[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: 32CFR199.24]

[Page 357-361]
 
                       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. 199.24  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 is available for purchase by members of the Selected Reserve and 
certain survivors of Selected Reserve members as specified in paragraph 
(c) of this section.
    (2) Statutory Authority. TRICARE Reserve Select is authorized by 10 
U.S.C. 1076d.
    (3) Scope of the Program. TRICARE Reserve Select is applicable in 
the 50 United States, the District of Columbia, Puerto Rico, and, to the 
extent practicable, other areas where members of the Selected Reserve 
serve. In locations other than the 50 states of the United States and 
the District of Columbia, the Assistant Secretary of Defense (Health 
Affairs) 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

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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 has 
satisfied all the ``qualifications'' that must be met before the member 
is authorized to purchase coverage. Only then may the member purchase 
coverage by submitting a completed request in the appropriate format 
along with payment of the applicable one month premium. The term 
``coverage'' indicates the benefit of TRICARE Standard or Extra 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), 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 Care Health Option Program (see Sec. 199.5), the Special 
Supplemental Food Program (see Sec. 199.23), and the Supplemental 
Health Care Program (see Sec. 199.16) except when referred by a 
Military 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) Premiums. TRICARE Reserve Select coverage is available for 
purchase by any Selected Reserve member if the member fulfills all of 
the statutory qualifications. A member of the Selected Reserve covered 
under TRICARE Reserve Select shall pay 28 percent of the total amount 
that the ASD(HA) determines on an appropriate actuarial basis as being 
appropriate for that coverage. There is one premium rate for member-only 
coverage and one premium rate for member and family coverage.
    (iii) Procedures. Under TRICARE Reserve Select, Reserve component 
members who fulfilled all of the statutory qualifications may purchase 
either the member-only type of coverage or the member and family type of 
coverage by submitting a completed request in the appropriate format 
along with payment of the applicable one month premium. 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 Sec. 199.17 of this Part.
    (b) TRICARE Reserve Select premiums. Members are charged premiums 
for coverage under TRICARE Reserve Select that represent 28 percent of 
the total annual premium 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 (and Extra) 
benefit for the TRICARE Reserve Select eligible population. Premiums are 
to be paid monthly, except as otherwise provided through administrative 
implementation, pursuant to procedures established by the ASD(HA).
    (1) Annual establishment of rates. (i) TRICARE Reserve Select 
monthly premium rates shall be established and updated annually on a 
calendar year basis to maintain an appropriate relationship with the 
annual changes in premiums for the Blue Cross and Blue Shield Standard 
Service Benefit Plan under the Federal Employees Health

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Benefits Program, a nationwide plan closely resembling TRICARE Standard 
(and Extra) coverage, or by other adjustment methodology determined to 
be appropriate by the ASD(HA) for each of the two types of coverage, 
member-only and member and family as described in paragraphs (d)(2) of 
this section.
    (ii) Annual rates for the first year TRICARE Reserve Select was 
offered (calendar year 2005) were based on the Federal Blue Cross and 
Blue Shield annual premiums, with adjustments based on estimated 
differences in covered populations, as determined by the ASD(HA).
    (2) Premium adjustments. In addition to the determinations described 
in paragraph (b)(1) of this section, premium adjustments may be made 
prospectively for any calendar year to reflect any significant program 
changes or any actual experience in the costs of administering the 
TRICARE Reserve Select Program.
    (3) Survivor coverage under TRICARE Reserve Select. A surviving 
family member of a Reserve Component service member who qualified for 
TRICARE Reserve Select coverage as described in paragraph (c)(3) of this 
section will pay premium rates as follows. 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.
    (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. The member's Service personnel office is responsible for 
keeping DEERS current with eligibility data.
    (2) Member Purchase. A member who is a member of a Reserve component 
of the Armed Forces qualifies to purchase TRICARE Reserve Select 
coverage if the member meets both the following conditions:
    (i) Is a member of the Selected Reserve of the Ready Reserve.
    (ii) Is not enrolled in, or eligible to enroll in, a health benefits 
plan under Chapter 89 of Title 5, U.S.C.
    (3) Survivor coverage under TRICARE Reserve Select. If a member of 
the Selected Reserve dies while in a period of TRICARE Reserve Select 
coverage, the family member(s) may purchase new or continue existing 
TRICARE Reserve Select coverage for up to six months beyond the date of 
the member's death.
    (d) Procedures--(1) Purchasing Coverage. A qualified member may 
purchase one of two types of coverage: member-only coverage or member 
and family coverage. Immediate family members of the Reserve component 
member, as defined in Sec. 199.3(b)(2)(i) (except former spouses) and 
Sec. 199.3 (b)(2)(ii) of this Part, may be included in such family 
coverage. To purchase either type of TRICARE Reserve Select coverage for 
effective dates of coverage described below, Reserve component members 
qualified under Sec. 199.24(c) must submit a request in the appropriate 
format, along with an initial payment of the applicable monthly premium 
required by paragraph (b) of this section to the appropriate TRICARE 
contractor in accordance with deadlines and other procedures established 
by the ASD(HA).
    (i) Continuation Coverage. Deadlines and other procedures may be 
established for a qualified member to purchase TRICARE Reserve Select 
coverage with an effective date immediately following the date of 
termination of coverage under another TRICARE program in which the 
member is the sponsor.
    (ii) Qualifying Life Event. Deadlines and other procedures may be 
established for a qualified member to purchase TRICARE Reserve Select 
coverage on the occasion of a qualifying life event that changes the 
immediate family composition (e.g., birth, adoption, divorce, etc.) that 
is eligible for coverage under TRICARE Reserve Select. The effective 
date for TRICARE Reserve Select coverage will be the

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date of the qualifying life event. 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 officials will update DEERS in the usual manner. 
The appropriate TRICARE contractor will then take appropriate action 
upon receipt of the completed request in the appropriate format along 
with payment of the applicable one month premium.
    (iii) Open Enrollment. Deadlines and other procedures may be 
established for a qualified member to purchase TRICARE Reserve Select 
coverage at any time. The effective date of coverage will coincide with 
the first day of a month.
    (iv) Survivor coverage under TRICARE Reserve Select. Deadlines and 
other procedures may be established for a surviving family member of a 
Reserve Component service member who qualified for TRICARE Reserve 
Select coverage as described in paragraph (c)(3) of this section to 
purchase new TRICARE Reserve Select coverage or continue existing 
TRICARE Reserve Select coverage for up to six months beyond the date of 
the member's death. The effective date of coverage will be the day 
following the date of the member's death.
    (2) Changing type of coverage. TRICARE Reserve Select members may 
request to change type of coverage during open enrollment or on the 
occasion of a qualifying life event that changes immediate family 
composition as described in paragraph (d)(1)(ii) of this section by 
submitting a completed request in the appropriate format.
    (3) Termination. 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)(1)(iv) of this 
section. The termination will become effective in accordance with 
procedures established by the ASD(HA). Members whose coverage under 
TRICARE Reserve Select terminates under paragraph (d)(3)(iii) or (iv) of 
this section will not be allowed to purchase coverage again under 
TRICARE Reserve Select for a period of one year following the effective 
the date of termination.
    (i) 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.
    (ii) Coverage may terminate for members who gain coverage under 
another TRICARE program in which the member is the sponsor.
    (iii) Coverage may terminate for members who fail to make a premium 
payment in accordance with procedures established by the ASD(HA).
    (iv) Members may request termination of coverage at any time by 
submitting a completed request in the appropriate format in accordance 
with established deadlines and procedures.
    (v) Coverage for survivors as described in paragraph (d)(1)(iv) of 
this section shall terminate six months after the date of death of the 
covered Reserve component member.
    (4) Processing. Upon receipt of a completed request in the 
appropriate format, the appropriate TRICARE contractor will process 
enrollment actions into DEERS in accordance with deadlines and other 
procedures established by the ASD(HA).
    (5) 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 section 199.20(d)(1)(ii)(B) or 
section 199.20(d)(1)(iii)(B) of this Part. If at the time a member who 
qualifies under paragraph (c) of this section purchases coverage in 
TRICARE Reserve Select, and the member was also eligible to enroll in 
the Continued Health Care Benefits Program (CHCBP) under section 
199.20(d)(1)(i) of this Part (except to the

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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 Sec. 199.20(d)(6) of this Part.
    (f) Preemption of State laws. (1) Pursuant to 10 U.S.C. 1103, the 
Department of Defense has determined that in the administration of 
chapter 55 of title 10, U.S. Code, preemption of State and local laws 
relating to health insurance, prepaid health plans, or other health care 
delivery or financing methods is necessary to achieve important Federal 
interests, including but not limited to the assurance of uniform 
national health programs for military families and the operation of such 
programs, at the lowest possible cost to the Department of Defense, that 
have a direct and substantial effect on the conduct of military affairs 
and national security policy of the United States. This determination is 
applicable to contracts that implement this section.
    (2) Based on the determination set forth in paragraph (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.

[72 FR 46383, August 20, 2007]