[Federal Register: June 21, 2006 (Volume 71, Number 119)]
[Rules and Regulations]
[Page 35527-35537]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21jn06-12]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD-2006-OS-0022]
RIN 0720-AA99
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Reserve Select for Members of the Selected Reserve
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule with comment period.
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SUMMARY: This interim final rule revises requirements and procedures
for TRICARE Reserve Select pursuant to section 701 of the National
Defense Authorization Act for FY 2006 (NDAA-06). TRICARE Reserve Select
is the premium-based medical coverage program first made available in
April 2005 for purchase by members of the Selected Reserve who fulfill
the statutory qualification of having served on active duty in support
of a contingency operation among other qualifications. By adding two
new tiers of premium sharing by the government (50% and 85% member
portion) to the existing premium tier (28% member portion), this
interim final rule expands availability of TRICARE Reserve Select to
include all Selected Reservists pursuant to section 702 of NDAA-06.
DATES: This rule is effective July 21, 2006. Submit comments on or
before August 21, 2006. Coverage established during the one-time
special open season described herein will be available no later than
October 1, 2006.
ADDRESSES: You may submit comments, identified by docket number and or
RIN number and title, by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, 1160
Defense Pentagon, Washington, DC 20301-1160.
Instructions: All submissions received must include the agency name
and docket number or Regulatory Information Number (RIN) for this
Federal Register document. The general policy for comments and other
submissions from members of the public is to make these submissions
available for public viewing on the Internet at http://regulations.gov
as they are received without change, including any personal identifiers
or contact information.
FOR FURTHER INFORMATION CONTACT: Jody Donehoo, TRICARE Management
Activity, TRICARE Operations, 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
An interim final rule was published in the Federal Register on
March 16, 2005 (70 FR 12798-12805), that addressed three provisions of
the Ronald W. Reagan National Defense Authorization Act for Fiscal Year
2005 (NDAA-05) (Pub. L. 108-375). That interim final rule established
requirements and procedures to make permanent two provisions of the
NDAA-05. Section 706 of the NDAA-05 made permanent the temporary
revisions to the Transitional Assistance Management Program (TAMP),
enacted in section 704 of the National Defense Authorization Act for
Fiscal Year 2004 (NDAA-04) (Pub.L. 18-136) 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 of the NDAA-05 made permanent the earlier TRICARE
eligibility for certain reserve component members authorized by section
703 of the NDAA-04 and section 1116 of the Emergency Supplemental. A
separate final rule will be issued for the requirements established by
sections 703 and 706 of the NDAA for FY05.
The interim final rule published on March 16, 2005, also
established requirements and procedures for implementation of TRICARE
Reserve Select, the program authorized by section 701 of the NDAA-05
for premium-based medical coverage for certain members of the Selected
Reserve and their family members. Before a final rule could be issued
subsequent to the interim final rule published in the Federal Register
on March 16, 2005 (70 FR 12798-12805), for the TRICARE Reserve Select
program, it became evident that subsequent legislation would likely
amend the statutory provisions in section 701 of the NDAA-05
implemented in the interim final rule.
Therefore, this interim rule contains the provisions of the former
interim rule on the TRICARE Reserve Select program (70 FR 12798-12805)
and addresses two provisions of the National Defense Authorization Act
for Fiscal Year 2006 (NDAA-06) (Pub. L. 109-163). First, section 701 of
the NDAA-06 contains several provisions to enhance the TRICARE Reserve
Select program implemented in fulfillment of section 701 of the NDAA-
05. Second, section 702 of the NDAA-06 expands the TRICARE Reserve
Select program to make it available to all members of the Selected
Reserve of the Ready Reserve by providing the statutory basis to
establish two tiers of premium sharing subject to a number of
additional specific statutory requirements, which are outlined in this
regulation. These two tiers are in addition to the premium sharing tier
established by section 701 of the NDAA-05.
The law authorizing the TRICARE Reserve Select program uses the
term ``eligibility'' to identify conditions under which a Reserve
component member may purchase coverage. For purposes of program
administration, the terms ``qualifying'' or ``qualified'' shall
generally be used in lieu of such terms as ``eligibility'' or
``eligible'' to refer to a Reserve component member who meets the
program requirements allowing purchase of TRICARE Reserve Select
coverage.
This interim rule introduces certain terminology for TRICARE
Reserve Select intended to reflect critical elements that distinguish
it from other long-established TRICARE health programs. For instance,
the effective date of eligibility for TRICARE has long been understood
to mean that the eligible individual may obtain care under the military
health system as of that date. However, that is not what it means in
the context of TRICARE Reserve Select. To avoid the inevitable
misunderstanding, this rule uses 239 the term ``qualify'' to mean that
the member's reserve component has validated that the member has
satisfied all the ``qualifications'' that must be met before the member
is authorized to purchase coverage under a particular tier. Only then
may the member purchase coverage by taking further action to submit a
completed application along with payment of a one month premium. The
term ``coverage'' indicates the benefit of TRICARE covering claims
submitted by TRICARE authorized providers, hospitals, and
[[Page 35528]]
suppliers for payment of covered services, supplies, and equipment.
II. 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 was made available worldwide to
certain members of the Selected Reserve and their family members.
TRICARE Reserve Select is authorized by 10 U.S.C. 1076b and 10 U.S.C.
1076d.
The major features of the program include the following. TRICARE
Reserve Select coverage is available for purchase by any Selected
Reserve member if the member fulfills all of the statutory
qualifications for one of the three premium tiers. The percentage of
the total amount of the premium that members pay in each of the three
premium tiers is prescribed by law: 28% for Tier 1,50% for Tier 2, and
85% for Tier 3. Within each tier there is one premium rate for self-
only coverage and one premium rate for self and family coverage.
Additionally, TRICARE rules apply unless otherwise specified; certain
special TRICARE programs are not part of TRICARE Reserve Select,
including the Extended Health Care Option (ECHO) program, the Special
Supplemental Food Program (also known as the Women, Infants, and
Children--Overseas Program), and the Supplemental 240 Health Care
Program, except when referred by a Medical Treatment Facility (MTF)
provider for incidental consults and the MTF provider maintains
clinical control over the episode of care. The TRICARE Dental Program
is already available under 10 USC 1076a to all members of the Selected
Reserve and their family members whether or not they purchase TRICARE
Reserve Select coverage.
Under TRICARE Reserve Select, Selected Reserve members who fulfill
all of the statutory qualifications for one of the three premium tiers
may purchase either the self-only type of coverage or the self and
family type of coverage by submitting a completed application form
along with the appropriate monthly premium at the time of enrollment.
When their coverage becomes effective, TRICARE Reserve Select
beneficiaries receive the TRICARE Standard (and Extra) benefit. TRICARE
Reserve Select features the deductible and cost share provisions of the
TRICARE Standard (and Extra) plan for active duty family members (ADFM)
for both the member and covered family members.
B. TRICARE Reserve Select premium tiers (paragraph 199.24(b)).
Members are charged premiums for coverage under TRICARE Reserve Select
that represent a portion of the total amount that the Assistant
Secretary of Defense, Health Affairs (ASD(HA)) determines on an
appropriate actuarial basis as being appropriate for coverage under the
TRICARE Standard benefit for the TRICARE Reserve Select eligible
population.
Members may qualify for one of three tiers of premium sharing with
the Department of Defense. The first tier was established by section
701 of the NDAA-05 as 28% of the total cost of the premium and
implemented in accordance with regulation issued March 16,2005, (70 FR
12798-12805).
Selected Reserve members who qualify to purchase TRICARE Reserve
Select coverage in Tier 1 shall pay 28% of the total cost of the
premium. In the event of the death of a member of the Selected Reserve
who is covered by TRICARE Reserve Select at the time of death, the
premium amount shall be at the self-only rate if there is only one
surviving family member to be covered by TRICARE Reserve Select and at
the self and family rate if there are two or more survivors to be
covered by TRICARE Reserve Select.
The NDAA-06 added two more tiers of premium sharing for members who
may qualify as specified in paragraph 199.24(c). Selected Reserve
members who qualify to purchase TRICARE Reserve Select coverage in Tier
2 shall pay 50% of the total cost of the premium. Selected Reserve
members who qualify to purchase TRICARE Reserve Select coverage in Tier
3 shall pay 85% of the total cost of the premium.
Annual rates for the first year TRICARE Reserve Select was offered
(calendar year 2005) were 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 (and Extra) coverage, with an adjustment based on
estimated 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 in calendar year 2005 represented
a 32% reduction from the Blue Cross and Blue Shield annual premium for
self-only coverage and represented an 8% 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).
Premiums are to be paid monthly, except as otherwise established as
part of the administrative implementation of TRICARE Reserve Select.
Monthly premium rates are established and updated annually to maintain
an appropriate relationship with the annual changes in Blue Cross and
Blue Shield premiums, or by other adjustment methodology determined to
be appropriate by the ASD(HA).
Separate rates will be established and updated annually for each of
the two types of coverage, self-only and self and family, within each
of the three tiers on a calendar year basis and are effective on the
first of January each year. The monthly rate for each month of a
calendar year is one-twelfth of the annual rate for that calendar year.
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 total annual premium for self-only
coverage was $3,214 and the total annual premium for self and family
coverage was $9,985. The member's portion of the annual premium for
self-only coverage under TRICARE Reserve Select in Tier 1 was $900 ($75
monthly). The member's portion of the annual premium for self and
family coverage under TRICARE Reserve Select in Tier 1 was $2,796 ($233
monthly).
For calendar year 2006, the total annual premium for self-only
coverage increased 8.5% to $3,487 (rounded to the nearest dollar) and
the total annual premium (Tier 1) for self and family coverage
increased 8.5% to $10,834 (rounded to the nearest dollar). The 8.5%
increase mirrors the increase in Blue Cross and Blue Shield rates in
the Federal Employee Health Benefits program.
(a) For calendar year 2006, the member's portion in Tier 1 is 28%
of the annual premium. Self-only coverage is $972 ($81 monthly). Self
and family coverage is $3,036 ($253 monthly).
(b) For calendar year 2006, the member's portion in Tier 2 is 50%
of the annual premium. Self-only coverage is $1,743.48 ($145.29
monthly). Self and family coverage is $5,417.04 ($451.42 monthly).
[[Page 35529]]
(b) For calendar year 2006, the member's portion in Tier 3 is 85%
of the annual premium. Self-only coverage is $2,964.00 ($247.00
monthly). Self and family coverage is $9,208.92 ($767.41 monthly).
C. Eligibility for qualifying to purchase TRICARE Reserve Select
coverage (paragraph I99.24(c)). This paragraph defines the statutory
conditions for each of the three tiers within which members of a
Reserve component may qualify to purchase TRICARE Reserve Select
coverage. The Reserve components of the Armed Forces have the
responsibility to determine and validate a member's qualifications to
purchase TRICARE Reserve Select coverage and to identify the premium
tier for which they qualify.
Section 701 of NDAA-05 established two distinct statutory basis for
qualifying to purchase TRICARE Reserve Select coverage under Tier 1.
The first statutory basis for Tier 1 established that 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, qualifies to
purchase TRICARE Reserve Select coverage in Tier 1 if the member meets
all of the following conditions:
(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) Executed a service agreement with his or her Reserve component
prior to purchasing TRICARE Reserve Select coverage, but no later than
October 28, 2005, to serve continuously in the Selected Reserve for a
period of 1 or more years; and,
(e) Is in a Selected Reserve status on the first day of coverage
for TRICARE Reserve Select and maintains continued membership in the
Selected Reserve.
This temporary opportunity for Tier 1 (until October 28, 2005)
applied to current members of the Selected Reserve, and also to former
members who served in support of a contingency after September 11,
2001, who rejoined the Selected Reserve, and who entered into a service
agreement for continued service.
In conformance with section 701(b)(2)(B) of the NDAA-05, the
Department took steps to notify reservists released from active duty on
or before April 26, 2005, who could potentially qualify for TRICARE
Reserve Select and provided them information on the opportunity and
procedures for entering into a service 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 service
agreement. Specifically, the Department delivered this information to
all potentially eligible members (376,800) through a mass mailing
conducted from April 22, 2005, to May 12, 2005.
The second statutory basis for Tier 1 established that a member or
former member of a Reserve component of the Armed Forces who was
released from active duty after April 26, 2005, qualifies to purchase
TRICARE Reserve Select coverage in Tier 1 if the member meets all of
the following conditions:
(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 in
support of a contingency operation on or after September 11, 2001
(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)); and
(c) Is released from active duty after April 26, 2005;
(d) Executed a service agreement with his or her Reserve component
to serve continuously in the Selected Reserve for a period of 1 or more
years on or before the date of release from active duty if released
from active duty before January 6, 2006, or not later than 90 days
after release from active duty if released from active duty on or after
January 6, 2006, except in the case of a member of the Individual Ready
Reserve described in below, with the effective date of the Service
agreement coinciding with the 246 TRS coverage begin date
(e) If not already a member of the Selected Reserve, the member
shall be in the Selected Reserve on the first day of coverage for
TRICARE Reserve Select and shall maintain continued membership in the
Selected Reserve. A member of the Individual Ready Reserve released
from active duty on or after January 6, 2006, who is unable to find a
position in the Selected Reserve and who qualifies TRICARE Reserve
Select coverage, except for membership in the Selected Reserve, has one
year from the expiration of the member's entitlements to care and
benefits following a qualifying period of active duty to execute a
service agreement with his or her Reserve component and become a member
of the Selected Reserve. A member of the Selected Reserve released from
active duty on or after January 6, 2006, who loses his or her position
in the Selected Reserve before the end of the Transitional Assistance
Management Program (TAMP) shall have one year from the expiration of
TAMP period to execute a service agreement with his or her Reserve
component and again become a member of the Selected Reserve. This
opportunity for Tier I coverage is now permanent under the statute.
The statutory basis for Tier 2 established that a member who is a
member of a Reserve component of the Armed Services qualifies to
purchase TRICARE Reserve. Select coverage in Tier 2 if the member meets
all of the following conditions:
(a) Executes a service agreement to serve continuously in the
Selected Reserve for a period of time that extends through the period
of coverage; and
(b) Maintains continued membership in the Selected Reserve as
determined by the member's Reserve component; and
(c) Submits certification in accordance with procedures established
by the Under Secretary of Defense for Personnel and Readiness that is
appropriate to substantiate the Reserve component member's assertion
that the member is one of the following:
--an eligible unemployment compensation recipient;
--either employed by an employer that does not offer a health benefits
plan to anyone working for the employer, or is in a category of
employees (based on hours, duties, employment agreement, or such other
characteristic, but not membership in the Selected Reserve) to which
the member's employer does not offer a health benefits plan;
--self-employed (where income earned from such self-employment is the
member's primary source of annual income, as reported to the IRS, other
than service in the Selected Reserve).
Further, the member shall submit certification appropriate to
substantiate the member's assertion of qualifying for Tier 2 in
accordance with procedures established by the Under Secretary of
Defense for Personnel and Readiness. Documentation required to support
the certifications includes supplementation covering the full period of
qualification. In the event that documentation fails to support
qualification or continued qualification or the condition of
[[Page 35530]]
qualification otherwise ceases to exist and the member fails to report
such event to the TRICARE contractor servicing the member's coverage,
the member's coverage under Tier 2 will terminate, effective on the
date the required condition ceased to exist. In that case, the member
may elect coverage in Tier 3 and will be responsible for the additional
premiums required for Tier 3, effective from that date.
The statutory basis for Tier 3 established that a member who is a
member of a Reserve component of the Armed Services qualifies to
purchase TRICARE Reserve 248 Select coverage in Tier 3 if the member
meets all of the following conditions.
(a) Executes a service agreement to serve continuously in the
Selected Reserve for a period of time that extends through the period
of coverage;
(b) Maintains continued membership in the Selected Reserve: and
(c) Does not qualify for either Tier 1 or Tier 2.
D. TRICARE Reserve Select enrollment procedures (paragraph
199.24(d)). To purchase TRICARE Reserve Select coverage, Reserve
component members qualified under paragraph 199.24(c) must complete and
submit the applicable TRICARE enrollment application, along with an
initial payment of the monthly premium share required under paragraph
199.24(b) to the appropriate TRICARE contractor in accordance with
deadlines and other procedures established by the ASD(HA) for receipt
not later than 30 days prior to the start of the period of coverage as
it has been determined. A member may purchase one of two types of
coverage: self-only coverage or self and family coverage.
For qualified members, the decision to purchase TRICARE Reserve
Select coverage in Tier I is a one-time opportunity. If not purchased
within the prescribed time limit, if coverage is taken for a period
less than the maximum period of eligibility, or if coverage is
terminated for any reason, coverage may not be initiated or extended
later, nor may any period of qualification be saved to be used later.
Members qualified under Tier I based upon qualifying active duty
that ended on or before April 26, 2005 are required to submit the
required application and premium 249 payment as soon as practicable
after entering into a Service Agreement with their respective Reserve
component. Members qualified under Tier I based upon qualifying active
duty that ended after April 26, 2005 are required to submit the proper
application and premium payment for receipt by the appropriate TRICARE
contractor not later than 30 days before the last day of qualifying
active duty or the last day of coverage under the Transition Assistance
Management Program, whichever is later, unless the otherwise qualified
member is a member of the Individual Ready Reserve at that time. In
that case, the member shall submit the required application and premium
payment as soon as practicable after entering into a Service Agreement
with his or her respective Reserve component.
Thus, for example, if a member served for one year in support of a
contingency operation, the member may purchase Tier I coverage for the
next four years if the member agrees to continue service in the
Selected Reserve 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
under the Tier 1 premium rate. This two-year coverage period based on
the qualifying period of active duty 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 under the Tier 1
premium rate beyond the period determined when the one-time choice is
made is by qualifying again through another period of active duty
service in support of a contingency operation.
Open Season is the time period during which a member who qualifies
for coverage in Tier 2 or Tier 3 may purchase new coverage, renew
existing coverage with or without 250 a change in type of coverage, or
terminate coverage. One open season will be offered each year in
accordance with procedures established by the ASD(HA). A one-time
special open season will be offered in 2006 for members to purchase
coverage and coverage will be available no later than October 1, 2006.
Before a member's coverage may be renewed during open season, the
service agreement must be valid through December 31st of the renewed
year of coverage and all other qualifications under Tier 2 or Tier 3
must be validated by the member's Reserve component. Actions requested
during an open season will take effect January 1st of the year
following the open season. Existing Coverage that is not renewed during
open season will be terminated no later than December 31st of that
year. Upon assignment to the Selected Reserves, members who qualify for
coverage under either Tier 2 Or Tier 3 may purchase coverage in
accordance with deadlines and other procedures established by the
ASD(HA). Members may request certain changes to their TRICARE Reserve
Select Coverage in connection with certain events called qualifying
life events in accordance with deadlines and other procedures
established by the ASD(HA). The first type of qualifying life event is
associated with changes in immediate family composition and it is the
responsibility of the member to provide his or her personnel office
with the necessary evidence required to substantiate the change in
immediate family composition. Personnel will update the Defense
Enrollment Eligibility Reporting System (DEERS) in the usual manner,
which will then notify the appropriate TRICARE contractor who will take
appropriate action upon receipt of a proper application. The second
type of qualifying life event is associated with changes in family
employment or health coverage status.
If a member who is covered under Tier I experiences a qualifying
life event, the only action a member may request is a change in type of
coverage. The member may request termination of coverage at any time;
however, they will not be allowed to purchase coverage again under Tier
1, unless the member qualifies again for Tier 1 coverage after the date
of termination for Tier 1 coverage. If a member who is covered under
either Tier 2 or Tier 3 experiences a qualifying life event, the member
may apply to purchase coverage, request changes in type of coverage, or
terminate coverage. Otherwise, a member who is covered under either
Tier 2 or Tier 3 may not request to terminate coverage outside of open
season.
A member of a Reserve component who qualifies to purchase coverage
may elect self-only or self and family coverage. Immediate family
members of the Reserve component member, as defined in Sec. Sec.
199.3(b)(2)(i) (except former spouses) and 199.3(b)(2)(ii) of this
part, may be included in such family coverage. After purchasing
coverage under Tier 1, members may change type of coverage only in
conjunction with a qualifying life event. After purchasing coverage
under Tiers 2 and 3, members may change type of coverage either during
an open season or in conjunction with a qualifying life event.
The period of coverage for members who qualify under Tier 1 is
equal to either the number of whole years covered by the executed
service agreement, or to one year in the case of a member who is
otherwise eligible but does not serve continuously on active duty for
90 days because of an injury,
[[Page 35531]]
illness, or disease incurred or aggravated while deployed.
The period of coverage for members released from active duty on or
before April 26, 2005 begins on the date that is the later of the
expiration of TAMP benefits or the 252 effective date of the service
agreement, but in no case later than October 28, 2005.
The period of coverage for members released from active duty after
April 26, 2005, begins on the first day following the date their TAMP
benefits period ends under section 199.3(e) of this part; or the date
that a member of the Individual Ready Reserve finds and occupies a
position in the Selected Reserve, up to one year after expiration of
TAMP benefits. The enrollment in TRICARE Reserve Select must be
accomplished within 60 days of assignment to the Selected Reserve. When
coverage is terminated or the member is otherwise disenrolled, a member
may not purchase coverage in Tier 1 again unless recalled to active
duty and the member qualifies again for this tier.
If a member of the Selected Reserves dies while in a period of
coverage under Tier 1, the family member(s) may purchase new or
continue TRICARE Reserve Select Tier 1 coverage for up to six months
beyond the date of the member's death upon payment of monthly premiums.
The premium amount shall be at the member only rate if there is only
one surviving family member to be covered by TRICARE Reserve Select and
at the member and family rate if there are two or more survivors to be
covered.
The maximum duration for any period of coverage purchased by
members who qualify for TRICARE Reserve Select under either Tier 2 or
Tier 3 is one year and will coincide with the calendar year. The period
of coverage begins in accordance with procedures established by the
ASD(HA) and ends December 31st of the same year in which the current
period of coverage began.
The period of coverage for members who purchase coverage in either
Tier 2 or Tier 3 during the annual open season begins January 1st of
the year immediately following the open season and ends December 31st
of that same year.
The period of coverage for members who purchase coverage in either
Tier 2 or Tier 3 as a result of assignment to the Selected Reserve or
as a result of a qualifying life event described below begins in
accordance with procedures established by the ASD(HA) and ends December
31st of the same year that coverage begins.
Coverage will terminate whenever a member ceases to meet the
qualifications for the particular tier under which coverage was
purchased or a request for termination is received in accordance with
established procedures. However, unless the member's Reserve component
terminates the member's service in the Selected Reserve, the service
agreement remains in force and the end date is unchanged. Termination
of coverage for the member will result in termination of coverage for
the member's family members in TRICARE Reserve Select, except for
qualified survivors of Reserve component members covered by TRICARE
Reserve Select under Tier 1 at the time of death. Failure to make a
premium payment in a timely manner will result in termination of
coverage for the member and any covered family members and denial of
claims for services received after the effective date of termination.
Members whose coverage under Tier 1 terminates will not be allowed to
purchase coverage again under Tier 1, unless the member qualifies again
for Tier 1 coverage after the date of termination. Members whose
coverage under any of the three tiers terminates may purchase coverage
again under either Tier 2 or Tier 3 if they qualify during the annual
open season, or in connection with a qualifying life event.
Effective January 6, 2006, with enactment of section 701 of the
NDAA-06, the rules changed with regard to the TRICARE Reserve Select
Tier 1 period of coverage when a member serves on active duty. Before
January 6, 2006, when a member covered by TRICARE Reserve Select serves
on active duty for a period of more than 30 days and receives other
TRICARE coverage, TRICARE Reserve Select coverage is superseded
[italics added] for the member and any covered family members, but the
period of coverage continues to run. During any period in which TRICARE
Reserve Select coverage is superseded, no premium payments for TRICARE
Reserve Select are due. If applicable, this other TRICARE coverage
includes early TRICARE coverage based on delayed-effective-date orders
under Sec. 199.3(b)(5) of this part and TAMP benefits under Sec.
199.3(e) of this part. If the original end date of TRICARE Reserve
Select coverage has not been reached by the time the other TRICARE
coverage terminates, TRICARE Reserve Select coverage will resume with
the same type of coverage in effect on the date coverage was suspended.
Coverage will continue until the original end date of coverage or until
coverage is otherwise terminated. In addition, TRICARE Reserve Select
coverage is also superseded by a new period of coverage established 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.
On or after January 6, 2006, when a member covered by TRICARE
Reserve Select under Tier 1 serves on active duty under orders for a
period of more than 30 days and receives other TRICARE coverage,
TRICARE Reserve Select Tier 1 coverage is suspended [italics added] for
the member and any covered family members and the period of coverage
stops. During any period in which TRICARE Reserve Select coverage is
suspended, no premium payments for TRICARE Reserve Select are due. If
applicable, this other TRICARE coverage includes early TRICARE coverage
based on delayed-effective-date orders under Sec. 199.3(b)(5) of this
part and TAMP benefits under Sec. 199.3(e) of this part. The end date
of the TRICARE Reserve Select Tier 1 period of coverage will be
extended for a period of time equal to the period of time that TRICARE
Reserve Select coverage was suspended. TRICARE Reserve Select Tier 1
coverage will continue until the adjusted end date, or until coverage
is otherwise terminated. In addition, the end date of the TRICARE
Reserve Select Tier 1 period of coverage will be extended for a period
of time equal to any new period of coverage established 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 and all
other qualifications are met.
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. Coverage under
TRICARE Reserve Select counts as coverage under a health benefit plan
for purposes of individuals qualifying for the Continued Health Care
Benefits Program (CHCBP) under Sec. 199.20(d)(1)(ii)(B) or Sec.
199.20(d)(1)(iii)(B) of this part. Some members and family members will
be eligible for Tier 1 of TRICARE Reserve Select, and may also be
eligible for CHCBP at the time of release from active duty.
This paragraph of the regulation provides that if a member
purchases TRICARE Reserve Select coverage that is later terminated, the
member or the
[[Page 35532]]
covered family members may then purchase CHCBP coverage for whatever
period is remaining of the original 18 month eligibility. For example,
in the case that TRICARE Reserve Select Tier 1 coverage that is
terminated because of transfer or discharge from the Selected Reserve
(such as through a reduction in force or base closure) of a member is
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. Eligibility and coverage for
TRICARE Reserve Select under either Tier 2 or Tier 3 has no effect on
eligibility for the CHCBP.
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, 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. 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.
We are in the process of determining whether the interim final rule
imposes ``collection of information'' requirements on the public within
the meaning of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3511). If the determination is in the affirmative, we will promptly
submit these to the Office of Management and Budget for review and
approval in accordance with the Paperwork Reduction Act.
We have examined the impact(s) of the final rule under Executive
Order 13132 and it does not have policies that have federalism
implications that would have substantial direct effects on the States,
on the relationship between the national government and the States, or
on the distribution of power and responsibilities among the various
levels of government, therefore, consultation with State and local
officials is not required.
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 revising the definition of ``TRICARE
Reserve Select'' to read as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
TRICARE Reserve Select. The program established under 10 U.S.C.
1076d and 32 CFR 199.24.
* * * * *
0
3. Section 199.24 is revised to read as follows:
Sec. 199.24 TRICARE Reserve Select.
(a) Establishment. TRICARE Reserve Select is established for the
purpose of offering TRICARE Standard and Extra health coverage to
qualified members of the Selected Reserve and their immediate family
members.
(1) Purpose. TRICARE Reserve Select is a premium-based health plan
that will be available to members of the Selected Reserve and their
immediate family members as specified in paragraph (c) of this section.
(2) Statutory Authority. TRICARE Reserve Select is authorized by 10
U.S.C. 1076b and 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) Terminology. Certain terminology is introduced for TRICARE
Reserve Select intended to reflect critical elements that distinguish
it from other long-established TRICARE health programs. For instance,
the effective date of eligibility for TRICARE has long been understood
to mean that the eligible individual may obtain care under the military
health system as of that date. However, that is not what it means in
the context of TRICARE Reserve Select. To avoid the inevitable
misunderstanding, this regulation uses the term ``qualify'' to mean
that the member's reserve component has validated that the member has
satisfied all the ``qualifications'' that must be met before the member
is authorized to purchase coverage under a particular premium tier.
Only then may the member purchase coverage by taking further action to
submit a completed application along with payment of a one month
premium. The term ``coverage'' indicates the benefit of TRICARE
covering claims submitted for payment of covered services, supplies,
and equipment furnished by TRICARE authorized providers, hospitals, and
suppliers.
(5) 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 otherwise prescribed by the ASD(HA),
[[Page 35533]]
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 members covered under TRICARE Reserve Select. These
include the Extended Health Care Option Program (see Sec. 199.5), and
the Special Supplemental Food Program (see Sec. 199.23), and the
Supplemental Health Care Program (see Sec. 199.16) except when
referred by a Medical Treatment Facility (MTF) provider for incidental
consults and the MTF provider maintains clinical control over the
episode of care. 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 eligible family members whether or
not they purchase TRICARE Reserve Select coverage.
(ii) Premium Tiers. TRICARE Reserve Select coverage is available
for 261 purchase by any Selected Reserve member if the member fulfills
all of the statutory qualifications for one of the three premium tiers.
The percentage of the total amount of the premium that members pay in
each of the three premium tiers is prescribed by law: 28% for Tier 1,
50% for Tier 2, and 85% for Tier 3. Within each tier there is one
premium rate for self-only coverage and one premium rate for self and
family coverage.
(iii) Enrollment system. Under TRICARE Reserve Select, Reserve
component members who have been validated as fulfilling all of the
statutory qualifications for one of the three premium tiers may
purchase either the self-only type of coverage or the self and family
type of coverage by submitting a completed application form along with
the appropriate monthly premium at the time of enrollment. Rules and
procedures for purchasing coverage and paying applicable premiums are
prescribed in this section.
(iv) Benefits. When their coverage becomes effective, TRICARE
Reserve Select beneficiaries receive the TRICARE Standard (and Extra)
benefit including access to military treatment facility services and
pharmacies, as described in Sec. 199.17 of this part. TRICARE Reserve
Select coverage features the deductible and cost share provisions of
the TRICARE Standard (and Extra) plan for active duty family members
for both the member and the member's covered family members. The
TRICARE Standard (and Extra) plan is described in section Sec. 199.17
of this part.
(b) TRICARE Reserve Select premium tiers. A member of the Selected
Reserve covered under TRICARE Reserve Select shall be required to pay a
portion of the total amount that the ASD(HA) determines on an
appropriate actuarial basis as being appropriate for that coverage. The
member's monthly share of the premium is one-twelfth of the annual
portion. The particular share of the premium to be paid by the member
is determined by the particular tier for which a member qualifies as
established in paragraphs (c)(2) of this section. The member's share of
the premium is to be paid monthly, except as otherwise provided through
administrative implementation, pursuant to procedures established by
the ASD(HA).
(1) Member's Share of the Total Premium. (i) Tier 1. Selected
Reserve members who qualify to purchase TRICARE Reserve Select coverage
under paragraph (c)(2)(i) of this section shall pay 28% of the total
cost of the premium as determined above. In the event of the death of a
member of the Selected Reserve who is covered by TRICARE Reserve Select
at the time of death, the premium amount shall be at the self-only rate
if there is only one surviving family member to be covered by TRICARE
Reserve Select and at the self and family rate if there are two or more
survivors to be covered by TRICARE Reserve Select.
(ii) Tier 2. Selected Reserve members who qualify to purchase
TRICARE Reserve Select coverage under paragraph (c)(2)(ii) of this
section shall pay 50% of the total cost of the premium as determined
paragraph (c) of this section.
(iii) Tier 3. Selected Reserve members who qualify to purchase
TRICARE Reserve Select coverage under paragraph (c)(2)(iii) of this
section shall pay 85% of the total cost of the premium as determined
paragraph (c) of this section.
(2) Annual establishment of rates. (i) TRICARE Reserve Select
monthly premium rates shall be established and updated annually on a
calendar year basis by the ASD(HA) for each of the two types of
coverage, self-only and self and family as described in paragraphs
(d)(2) of this section, within each of the premium tiers.
(ii) Annual rates for the first year TRICARE Reserve Select was
offered (calendar year 2005) were 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 (and Extra) coverage, with adjustments
based on estimated differences in covered populations, as determined by
the ASD(HA).
(A) For calendar year 2005, the total annual premium for self-only
coverage was $3,214 and the total annual premium for self and family
coverage was $9,985. The member's portion of the annual premium for
self-only coverage under TRICARE Reserve Select in Tier 1 was $900 ($75
monthly). The member's portion of the annual premium for self and
family coverage under TRICARE Reserve Select in Tier 1 was $2,796 ($233
monthly).
(B) For calendar year 2006, the total annual premium for self-only
coverage is $3,487 and the total annual premium for self and family
coverage is $10,834 (rounded to the nearest dollar).
(1) In Tier 1, the member's portion is 28% of the annual premium.
Self-only coverage is $972 ($81 monthly). Self and family coverage is
$3,036 ($253 monthly).
(2) In Tier 2, the member's portion is 50% of the annual premium.
Self-only coverage is $1,743.48 ($145.29 monthly). Self and family
coverage is $5,417.04 ($451.42 monthly).
(3) In Tier 3, the member's portion is 85% of the annual premium.
Self-only coverage is $2,964.00 ($247.00 monthly). Self and family
coverage is $9,208.92 ($767.41 monthly).
(3) Premium adjustments. In addition to the determinations
described in paragraph (b)(2)(i) 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.
(c) Eligibility for (qualifying to purchase) TRICARE Reserve Select
coverage. (1) General--The law authorizing the TRICARE Reserve Select
program uses the term ``eligibility'' to identify conditions under
which a Reserve component member may purchase coverage. For purposes of
program administration, the terms ``qualifying'' or ``qualified'' shall
generally be used in lieu of such terms as ``eligibility'' or
``eligible'' to refer to a Reserve component member who meets the
program requirements allowing purchase of TRICARE Reserve Select
coverage.
(2) Reserve component members who meet the qualifications defined
in paragraphs (c)(2)(i), (c)(2)(ii), or (c)(2)(iii), and have their
qualifications validated under procedures in paragraph (c)(2)(iv) of
this section may purchase TRICARE Reserve Select coverage as defined in
this section. The Reserve components of the Armed Forces have the
responsibility to determine and validate a member's qualifications to
purchase TRICARE
[[Page 35534]]
Reserve Select coverage and identify the premium tier for which the
member qualifies.
(i) Tier 1. (A) 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, qualifies to purchase TRICARE Reserve Select coverage in Tier 1
if the member meets all of the following conditions:
(1) 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);
(2) 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);
(3) Was released from active duty on or before April 26, 2005;
(4) Executed a service agreement with his or her Reserve component
to serve continuously in the Selected Reserve for a period of 1 or more
years prior to purchasing TRICARE Reserve Select coverage, but no later
than October 28, 2005; and
(5) Is in a Selected Reserve status on the first day of coverage
for TRICARE Reserve Select and maintains continued membership in the
Selected Reserve.
(B) Members released from active duty after April 26, 2005. A
member released from active duty after April 26, 2005, who is a member
of a Reserve component of the Armed Forces qualifies to purchase
TRICARE Reserve Select coverage in Tier 1 if the member meets all of
the following conditions:
(1) 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);
(2) 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));
(3) Is released from active duty after April 26, 2005;
(4) Executed a service agreement with his or her Reserve component
to serve continuously in the Selected Reserve for a period of 1 or more
years on or before the date of release from active duty if released
from active duty before January 6, 2006, or not later than 90 days
after release from active duty if released from active duty on or after
January 6, 2006, except in the case of a member of the Individual Ready
Reserve described in paragraph (c)(2)(i)(B)(5) of this section, with
the effective date of the Service agreement coinciding with the TRS
coverage begin date; and
(5) If not already a member of the Selected Reserve, the member
shall be in the Selected Reserve on the first day of coverage for
TRICARE Reserve Select and shall maintain continued membership in the
Selected Reserve. A member of the Individual Ready Reserve released
from active duty on or after January 6, 2006, who is unable to find a
position in the Selected Reserve and qualifies for TRICARE Reserve
Select coverage, except for membership in the Selected Reserve, has one
year from the expiration of the member's entitlements to care and
benefits following a qualifying period of active duty to execute a
service agreement with his or her Reserve component and become a member
of the Selected Reserve. A member of the Selected Reserve released from
active duty on or after January 6, 2006, who loses his or her position
in the Selected Reserve before the end of the Transitional Assistance
Management Program (TAMP) shall have one year from the expiration of
TAMP period to execute a service agreement with his or her Reserve
component and again become a member of the Selected Reserve.
(ii) Tier 2. A member who is a member of a Reserve component of the
Armed Forces qualifies to purchase TRICARE Reserve Select coverage in
Tier 2 if the member meets all of the following conditions:
(A) Executes a service agreement with his or her Reserve component
to serve continuously in the Selected Reserve for a period of time that
extends through the period of coverage;
(B) Maintains continued membership in the Selected Reserve; and
(C) Submits certification in accordance with procedures established
by the Under Secretary of Defense for Personnel and Readiness that is
appropriate to substantiate the Reserve component member's assertion
that the member is one of the following:
(1) An eligible unemployment compensation recipient. This is a
member who, with respect to any month, is determined eligible for any
day of such month for unemployment compensation under State law (as
defined in section 205(9) of the Federal-State Extended Unemployment
Compensation Act of 1970), including Federal unemployment compensation
laws administered through the State;
(2) An employee ineligible for health care benefits under an
employer-sponsored health benefits plan. A Reserve component member
shall be considered ineligible for health care benefits under an
employer-sponsored health benefits plan only if the member is an
employee and either:
(i) Is employed by an employer that does not offer a health
benefits plan to anyone working for the employer; or
(ii) Is in a category of employees to which the member's employer
does not offer a health benefits plan, if such category is designated
by the employer based on hours, duties, employment agreement, or such
other characteristic, other than membership in the Selected Reserve, as
the regulations administering this section prescribe (such as part-time
employees).
(3) Self-employed. A Reserve component member shall be considered
to be self-employed if the income earned from such self-employment is
the member's primary source of annual income, as reported to the IRS,
other than service in the Selected Reserve.
(iii) Tier 3. A member who is a member of a Reserve component of
the Armed Forces qualifies to purchase TRICARE Reserve Select coverage
in Tier 3 if the member meets all of the following conditions:
(A) Executes a service agreement with his or her Reserve component
to serve continuously in the Selected Reserve for a period of time that
extends through the period of coverage;
(B) Maintains continued membership in the Selected Reserve; and
(C) Does not qualify under paragraphs (c)(2)(i) or (c)(2)(ii).
(iv) Procedures validating qualifications for TRS coverage. (A) The
Reserve components are responsible for determining the member's Reserve
category, details of potentially qualifying active duty periods,
periods of obligation, and other military personnel matters that are
pertinent to validating the member's qualifications and identification
of the premium tier for which a member may purchase coverage. An
executed service agreement does not guarantee Selected Reserve status
for the full time period covered by the service agreement. Further, the
member shall submit certification appropriate to substantiate the
member's assertion of qualifying under paragraph (c)(2)(ii) of this
section in accordance with procedures established by the Under
Secretary of Defense for Personnel and Readiness.
(B) Documentation required to support the certifications referred
to in paragraph (c)(2)(ii)(C) of this section includes supplementation
covering the
[[Page 35535]]
full period of qualification. In the event that documentation fails to
support qualification or continued qualification or the condition of
qualification otherwise ceases to exist and the member fails to report
such event to the TRICARE contractor servicing the member's coverage,
the member's coverage under Tier 2 will terminate, effective on the
date the required condition ceased to exist. In that case, the member's
coverage will be in Tier 3 and the member will be responsible for the
additional premiums required for Tier 3, effective from that date.
(d) TRICARE Reserve Select enrollment procedures.
(1) Application procedures. To purchase TRICARE Reserve Select
coverage, qualified Reserve component members must complete and submit
the applicable TRICARE enrollment application, along with an initial
payment of the appropriate monthly premium share required by paragraph
(b)(3) of this section to the appropriate TRICARE contractor in
accordance with deadlines and other procedures established by the
ASD(HA).
(i) Tier 1. For qualified members, the decision to purchase TRICARE
Reserve Select coverage in Tier 1 is a one-time opportunity. If not
purchased in a timely manner, if coverage is taken for a period less
than the maximum period of qualification, or if coverage is terminated
for any reason, coverage may not be initiated or extended later, nor
may any period of qualification be saved to be used later. Members
qualified under paragraph (c)(2)(i)(A) of this section are required to
submit the required application and premium payment as soon as
practicable after entering into a Service Agreement with their
respective Reserve component. Members qualified under paragraph
(c)(2)(i)(B) of this section are required to submit the required
application and premium payment for receipt by the appropriate TRICARE
contractor not later than 30 days before the last day of qualifying
active duty or the last day of coverage under the Transition Assistance
Management Program, whichever is later, unless the otherwise qualified
member is a member of the Individual Ready Reserve at that time. In
that case, the member shall submit the required application and premium
payment as soon as practicable after entering into a Service Agreement
with his or her respective Reserve component.
(ii) Open Season for Tiers 2 and 3. Open Season is the time period
during which a member who qualifies for coverage under either paragraph
(c)(2)(ii) or paragraph (c)(2)(iii) of this section may purchase new
coverage, renew existing coverage with or without a change in type of
coverage, or terminate coverage. One open season will be offered each
year in accordance with procedures established by the ASD(HA). Before a
member's coverage may be renewed, the service agreement must be valid
through December 31st of the renewed year of coverage and all other
qualifications under either paragraph (c)(2)(ii) or paragraph
(c)(2)(iii) of this section must be validated by the member's Reserve
component. Actions requested during an open season will take effect
January 1st of the year following the open season. Existing coverage
that is not renewed will be terminated no later than December 31st of
that year. A one-time special open season will be offered in 2006 for
members to purchase coverage.
(iii) New Selected Reservists. Upon assignment to the Selected
Reserves, members who qualify for coverage under either paragraph
(c)(2)(ii) or paragraph (c)(2)(iii) of this section may purchase
coverage in accordance with deadlines and other procedures established
by the ASD(HA).
(iv) Qualifying Life Events. TRS members may request certain
changes to their TRS coverage in connection with certain events called
qualifying life events in accordance with deadlines and other
procedures established by the ASD(HA). The first type of qualifying
life event is associated with changes in immediate family composition.
The second type of qualifying life event is associated with changes in
family employment or health coverage status. If a member who is covered
under Tier 1 experiences a qualifying life event, the only action a
member may request is a change in type of coverage. (The member may
request termination of coverage at any time; however, the member will
not be allowed to purchase coverage again under Tier 1, unless he or
she qualifies again after the date of termination for Tier 1 coverage).
If a member who is covered under either Tier 2 or Tier 3 experiences a
qualifying life event, the member may apply to purchase coverage,
request changes in type of coverage, or terminate coverage.
(2) Type of coverage. A member of a Reserve component who qualifies
to purchase coverage under paragraph 272(c) of this section may elect
self-only or self and family coverage. Immediate family members as
defined in Sec. Sec. 199.3(b)(2)(i) (except former spouses) and 199.3
(b)(2)(ii) of this part may be included in such family coverage.
(i) Tier 1. After purchasing coverage, members who qualified under
paragraph (c)(2)(i)(A) or (c)(2)(i)(B) of this section may change type
of coverage only in conjunction with a qualifying life event described
in paragraph (d)(1)(iv) of this section. The change will become
effective in accordance with procedures established by the ASD(HA).
(ii) Tiers 2 and 3. After purchasing coverage, members who
qualified under either paragraph (c)(2)(ii) or paragraph (c)(2)(iii) of
this section may change type of coverage either during an open season
described in paragraph (d)(1)(ii) of this section or in conjunction
with a qualifying life event described in paragraph (d)(1)(iv) of this
section. The change will become effective in accordance with procedures
established by the ASD(HA).
(3) Period of coverage.
(i) Tier 1. (A) The period of coverage for members who qualify
under (c)(2)(i) of this section shall be equal to the lesser of--
(1) one year, in the case of a member who otherwise qualifies but
does not serve continuously on active duty for 90 days because of an
injury, illness, or disease incurred or aggravated while deployed;
(2) one year for each consecutive period of 90 days of continuous
active duty described in paragraph (c)(2)(i)(A)(1) or (c)(2)(i)(B)(1);
or
(3) the number of whole years for which the member agrees under
paragraph (c)(2)(i)(A)(4) or (c)(2)(i)(B)(4) to continue to serve in
the Selected Reserve after the coverage begins.
(B) The number of years established by the service agreement that
was entered into prior to beginning coverage in TRICARE Reserve Select
under paragraph (c)(2)(i)(A)(4) or (c)(2)(i)(B)(4) of this section 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
service agreement. The number of years of coverage may only be changed
if the member is recalled to active duty and qualifies again for a new
period of coverage under paragraph (c)(2)(i) of this section. When
coverage is terminated for any reason, a member may not purchase
coverage again under paragraph (c)(2)(i)(B) unless recalled to active
duty and the member qualifies again for a new period of coverage under
paragraph (c) of this section.
(C) The period of coverage for members who qualify under paragraph
(c)(2)(i)(A) of this section begins on the date that is the later of
the expiration of TAMP benefits under Sec. 199.3(e) of this part or
the effective date of the service agreement referred to in paragraph
(c)(2)(i)(A)(4) of this section, but in no
[[Page 35536]]
case later than October 28, 2005. The period of coverage for members
who qualify under (c)(2)(i)(B) of this section begins the later of the
day after the last day of active duty; the day after the expiration of
TAMP benefits under Sec. 19(e) of this part; or the date that a member
of the Individual Ready Reserve finds and occupies a position in the
Selected Reserve, up to one year after either the last day of active
duty or the expiration of TAMP benefits, whichever is later.
(D) If a member of the Selected Reserves dies while in a period of
TRICARE Reserve Select coverage under Tier 1, the family member(s) may
purchase new or continuing TRICARE Reserve Select coverage under Tier 1
for up to six months beyond the date of the member's death upon payment
of monthly premiums. The premium amount payable shall be as determined
in accordance with paragraph (b)(1)(i) of this section.
(ii) Tiers 2 and 3. The maximum duration for any period of coverage
purchased by members who qualify for TRICARE Reserve Select under
either paragraph (c)(2)(ii) or paragraph (c)(2)(iii) is one year and
will coincide with the calendar year. The period of coverage begins in
accordance with procedures established by the ASD(HA) and ends December
31st of the same year in which the current period of coverage began.
(4) Enrollment processing. Following validation, upon receipt of a
completed TRICARE Reserve Select application, along with an initial
payment of the appropriate monthly premium share required by paragraph
(b) of this section, the appropriate TRICARE contractor will process
enrollment actions into DEERS in accordance with deadlines and other
procedures established by the ASD(HA).
(5) Termination. Coverage will terminate whenever a member ceases
to meet any of the qualifications for the particular tier under which
coverage was purchased or a request for termination for Tier 1 coverage
is received in accordance with procedures established by the ASD(HA).
However, unless the member's Reserve component terminates the member's
service in the Selected Reserve, the service agreement described in
paragraph (c) of this section remains in force and the end date is
unchanged. Termination of coverage for the member will result in
termination of coverage for the member's family members in TRICARE
Reserve Select, except as described in paragraphs (d)(3)(i)(D). The
termination will become effective in accordance with procedures
established by the ASD(HA).
(i) Tier 1. Members whose coverage under Tier 1 terminates will not
be allowed to purchase coverage again under Tier 1, unless the member
qualifies again for Tier 1 coverage under (c)(2)(i)(B) of this section
after the date of termination. However, the member may qualify for
coverage under conditions identified either in paragraphs (c)(2)(ii) or
(c)(2)(iii) of this section.
(A) Members who qualify under paragraph (c)(2)(i) of this section
may request to terminate coverage at any time.
(B) Coverage shall terminate for members who no longer qualify for
TRICARE Reserve Select as specified in paragraph (c) of this section,
including when the member's service in the Selected Reserve terminates.
(C) Coverage may terminate for members who fail to make a premium
payment in accordance with procedures established by the ASD(HA).
(D) Coverage for survivors as described in paragraph (d)(3)(i)(D)
shall terminate six months after the date of death of the covered
Reserve component member.
(ii) Tiers 2 and 3. (A) Members who qualify under either paragraph
(c)(2) or paragraph (c)(3) in this section may request to terminate
coverage only during an open season by notifying the appropriate
TRICARE office.
(B) Coverage shall terminate for members who no longer qualify for
TRICARE Reserve Select as specified under either paragraph (c)(2) or
paragraph (c)(3) of this section, including when the member's service
in the Selected Reserve terminates. However, members whose coverage
under Tier 2 terminates may be able to purchase continued coverage
under Tier 3 outside of open season if they qualify under paragraph
(c)(2)(iii).
(C) Coverage may terminate for members who fail to make a premium
payment in accordance with procedures established by the ASD(HA).
(D) During the month that a Reserve component member qualified for
coverage under paragraph (c)(2)(ii) of this section ceases to qualify,
the Reserve component member must submit a request to terminate
coverage under Tier 2. Failure to do so will result with the member
being retroactively enrolled in Tier 3 as of the date the member no
longer qualified for Tier 2. Such member will be responsible for the
payment of Tier 3 premiums.
(6) Effect of Other TRICARE Benefits on TRICARE Reserve Select.
During any period in which members covered by TRICARE Reserve Select
receive full TRICARE medical benefits (except the certain special
programs listed in paragraph (a)(5)(i)(B) of this section), no premium
payments for TRICARE Reserve Select are due.
(i) Tier 1. (A) Before January 6, 2006, when a member who was
covered by TRICARE Reserve Select under Tier 1 serves on active duty
for a period of more than 30 days and either is released from active
duty or whose TAMP benefits under Sec. 199.3(e) of this part end
before January 6, 2006, receives other TRICARE benefits; TRICARE
Reserve Select coverage is superseded for the member and any covered
family members, but the period of coverage continues to run and the end
date of coverage remains unchanged. If applicable, such TRICARE
coverage includes early TRICARE benefits based on delayed-effective-
date orders under Sec. 199.3(b)(5) of this part. If the original end
date of TRICARE Reserve Select coverage has not been reached by the
time the other TRICARE benefits terminate, TRICARE Reserve Select
coverage will resume with the same type of coverage in effect on the
date coverage was suspended. TRICARE Reserve Select coverage will
continue until the original end date of coverage or until coverage is
otherwise terminated. The service agreement in effect as described in
paragraphs (c)(2)(i)(A)(4) or (c)(2)(i)(B)(4) of this section remains
in force and the end date is unchanged. In addition, TRICARE Reserve
Select coverage is also superseded by a new period of coverage
established as a result of qualifying again under paragraph
(c)(2)(1)(B) of this section.
(B) On or after January 6, 2006, when a member who was covered by
TRICARE Reserve Select under Tier 1 serves on active duty for a period
of more than 30 days and either is released from active duty or whose
TAMP benefits under Sec. 199.3(e) of this part end on or after January
6, 2006, receives other TRICARE benefits; TRICARE Reserve Select
coverage is suspended for the member and any covered family members. If
such coverage was in effect on January 6, 2006, the effective date of
the suspension is January 6, 2006. If applicable, such TRICARE coverage
includes early TRICARE coverage based on delayed-effective-date orders
under Sec. 199.3(b)(5) of this part and TAMP benefits under Sec.
199.3(e) of this part. The end date of the TRICARE Reserve Select
period of coverage will be extended for a period of time equal to the
period of time that TRS coverage was suspended. TRICARE Reserve Select
coverage will continue until the
[[Page 35537]]
adjusted end date, or until coverage is otherwise terminated. The
service agreement in effect as described in paragraphs (c)(2)(i)(A)(4)
or (c)(2)(i)(B)(4) of this section remains in force and the end date is
unchanged. In addition, the end date of the TRICARE Reserve Select
period of coverage will be extended for a period of time equal to any
new period of coverage established as a result of qualifying again
under paragraph (c)(2)(i)(B) of this section.
(ii) Tiers 2 and 3. When a member covered by TRICARE Reserve Select
under either Tier 2 or Tier 3 receives other TRICARE coverage, TRICARE
Reserve Select coverage is superseded for the member and any covered
family members, but the period of coverage continues to run and the end
date of coverage remains unchanged. The service agreement described in
paragraphs (c)(2)(ii) and (c)(2)(iii) of this section remains in force
and the end data remains unchanged.
(7) Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on members' costs or access to care,
members may be given the opportunity to change their type of coverage
or terminate coverage coincident with the revisions.
(e) Relationship to Continued Health Care Benefits Program.
Coverage under TRICARE Reserve Select counts as coverage under a health
benefit plan for purposes of individuals qualifying for the Continued
Health Care Benefits Program (CHCBP) under Sec. 199.20(d)(1)(ii)(B) or
Sec. 199.2(d)(1)(iii)(B) of this part.
(1) Tier 1. If at the time a member who qualifies under (c)(2)(i)
of this section purchases coverage in TRICARE Reserve Select, or
resumes TRICARE Reserve Select coverage after a period in which
coverage was superseded under paragraph (d)(6)(i)(A) or suspended under
paragraph (d)(6)(i)(B) 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's coverage under
TRICARE Reserve Select terminates 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 termination of TRICARE Reserve Select
coverage, begin CHCBP coverage by following the applicable procedures
to purchase CHCBP coverage. The period of coverage will be as provided
in 199.20(d)(6) of the part.
(2) Tiers 2 and 3. Coverage for TRICARE Reserve Select under either
paragraph (c)(2)(ii) or paragraph (c)(2)(iii) of this section has no
effect on eligibility for the CHCBP.
(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 (f)(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
(f)(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: June 13, 2006.
L.M. Bynum,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 06-5490 Filed 6-20-06; 8:45 am]
BILLING CODE 5001-06-M