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Privacy Act Statement
This statement serves to inform you of the purpose for collecting personal information required for the Delta Dental Federal Government Programs (DDFGP) Information System (IS) and how it will be used.
Authority: 10 U.S.C. Chapter 55, Medical and Dental Care; 38 U.S.C. 1781, Medical Care for Survivors and Dependents of Certain Veterans; 32 CFR 199.22, TRICARE Retiree Dental Program (TRDP); and E.O. 9397 (SSN), as amended.
Purpose: To obtain information from an individual for records pertaining to eligibility, claims processing, quality of care review, customer service enhancement, and payment related to the TRICARE Retiree Dental Program.
Routine Uses: Information collected may be used and disclosed generally as permitted under 45 CFR Parts 160 and 164, Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, as implemented by DoD 6025.18-R, the DoD Health Information Privacy Regulation. In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act of 1974, the DoD "Blanket Routine Uses" under 5 U.S.C. 552a (b) (3) apply to this collection. Information from this system may be shared with federal, state, local, or foreign government agencies, and with private business entities, including individual providers of care, on matters relating to eligibility, claims pricing and payment, fraud, program abuse, utilization review, quality assurance, peer review, program integrity, third-party liability, coordination of benefits, and civil and criminal litigation.
Disclosure: Voluntary. If you choose not to provide your information, no penalty may be imposed, but absence of the requested information may result in the denial of benefits.