[Code of Federal Regulations]
[Title 32, Volume 2]
[Revised as of July 1, 2008]
From the U.S. Government Printing Office via GPO Access
[CITE: 32CFR199.20]

[Page 336-340]
 
                       TITLE 32--NATIONAL DEFENSE
 
        CHAPTER I--OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED)
 
PART 199_CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES 
 
Sec. 199.20  Continued Health Care Benefit Program (CHCBP).

    (a) Purpose. The CHCBP is a premium based temporary health care 
coverage program that will be available to qualified beneficiaries (set 
forth in paragraph (d)(1) of this section). Medical coverage under this 
program will mirror the benefits offered via the basic CHAMPUS program. 
Premium costs for this coverage are payable by enrollees to a Third 
Party Administrator. The CHCBP is not part of the CHAMPUS program. 
However, as set forth in this section, it functions under most of the 
rules and procedures of CHAMPUS. Because the purpose of the CHCBP is to 
provide a continuation health care benefit for the Department of Defense 
and the other Uniformed Services (e.g., NOAA, PHS, and the Coast Guard) 
health care beneficiaries losing eligibility, it will be administered so 
that it appears, to the maximum extent possible, to be part of CHAMPUS.
    (b) General provisions. Except for any provisions the Director, 
OCHAMPUS may exclude, the general provisions of Sec. 199.1 shall apply 
to the CHCBP as they do to CHAMPUS.
    (c) Definitions. Except as may be specifically provided in this 
section, to the extent terms defined in Sec. 199.2 are relevant to the 
administration of the CHCBP, the definitions contained in that section 
shall apply to the CHCBP as they do to CHAMPUS.
    (d) Eligibility and enrollment--(1) Eligibility. Enrollment in the 
CHCBP is open to the following individuals:
    (i) Members of Uniformed Services, who:
    (A) Are discharged or released from active duty (or full time 
National Guard duty), whether voluntarily or involuntarily, under other 
than adverse conditions;
    (B) Immediately preceding that discharge or release, were entitled 
to medical and dental care under 10 U.S.C. 1074(a) (except in the case 
of a member discharged or released from full-time National Guard duty); 
and,
    (C) After that discharge or release and any period of transitional 
health care provided under 10 U.S.C. 1145(a) would not otherwise be 
eligible for any benefit under 10 U.S.C. chapter 55.
    (ii) A person who:
    (A) Ceases to meet requirements for being considered an unmarried 
dependent child of a member or former member of the armed forces under 
10 U.S.C. 1072(2)(D);
    (B) On the day before ceasing to meet those requirements, was 
covered under a health benefits plan under 10 U.S.C. chapter 55, or 
transitional health care under 10 U.S.C. 1145(a) as a dependent of the 
member or former member; and,
    (C) Would not otherwise be eligible for any benefits under 10 U.S.C. 
chapter 55.
    (iii) A person who:
    (A) Is an unremarried former spouse of a member or former member of 
the armed forces;
    (B) On the day before the date of the final decree of divorce, 
dissolution, or annulment was covered under a health benefits plan under 
10 U.S.C. chapter 55, or transitional health care under 10 U.S.C. 
1145(a) as a dependent of the member or former member; and,

[[Page 337]]

    (C) Is not a dependent of the member or former member under 10 
U.S.C. 1072(2)(F) or (G) or ends a one-year period of dependency under 
10 U.S.C. 1072(2)(H).
    (iv) An unmarried person who:
    (A) Is placed in the legal custody of a member or former member by a 
court or who is placed in the home of a member or former member by a 
recognized placement agency in anticipation of the legal adoption of the 
child; and
    (B) Either:
    (1) Has not attained the age of 21 if not in school or age 23 if 
enrolled in a full time course of study at an institution of higher 
learning; or
    (2) Is incapable of self-support because of a mental or physical 
incapacity which occurred while the person was considered a dependent of 
the member or former member; and
    (C) Is dependent on the member or former member for over one-half of 
the person's support; and
    (D) Resides with the member or former member unless separated by the 
necessity of military service or to receive institutional care as a 
result of disability or incapacitation; and
    (E) Is not a dependent of a member or former member as described in 
Sec. 199.3(b)(2).
    (2) Effective date. Except for the special transitional provisions 
in paragraph (r) of this section, eligibility in the CHCBP is limited to 
individuals who lost their entitlement to regular military health 
services system benefits on or after October 1, 1994.
    (3) Notification of eligibility. (i) The Department of Defense and 
the other Uniformed Services (National Oceanic and Atmospheric 
Administration (NOAA), Public Health Service (PHS), Coast Guard) will 
notify persons eligible to receive health benefits under the CHCBP.
    (ii) In the case of a member who becomes (or will become) eligible 
for continued coverage, the Department of Defense shall notify the 
member of their rights for coverage as part of pre-separation counseling 
conducted under 10 U.S.C. 1142.
    (iii) In the case of a child of a member or former member who 
becomes eligible for continued coverage:
    (A) The member or former member may submit to the Third Party 
Administrator a notice of the child's change in status (including the 
child's name, address, and such other information needed); and
    (B) The Third Party Administrator, within 14 days after receiving 
such information, will inform the child of the child's rights under 10 
U.S.C. 1142.
    (iv) In the case of a former spouse of a member or former member who 
becomes eligible for continued coverage, the Third Party Administrator 
will notify the individual of eligibility for CHCBP when he or she 
declares the change in marital status to a military personnel office.
    (4) Election of coverage. (i) In order to obtain continued coverage, 
written election by eligible beneficiary must be made, within a 
prescribed time period. In the case of a member discharged or released 
from active duty (or full time National Guard duty), whether voluntarily 
or involuntarily; an unremarried spouse of a member or former member; or 
a child emancipated from a member or former member, the written election 
shall be submitted to the Third Party Administrator before the end of 
the 60-day period beginning on the later of:
    (A) The date of the discharge or release of the member from active 
duty or full-time National Guard duty;
    (B) The date on which the period of transitional health care 
applicable to the member under 10 U.S.C. 1145(a) ends;
    (C) In the case of an unremarried former spouse of a member or 
former member, the date the one-year extension of dependency under 10 
U.S.C. 1072(2)(H) expires; or
    (D) The date the member receives the notification of eligibility.
    (ii) A member of the armed forces who is eligible for enrollment 
under paragraph (d)(1)(i) of this section may elect self-only or family 
coverage. Family members who may be included in such family coverage are 
the spouse and children of the member.
    (5) Enrollment. Enrollment in the Continued Health Care Benefit 
Program will be accomplished by submission of an application to a Third 
Party Administrator (TPA). Upon submittal of an application to the Third 
Party

[[Page 338]]

Administrator, the enrollee must submit proof of eligibility. One of the 
following types of evidence will validate eligibility for care:
    (i) A Defense Enrollment Eligibility Reporting System (DEERS) 
printout which indicates the appropriate sponsor status and the 
sponsor's and dependent's eligibility dates;
    (ii) A copy of a verified and approved DD Form 1172, ``Application 
for Uniformed Services Identification and Privilege Card'';
    (iii) A front and back copy of a DD Form 1173, ``Uniformed Services 
Identification and Privilege Card'' overstamped ``TA'' for Transition 
Assistance Management Program; or
    (iv) A copy of a DD Form 214--``Certificate of Release or Discharge 
from Active Duty''.
    (6) Period of coverage. CHCBP coverage may not extend beyond:
    (i) For a member discharged or released from active duty (or full 
time National Guard duty), whether voluntarily or involuntarily, the 
date which is 18 months after the date the member ceases to be entitled 
to care under 10 U.S.C. 1074(a) and any transitional care under 10 
U.S.C. 1145.
    (ii) In the case of an unmarried dependent child of a member or 
former member, the date which is 36 months after the date on which the 
person first ceases to meet the requirements for being considered an 
unmarried dependent child under 10 U.S.C. 1072(2)(D).
    (iii) In the case of an unremarried former spouse of a member or 
former member, the date which is 36 months after the later of:
    (A) The date on which the final decree of divorce, dissolution, or 
annulment occurs; or
    (B) If applicable, the date the one-year extension of dependency 
under 10 U.S.C. 1072(2)(H) expires.
    (iv) In the case of an unremarried former spouse of a member or 
former member, whose divorce occurred prior to the end of transitional 
coverage, the period of coverage under the CHCBP is unlimited, if:
    (A) Has not remarried before the age of 55; and
    (B) Was enrolled in the CHCBP as the dependent of an involuntarily 
separated member during the 18-month period before the date of the 
divorce, dissolution, or annulment; and
    (C) Is receiving a portion of the retired or retainer pay of a 
member or former member or an annuity based on the retainer pay of the 
member; or
    (D) Has a court order for payment of any portion of the retired or 
retainer pay; or
    (E) Has a written agreement (whether voluntary or pursuant to a 
court order) which provides for an election by the member or former 
member to provide an annuity to the former spouse.
    (v) For the beneficiary who becomes eligible for the Continued 
Health Care Benefit Program by ceasing to meet the requirements for 
being considered an unmarried dependent child of a member or former 
member, health care coverage may not extend beyond the date which is 36 
months after the date the member becomes ineligible for medical and 
dental care under 10 U.S.C. 1074(a) and any transitional health care 
under 10 U.S.C. 1145(a).
    (vi) Though beneficiaries have sixty-days (60) to elect coverage 
under the CHCBP, upon enrolling, the period of coverage must begin the 
day after entitlement to a military health care plan (including 
transitional health care under 10 U.S.C. 1145(a)) ends.
    (e) CHCBP benefits--(1) In general. Except as provided in paragraph 
(e)(2) of this section, the provisions of Sec. 199.4 shall apply to the 
CHCBP as they do to CHAMPUS.
    (2) Exceptions. The following provisions of Sec. 199.4 are not 
applicable to the CHCBP:
    (i) Paragraph (a)(2) of this section concerning eligibility:
    (ii) All provisions regarding nonavailability statements or 
requirements to use facilities of the Uniformed Services.
    (3) Beneficiary liability. For purposes of CHAMPUS deductible and 
cost sharing requirements and catastrophic cap limits, amounts 
applicable to the categories of beneficiaries to which the CHCBP 
enrollee last belonged shall continue to apply, except that for 
separating active duty members, amounts applicable to dependents of 
active duty members shall apply.

[[Page 339]]

    (f) Authorized providers. The provisions of Sec. 199.6 shall apply 
to the CHCBP as they do to CHAMPUS.
    (g) Claims submission, review, and payment. The provisions of Sec. 
199.7 shall apply to the CHCBP as they do to CHAMPUS, except that no 
provisions regarding nonavailability statements shall apply.
    (h) Double coverage. The provisions of Sec. 199.8 shall apply to 
the CHCBP as they do to CHAMPUS.
    (i) Fraud, abuse, and conflict of interest. Administrative remedies 
for fraud, abuse and conflict of interest. The provisions of Sec. 199.9 
shall apply to the CHCBP as they do to CHAMPUS.
    (j) Appeal and hearing procedures. The provisions of Sec. 199.10 
shall apply to the CHCBP as they do to CHAMPUS.
    (k) Overpayment recovery. The provisions of Sec. 199.11 shall apply 
to the CHCBP as they do to CHAMPUS.
    (l) Third Party recoveries. The provisions of Sec. 199.12 shall 
apply to the CHCBP as they do to CHAMPUS.
    (m) Provider reimbursement methods. The provisions of Sec. 199.14 
shall apply to the CHCBP as they do to CHAMPUS.
    (n) Peer Review Organization Program. The provisions of Sec. 199.15 
shall apply to the CHCBP as they do to CHAMPUS.
    (o) Preferred provider organization programs available. Any 
preferred provider organization program under this part that provides 
for reduced cost sharing for using designated providers, such as the 
``TRICARE Extra'' option under Sec. 199.17, shall be available to 
participants in the CHCBP as it is to CHAMPUS beneficiaries.
    (p) Special programs not applicable--(1) In general. Special 
programs established under this part that are not part of the basic 
CHAMPUS program established pursuant to 10 U.S.C. 1079 and 1086 are not, 
unless specifically provided in this section, available to participants 
in the CHCBP.
    (2) Examples. The special programs referred to in paragraph (p)(1) 
of this section include:
    (i) The Extended Care Health Option (ECHO) under Sec. 199.5.
    (ii) The Active Duty Dependents Dental Plan under Sec. 199.13;
    (iii) The Supplemental Health Care Program under Sec. 199.16; and
    (iv) The TRICARE Enrollment Program under Sec. 199.17, except for 
TRICARE Extra program under that section.
    (3) Exemptions to the restriction. In addition to the provision to 
make TRICARE Extra available to CHCBP beneficiaries, the following two 
demonstration projects are also available to CHCBP enrollees:
    (i) Home Health Care Demonstration; and
    (ii) Home Health Care-Case Management Demonstration.
    (q) Premiums--(1) Rates. Premium rates will be established by the 
Assistant Secretary of Defense (Health Affairs) for two rate groups--
individual and family. Eligible beneficiaries will select the level of 
coverage they require at the time of initial enrollment (either 
individual or family) and pay the appropriate premium payment. The rates 
are based on Federal Employee Health Benefit Program employee and agency 
contributions required for a comparable health benefits plan, plus an 
administrative fee. The administrative fee, not to exceed ten percent of 
the basic premium amount, shall be determined based on actual expected 
administrative costs for administration of the program. Premiums may be 
revised annually and shall be published annually for each fiscal year. 
Premiums will be paid by enrollees quarterly.
    (2) Effects of failure to make premium payments. Failure by 
enrollees to submit timely and proper premium payments will result in 
denial of continued enrollment and denial of payment of medical claims. 
Premium payments which are late 30 days or more past the start of the 
quarter for which payment is due will result in the ending of 
beneficiary enrollment. Beneficiaries denied continued enrollment due to 
lack of premium payments will not be allowed to reenroll. In such a 
case, benefit coverage will cease at the end of the ninety day (90) 
period for which a premium payment was received. Enrollees will be held 
liable for medical costs incurred after losing eligibility.
    (r) Transitional provisions. (1) There will be a sixty-day period of 
enrollment for all eligible beneficiaries (outlined

[[Page 340]]

in paragraph (d)(1) of this section) whose entitlement to regular 
military health services system coverage ended on or after August 2, 
1994, but prior to the CHCBP implementation on October 1, 1994.
    (2) Enrollment in the U.S. VIP program may continue up to October 1, 
1994. Policies written prior to October 1, 1994, will remain in effect 
until the end of the policy life.
    (3) On or after the October 1, 1994, implementation of the Continued 
Health Care Benefit Program, beneficiaries who enrolled in the U.S. VIP 
program prior to October 1, 1994, may elect to cancel their U.S. VIP 
policy and enroll in the CHCBP.
    (4) With the exception of persons enrolled in the U.S. VIP program 
who may convert to the CHCBP, individuals who lost their entitlement to 
regular military health services system coverage prior to August 2, 
1994, are not eligible for the CHCBP.
    (s) Procedures. The Director, OCHAMPUS, may establish other rules 
and procedures for the administration of the Continued Health Care 
Benefit Program.

[59 FR 49818, Sept. 30, 1994, as amended at 62 FR 35097, June 30, 1997; 
64 FR 46141, Aug. 24, 1999; 69 FR 51569, Aug. 20, 2004]