38 U.S.C. § 1712C — Dental insurance plan for veterans and survivors and dependents of veterans
submitted 10 years ago by Pub. L. 114-218 to r/title-38-VETERANS-BENEFITS · 613 words · no verdicts yet
The Secretary must establish and administer a voluntary dental insurance plan for specified veterans and certain survivors and dependents. Covered people pay the full premium and copayments, and the section sets rules for benefits, enrollment, disenrollment, and administration.
(a) In general. The Secretary* must establish and administer a dental insurance plan for the veterans, survivors, and dependents described in (b).
(b) Covered veterans and survivors and dependents. The covered people are (1) veterans enrolled in the annual patient-enrollment system under section 1705, and (2) survivors or dependents of veterans eligible for medical care under section 1781.
(c) Administration. The Secretary must contract with a dental insurer to administer the plan.
(d) Benefits. The plan must provide the dental-care and treatment benefits the Secretary considers appropriate, including diagnostic, preventive, endodontic and other restorative, surgical, and emergency services.
(e) Enrollment. (1) Enrollment is voluntary. (2) Enrollment lasts for the minimum period the Secretary prescribes for this section.
(f) Premiums. (1) The Secretary must set premiums at amounts that cover all costs of carrying out this section. (2) The Secretary must adjust premiums each year. Every person covered when an adjustment is made must be told the amount and effective date of the adjustment. (3) Each covered person must pay the entire premium and the full cost of all copayments.
(g) Voluntary disenrollment. (1) The Secretary must allow a person to disenroll voluntarily during the 30 days beginning on the person’s enrollment date. The Secretary must also allow voluntary disenrollment in circumstances the Secretary prescribes, but only if it does not jeopardize the plan’s financial integrity. (2) Those circumstances must include: (A) the person moves outside the plan’s jurisdiction and therefore cannot use its benefits; (B) a serious medical condition prevents the person from obtaining its benefits; and (C) other circumstances the Secretary prescribes. (3) The Secretary must establish procedures for deciding whether disenrollment under (1)(B) is allowed, and the procedures must provide timely decisions.
(h) Relationship to dental care provided by the Secretary. This section does not change the Secretary’s duty to provide dental care under section 1712. Participation in this plan does not change a person’s entitlement to outpatient dental services, treatment, or related dental appliances under section 1712.
(i) Regulations. The plan must be administered under regulations prescribed by the Secretary.
The Secretary* shall establish and administer a dental insurance plan for veterans and survivors and dependents of veterans described in subsection (b).
The veterans and survivors and dependents of veterans described in this subsection are as follows:
Any veteran* who is enrolled in the system of annual patient enrollment under section 1705 of this title.
Any survivor or dependent of a veteran who is eligible for medical care under section 1781 of this title.
The Secretary shall contract with a dental insurer to administer the dental insurance plan under this section.
The dental insurance plan under this section shall provide such benefits for dental care and treatment as the Secretary considers appropriate for the dental insurance plan, including diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services.
Enrollment in the dental insurance plan under this section shall be voluntary.
Enrollment in the dental insurance plan shall be for such minimum period as the Secretary shall prescribe for purposes of this section.
Premiums for coverage under the dental insurance plan under this section shall be in such amount or amounts as the Secretary shall prescribe to cover all costs associated with carrying out this section.
The Secretary shall adjust the premiums payable under this section for coverage under the dental insurance plan on an annual basis. Each individual covered by the dental insurance plan at the time of such an adjustment shall be notified of the amount and effective date of such adjustment.
Each individual covered by the dental insurance plan shall pay the entire premium for coverage under the dental insurance plan, in addition to the full cost of any copayments.
With respect to enrollment in the dental insurance plan under this section, the Secretary shall—
permit the voluntary disenrollment of an individual in the dental insurance plan if the disenrollment occurs during the 30-day period beginning on the date of the enrollment of the individual in the dental insurance plan; and
permit the voluntary disenrollment of an individual in the dental insurance plan for such circumstances as the Secretary shall prescribe for purposes of this subsection, but only to the extent such disenrollment does not jeopardize the fiscal integrity of the dental insurance plan.
The circumstances prescribed under paragraph (1)(B) shall include the following:
If an individual enrolled in the dental insurance plan relocates to a location outside the jurisdiction of the dental insurance plan that prevents use of the benefits under the dental insurance plan.
If an individual enrolled in the dental insurance plan is prevented by a serious medical condition from being able to obtain benefits under the dental insurance plan.
Such other circumstances as the Secretary shall prescribe for purposes of this subsection.
The Secretary shall establish procedures for determinations on the permissibility of voluntary disenrollments under paragraph (1)(B). Such procedures shall ensure timely determinations on the permissibility of such disenrollments.
Nothing in this section shall affect the responsibility of the Secretary to provide dental care under section 1712 of this title, and the participation of an individual in the dental insurance plan under this section shall not affect the entitlement of the individual to outpatient dental services and treatment, and related dental appliances, under such section 1712.
The dental insurance plan under this section shall be administered under such regulations as the Secretary shall prescribe.
Source credit: (Added Pub. L. 114–218, § 2(a)(1), July 29, 2016, 130 Stat. 842; amended Pub. L. 117–42, § 2, Sept. 30, 2021, 135 Stat. 342.)
- 2016Enacted · Pub. L. 114-218 · 130 Stat. 842
- 2021Amended · Pub. L. 117-42 · 135 Stat. 342
A history note hasn’t been published yet. The record shows enactment by Pub. L. 114-218 on 2016-07-29.
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