[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: 32CFR220.2]

[Page 429-430]
 
                       TITLE 32--NATIONAL DEFENSE
 
        CHAPTER I--OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED)
 
PART 220_COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR 
 
Sec. 220.2  Statutory obligation of third party payer to pay.

    (a) Basic rule. Pursuant to 10 U.S.C. 1095(a)(1), a third party 
payer has an obligation to pay the United States the reasonable charges 
for healthcare services provided in or through any facility of the 
Uniformed Services to a covered beneficiary who is also a beneficiary 
under the third party payer's plan. The obligation to pay is to the 
extent that the beneficiary would be eligible to receive reimbursement 
or indemnification from the third party payer if the beneficiary were to 
incur the costs on the beneficiary's own behalf.
    (b) Application of cost shares. If the third party payer's plan 
includes a requirement for a deductible or copayment by the beneficiary 
of the plan, then the amount the United States may collect from the 
third party payer is the reasonable charge for the care provided less 
the appropriate deductible or copayment amount.
    (c) Claim from United States exclusive. The only way for a third 
party payer to satisfy its obligation under 10 U.S.C. 1095 is to pay the 
facility of the uniformed service or other authorized representative of 
the United States. Payment by a third party payer to the beneficiary 
does not satisfy 10 U.S.C. 1095.
    (d) Assignment of benefits or other submission by beneficiary not 
necessary. The obligation of the third party payer to

[[Page 430]]

pay is not dependent upon the beneficiary executing an assignment of 
benefits to the United States. Nor is the obligation to pay dependent 
upon any other submission by the beneficiary to the third party payer, 
including any claim or appeal. In any case in which a facility of the 
Uniformed Services makes a claim, appeal, representation, or other 
filing under the authority of this part, any procedural requirement in 
any third party payer plan for the beneficiary of such plan to make the 
claim, appeal, representation, or other filing must be deemed to be 
satisfied. A copy of the completed and signed DoD insurance declaration 
form will be provided to payers upon request, in lieu of a claimant's 
statement or coordination of benefits form.
    (e) Preemption of conflicting State laws. Any provision of a law or 
regulation of a State or political subdivision thereof that purports to 
establish any requirement on a third party payer that would have the 
effect of excluding from coverage or limiting payment, for any health 
care services for which payment by the third party payer under 10 U.S.C. 
1095 or this part is required, is preempted by 10 U.S.C. 1095 and shall 
have no force or effect in connection with the third party payer's 
obligations under 10 U.S.C. 1095 or this part.

[55 FR 21748, May 29, 1990, as amended at 57 FR 41101, Sept. 9, 1992; 65 
FR 7727, Feb. 16, 2000; 67 FR 57740, Sept. 12, 2002]