[Federal Register: March 16, 2005 (Volume 70, Number 50)]
[Rules and Regulations]
[Page 12798-12805]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16mr05-5]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN-0720-AA90
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Reserve Select for Certain Members of the Selected
Reserve; Transitional Assistance Management Program; Early Eligibility
for TRICARE for Certain Reserve Component Members
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule with comment period.
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SUMMARY: This interim final rule establishes requirements and
procedures for implementation of TRICARE Reserve Select. It also
revises requirements and procedures for the Transitional Assistance
Management Program. In addition, it establishes
[[Page 12799]]
requirements and procedures for implementation of the earlier TRICARE
eligibility for certain reserve component members. The rule is being
published as an interim final rule with comment period in order to
comply with statutory effective dates.
DATES: This rule is effective April 15, 2005. Submit comments on or
before May 16, 2005.
ADDRESSES: Because of staff and resource limitations, we cannot accept
comments by facsimile (FAX) transmission or e-mail. Mail written
comments to the following address ONLY: TRICARE Management Activity,
TRICARE Operations/Strategic Initiatives Division, Sky 5 Suite 810,
5111 Leesburg Pike, Falls Church, VA 22041-3206; Attention: Jody
Donehoo, Program Analyst.
FOR FURTHER INFORMATION CONTACT: Jody Donehoo, Office of the Assistant
Secretary of Defense (Health Affairs), telephone (703) 681-0039.
Questions regarding payment of specific claims under the TRICARE
allowable charge method should be addressed to the appropriate TRICARE
contractor.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
The Ronald W. Reagan National Defense Authorization Act for Fiscal
Year 2005 (NDAA-05) (Pub. L. 108-375) contains several provisions to
enhance health care benefits for reservists and their family members.
Three of the provisions are addressed in this interim final rule.
First, section 701 provides for premium-based medical coverage for
certain members of the Selected Reserve and their eligible family
members. Section 706 makes permanent the temporary revisions to the
Transitional Assistance Management Program, enacted in section 704 of
the National Defense Authorization Act for Fiscal Year 2004 (NDAA-04)
(Pub. L. 108-136) and section 1117 of the Emergency Supplemental
Appropriations Act for the Reconstruction of Iraq and Afghanistan, 2004
(Emergency Supplemental) (Pub. L. 108-106). Section 703 makes permanent
the earlier TRICARE eligibility for certain reserve component members
authorized by section 703 of NDAA-04 and section 1116 of the Emergency
Supplemental.
These provisions represent significant enhancements to the health
care benefits available to reservists and their eligible family
members. They focus particularly on reservists and guardsmen activated
in support of a contingency operation after September 11, 2001. Prior
to the statutory changes enacted since November 2003, reservists and
their families received TRICARE health care benefits when activated for
more than 30 consecutive days. Now, TRICARE benefits begin up to 90
days prior to activation for those who receive delayed-effective-date
orders, and coverage is extended to a full 180 days after a period of
active service in support of a contingency operation. These changes
provide for an easier transition to and from civilian life. And, for
those who served in support of a contingency operation and who commit
to continued service in the Selected Reserve, a new health benefits
program will allow them to obtain through TRICARE health coverage
comparable to that available to full-time civilian employees of the
Department of Defense. This new program is called ``TRICARE Reserve
Select.'' It is subject to a number of specific statutory requirements,
which are outlined in this regulation.
II. Provisions of the Rule Regarding the Tricare Reserve Select Program
A. Establishment of the TRICARE Reserve Select Program (paragraph
199.24(a)). This paragraph describes the nature, purpose, statutory
basis, scope, and major features of TRICARE Reserve Select, a premium-
based medical coverage program that will be available to certain
members of the Selected Reserve and their dependents. TRICARE Reserve
Select is authorized by 10 U.S.C. 1076d, and is applicable worldwide.
The major features of the program include the following: TRICARE rules
apply unless otherwise specified; certain special TRICARE programs are
not part of TRICARE Reserve Select, including the Supplemental Health
Care Program, the Extended Health Care Option (ECHO) program, and the
Special Supplemental Food Program (also known as the Women, Infants,
and Children--Overseas Program). The TRICARE Dental Program is already
available under 10 U.S.C. 1076a to all members of the Selected Reserve
and their family members whether or not they enroll in TRICARE Reserve
Select. Under TRICARE Reserve Select, eligible Selected Reserve members
may enroll for self-only or self and family coverage. When their
enrollment becomes effective, TRICARE Reserve Select beneficiaries
receive the TRICARE Standard benefit. TRICARE Reserve Select features
the deductible and cost share provisions of the TRICARE Standard plan
for active duty family members (ADFM) for both the member and eligible
family members.
B. Eligibility for enrollment in TRICARE Reserve Select (paragraph
199.24(b)). This paragraph defines who is eligible to enroll in TRICARE
Reserve Select, based on statutory provisions. To be eligible, a person
must be a member of a reserve component of the armed forces, who serves
on active duty for 90 consecutive days or more related to a contingency
operation on or after September 11, 2001, and, on or before the date of
release from active duty, agrees to serve continuously in the Selected
Reserve for a period of one or more whole years following release from
active duty, and, if not already a member of the Selected Reserve,
actually begins serving in the Selected Reserve prior to the date upon
which TRICARE Reserve Select coverage is effective. The member must
meet the qualifications for continued service in the Selected Reserve
as determined by the member's reserve component. If the member was
released from active duty on or before April 26, 2005, the member has
until October 28, 2005, to sign an agreement to serve continuously in
the Selected Reserve for a period of one or more whole years in order
to be eligible to enroll in TRICARE Reserve Select. This temporary
opportunity (until October 28, 2005) applies to current members of the
Selected Reserve, and also to former members who served in support of a
contingency after 9/11, rejoin the Selected Reserve, and enter into an
agreement for continued service. In conformance with section
701(b)(2)(B) of the NDAA-05, the Department will take reasonable steps
to the maximum extent practicable to notify reservists released from
active duty on or before April 26, 2005, who may be eligible for
TRICARE Reserve Select and provide them information on the opportunity
and procedures for entering into an agreement together with a clear
explanation of the benefits that the member is eligible to receive
under TRICARE Reserve Select as a result of entering into such
agreement. Eligible family members of eligible reserve members enrolled
in TRICARE Reserve Select are also eligible for enrollment in TRICARE
Reserve Select. Eligibility determinations are the responsibility of
the Reserve Components of the Armed Services.
C. TRICARE Reserve Select enrollment procedures (paragraph
199.24(c)). In order to be covered under TRICARE Reserve Select,
eligible reserve component members released from active duty after
April 26, 2005, must enter into an agreement prior to being released to
serve continuously in the reserves for a period of one or more
[[Page 12800]]
whole years following such date, and the member must meet the
qualifications for continuous service in the Selected Reserve as
determined by the member's reserve component. The member must then
enroll by signing the appropriate TRICARE enrollment form and
submitting the initial monthly premium to the appropriate TRICARE
contractor, not later than 30 days prior to the end of their
Transitional Assistance Management Program benefit period. A member may
elect self-only or self and family coverage, and may enroll for one
year of TRICARE Reserve Select coverage for every 90 days of continuous
active-duty service, to the extent that the member agrees to continue
service in the Selected Reserves for the same number of years after
coverage begins. Members released from active duty on or before April
26, 2005 may enroll in TRICARE Reserve Select upon execution of the
agreement to serve continuously in the Selected Reserve. Coverage
becomes effective the later of the end of TAMP coverage or the
effective date of the agreement to serve in the Selected Reserve.
Except for members released from active duty on or before April 26,
2005, enrollment in TRICARE Reserve Select must be accomplished prior
to the expiration of Transition Assistance Management Program (TAMP)
benefits, and coverage begins at the expiration of TAMP benefits and
runs continuously until eligibility expires or is otherwise terminated.
When enrollment is terminated or the member is otherwise disenrolled, a
member may not re-enroll unless recalled to active duty and the member
re-qualifies for this benefit.
For eligible members, the decision to enroll in TRICARE Reserve
Select or to decline enrollment is a one-time choice. If it is
declined, or if coverage is taken for a period less than the maximum
period of eligibility, coverage may not be initiated or extended later,
nor may any period of eligibility be saved until later. Thus, for
example, if a member served for one year in support of a contingency
operation, the member earns potential eligibility for the next four
years if the member agrees to continue service in the Selected Reserves
for four years. However, if that member elects to continue service in
the Selected Reserve for only two years, the member will qualify for
only two years of TRICARE Reserve Select coverage. This two-year
coverage period cannot be extended later, even if the member later
extends Selected Reserve service for two more years. The only way to
extend TRICARE Reserve Select coverage beyond the period determined
when the one-time choice is made is by re-qualifying through another
period of active duty service in support of a contingency operation.
If, while enrolled in TRICARE Reserve Select a member is recalled
to active duty for a period of more than 30 consecutive days, TRICARE
Reserve Select coverage is superseded by active duty military health
benefits for the member and the member's immediate family, but the
coverage period continues to run. When the member is released from
active duty, TRICARE Reserve Select coverage will resume for the member
and the member's immediate family provided the member had been enrolled
in family coverage on the date TRICARE Reserve Select coverage was
superseded by active duty health benefits. TRICARE Reserve Select
coverage will continue until the member's eligibility expires, is
otherwise terminated, or the member is disenrolled. Following the
member's release from active duty, TRICARE Reserve Select coverage will
be further superseded by TAMP benefits, if applicable. In addition,
TRICARE Reserve Select coverage is also superseded, if applicable, by
any period of early TRICARE coverage based on delayed-effective-date
orders or by a new enrollment, as a result of re-qualifying through
another period of active duty service in support of a contingency
operation. During any period in which TRICARE Reserve Select coverage
is superseded, no premium payments for TRICARE Reserve Select are due
for the period being superseded.
Under certain circumstances, reserve members may change their
TRICARE Reserve Select type of coverage. After initial enrollment, the
reserve member may not change from self-only to self and family
enrollment, or change from self and family enrollment to self-only
enrollment, except on the occasion of certain events affecting the
family, such as the birth of a child, the marriage or divorce of the
sponsor, the legal adoption of a child, or placement by a court of a
child as a legal ward in the sponsor's home, or certain events
affecting family health coverage, such as an employment change of the
member or spouse. It is the responsibility of the TRS member to provide
the necessary evidence required regarding the circumstances permitting
the change in enrollment to the appropriate TRICARE contractor. The
Director, TRICARE Management Activity shall issue guidelines as
necessary to implement these provisions. All such changes are effective
prospectively.
Failure to make a premium payment in a timely manner will result in
permanent disenrollment of the member and the member's immediate family
and denial of claims for services received on or after the effective
date of disenrollment, which is the end of the last month for which the
premium was paid. Members and their immediate family will not be
allowed to re-enroll, unless the member qualifies for a new period of
eligibility.
A reserve member whose service in the Selected Reserve ends is
automatically disenrolled, along with the member's eligible family
members, based on the date the member terminated service in the
Selected Reserve.
D. TRICARE Reserve Select premiums (paragraph 199.24(d)). Annual
premiums are charged for coverage under TRICARE Reserve Select.
Premiums are to be paid monthly, except as otherwise established as
part of the administrative implementation of TRICARE Reserve Select.
The monthly premium rates are established and updated annually on a
calendar year basis and are effective on the first of January each
year, for the two types of coverage--self-only and self and family. The
rates are based on 28 percent of the total estimated amount reasonable
for coverage under the TRICARE Standard benefit for the TRICARE Reserve
Select eligible population, as determined by the Assistant Secretary of
Defense (Health Affairs) (ASD(HA)) on an appropriate actuarial basis.
The monthly rate for each month of a calendar year is one-twelfth of
the annual rate for that calendar year, rounded to the nearest dollar.
Annual rates are based on the annual premiums for the Blue Cross
and Blue Shield Standard Service Benefit Plan under the Federal
Employees Health Benefits Program, a nationwide plan closely resembling
TRICARE Standard coverage, with adjustments based on demographic
differences in covered populations, as determined by the ASD(HA). Based
on an analysis of demographic differences between Blue Cross and Blue
Shield participants and beneficiaries eligible for TRICARE Reserve
Select, the adjustment amount is for purposes of calendar year 2005 a
32 percent reduction from the Blue Cross and Blue Shield annual premium
for self-only coverage and an 8 percent reduction from the Blue Cross
and Blue Shield annual premium for self and family coverage. (The
difference in the percentage reductions between self-only and self and
family premiums is due to the disproportionately high number of high
cost, single, elderly retiree federal employees covered by Blue Cross
and Blue Shield self-only coverage.)
[[Page 12801]]
Premiums will be adjusted annually to maintain an appropriate
relationship with the annual changes in Blue Cross and Blue Shield
premiums.
In addition to these annual premium changes, premium adjustments
may also be made prospectively for any calendar year to reflect any
significant program changes or any actual experience in the costs of
administering the TRICARE Reserve Select Program.
For calendar year 2005, the annual premium for self-only coverage
is $900 (monthly premium $75), and the annual premium for self and
family coverage is $2,796 (monthly premium $233). These premiums will
change effective January 2006.
E. Relationship to Continued Health Care Benefits Program (CHCBP)
(paragraph 199.24(e)). This paragraph addresses the relationship
between TRICARE Reserve Select and the CHCBP. CHCBP is a program that
(among other things) allows members released from active duty to
purchase continued health care coverage through TRICARE. This coverage
is available for a period of 18 months. Some members at the time of
release from active duty will be eligible for either TRICARE Reserve
Select or CHCBP. This paragraph of the regulation provides that if a
member enrolls in TRICARE Reserve Select, but later is disenrolled, the
member or the covered family members may then activate CHCBP coverage
for whatever period is remaining of the original 18 month eligibility.
For example, in the case that TRICARE Reserve Select enrollment is
ended because of discharge from the Selected Reserve (such as through a
reduction in force or base closure) of a member within 18 months of
release from active duty, the member could choose to continue health
care coverage under CHCBP for the remainder of the period at the
applicable CHCBP premiums.
F. Preemption of State laws (paragraph 199.24(f)). This paragraph
explains that the preemptions of State and local laws established for
the TRICARE program also apply to TRICARE Reserve Select. Any State or
local law or regulation pertaining to health insurance, prepaid health
plans, or other health care delivery, administration, and financing
methods is preempted and does not apply in connection with TRICARE
Reserve Select. This includes State and local laws imposing premium
taxes on health insurance carriers or underwriters or other plan
managers, or similar taxes on such entities. Preemption does not apply
to taxes, fees, or other payments on net income or profit realized by
such entities in the conduct of business relating to DoD health
services contracts, if those taxes, fees or other payments are
applicable to a broad range of business activity. For the purposes of
assessing the effect of Federal preemption of State and local taxes and
fees in connection with DoD health services contracts, interpretations
shall be consistent with those applicable to the Federal Employees
Health Benefits Program under 5 U.S.C. 8909(f).
G. Administration (paragraph 199.24(g)). This paragraph provides
that the ASD(HA) may establish other rules and procedures necessary for
the effective administration of TRICARE Reserve Select.
III. Provisions of the Rule Regarding the Transitional Assistance
Management Program
A. Eligibility under the Transitional Assistance Management Program
(TAMP) (paragraph 199.3(e)). Section 706 of NDAA-05 makes permanent
revisions to the Transitional Assistance Management Program, which was
temporarily revised by section 704 of NDAA-04 and section 1117 of the
Emergency Supplemental. Based on these enactments, several categories
of armed forces members are eligible for transitional health care after
serving on active duty. These include:
1. A member who is involuntarily separated from active duty;
2. A member of a reserve component who is separated from active
duty to which called or ordered in support of a contingency operation
if the active duty is active duty for a period of more than 30
consecutive days;
3. A member who is separated from active duty for which the member
is involuntarily retained under 10 U.S.C. 12305 in support of a
contingency operation; or
4. A member who is separated from active duty served pursuant to a
voluntary agreement of the member to remain on active duty for a period
of less than one year in support of a contingency operation.
(2) A spouse (as described in paragraph (b)(2)(i) of this section
except for former spouses) and child (as described in paragraph
(b)(2)(ii) of this section) of a member described in paragraph (e)(1)
of this section is also eligible for TAMP benefits under TRICARE.
The spouse and children of the member are also eligible for TAMP
benefits. TAMP benefits begin the day after the member is separated
from active duty, and end 180 days later. Eligibility is determined by
the armed forces.
B. Beneficiary liability under TAMP. (paragraph 199.4(f)(2)(vi)).
This paragraph establishes that TAMP beneficiaries (including the
member) are subject to the TRICARE Standard deductible and cost sharing
rules applicable to active duty family members.
IV. Provisions of the Rule Regarding Early Eligibility for Tricare for
Certain Reserve Component Members
A. Eligibility (paragraph 199.3(b)(5)). This paragraph incorporates
requirements and procedures for implementation of the earlier temporary
TRICARE eligibility for certain reserve component members authorized by
section 703 of NDAA-04 and section 1116 of the Emergency Supplemental,
which provisions were made permanent by section 703 of NDAA-05. Under
this paragraph reserve component members issued delayed-effective-date
orders for service in support of a contingency operation, and their
family members, are eligible for TRICARE on the date the orders are
issued, up to 90 days prior to the date on which the period of active
duty of more than 30 consecutive days is to begin.
V. Regulatory Procedures
Executive Order 12866 requires certain regulatory assessments for
any significant regulatory action that would result in an annual effect
on the economy of $100 million or more, or have other substantial
impacts. The Congressional Review Act establishes certain procedures
for major rules, defined as those with similar major 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 that would
have significant impact on a substantial number of small entities. This
interim final rule is not subject to any of those requirements because
it would not have any of these substantial impacts. Any substantial
impacts associated with implementation of TRICARE Reserve Select are
already determined by statute and are outside any discretionary action
of DoD or effect of this regulation.
This rule, however, does address novel policy issues relating to
implementation of a new medical benefits program for members of the
armed forces. Thus, this rule has been reviewed by the Office of
Management and Budget under E.O. 12866.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-
[[Page 12802]]
3511). Information needed for TRICARE Reserve Select is obtained from
active duty military service records.
This rule is being issued as an interim final rule, with comment
period, as an exception to our standard practice of soliciting public
comments prior to issuance. This is because Congress has established an
April 26, 2005 effective date for eligible members' entitlement to
TRICARE Reserve Select. The 180-day TAMP coverage period and the
delayed effect date orders pre-mobilization eligibility period
entitlements became effective on the date of enactment. This rule
changes the regulation to conform to the statutory entitlement. Based
on these statutory requirements, the ASD(HA) has determined that
following the standard practice in this case would be unnecessary,
impractical, and contrary to the public interest.
Public comments are invited. All comments will be carefully
considered. A discussion of the major issues received by public
comments will be included with the issuance of the final rule.
List of Subjects in 32 CFR Part 199
Claims, handicapped, health insurance, and military personnel.
0
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
0
2. Section 199.2(b) is amended by adding the following two definitions
and placing them in alphabetical order to read as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
Transitional Assistance Management Program (TAMP). The program
established under 10 U.S.C. Sec. 1145(a) and Sec. 199.3(e) of this
part.
* * * * *
TRICARE Reserve Select. The program established under 10 U.S.C.
Sec. 1076d and Sec. 199.24 of this part.
* * * * *
0
3. Section 199.3 is amended by adding new paragraph (b)(5) and revising
paragraph (e) to read as follows:
Sec. 199.3 Eligibility.
* * * * *
(b) * * *
(5) Reserve Component Members Issued Delayed-Effective-Date Orders.
(i) Member. A member of a reserve component of the armed forces who
is ordered to active duty for a period of more than 30 consecutive days
in support of a contingency operation under a provision of law referred
to in section 101(a)(13)(B) of Title 10, United States Code, that
provides for active-duty service to begin on a date after the date of
the issuance of the order.
(ii) Dependents. CHAMPUS eligible dependents under this paragraph
(b)(5) are those identified in paragraphs (b)(2)(i) (except former
spouses) and (b)(2)(ii) of this section.
(iii) Effective date. The eligibility established by paragraphs
(b)(5)(i) and (ii) of this section shall begin on or after November 6,
2003, and shall be effective on the later of the date that is:
(A) The date of issuance of the order referred to in paragraph
(b)(5)(i) of this section; or
(B) 90 days before the date on which the period of active duty is
to begin.
(iv) Termination date. The eligibility established by paragraphs
(b)(5)(i) and (ii) of this section ends upon entry of the member onto
active duty (at which time CHAMPUS eligibility for the dependents of
the member is established under paragraph (b)(2) of this section) or
upon cancellation or amendment of the orders referred to in paragraph
(b)(5)(i) of this section such that they no longer meet the
requirements of that paragraph (b)(5)(i).
* * * * *
(e) Eligibility under the Transitional Assistance Management
Program (TAMP).
(1) A member of the armed forces is eligible for transitional
health care if the member is:
(i) A member who is involuntarily separated from active duty.
(ii) A member of a Reserve component who is separated from active
duty to which called or ordered in support of a contingency operation
if the active duty is active duty for a period of more than 30
consecutive days.
(iii) A member who is separated from active duty for which the
member is involuntarily retained under 10 U.S.C. 12305 in support of a
contingency operation; or
(iv) A member who is separated from active duty served pursuant to
a voluntary agreement of the member to remain on active duty for a
period of less than 1 year in support of a contingency operation.
(2) A spouse (as described in paragraph (b)(2)(i) of this section
except former spouses) and child (as described in paragraph (b)(2)(ii)
of this section) of a member described in paragraph (e)(1) of this
section is also eligible for TAMP benefits under TRICARE.
(3) TAMP benefits under TRICARE begin on the day after the member
is separated from active duty, and, if such separation occurred on or
after November 6, 2003, and end 180 days after such date. TRICARE
benefits available to both the member and eligible family members are
generally those available to family members of members of the uniformed
services under this Part. Each branch of service will determine
eligibility for its members and eligible family members and provide
data to DEERS.
* * * * *
0
4. Section 199.4 is amended by adding new paragraph (f)(2)(vi) to read
as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(f) * * *
(2) * * *
(vi) Transitional Assistance Management Program (TAMP). Members of
the Armed Forces (and their family members) who are eligible for TAMP
under paragraph 199.3(e) of this Part are subject to the same
beneficiary or sponsor liability as family members of members of the
uniformed services described in this paragraph (f)(2).
* * * * *
0
5. Section 199.24 is added to read as follows:
Sec. 199.24 TRICARE standard coverage for certain selected reserve
members.
(a) Establishment. TRICARE Reserve Select is established for the
purpose of offering TRICARE health benefits to eligible members of the
Selected Reserve and their immediate family.
(1) Purpose. TRICARE Reserve Select is a premium-based medical
coverage program that will be available to certain members of the
Selected Reserve and their immediate family as specified in paragraph
(b) of this section.
(2) Statutory Authority. TRICARE Reserve Select is authorized by 10
U.S.C. 1076d.
(3) Scope of the Program. TRICARE Reserve Select is applicable in
the 50 United States, the District of Columbia, Puerto Rico, and, to
the extent practicable, other areas where members of the Selected
Reserve serve. In locations other than the 50 states of the United
States and the District of Columbia, the Assistant Secretary of Defense
may authorize modifications to the program rules and procedures as may
be appropriate to the area involved.
(4) Major Features of TRICARE Reserve Select. The major features of
the program include the following:
(i) TRICARE rules applicable. (A) Unless specified in this section
or
[[Page 12803]]
otherwise prescribed by the Assistant Secretary of Defense (Health
Affairs) (ASD(HA)), provisions of 32 CFR Part 199 apply to TRICARE
Reserve Select.
(B) Certain special programs established in 32 CFR Part 199 are not
available to enrollees in TRICARE Reserve Select. These include the
Supplemental Health Care Program (see Sec. 199.16), the Extended
Health Care Option Program (see Sec. 199.5), and the Special
Supplemental Food Program (see Sec. 199.23). The TRICARE Dental
Program (see Sec. 199.13) is independent of this program and is
otherwise available to all members of the Selected Reserve and their
dependents whether or not they are enrolled in TRICARE Reserve Select.
(ii) Enrollment system. Under TRICARE Reserve Select, eligible
Reserve component members may enroll for self-only or self and family
coverage. Rules and procedures for enrollment and payment of applicable
premiums are prescribed in this section. When their enrollment becomes
effective TRICARE Reserve Select beneficiaries receive the TRICARE
Standard benefit, as described in Sec. 199.17.
(iii) Benefits. Eligible persons may be enrolled in TRICARE Reserve
Select, which features the deductible and cost share provisions of the
TRICARE Standard plan for active duty family members for both the
member and the member's dependents. The TRICARE Standard plan is
described in Sec. 199.17.
(b) Eligibility for enrollment in TRICARE Reserve Select. (1)
Eligibility. Individuals are eligible for enrollment in TRICARE Reserve
Select who meet the eligibility criteria defined in paragraphs
(b)(1)(i), (b)(1)(ii), or (b)(1)(iii) of this section.
(i) Members released from active duty after April 26, 2005. A
member released from active duty after April 26, 2005 that is a member
of a Reserve component of the Armed Forces is eligible for TRICARE
Reserve Select if the member:
(A) Is called or ordered to active duty for a period of more than
30 days on or after September 11, 2001 under a provision of law
referred to in 10 U.S.C. 101(a)(13)(B).
(B) Serves continuously on active duty for 90 days or more pursuant
to such call or order to active duty (unless such continuous service on
active duty is less than 90 days solely due to an injury, illness, or
disease incurred or aggravated while deployed, as provided in 10 U.S.C.
1076d(b(2)(A));.
(C) Is released from active duty after April 26, 2005.
(D) On or before the date of release from active duty, agrees to
serve continuously in the Selected Reserve for a period of 1 or more
years upon release from active duty; and
(E) Meets the qualifications for continued membership in the
Selected Reserve as determined by the member's Reserve component.
(ii) Members released from active duty on or before April 26, 2005.
A member or former member of a Reserve component of the Armed Forces
who was released from active duty on or before April 26, 2005 is
eligible for TRICARE Reserve Select if the member:
(A) Was called or ordered to active duty for a period of more than
30 days on or after September 11, 2001 under a provision of law
referred to in 10 U.S.C. 101(a)(13)(B).
(B) Served continuously on active duty for 90 days or more pursuant
to such call or order to active duty (unless such continuous service on
active duty is less than 90 days solely due to an injury, illness, or
disease incurred or aggravated while deployed, as provided in 10 U.S.C.
1076d(b(2)(A)).
(C) Was released from active duty on or before April 26, 2005.
(D) Prior to enrollment in TRICARE Reserve Select, signs an
agreement no later than October 28, 2005 to serve continuously in the
Selected Reserved for a period of 1 or more years; and
(E) Meets the qualifications for continued membership in the
Selected Reserve as determined by the member's Reserve component.
(iii) Immediate family of reserve members. While an eligible member
of a Reserve component is enrolled in TRICARE Reserve Select,
dependents of such member, as defined in paragraphs (b)(2)(i) (except
former spouses) and (b)(2)(ii) of this section are eligible to be
enrolled for the same period as the member.
(2) Additional procedures applicable to eligibility. The Reserve
components are responsible for determining members' duty status,
periods of obligation, and other military personnel matters that are
pertinent to establishing eligibility for TRICARE Reserve Select.
(c) TRICARE Reserve Select enrollment procedures. (1) Enrollment
required. In order to be covered under TRICARE Reserve Select, eligible
Reserve component members must complete and submit the applicable
TRICARE enrollment form, and an initial premium required by paragraph
(d) of this section. Enrollment is accomplished by submission of an
application to the appropriate TRICARE Contractor in accordance with
procedures established by the ASD(HA).
(2) Election of type of coverage. A member of a Reserve component
who is eligible for enrollment under paragraph (b) of this section may
elect self-only or self and family coverage. Family members who may be
included in such family coverage are dependents referred to in
paragraph (b)(1)(iii) of this section.
(3) Period of coverage. Except eligible members released from
active duty on or before April 26, 2005, a member must before being
released from active duty enter into an agreement to serve continuously
in the Selected Reserve, and the member must meet the qualifications
for continued service in the Selected Reserve as determined by the
member's Reserve component. The member must then enroll in TRICARE
Reserve Select prior to 30 days before the expiration of Transition
Assistance Management Program (TAMP) benefits under Sec. 199.3(e) of
this part.
(i) Except members released from active duty on or before April 26,
2005, coverage begins at the expiration of TAMP benefits under Sec.
199.3(e) of this part and runs continuously until eligibility expires
or is otherwise terminated, or the member is disenrolled. (See
paragraphs (c)(4)(i), (5), or (6) of this section.) When enrollment is
terminated, a member may not re-enroll unless recalled to active duty
and the member re-qualifies for a new period of benefits under
paragraph (b) of this section.
(ii) For members released from active duty on or before April 26,
2005, coverage begins on the date that is the later of the expiration
of TAMP benefits under Sec. 199.3(e) or the effective date of the
member's agreement referred to in paragraph (b)(1)(ii)(D) of this
section.
(iii) When a member enrolled in TRICARE Reserve Select is recalled
to active duty for a period of more than 30 days TRICARE Reserve Select
coverage is superseded by active duty military medical benefits for the
member and for any family member enrolled in TRICARE Reserve Select,
but the coverage period continues to run. When the member is released
from active duty, TRICARE Reserve Select coverage will resume for the
member (and the member's family members provided the member had been
enrolled in self and family coverage on the date TRICARE Reserve Select
coverage was superseded by active duty health benefits). TRICARE
Reserve Select coverage will continue until the member's eligibility
expires or is otherwise terminated, or the member is disenrolled. (See
paragraphs (c)(4)(i), (5), or (6) of this section.) Following the
member's release from active duty, TRICARE Reserve Select coverage will
also be superseded by TAMP benefits under Sec. 199.3(e) of this Part,
if applicable. In
[[Page 12804]]
addition, TRICARE Reserve Select coverage is also superseded, if
applicable, by any period of early TRICARE coverage based on delayed
effective date orders under Sec. 199.3(b)(5) of this Part or by a new
enrollment, as a result of re-qualifying through another period of
active duty service in support of a contingency operation under Sec.
199.24(c) of this Part. During any period in which TRICARE Reserve
Select coverage is superseded, no premium payments for TRICARE Reserve
Select are due.
(iv) Members who are eligible for TRICARE Reserve Select under
paragraph (b) of this section may enroll for one year of TRICARE
Reserve Select coverage for every 90 days of continuous active-duty
service, subject to the limitation in paragraph (c)(3)(v) of this
section. If such continuous service on active duty is less than 90 days
solely due to an injury, illness, or disease incurred or aggravated
while deployed, then the otherwise eligible member may enroll for one
year of TRICARE Reserve Select coverage, as provided in 10 U.S.C.
1076d(b(2)(A).
(v) The number of years for which the member and family are
eligible under paragraph (c)(3)(iv) of this section may not exceed the
number of whole years for which the member agrees to continue service
in the Selected Reserves before coverage begins, per the service
agreement entered into under paragraph (b)(1) of this section. The
number of years established by the member's agreement that was entered
into prior to beginning coverage under TRICARE Reserve Select may not
later be changed, even if that number of years was fewer than the
maximum number of years that the member could have established in the
agreement. The number of years of coverage may only be changed if the
member is recalled to active duty and the member re-qualifies for a new
period of benefits under paragraph (b) of this section.
(vi) When a member's eligibility is terminated or the member is
disenrolled from TRICARE Reserve Select under paragraphs (c)(4)(i),
(5), or (6) of this section, the member may not re-enroll unless
recalled to active duty and the member re-qualifies for a new period of
benefits under paragraph (b) of this section.
(4) Changes to type of coverage. Under certain circumstances,
reserve members may change their TRICARE Reserve Select type of
coverage.
(i) Disenrollment. Reserve members may disenroll from the program
at any time by notifying the appropriate TRICARE office. Disenrollment
of the member will result in automatic disenrollment of the member's
family members in TRICARE Reserve Select.
(ii) Change from self and family type of coverage to self-only type
of coverage. After initial enrollment, sponsors may change type of
coverage from self and family to self-only only when an event occurs
that changes the composition of the family, such as divorce, legal
separation, or death of a family member, or changes in family
employment or health coverage status. The change will become effective
in accordance with procedures established by the ASD(HA).
(iii) Change from self-only type of coverage to self and family
type of coverage. After initial enrollment, the reserve member may
change type of coverage from self-only to self and family only when an
event occurs that changes the composition of the family, such as the
birth of a child, marriage of the sponsor, legal adoption of a child,
or placement by a court of a child as a legal ward in the sponsor's
home, or certain events affecting family health coverage, such as an
employment change. The change will become effective in accordance with
procedures established by the ASD(HA).
(5) Effect of failure to pay applicable premiums. Failure by
enrollees to make a premium payment as required in a timely manner will
result in automatic disenrollment from TRICARE Reserve Select and
denial of payment of claims for services provided on or after the first
day of the month for which the premium payment was not paid.
Beneficiaries disenrolled due to lack of premium payments will not be
allowed to re-enroll, absent the member acquiring a new period of
eligibility based upon qualifying active duty service after the date of
disenrollment. Disenrollment of the member for failure to pay
applicable premiums will also result in automatic disenrollment of the
member and the member's family members from TRICARE Reserve Select.
(6) Ineligibility. A reserve member who ceases to be eligible for
TRICARE Reserve Select as specified in paragraph (b) of this section or
whose eligibility is terminated based on termination of the member's
service in the Selected Reserve shall be disenrolled and shall no
longer be eligible. Disenrollment of the member due to ineligibility
will result in automatic disenrollment of the member's family members
in TRICARE Reserve Select.
(7) Effective date of disenrollment. Disenrollments become
effective:
(i) In the case of disenrollment due to ineligibility (other than
relating to the death of a member), on the date of ineligibility.
(ii) In the case of disenrollment due to nonpayment of premiums, at
the end of the last month for which premiums were paid.
(iii) In all other cases, at the end of the month in which the
event causing disenrollment occurred.
(8) Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on participants' costs or access to
care, beneficiaries may be given the opportunity to change their
enrollment status coincident with the revisions.
(d) TRICARE Reserve Select premiums. Premiums shall be charged for
coverage under TRICARE Reserve Select. Premiums are to be paid monthly,
except as otherwise provided through administrative implementation,
pursuant to procedures established by the ASD(HA).
(1) Establishment of rates. (i) TRICARE Reserve Select monthly
premium rates are established annually on a calendar year basis by the
ASD(HA) for the two types of coverage--self-only and self and family.
The annual rates are based on 28 percent of the total estimated amount
(rounded to the nearest dollar) reasonable for health care coverage for
the TRICARE Reserve Select eligible population under the TRICARE
Standard benefit, as determined by the ASD(HA) on an appropriate
actuarial basis. The monthly rate for each month of a calendar year is
one-twelfth of the annual rate for that calendar year, rounded to the
nearest dollar.
(ii) Initial annual rates are based on the annual premiums for the
Blue Cross and Blue Shield Standard Service Benefit Plan under the
Federal Employees Health Benefits Program, a nationwide plan closely
resembling TRICARE Standard coverage, with an adjustment based on
estimated differences in covered populations, as determined by the
ASD(HA).
(2) Premium adjustments. In addition to the determinations
described in paragraph (d)(1) of this section, premium adjustments may
be made prospectively for any calendar year to reflect any significant
program changes or any actual experience in the costs of administering
the TRICARE Reserve Select Program.
(3) Premium rates for calendar year 2005. (i) For calendar year
2005, the annual premium for self-only coverage under TRICARE Reserve
Select is $900.
(ii) For calendar year 2005, the annual premium for self and family
coverage under TRICARE Reserve Select is $2,796.
[[Page 12805]]
(e) Relationship to Continued Health Care Benefits Program. If at
the time a member enrolls in TRICARE Reserve Select, or resumes TRICARE
Reserve Select coverage after a period in which coverage was superseded
under paragraph (c)(3)(iii) of this section, the member was also
eligible to enroll in the Continued Health Care Benefits Program
(CHCBP) under Sec. 199.20(d)(1)(i) of this part (except to the extent
eligibility in CHCBP was affected by enrollment in TRICARE Reserve
Select), enrollment in TRICARE Reserve Select will be deemed to also
constitute preliminary enrollment in CHCBP. If for any reason the
member becomes disenrolled from TRICARE Reserve Select before the date
that is 18 months after discharge or release from the most recent
period of active duty upon which CHCBP eligibility was based, the
member or the member's family members eligible to be included in CHCBP
coverage may, within 30 days of the effective date of the
disenrollment, begin CHCBP coverage by paying the applicable premium.
The period of coverage will be as provided in Sec. 199.20(d)(6) of
this part.
(f) Preemption of State laws. (1) Pursuant to 10 U.S.C. 1103, the
Department of Defense has determined that in the administration of
chapter 55 of title 10, U.S. Code, preemption of State and local laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods is necessary to achieve important
Federal interests, including but not limited to the assurance of
uniform national health programs for military families and the
operation of such programs at the lowest possible cost to the
Department of Defense, that have a direct and substantial effect on the
conduct of military affairs and national security policy of the United
States. This determination is applicable to contracts that implement
this section.
(2) Based on the determination set forth in paragraph (e)(1) of
this section, any State or local law or regulation pertaining to health
insurance, prepaid health plans, or other health care delivery,
administration, and financing methods is preempted and does not apply
in connection with TRICARE Reserve Select. Any such law, or regulation
pursuant to such law, is without any force or effect, and State or
local governments have no legal authority to enforce them in relation
to TRICARE Reserve Select. (However, the Department of Defense may, by
contract, establish legal obligations on the part of DoD contractors to
conform with requirements similar to or identical to requirements of
State or local laws or regulations with respect to TRICARE Reserve
Select.)
(3) The preemption of State and local laws set forth in paragraph
(e)(2) of this section includes State and local laws imposing premium
taxes on health insurance carriers or underwriters or other plan
managers, or similar taxes on such entities. Such laws are laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods, within the meaning of 10 U.S.C.
1103. Preemption, however, does not apply to taxes, fees, or other
payments on net income or profit realized by such entities in the
conduct of business relating to DoD health services contracts, if those
taxes, fees or other payments are applicable to a broad range of
business activity. For the purposes of assessing the effect of Federal
preemption of State and local taxes and fees in connection with DoD
health services contracts, interpretations shall be consistent with
those applicable to the Federal Employees Health Benefits Program under
5 U.S.C. 8909(f).
(g) Administration. The ASD(HA) may establish other rules and
procedures for the effective administration of TRICARE Reserve Select,
and may authorize exceptions to requirements of this section, if
permitted by law, based on extraordinary circumstances.
Dated: March 11, 2005.
Jeannette Owings-Ballard,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-5219 Filed 3-15-05; 8:45 am]
BILLING CODE 5001-06-P