TN 19 (03-93)

HI 00805.731 Change in CHAMPUS Law Required Relief in 1992

A. BACKGROUND

Under the Department of Defense Authorization Act (P.L.102-190) of 12/5/ 91, individuals have their CHAMPUS benefits restored if they prove they are:

  • under age 65; and

  • entitled to Part A of Medicare on the basis of disability;

  • if dually eligible for Medicare on the basis of DIB and ESRD, had Medicare initially based on DIB; and

  • enrolled in Part B (SMI).

Disabled CHAMPUS beneficiaries have prescription drug coverage that CHAMPUS provides and Medicare does not. They also receive certain payments from CHAMPUS towards Medicare deductibles and coinsurance.

NOTE: The law made no change in CHAMPUS termination being required for those who are eligible for HI on the basis of age or only ESRD. However, CHAMPUS will investigate ESRD beneficiaries on a case-by-case basis to see if reinstatement is possible.

Some of the disabled beneficiaries who were terminated from CHAMPUS and did not have SMI were not promptly informed that they could have CHAMPUS again if they enrolled in SMI. Also, some disabled beneficiaries had SMI but terminated it because of misinterpretation of the new legislation.

B. POLICY

Equitable relief was made available for disabled beneficiaries who:

  • lost CHAMPUS,

  • had HI,

  • were not enrolled in SMI, and

  • missed the 1992 GEP because prompt notice was not sent about their right to be reenrolled in CHAMPUS if they have SMI.

The 1992 GEP was extended under equitable relief to undo the harm resulting from DoD's failure to notify former CHAMPUS beneficiaries (who have HI based on disability) of the change in the law.

Enrollment at any time during 1992 was deemed to be enrollment during the 1992 GEP, and SMI began 7/1/92.

No change was made in calculating the premium surcharge for late enrollment. Months after the end of the IEP through 3/92 (the end of the “deemed enrolled” GEP) had to be counted (excluding months, if any, as provided in HI 01001.010).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805731
HI 00805.731 - Change in CHAMPUS Law Required Relief in 1992 - 03/17/1993
Batch run: 01/27/2009
Rev:03/17/1993