IN THE CASE OF:	

		BOARD DATE:	17 September 2009  

		DOCKET NUMBER:  AR20080018883 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests, in effect, that the dates in the Defense Enrollment Eligibility Report System (DEERS) be updated to reflect that his family members were eligible for dental care under the TRICARE Dental Plan (TDP) during the period 14 October 2004 until present.  He also requests that he be reimbursed for the dental bills he paid during this period.

2.  The applicant states, in effect, that DEERS erroneously dropped his dental coverage in August 2005.  As a result, he has incurred dental bills for family dental care, which is a great injustice because he now has outstanding dental bills.  He claims he sent in his reenrollment documents in November and December only to be told by TRICARE that his coverage would not be effective until January 2006.  He further states that although his disenrollment was through no fault of his own, TRICARE/DEERS has refused to rectify their error.

3.  The applicant provides the following documents in support of his application:  DA Form 4187 (Personnel Action); Dental Billing Statement; U.S. Army Human Resources Command (HRC) Orders 311-02, dated 7 November 2005; HRC memorandum, dated 20 October 2005; U.S. Army Air Defense Artillery Center and Fort Bliss Permanent Orders 288-501, dated 14 October 2004; DD Form 214 (Certificate of Release or Discharge from Active Duty); DD Form 215 (Correction to DD Form 214); DD Form 4 (Enlistment/Reenlistment Document Armed Forces of the United States); page 2 of U.S. Army Europe Transition Center-Darmstadt Orders 133-02, dated 13 May 1997; DA Form 2-1 (Personnel Qualification Record-Part 1); and ARPC Form 249-E (Chronological Statement of Retirement Points).

CONSIDERATION OF EVIDENCE:

1.  The applicant's record shows he is currently serving on active duty in the rank of first sergeant at Fort Riley, Kansas.

2.  The applicant's record shows he initially enlisted in the Regular Army (RA) and served on active duty during the period 4 August 1982 through 2 June 1997.

3.  On 20 October 1999, the applicant enlisted in the U.S. Army Reserve and served continuously in a Reserve Component in various statuses until being discharged for the purpose of enlistment in the RA on 27 October 2005.

4.  U.S. Army Air Defense Artillery Center and Fort Bliss, Fort Bliss, Texas, Permanent Orders 288-501, dated 14 October 2004, with the deployment roster directed the deployment of the applicant's unit to Iraq in support of Operation Iraqi Freedom on or about 10 October 2004.

5.  The DD Form 214 issued to the applicant shows he served on active duty from 3 October 2004 through 27 October 2005, at which time he was honorably released from active duty under the provisions of chapter 4, Army Regulation 635-200 (Personnel Separations), by reason of completion of required active service.  It also shows he completed a total of 1 year and 25 days of active military service during that period.  Item 18 (Remarks) shows the applicant served in Kuwait and Iraq during the period 16 October 2004 through 27 August 2005.

6.  On 20 October 2005, in accordance with Military Personnel Message 05-143, the applicant's request for enlistment in the RA in the rank of master sergeant with the primary military occupational specialty 92Y was approved.  It further stipulated there would be no break in service.

7.  On 28 October 2005, the applicant enlisted in the RA for a period of 6 years.

8.  U.S. Army Human Resources Command, Alexandria, Virginia, Orders 311-02, dated 7 November 2005, reassigned the applicant to the 25th Infantry Headquarters Brigade, Fort Riley, Kansas, with a reporting date of 22 November 2005.  The special instructions contained in these orders stated the applicant was to enroll himself and family members with the new TRICARE Region and confirm his DEERS information.  It further stated that additional information could be accessed through the TRICARE website.

9.  On 1 May 2009, an advisory opinion was obtained from the Department of Defense, Chief, Beneficiary Services Branch, in connection with this case.  This official stated that DEERS reflected the applicant's TDP enrollments for the applicant's family under his sponsorship as a member of the Active Guard Reserve (AGR) started on 1 May 2005 and ended on 31 October 2005 and his sponsorship and family enrollment as an active duty Soldier started on 1 January 2006 and has remained in effect through the present.  This official also stated that she contacted the United Concordia Companies, Inc. (UCCI), who confirmed the enrollment dates for the applicant's family members.  The UCCI representative also stated they had received the applicant's application to enroll in the TDP for active duty family members on 15 December 2008, but were unable to confirm if the UCCI received an application for TDP enrollment in November 2008 as indicated by the applicant.

10.  The UCCI TDP National Fee for Service Schedule provides the authorized allowable amounts of insurance claim payments for dental procedures.  It shows that the following amounts would be paid by UCCI for the identified procedures:  Adult Prophylaxis - $57.00, Child Prophylaxis - $42.00, Fluoride Child - $24.00, X-ray Bitewing - $37.00, Periodic Exam - $28.00, Periapical X-ray - $17.00, Periapical - $13.00, Fillings Tooth Color Surface - $132.00, Gingivoplasty - $433.00.

11.  The Department of Defense TDP is managed by United Concordia which is the Department of Defense’s choice as its dental health partner for more than 1.8 million enrollees in the TDP and 100,000 members of the Active Duty Dental Program.  The TDP is available to family members of all active duty service members of any of the seven uniformed services and to National Guard/Reserve members and/or their families.  To be eligible for the TDP, the sponsor must have at least 12 months remaining on his or her service commitment at the time of enrollment.  If the member resides in the continental United States service area, that member will receive the greatest value by visiting TDP participating dentists.  Participating dentists will complete and submit claims on behalf of the member, submit predetermination requests when appropriate, and accept payment directly from United Concordia.  TRICARE medical and dental are two different programs.  A member must enroll in each separately.

12.  The TDP provides selected services including endodontic, periodontal, and oral surgery at a reduced cost-share for members, depending on their rank.  The United Concordia official web site provides a detailed listing of covered services and/or co-payments.  The TDP is an affordable option for eligible members.  With government-shared premiums and cost-shares, the member receives the most coverage for minimal out-of-pocket costs.  Member cost-shares vary depending upon the sponsor's pay grade.

13.  Family members of active duty service members including spouses and unmarried children (including stepchildren, adopted children, and wards) under the age of 21 are eligible for enrollment in the TDP.  Unmarried children will be eligible up to the end of the month in which they turn 21 and they may be eligible after age 21 if they meet the requirements of being full-time students or have a disabling illness or injury.

14.  The following individuals are not eligible to enroll in the TDP:  active duty service members, National Guard/Reserve members called or ordered to active duty for more than 30 consecutive days, retired service members and their families, former spouses, parents and parents-in-law, disabled veterans, and foreign military personnel.

15.  National Guard/Reserve family members are eligible for enrollment in the TDP even if their sponsor does not enroll.  The plan offers continuous dental coverage throughout the National Guard/Reserve sponsor's changing status – from inactive to active and back again.  In fact, if a National Guard/Reserve sponsor is activated, family members will enjoy reduced monthly premiums while their sponsor is on active duty because they are considered "active duty family members" during that time.  Additionally, because family member enrollment is not dependent on the sponsor's enrollment, family members can enroll in the TDP at any time.  Family members who are eligible include spouses and unmarried children (including stepchildren, adopted children, and wards) under the age of 21.  Unmarried children may be eligible after age 21 if they meet the requirements of being full-time students or have a disabling illness or injury.

16.  Dependents of active duty members, Selected Reserve, and Individual Ready Reserve sponsors and their families are eligible for the TDP.  Before enrollment can be completed, United Concordia must confirm eligibility for coverage with DEERS.  DEERS enrollment is the responsibility of the individual.  National Guard/Reserve sponsors are eligible to enroll in the TDP when they are not on active duty for more than 30 consecutive days.  If a National Guard/
Reserve sponsor enrolled in the TDP is called or ordered to active duty for more than 30 consecutive days, he or she will automatically be disenrolled from the program during the period of activation and automatically re-enrolled upon deactivation.  If a Reserve member is activated, the family will remain enrolled in the TDP.  The family members will enjoy reduced monthly premiums because they are considered "active duty family members" during that time.  When the sponsor returns to Reserve status, the premiums for the family members will return to the Reserve member rate.  There will be no interruption in the family's coverage.

17.  If a National Guard/Reserve sponsor enrolls the family member(s) while on active orders and is then inactivated, the family will remain enrolled in the TDP.  The premiums will automatically change to the higher Reserve member rate.  The sponsor then has the option to enroll.  The sponsor must submit a completed enrollment form and initial premium payment in order to obtain coverage.  The sponsor will be required to complete the minimum 12-month enrollment period.

DISCUSSION AND CONCLUSIONS:

1.  The applicant’s request for reimbursement of dental services claims was carefully considered and found to have merit.  The applicant has been a member of the Army in good standing and eligible for continuous enrollment in the TDP since 1 May 2005.  There is no reason to believe the applicant would have had his family seek out routine dental care during the period between his AGR service and RA-eligible service during November and December 2005 had he not believed they were enrolled in the TDP.

2.  The evidence of record confirms the applicant's family members were enrolled in the TDP during the period 1 May 2005 through 31 October 2005 while he was serving in Iraq in an AGR status, and that although he submitted enrollment documents to continue this care in conjunction with his RA enlistment of 28 October 2005, his family was not reenrolled based on his RA status until 1 January 2006, which left a gap in his coverage during the months of November and December 2005 which should be covered in the interest of justice and equity at this time.

3.  Reimbursement of the entire dental bill submitted by the applicant would not be appropriate given the reimbursement provided to enrolled members is limited to that fee authorized by the UCCI TDP National Fee for Service Schedule which would authorized payment of $1,223.00 for the dental procedures received by the applicant’s family members during the period he was erroneously dropped from DEERS and the TDP.  Thus, it would appropriate to reimburse the applicant this amount.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

____x____  ____x____  _____x___  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for partial relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by showing he was enrolled in DEERS and the TDP during the period 1 November through 31 December 2005 and by reimbursing him $1,223.00 for the dental care received by his family members during this period.



      ____________x_____________
                 CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.

ABCMR Record of Proceedings (cont)                                         AR20080018883



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ABCMR Record of Proceedings (cont)                                         AR20080018883



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