, we allowed for

quarterly installment payments of the enrollment fees. In keeping with

the nature of a more continuous enrollment process, we proposed that

retirees, their families, and other beneficiaries required to pay an

annual enrollment fee would be

[[Page 13913]]

offered additional flexibility in fee payment by allowing for monthly

or quarterly installment payments of enrollment fees. Subsequent to our

notice of proposed rulemaking, section 712 of the FY 1999 National

Defense Authorization Act modified 10 U.S.C. 1097a to expand payment

options to include monthly payment of enrollment fees via an allotment

from retired or retainer pay, or monthly payment via electronic funds

transfer from a financial institution.

Provisions of the Final Rule

The final rule has been modified to implement the statutory

direction given in the FY 1999 National Defense Authorization Act.

III. Regulatory Procedures

Executive Order 12866 requires certain regulatory assessments for

any significant regulatory action, defined as one which would result in

an annual effect on the economy of $100 million or more, or 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 is not a significant regulatory action under the provisions of

Executive Order 12866, and it would not have a significant impact on a

substantial number of small entities.

The final rule will not impose additional information collection

requirements on the public under the Paperwork Reduction Act of 1995

(44 U.S.C. Chapter 55).

List of Subjects in 32 CFR Part 199

Claims, Health insurance, Individuals and disabilities, Military

personnel, Reporting and recordkeeping requirements.

Accordingly, 32 CFR Part 199 is 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 199.17 is amended by revising paragraphs (o)(2) and

(o)(3), redesignating paragraphs (o)(4) and (o)(5) and (o)(5) and

(o)(6), and adding new paragraph (o)(4), to read as follows:

Sec. 199.17 TRICARE Program.

* * * * *

(o) * * *

(2) Enrollment period. Beneficiaries who select the TRICARE Prime

option remain enrolled for 12 month increments until: they take action

to disenroll; they are no longer eligible for enrollment in TRICARE

Prime; or they are disenrolled for failure to pay required enrollment

fees. For those who remain eligible for TRICAREPrime enrollment, no

later than 15 days before the expiration date of an enrollment, the

sponsor will be sent a written notification of the pending expiration

and renewal of the TRICARE Prime enrollment. TRICARE Prime enrollments

shall be automatically renewed upon the expiration of the enrollment

unless the renewal is declined by the sponsor. Termination of

enrollment for failure to pay enrollment fees is addressed in paragraph

(o)(3) of this section.

(3) Installment payments of enrollment fee. The enrollment fee

required by Sec. 199.18(c) may be paid in monthly or quarterly

installments. Monthly fees may be payable by an allotment from retired

or retainer pay, or paid from a financial institution through an

electronic transfer of funds. For beneficiaries paying enrollment fees

on an installment basis, failure to make a required installment payment

on a timely basis [including a grace period, as determined by the

Assistant Secretary of Defense (Health Affairs)] will result in

termination of the beneficiary's enrollment in Prime and

disqualification from future enrollment in Prime for a period of one

year.

(4) Voluntary disenrollment. Any beneficiary for whom enrollment in

Prime is voluntary may disenroll at any time. Disenrollment will take

effect in accordance with administrative procedures established by the

Assistant Secretary of Defense (Health Affairs). Beneficiaries who

disenroll prior to their annual enrollment renewal date will not be

eligible to reenroll in Prime for a one-year period from the effective

date of the disenrollment. This one year exclusion may be waived by the

Assistant Secretary of Defense (Health Affairs) based on extraordinary

circumstances.

* * * * *

Dated: March 17, 1999.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 99-7034 Filed 3-22-99; 8:45 am]

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