Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select for Certain Members of the Selected Reserve; Transitional Assistance Management Program; Early Eligibility for TRICARE for Certain Reserve Component Members, 12798-12805 [05-5219]
Download as PDF
<![CDATA[
12798
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
is carried forward to 2005 as gain in that
same class.
Example 3. (i) The facts are the same as in
Examples 1 and 2, and at the end of 2005,
X has the following classes of income:
Interest income class ....................................
Qualified dividend income .........................
Net loss in short-term capital gain class .....
Net long-term capital gain in 28-percent
gain class ...................................................
Net long-term capital gain in unrecaptured
section 1250 gain class .............................
Net long-term capital gain in all other
long-term capital gain class (carried forward from 2004) .......................................
$5
20
(50)
10
135
160
(ii) There are no long-term capital losses to
net against the long-term capital gains. Thus,
the net short-term capital loss is used to
offset the net capital gains in the classes of
long-term capital gain and loss, in turn, until
exhaustion of the class, beginning with the
class subject to the highest Federal income
tax rate and ending with the class subject to
the lowest rate. The $50 net short-term loss
reduces the $10 net gain in the 28-percent
gain class to $0. The remaining $40 net loss
reduces the $135 net gain in the
unrecaptured section 1250 gain class to $95.
As in Examples 1 and 2, during 2005,
qualified dividend income is taxed at a lower
rate than interest income; gain in the
unrecaptured section 1250 gain class is taxed
at 25 percent; and gain in the all other longterm capital gain class is taxed at a rate lower
than 25 percent. The annuity amount is
deemed to be distributed from all the classes
in the ordinary income category and then
from the classes in the capital gains category,
beginning with the class subject to the
highest Federal income tax rate and ending
with the class subject to the lowest rate.
Therefore, in the hands of the recipient, the
2005 annuity amount has the following
characteristics:
Interest income .............................................
Qualified dividend income .........................
Unrecaptured section 1250 gain .................
$5
20
75
(iii) The remaining $20 gain in the
unrecaptured section 1250 gain class and the
$160 gain in the all other long-term capital
gain class that are not treated as distributed
to the recipient in 2005 are carried forward
to 2006 as gains in their respective classes.
Example 4. (i) The facts are the same as in
Examples 1, 2 and 3, and at the end of 2006,
X has the following classes of income:
Interest income class ....................................
Qualified dividend income class ................
Net loss in short-term capital gain class .....
Net long-term capital loss in 28-percent
gain class ...................................................
Net long-term capital gain in unrecaptured
section 1250 gain class (carried forward
from 2005) .................................................
Net long-term capital gain in all other
long-term capital gain class (carried forward from 2005) .......................................
$ 95
10
(20)
(350)
20
160
(ii) A net long-term capital loss in one class
is used to offset the net capital gains in the
other classes of long-term capital gain and
loss, in turn, until exhaustion of the class,
beginning with the class subject to the
highest Federal income tax rate and ending
with the class subject to the lowest rate. The
$350 net loss in the 28-percent gain class
reduces the $20 net gain in the unrecaptured
section 1250 gain class to $0. The remaining
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
$330 net loss reduces the $160 net gain in the
all other long-term capital gain class to $0.
As in Examples 1, 2 and 3, during 2006,
qualified dividend income is taxed at a lower
rate than interest income. The annuity
amount is deemed to be distributed from all
the classes in the ordinary income category
and then from the classes in the capital gains
category, beginning with the class subject to
the highest Federal income tax rate and
ending with the class subject to the lowest
rate. In the hands of the recipient, the 2006
annuity amount has the following
characteristics:
Interest income .............................................
Qualified dividend income .........................
$ 95
5
(iii) The remaining $5 of qualified
dividend income that is not treated as
distributed to the recipient in 2006 is carried
forward to 2007 as qualified dividend
income. The $20 net loss in the short-term
capital gain class and the $170 net loss in the
28-percent gain class are carried forward to
2007 as net losses in their respective classes.
Example 5. (i) X, a charitable remainder
annuity trust described in section 664(d)(1),
is created on January 1, 2002. The annual
annuity amount is $100. Except for qualified
5-year gain of $200 realized before May 6,
2003, but not distributed, X has no other
gains or losses carried over from former
years. X’s income for the 2007 tax year is as
follows:
Interest income class ....................................
Net gain in short-term capital gain class ....
Net long-term capital gain in 28-percent
gain class ...................................................
Net long-term capital gain in unrecaptured
section 1250 gain class .............................
Net long-term capital gain in all other
long-term capital gain class .....................
$ 10
5
5
10
10
(ii) The annuity amount is deemed to be
distributed from all the classes in the
ordinary income category and then from the
classes in the capital gains category,
beginning with the class subject to the
highest Federal income tax rate and ending
with the class subject to the lowest rate. In
2007, gains distributed to a recipient from
both the qualified 5-year gain class and the
all other long-term capital gains class are
taxed at a 15/5 percent tax rate. Since after
December 31, 2008, gains distributed from
the qualified 5-year gain class will be taxed
at a lower rate than gains distributed from the
other classes of long-term capital gain and
loss, distributions from the qualified 5-year
gain class are made after distributions from
the other classes of long-term capital gain
and loss. In the hands of the recipient, the
2007 annuity amount has the following
characteristics:
Interest income .............................................
Short-term capital gain ................................
28-percent gain .............................................
Unrecaptured section 1250 gain .................
All other long-term capital gain ..................
Qualified 5-year gain (taxed as all other
long-term capital gain) .............................
$10
5
5
10
10
60
(iii) The remaining $140 of qualified 5-year
gain that is not treated as distributed to the
recipient in 2007 is carried forward to 2008
as qualified 5-year gain.
(ix) Effective dates. The rules in this
paragraph (d)(1) that require long-term
PO 00000
Frm 00012
Fmt 4700
Sfmt 4700
capital gains to be distributed in the
following order: first, 28-percent gain
(gains and losses from collectibles and
section 1202 gains); second,
unrecaptured section 1250 gain (longterm gains not treated as ordinary
income that would be treated as
ordinary income if section 1250(b)(1)
included all depreciation); and then, all
other long-term capital gains are
applicable for taxable years ending on or
after December 31, 1998. The rules in
this paragraph (d)(1) that provide for the
netting of capital gains and losses are
applicable for taxable years ending on or
after December 31, 1998. The rule in the
second sentence of paragraph (d)(1)(vi)
of this section is applicable for taxable
years ending on or after December 31,
1998. The rule in the third sentence of
paragraph (d)(1)(vi) of this section is
applicable for distributions made in
taxable years ending on or after
December 31, 1998. All other provisions
of this paragraph (d)(1) are applicable
for taxable years ending after November
20, 2003.
*
*
*
*
*
Mark E. Matthews,
Deputy Commissioner for Services and
Enforcement.
Approved: March 10, 2005.
Eric Solomon,
Acting Deputy Assistant Secretary of the
Treasury.
[FR Doc. 05–5110 Filed 3–15–05; 8:45 am]
BILLING CODE 4830–01–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8–R]
RIN–0720–AA90
Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS);
TRICARE Reserve Select for Certain
Members of the Selected Reserve;
Transitional Assistance Management
Program; Early Eligibility for TRICARE
for Certain Reserve Component
Members
Office of the Secretary, DoD.
Interim final rule with comment
AGENCY:
ACTION:
period.
SUMMARY: This interim final rule
establishes requirements and
procedures for implementation of
TRICARE Reserve Select. It also revises
requirements and procedures for the
Transitional Assistance Management
Program. In addition, it establishes
E:\FR\FM\16MRR1.SGM
16MRR1
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
requirements and procedures for
implementation of the earlier TRICARE
eligibility for certain reserve component
members. The rule is being published as
an interim final rule with comment
period in order to comply with statutory
effective dates.
DATES: This rule is effective April 15,
2005. Submit comments on or before
May 16, 2005.
ADDRESSES: Because of staff and
resource limitations, we cannot accept
comments by facsimile (FAX)
transmission or e-mail. Mail written
comments to the following address
ONLY: TRICARE Management Activity,
TRICARE Operations/Strategic
Initiatives Division, Sky 5 Suite 810,
5111 Leesburg Pike, Falls Church, VA
22041–3206; Attention: Jody Donehoo,
Program Analyst.
FOR FURTHER INFORMATION CONTACT: Jody
Donehoo, Office of the Assistant
Secretary of Defense (Health Affairs),
telephone (703) 681–0039.
Questions regarding payment of
specific claims under the TRICARE
allowable charge method should be
addressed to the appropriate TRICARE
contractor.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
The Ronald W. Reagan National
Defense Authorization Act for Fiscal
Year 2005 (NDAA–05) (Pub. L. 108–375)
contains several provisions to enhance
health care benefits for reservists and
their family members. Three of the
provisions are addressed in this interim
final rule. First, section 701 provides for
premium-based medical coverage for
certain members of the Selected Reserve
and their eligible family members.
Section 706 makes permanent the
temporary revisions to the Transitional
Assistance Management Program,
enacted in section 704 of the National
Defense Authorization Act for Fiscal
Year 2004 (NDAA–04) (Pub. L. 108–136)
and section 1117 of the Emergency
Supplemental Appropriations Act for
the Reconstruction of Iraq and
Afghanistan, 2004 (Emergency
Supplemental) (Pub. L. 108–106).
Section 703 makes permanent the
earlier TRICARE eligibility for certain
reserve component members authorized
by section 703 of NDAA–04 and section
1116 of the Emergency Supplemental.
These provisions represent significant
enhancements to the health care
benefits available to reservists and their
eligible family members. They focus
particularly on reservists and
guardsmen activated in support of a
contingency operation after September
11, 2001. Prior to the statutory changes
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
enacted since November 2003, reservists
and their families received TRICARE
health care benefits when activated for
more than 30 consecutive days. Now,
TRICARE benefits begin up to 90 days
prior to activation for those who receive
delayed-effective-date orders, and
coverage is extended to a full 180 days
after a period of active service in
support of a contingency operation.
These changes provide for an easier
transition to and from civilian life. And,
for those who served in support of a
contingency operation and who commit
to continued service in the Selected
Reserve, a new health benefits program
will allow them to obtain through
TRICARE health coverage comparable to
that available to full-time civilian
employees of the Department of
Defense. This new program is called
‘‘TRICARE Reserve Select.’’ It is subject
to a number of specific statutory
requirements, which are outlined in this
regulation.
II. Provisions of the Rule Regarding the
Tricare Reserve Select Program
A. Establishment of the TRICARE
Reserve Select Program (paragraph
199.24(a)). This paragraph describes the
nature, purpose, statutory basis, scope,
and major features of TRICARE Reserve
Select, a premium-based medical
coverage program that will be available
to certain members of the Selected
Reserve and their dependents. TRICARE
Reserve Select is authorized by 10
U.S.C. 1076d, and is applicable
worldwide. The major features of the
program include the following:
TRICARE rules apply unless otherwise
specified; certain special TRICARE
programs are not part of TRICARE
Reserve Select, including the
Supplemental Health Care Program, the
Extended Health Care Option (ECHO)
program, and the Special Supplemental
Food Program (also known as the
Women, Infants, and Children—
Overseas Program). The TRICARE
Dental Program is already available
under 10 U.S.C. 1076a to all members of
the Selected Reserve and their family
members whether or not they enroll in
TRICARE Reserve Select. Under
TRICARE Reserve Select, eligible
Selected Reserve members may enroll
for self-only or self and family coverage.
When their enrollment becomes
effective, TRICARE Reserve Select
beneficiaries receive the TRICARE
Standard benefit. TRICARE Reserve
Select features the deductible and cost
share provisions of the TRICARE
Standard plan for active duty family
members (ADFM) for both the member
and eligible family members.
PO 00000
Frm 00013
Fmt 4700
Sfmt 4700
12799
B. Eligibility for enrollment in
TRICARE Reserve Select (paragraph
199.24(b)). This paragraph defines who
is eligible to enroll in TRICARE Reserve
Select, based on statutory provisions. To
be eligible, a person must be a member
of a reserve component of the armed
forces, who serves on active duty for 90
consecutive days or more related to a
contingency operation on or after
September 11, 2001, and, on or before
the date of release from active duty,
agrees to serve continuously in the
Selected Reserve for a period of one or
more whole years following release from
active duty, and, if not already a
member of the Selected Reserve,
actually begins serving in the Selected
Reserve prior to the date upon which
TRICARE Reserve Select coverage is
effective. The member must meet the
qualifications for continued service in
the Selected Reserve as determined by
the member’s reserve component. If the
member was released from active duty
on or before April 26, 2005, the member
has until October 28, 2005, to sign an
agreement to serve continuously in the
Selected Reserve for a period of one or
more whole years in order to be eligible
to enroll in TRICARE Reserve Select.
This temporary opportunity (until
October 28, 2005) applies to current
members of the Selected Reserve, and
also to former members who served in
support of a contingency after 9/11,
rejoin the Selected Reserve, and enter
into an agreement for continued service.
In conformance with section
701(b)(2)(B) of the NDAA–05, the
Department will take reasonable steps to
the maximum extent practicable to
notify reservists released from active
duty on or before April 26, 2005, who
may be eligible for TRICARE Reserve
Select and provide them information on
the opportunity and procedures for
entering into an agreement together with
a clear explanation of the benefits that
the member is eligible to receive under
TRICARE Reserve Select as a result of
entering into such agreement. Eligible
family members of eligible reserve
members enrolled in TRICARE Reserve
Select are also eligible for enrollment in
TRICARE Reserve Select. Eligibility
determinations are the responsibility of
the Reserve Components of the Armed
Services.
C. TRICARE Reserve Select
enrollment procedures (paragraph
199.24(c)). In order to be covered under
TRICARE Reserve Select, eligible
reserve component members released
from active duty after April 26, 2005,
must enter into an agreement prior to
being released to serve continuously in
the reserves for a period of one or more
E:\FR\FM\16MRR1.SGM
16MRR1
12800
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
whole years following such date, and
the member must meet the
qualifications for continuous service in
the Selected Reserve as determined by
the member’s reserve component. The
member must then enroll by signing the
appropriate TRICARE enrollment form
and submitting the initial monthly
premium to the appropriate TRICARE
contractor, not later than 30 days prior
to the end of their Transitional
Assistance Management Program benefit
period. A member may elect self-only or
self and family coverage, and may enroll
for one year of TRICARE Reserve Select
coverage for every 90 days of
continuous active-duty service, to the
extent that the member agrees to
continue service in the Selected
Reserves for the same number of years
after coverage begins. Members released
from active duty on or before April 26,
2005 may enroll in TRICARE Reserve
Select upon execution of the agreement
to serve continuously in the Selected
Reserve. Coverage becomes effective the
later of the end of TAMP coverage or the
effective date of the agreement to serve
in the Selected Reserve.
Except for members released from
active duty on or before April 26, 2005,
enrollment in TRICARE Reserve Select
must be accomplished prior to the
expiration of Transition Assistance
Management Program (TAMP) benefits,
and coverage begins at the expiration of
TAMP benefits and runs continuously
until eligibility expires or is otherwise
terminated. When enrollment is
terminated or the member is otherwise
disenrolled, a member may not re-enroll
unless recalled to active duty and the
member re-qualifies for this benefit.
For eligible members, the decision to
enroll in TRICARE Reserve Select or to
decline enrollment is a one-time choice.
If it is declined, or if coverage is taken
for a period less than the maximum
period of eligibility, coverage may not
be initiated or extended later, nor may
any period of eligibility be saved until
later. Thus, for example, if a member
served for one year in support of a
contingency operation, the member
earns potential eligibility for the next
four years if the member agrees to
continue service in the Selected
Reserves for four years. However, if that
member elects to continue service in the
Selected Reserve for only two years, the
member will qualify for only two years
of TRICARE Reserve Select coverage.
This two-year coverage period cannot be
extended later, even if the member later
extends Selected Reserve service for two
more years. The only way to extend
TRICARE Reserve Select coverage
beyond the period determined when the
one-time choice is made is by re-
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
qualifying through another period of
active duty service in support of a
contingency operation.
If, while enrolled in TRICARE Reserve
Select a member is recalled to active
duty for a period of more than 30
consecutive days, TRICARE Reserve
Select coverage is superseded by active
duty military health benefits for the
member and the member’s immediate
family, but the coverage period
continues to run. When the member is
released from active duty, TRICARE
Reserve Select coverage will resume for
the member and the member’s
immediate family provided the member
had been enrolled in family coverage on
the date TRICARE Reserve Select
coverage was superseded by active duty
health benefits. TRICARE Reserve Select
coverage will continue until the
member’s eligibility expires, is
otherwise terminated, or the member is
disenrolled. Following the member’s
release from active duty, TRICARE
Reserve Select coverage will be further
superseded by TAMP benefits, if
applicable. In addition, TRICARE
Reserve Select coverage is also
superseded, if applicable, by any period
of early TRICARE coverage based on
delayed-effective-date orders or by a
new enrollment, as a result of requalifying through another period of
active duty service in support of a
contingency operation. During any
period in which TRICARE Reserve
Select coverage is superseded, no
premium payments for TRICARE
Reserve Select are due for the period
being superseded.
Under certain circumstances, reserve
members may change their TRICARE
Reserve Select type of coverage. After
initial enrollment, the reserve member
may not change from self-only to self
and family enrollment, or change from
self and family enrollment to self-only
enrollment, except on the occasion of
certain events affecting the family, such
as the birth of a child, the marriage or
divorce of the sponsor, the legal
adoption of a child, or placement by a
court of a child as a legal ward in the
sponsor’s home, or certain events
affecting family health coverage, such as
an employment change of the member
or spouse. It is the responsibility of the
TRS member to provide the necessary
evidence required regarding the
circumstances permitting the change in
enrollment to the appropriate TRICARE
contractor. The Director, TRICARE
Management Activity shall issue
guidelines as necessary to implement
these provisions. All such changes are
effective prospectively.
Failure to make a premium payment
in a timely manner will result in
PO 00000
Frm 00014
Fmt 4700
Sfmt 4700
permanent disenrollment of the member
and the member’s immediate family and
denial of claims for services received on
or after the effective date of
disenrollment, which is the end of the
last month for which the premium was
paid. Members and their immediate
family will not be allowed to re-enroll,
unless the member qualifies for a new
period of eligibility.
A reserve member whose service in
the Selected Reserve ends is
automatically disenrolled, along with
the member’s eligible family members,
based on the date the member
terminated service in the Selected
Reserve.
D. TRICARE Reserve Select premiums
(paragraph 199.24(d)). Annual
premiums are charged for coverage
under TRICARE Reserve Select.
Premiums are to be paid monthly,
except as otherwise established as part
of the administrative implementation of
TRICARE Reserve Select. The monthly
premium rates are established and
updated annually on a calendar year
basis and are effective on the first of
January each year, for the two types of
coverage—self-only and self and family.
The rates are based on 28 percent of the
total estimated amount reasonable for
coverage under the TRICARE Standard
benefit for the TRICARE Reserve Select
eligible population, as determined by
the Assistant Secretary of Defense
(Health Affairs) (ASD(HA)) on an
appropriate actuarial basis. The monthly
rate for each month of a calendar year
is one-twelfth of the annual rate for that
calendar year, rounded to the nearest
dollar.
Annual rates are based on the annual
premiums for the Blue Cross and Blue
Shield Standard Service Benefit Plan
under the Federal Employees Health
Benefits Program, a nationwide plan
closely resembling TRICARE Standard
coverage, with adjustments based on
demographic differences in covered
populations, as determined by the
ASD(HA). Based on an analysis of
demographic differences between Blue
Cross and Blue Shield participants and
beneficiaries eligible for TRICARE
Reserve Select, the adjustment amount
is for purposes of calendar year 2005 a
32 percent reduction from the Blue
Cross and Blue Shield annual premium
for self-only coverage and an 8 percent
reduction from the Blue Cross and Blue
Shield annual premium for self and
family coverage. (The difference in the
percentage reductions between self-only
and self and family premiums is due to
the disproportionately high number of
high cost, single, elderly retiree federal
employees covered by Blue Cross and
Blue Shield self-only coverage.)
E:\FR\FM\16MRR1.SGM
16MRR1
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
Premiums will be adjusted annually to
maintain an appropriate relationship
with the annual changes in Blue Cross
and Blue Shield premiums.
In addition to these annual premium
changes, premium adjustments may also
be made prospectively for any calendar
year to reflect any significant program
changes or any actual experience in the
costs of administering the TRICARE
Reserve Select Program.
For calendar year 2005, the annual
premium for self-only coverage is $900
(monthly premium $75), and the annual
premium for self and family coverage is
$2,796 (monthly premium $233). These
premiums will change effective January
2006.
E. Relationship to Continued Health
Care Benefits Program (CHCBP)
(paragraph 199.24(e)). This paragraph
addresses the relationship between
TRICARE Reserve Select and the
CHCBP. CHCBP is a program that
(among other things) allows members
released from active duty to purchase
continued health care coverage through
TRICARE. This coverage is available for
a period of 18 months. Some members
at the time of release from active duty
will be eligible for either TRICARE
Reserve Select or CHCBP. This
paragraph of the regulation provides
that if a member enrolls in TRICARE
Reserve Select, but later is disenrolled,
the member or the covered family
members may then activate CHCBP
coverage for whatever period is
remaining of the original 18 month
eligibility. For example, in the case that
TRICARE Reserve Select enrollment is
ended because of discharge from the
Selected Reserve (such as through a
reduction in force or base closure) of a
member within 18 months of release
from active duty, the member could
choose to continue health care coverage
under CHCBP for the remainder of the
period at the applicable CHCBP
premiums.
F. Preemption of State laws
(paragraph 199.24(f)). This paragraph
explains that the preemptions of State
and local laws established for the
TRICARE program also apply to
TRICARE Reserve Select. Any State or
local law or regulation pertaining to
health insurance, prepaid health plans,
or other health care delivery,
administration, and financing methods
is preempted and does not apply in
connection with TRICARE Reserve
Select. This includes State and local
laws imposing premium taxes on health
insurance carriers or underwriters or
other plan managers, or similar taxes on
such entities. Preemption does not
apply to taxes, fees, or other payments
on net income or profit realized by such
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
entities in the conduct of business
relating to DoD health services
contracts, if those taxes, fees or other
payments are applicable to a broad
range of business activity. For the
purposes of assessing the effect of
Federal preemption of State and local
taxes and fees in connection with DoD
health services contracts, interpretations
shall be consistent with those applicable
to the Federal Employees Health
Benefits Program under 5 U.S.C. 8909(f).
G. Administration (paragraph
199.24(g)). This paragraph provides that
the ASD(HA) may establish other rules
and procedures necessary for the
effective administration of TRICARE
Reserve Select.
III. Provisions of the Rule Regarding
the Transitional Assistance
Management Program
A. Eligibility under the Transitional
Assistance Management Program
(TAMP) (paragraph 199.3(e)). Section
706 of NDAA–05 makes permanent
revisions to the Transitional Assistance
Management Program, which was
temporarily revised by section 704 of
NDAA–04 and section 1117 of the
Emergency Supplemental. Based on
these enactments, several categories of
armed forces members are eligible for
transitional health care after serving on
active duty. These include:
1. A member who is involuntarily
separated from active duty;
2. A member of a reserve component
who is separated from active duty to
which called or ordered in support of a
contingency operation if the active duty
is active duty for a period of more than
30 consecutive days;
3. A member who is separated from
active duty for which the member is
involuntarily retained under 10 U.S.C.
12305 in support of a contingency
operation; or
4. A member who is separated from
active duty served pursuant to a
voluntary agreement of the member to
remain on active duty for a period of
less than one year in support of a
contingency operation.
(2) A spouse (as described in
paragraph (b)(2)(i) of this section except
for former spouses) and child (as
described in paragraph (b)(2)(ii) of this
section) of a member described in
paragraph (e)(1) of this section is also
eligible for TAMP benefits under
TRICARE.
The spouse and children of the
member are also eligible for TAMP
benefits. TAMP benefits begin the day
after the member is separated from
active duty, and end 180 days later.
Eligibility is determined by the armed
forces.
PO 00000
Frm 00015
Fmt 4700
Sfmt 4700
12801
B. Beneficiary liability under TAMP.
(paragraph 199.4(f)(2)(vi)). This
paragraph establishes that TAMP
beneficiaries (including the member) are
subject to the TRICARE Standard
deductible and cost sharing rules
applicable to active duty family
members.
IV. Provisions of the Rule Regarding
Early Eligibility for Tricare for Certain
Reserve Component Members
A. Eligibility (paragraph 199.3(b)(5)).
This paragraph incorporates
requirements and procedures for
implementation of the earlier temporary
TRICARE eligibility for certain reserve
component members authorized by
section 703 of NDAA–04 and section
1116 of the Emergency Supplemental,
which provisions were made permanent
by section 703 of NDAA–05. Under this
paragraph reserve component members
issued delayed-effective-date orders for
service in support of a contingency
operation, and their family members,
are eligible for TRICARE on the date the
orders are issued, up to 90 days prior to
the date on which the period of active
duty of more than 30 consecutive days
is to begin.
V. Regulatory Procedures
Executive Order 12866 requires
certain regulatory assessments for any
significant regulatory action that would
result in an annual effect on the
economy of $100 million or more, or
have other substantial impacts. The
Congressional Review Act establishes
certain procedures for major rules,
defined as those with similar major
impacts. The Regulatory Flexibility Act
(RFA) requires that each Federal agency
prepare, and make available for public
comment, a regulatory flexibility
analysis when the agency issues a
regulation that would have significant
impact on a substantial number of small
entities. This interim final rule is not
subject to any of those requirements
because it would not have any of these
substantial impacts. Any substantial
impacts associated with implementation
of TRICARE Reserve Select are already
determined by statute and are outside
any discretionary action of DoD or effect
of this regulation.
This rule, however, does address
novel policy issues relating to
implementation of a new medical
benefits program for members of the
armed forces. Thus, this rule has been
reviewed by the Office of Management
and Budget under E.O. 12866.
This rule will not impose additional
information collection requirements on
the public under the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501–
E:\FR\FM\16MRR1.SGM
16MRR1
12802
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
ordered to active duty for a period of
more than 30 consecutive days in
support of a contingency operation
under a provision of law referred to in
section 101(a)(13)(B) of Title 10, United
States Code, that provides for activeduty service to begin on a date after the
date of the issuance of the order.
(ii) Dependents. CHAMPUS eligible
dependents under this paragraph (b)(5)
are those identified in paragraphs
(b)(2)(i) (except former spouses) and
(b)(2)(ii) of this section.
(iii) Effective date. The eligibility
established by paragraphs (b)(5)(i) and
(ii) of this section shall begin on or after
November 6, 2003, and shall be effective
on the later of the date that is:
(A) The date of issuance of the order
referred to in paragraph (b)(5)(i) of this
section; or
(B) 90 days before the date on which
the period of active duty is to begin.
(iv) Termination date. The eligibility
established by paragraphs (b)(5)(i) and
(ii) of this section ends upon entry of
the member onto active duty (at which
time CHAMPUS eligibility for the
dependents of the member is
List of Subjects in 32 CFR Part 199
established under paragraph (b)(2) of
Claims, handicapped, health
this section) or upon cancellation or
insurance, and military personnel.
amendment of the orders referred to in
I Accordingly, 32 CFR part 199 is
paragraph (b)(5)(i) of this section such
amended as follows:
that they no longer meet the
requirements of that paragraph (b)(5)(i).
PART 199—[AMENDED]
*
*
*
*
*
I 1. The authority citation for part 199
(e) Eligibility under the Transitional
continues to read as follows:
Assistance Management Program
(TAMP).
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
(1) A member of the armed forces is
eligible for transitional health care if the
I 2. Section 199.2(b) is amended by
member is:
adding the following two definitions and
(i) A member who is involuntarily
placing them in alphabetical order to
separated from active duty.
read as follows:
(ii) A member of a Reserve component
who is separated from active duty to
§ 199.2 Definitions.
which called or ordered in support of a
*
*
*
*
*
contingency operation if the active duty
(b) * * *
is active duty for a period of more than
Transitional Assistance Management
30 consecutive days.
Program (TAMP). The program
(iii) A member who is separated from
established under 10 U.S.C. § 1145(a)
active duty for which the member is
and §199.3(e) of this part.
involuntarily retained under 10 U.S.C.
*
*
*
*
*
TRICARE Reserve Select. The program 12305 in support of a contingency
established under 10 U.S.C. § 1076d and operation; or
(iv) A member who is separated from
§ 199.24 of this part.
active duty served pursuant to a
*
*
*
*
*
voluntary agreement of the member to
I 3. Section 199.3 is amended by adding
remain on active duty for a period of
new paragraph (b)(5) and revising
less than 1 year in support of a
paragraph (e) to read as follows:
contingency operation.
(2) A spouse (as described in
§ 199.3 Eligibility.
paragraph (b)(2)(i) of this section except
*
*
*
*
*
former spouses) and child (as described
(b) * * *
in paragraph (b)(2)(ii) of this section) of
(5) Reserve Component Members
a member described in paragraph (e)(1)
Issued Delayed-Effective-Date Orders.
of this section is also eligible for TAMP
(i) Member. A member of a reserve
benefits under TRICARE.
component of the armed forces who is
3511). Information needed for TRICARE
Reserve Select is obtained from active
duty military service records.
This rule is being issued as an interim
final rule, with comment period, as an
exception to our standard practice of
soliciting public comments prior to
issuance. This is because Congress has
established an April 26, 2005 effective
date for eligible members’ entitlement to
TRICARE Reserve Select. The 180-day
TAMP coverage period and the delayed
effect date orders pre-mobilization
eligibility period entitlements became
effective on the date of enactment. This
rule changes the regulation to conform
to the statutory entitlement. Based on
these statutory requirements, the
ASD(HA) has determined that following
the standard practice in this case would
be unnecessary, impractical, and
contrary to the public interest.
Public comments are invited. All
comments will be carefully considered.
A discussion of the major issues
received by public comments will be
included with the issuance of the final
rule.
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
PO 00000
Frm 00016
Fmt 4700
Sfmt 4700
(3) TAMP benefits under TRICARE
begin on the day after the member is
separated from active duty, and, if such
separation occurred on or after
November 6, 2003, and end 180 days
after such date. TRICARE benefits
available to both the member and
eligible family members are generally
those available to family members of
members of the uniformed services
under this Part. Each branch of service
will determine eligibility for its
members and eligible family members
and provide data to DEERS.
*
*
*
*
*
I 4. Section 199.4 is amended by adding
new paragraph (f)(2)(vi) to read as
follows:
§ 199.4
Basic program benefits.
*
*
*
*
*
(f) * * *
(2) * * *
(vi) Transitional Assistance
Management Program (TAMP).
Members of the Armed Forces (and their
family members) who are eligible for
TAMP under paragraph 199.3(e) of this
Part are subject to the same beneficiary
or sponsor liability as family members
of members of the uniformed services
described in this paragraph (f)(2).
*
*
*
*
*
I 5. Section 199.24 is added to read as
follows:
§ 199.24 TRICARE standard coverage for
certain selected reserve members.
(a) Establishment. TRICARE Reserve
Select is established for the purpose of
offering TRICARE health benefits to
eligible members of the Selected
Reserve and their immediate family.
(1) Purpose. TRICARE Reserve Select
is a premium-based medical coverage
program that will be available to certain
members of the Selected Reserve and
their immediate family as specified in
paragraph (b) of this section.
(2) Statutory Authority. TRICARE
Reserve Select is authorized by 10
U.S.C. 1076d.
(3) Scope of the Program. TRICARE
Reserve Select is applicable in the 50
United States, the District of Columbia,
Puerto Rico, and, to the extent
practicable, other areas where members
of the Selected Reserve serve. In
locations other than the 50 states of the
United States and the District of
Columbia, the Assistant Secretary of
Defense may authorize modifications to
the program rules and procedures as
may be appropriate to the area involved.
(4) Major Features of TRICARE
Reserve Select. The major features of the
program include the following:
(i) TRICARE rules applicable. (A)
Unless specified in this section or
E:\FR\FM\16MRR1.SGM
16MRR1
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
otherwise prescribed by the Assistant
Secretary of Defense (Health Affairs)
(ASD(HA)), provisions of 32 CFR Part
199 apply to TRICARE Reserve Select.
(B) Certain special programs
established in 32 CFR Part 199 are not
available to enrollees in TRICARE
Reserve Select. These include the
Supplemental Health Care Program (see
§ 199.16), the Extended Health Care
Option Program (see § 199.5), and the
Special Supplemental Food Program
(see § 199.23). The TRICARE Dental
Program (see § 199.13) is independent of
this program and is otherwise available
to all members of the Selected Reserve
and their dependents whether or not
they are enrolled in TRICARE Reserve
Select.
(ii) Enrollment system. Under
TRICARE Reserve Select, eligible
Reserve component members may enroll
for self-only or self and family coverage.
Rules and procedures for enrollment
and payment of applicable premiums
are prescribed in this section. When
their enrollment becomes effective
TRICARE Reserve Select beneficiaries
receive the TRICARE Standard benefit,
as described in § 199.17.
(iii) Benefits. Eligible persons may be
enrolled in TRICARE Reserve Select,
which features the deductible and cost
share provisions of the TRICARE
Standard plan for active duty family
members for both the member and the
member’s dependents. The TRICARE
Standard plan is described in § 199.17.
(b) Eligibility for enrollment in
TRICARE Reserve Select. (1) Eligibility.
Individuals are eligible for enrollment
in TRICARE Reserve Select who meet
the eligibility criteria defined in
paragraphs (b)(1)(i), (b)(1)(ii), or
(b)(1)(iii) of this section.
(i) Members released from active duty
after April 26, 2005. A member released
from active duty after April 26, 2005
that is a member of a Reserve
component of the Armed Forces is
eligible for TRICARE Reserve Select if
the member:
(A) Is called or ordered to active duty
for a period of more than 30 days on or
after September 11, 2001 under a
provision of law referred to in 10 U.S.C.
101(a)(13)(B).
(B) Serves continuously on active
duty for 90 days or more pursuant to
such call or order to active duty (unless
such continuous service on active duty
is less than 90 days solely due to an
injury, illness, or disease incurred or
aggravated while deployed, as provided
in 10 U.S.C. 1076d(b(2)(A));.
(C) Is released from active duty after
April 26, 2005.
(D) On or before the date of release
from active duty, agrees to serve
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
continuously in the Selected Reserve for
a period of 1 or more years upon release
from active duty; and
(E) Meets the qualifications for
continued membership in the Selected
Reserve as determined by the member’s
Reserve component.
(ii) Members released from active duty
on or before April 26, 2005. A member
or former member of a Reserve
component of the Armed Forces who
was released from active duty on or
before April 26, 2005 is eligible for
TRICARE Reserve Select if the member:
(A) Was called or ordered to active
duty for a period of more than 30 days
on or after September 11, 2001 under a
provision of law referred to in 10 U.S.C.
101(a)(13)(B).
(B) Served continuously on active
duty for 90 days or more pursuant to
such call or order to active duty (unless
such continuous service on active duty
is less than 90 days solely due to an
injury, illness, or disease incurred or
aggravated while deployed, as provided
in 10 U.S.C. 1076d(b(2)(A)).
(C) Was released from active duty on
or before April 26, 2005.
(D) Prior to enrollment in TRICARE
Reserve Select, signs an agreement no
later than October 28, 2005 to serve
continuously in the Selected Reserved
for a period of 1 or more years; and
(E) Meets the qualifications for
continued membership in the Selected
Reserve as determined by the member’s
Reserve component.
(iii) Immediate family of reserve
members. While an eligible member of
a Reserve component is enrolled in
TRICARE Reserve Select, dependents of
such member, as defined in paragraphs
(b)(2)(i) (except former spouses) and
(b)(2)(ii) of this section are eligible to be
enrolled for the same period as the
member.
(2) Additional procedures applicable
to eligibility. The Reserve components
are responsible for determining
members’ duty status, periods of
obligation, and other military personnel
matters that are pertinent to establishing
eligibility for TRICARE Reserve Select.
(c) TRICARE Reserve Select
enrollment procedures. (1) Enrollment
required. In order to be covered under
TRICARE Reserve Select, eligible
Reserve component members must
complete and submit the applicable
TRICARE enrollment form, and an
initial premium required by paragraph
(d) of this section. Enrollment is
accomplished by submission of an
application to the appropriate TRICARE
Contractor in accordance with
procedures established by the ASD(HA).
(2) Election of type of coverage. A
member of a Reserve component who is
PO 00000
Frm 00017
Fmt 4700
Sfmt 4700
12803
eligible for enrollment under paragraph
(b) of this section may elect self-only or
self and family coverage. Family
members who may be included in such
family coverage are dependents referred
to in paragraph (b)(1)(iii) of this section.
(3) Period of coverage. Except eligible
members released from active duty on
or before April 26, 2005, a member must
before being released from active duty
enter into an agreement to serve
continuously in the Selected Reserve,
and the member must meet the
qualifications for continued service in
the Selected Reserve as determined by
the member’s Reserve component. The
member must then enroll in TRICARE
Reserve Select prior to 30 days before
the expiration of Transition Assistance
Management Program (TAMP) benefits
under § 199.3(e) of this part.
(i) Except members released from
active duty on or before April 26, 2005,
coverage begins at the expiration of
TAMP benefits under § 199.3(e) of this
part and runs continuously until
eligibility expires or is otherwise
terminated, or the member is
disenrolled. (See paragraphs (c)(4)(i),
(5), or (6) of this section.) When
enrollment is terminated, a member may
not re-enroll unless recalled to active
duty and the member re-qualifies for a
new period of benefits under paragraph
(b) of this section.
(ii) For members released from active
duty on or before April 26, 2005,
coverage begins on the date that is the
later of the expiration of TAMP benefits
under § 199.3(e) or the effective date of
the member’s agreement referred to in
paragraph (b)(1)(ii)(D) of this section.
(iii) When a member enrolled in
TRICARE Reserve Select is recalled to
active duty for a period of more than 30
days TRICARE Reserve Select coverage
is superseded by active duty military
medical benefits for the member and for
any family member enrolled in
TRICARE Reserve Select, but the
coverage period continues to run. When
the member is released from active duty,
TRICARE Reserve Select coverage will
resume for the member (and the
member’s family members provided the
member had been enrolled in self and
family coverage on the date TRICARE
Reserve Select coverage was superseded
by active duty health benefits).
TRICARE Reserve Select coverage will
continue until the member’s eligibility
expires or is otherwise terminated, or
the member is disenrolled. (See
paragraphs (c)(4)(i), (5), or (6) of this
section.) Following the member’s
release from active duty, TRICARE
Reserve Select coverage will also be
superseded by TAMP benefits under
§ 199.3(e) of this Part, if applicable. In
E:\FR\FM\16MRR1.SGM
16MRR1
12804
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
addition, TRICARE Reserve Select
coverage is also superseded, if
applicable, by any period of early
TRICARE coverage based on delayed
effective date orders under § 199.3(b)(5)
of this Part or by a new enrollment, as
a result of re-qualifying through another
period of active duty service in support
of a contingency operation under
§ 199.24(c) of this Part. During any
period in which TRICARE Reserve
Select coverage is superseded, no
premium payments for TRICARE
Reserve Select are due.
(iv) Members who are eligible for
TRICARE Reserve Select under
paragraph (b) of this section may enroll
for one year of TRICARE Reserve Select
coverage for every 90 days of
continuous active-duty service, subject
to the limitation in paragraph (c)(3)(v) of
this section. If such continuous service
on active duty is less than 90 days
solely due to an injury, illness, or
disease incurred or aggravated while
deployed, then the otherwise eligible
member may enroll for one year of
TRICARE Reserve Select coverage, as
provided in 10 U.S.C. 1076d(b(2)(A).
(v) The number of years for which the
member and family are eligible under
paragraph (c)(3)(iv) of this section may
not exceed the number of whole years
for which the member agrees to
continue service in the Selected
Reserves before coverage begins, per the
service agreement entered into under
paragraph (b)(1) of this section. The
number of years established by the
member’s agreement that was entered
into prior to beginning coverage under
TRICARE Reserve Select may not later
be changed, even if that number of years
was fewer than the maximum number of
years that the member could have
established in the agreement. The
number of years of coverage may only
be changed if the member is recalled to
active duty and the member re-qualifies
for a new period of benefits under
paragraph (b) of this section.
(vi) When a member’s eligibility is
terminated or the member is disenrolled
from TRICARE Reserve Select under
paragraphs (c)(4)(i), (5), or (6) of this
section, the member may not re-enroll
unless recalled to active duty and the
member re-qualifies for a new period of
benefits under paragraph (b) of this
section.
(4) Changes to type of coverage.
Under certain circumstances, reserve
members may change their TRICARE
Reserve Select type of coverage.
(i) Disenrollment. Reserve members
may disenroll from the program at any
time by notifying the appropriate
TRICARE office. Disenrollment of the
member will result in automatic
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
disenrollment of the member’s family
members in TRICARE Reserve Select.
(ii) Change from self and family type
of coverage to self-only type of coverage.
After initial enrollment, sponsors may
change type of coverage from self and
family to self-only only when an event
occurs that changes the composition of
the family, such as divorce, legal
separation, or death of a family member,
or changes in family employment or
health coverage status. The change will
become effective in accordance with
procedures established by the ASD(HA).
(iii) Change from self-only type of
coverage to self and family type of
coverage. After initial enrollment, the
reserve member may change type of
coverage from self-only to self and
family only when an event occurs that
changes the composition of the family,
such as the birth of a child, marriage of
the sponsor, legal adoption of a child, or
placement by a court of a child as a legal
ward in the sponsor’s home, or certain
events affecting family health coverage,
such as an employment change. The
change will become effective in
accordance with procedures established
by the ASD(HA).
(5) Effect of failure to pay applicable
premiums. Failure by enrollees to make
a premium payment as required in a
timely manner will result in automatic
disenrollment from TRICARE Reserve
Select and denial of payment of claims
for services provided on or after the first
day of the month for which the
premium payment was not paid.
Beneficiaries disenrolled due to lack of
premium payments will not be allowed
to re-enroll, absent the member
acquiring a new period of eligibility
based upon qualifying active duty
service after the date of disenrollment.
Disenrollment of the member for failure
to pay applicable premiums will also
result in automatic disenrollment of the
member and the member’s family
members from TRICARE Reserve Select.
(6) Ineligibility. A reserve member
who ceases to be eligible for TRICARE
Reserve Select as specified in paragraph
(b) of this section or whose eligibility is
terminated based on termination of the
member’s service in the Selected
Reserve shall be disenrolled and shall
no longer be eligible. Disenrollment of
the member due to ineligibility will
result in automatic disenrollment of the
member’s family members in TRICARE
Reserve Select.
(7) Effective date of disenrollment.
Disenrollments become effective:
(i) In the case of disenrollment due to
ineligibility (other than relating to the
death of a member), on the date of
ineligibility.
PO 00000
Frm 00018
Fmt 4700
Sfmt 4700
(ii) In the case of disenrollment due
to nonpayment of premiums, at the end
of the last month for which premiums
were paid.
(iii) In all other cases, at the end of the
month in which the event causing
disenrollment occurred.
(8) Periodic revision. Periodically,
certain features, rules or procedures of
TRICARE Reserve Select may be
revised. If such revisions will have a
significant effect on participants’ costs
or access to care, beneficiaries may be
given the opportunity to change their
enrollment status coincident with the
revisions.
(d) TRICARE Reserve Select
premiums. Premiums shall be charged
for coverage under TRICARE Reserve
Select. Premiums are to be paid
monthly, except as otherwise provided
through administrative implementation,
pursuant to procedures established by
the ASD(HA).
(1) Establishment of rates. (i)
TRICARE Reserve Select monthly
premium rates are established annually
on a calendar year basis by the ASD(HA)
for the two types of coverage—self-only
and self and family. The annual rates
are based on 28 percent of the total
estimated amount (rounded to the
nearest dollar) reasonable for health care
coverage for the TRICARE Reserve
Select eligible population under the
TRICARE Standard benefit, as
determined by the ASD(HA) on an
appropriate actuarial basis. The monthly
rate for each month of a calendar year
is one-twelfth of the annual rate for that
calendar year, rounded to the nearest
dollar.
(ii) Initial annual rates are based on
the annual premiums for the Blue Cross
and Blue Shield Standard Service
Benefit Plan under the Federal
Employees Health Benefits Program, a
nationwide plan closely resembling
TRICARE Standard coverage, with an
adjustment based on estimated
differences in covered populations, as
determined by the ASD(HA).
(2) Premium adjustments. In addition
to the determinations described in
paragraph (d)(1) of this section,
premium adjustments may be made
prospectively for any calendar year to
reflect any significant program changes
or any actual experience in the costs of
administering the TRICARE Reserve
Select Program.
(3) Premium rates for calendar year
2005. (i) For calendar year 2005, the
annual premium for self-only coverage
under TRICARE Reserve Select is $900.
(ii) For calendar year 2005, the annual
premium for self and family coverage
under TRICARE Reserve Select is
$2,796.
E:\FR\FM\16MRR1.SGM
16MRR1
Federal Register / Vol. 70, No. 50 / Wednesday, March 16, 2005 / Rules and Regulations
(e) Relationship to Continued Health
Care Benefits Program. If at the time a
member enrolls in TRICARE Reserve
Select, or resumes TRICARE Reserve
Select coverage after a period in which
coverage was superseded under
paragraph (c)(3)(iii) of this section, the
member was also eligible to enroll in the
Continued Health Care Benefits Program
(CHCBP) under § 199.20(d)(1)(i) of this
part (except to the extent eligibility in
CHCBP was affected by enrollment in
TRICARE Reserve Select), enrollment in
TRICARE Reserve Select will be deemed
to also constitute preliminary
enrollment in CHCBP. If for any reason
the member becomes disenrolled from
TRICARE Reserve Select before the date
that is 18 months after discharge or
release from the most recent period of
active duty upon which CHCBP
eligibility was based, the member or the
member’s family members eligible to be
included in CHCBP coverage may,
within 30 days of the effective date of
the disenrollment, begin CHCBP
coverage by paying the applicable
premium. The period of coverage will
be as provided in § 199.20(d)(6) of this
part.
(f) Preemption of State laws. (1)
Pursuant to 10 U.S.C. 1103, the
Department of Defense has determined
that in the administration of chapter 55
of title 10, U.S. Code, preemption of
State and local laws relating to health
insurance, prepaid health plans, or
other health care delivery or financing
methods is necessary to achieve
important Federal interests, including
but not limited to the assurance of
uniform national health programs for
military families and the operation of
such programs at the lowest possible
cost to the Department of Defense, that
have a direct and substantial effect on
the conduct of military affairs and
national security policy of the United
States. This determination is applicable
to contracts that implement this section.
(2) Based on the determination set
forth in paragraph (e)(1) of this section,
any State or local law or regulation
pertaining to health insurance, prepaid
health plans, or other health care
delivery, administration, and financing
methods is preempted and does not
apply in connection with TRICARE
Reserve Select. Any such law, or
regulation pursuant to such law, is
without any force or effect, and State or
local governments have no legal
authority to enforce them in relation to
TRICARE Reserve Select. (However, the
Department of Defense may, by contract,
establish legal obligations on the part of
DoD contractors to conform with
requirements similar to or identical to
requirements of State or local laws or
VerDate jul<14>2003
13:50 Mar 15, 2005
Jkt 205001
regulations with respect to TRICARE
Reserve Select.)
(3) The preemption of State and local
laws set forth in paragraph (e)(2) of this
section includes State and local laws
imposing premium taxes on health
insurance carriers or underwriters or
other plan managers, or similar taxes on
such entities. Such laws are laws
relating to health insurance, prepaid
health plans, or other health care
delivery or financing methods, within
the meaning of 10 U.S.C. 1103.
Preemption, however, does not apply to
taxes, fees, or other payments on net
income or profit realized by such
entities in the conduct of business
relating to DoD health services
contracts, if those taxes, fees or other
payments are applicable to a broad
range of business activity. For the
purposes of assessing the effect of
Federal preemption of State and local
taxes and fees in connection with DoD
health services contracts, interpretations
shall be consistent with those applicable
to the Federal Employees Health
Benefits Program under 5 U.S.C. 8909(f).
(g) Administration. The ASD(HA) may
establish other rules and procedures for
the effective administration of TRICARE
Reserve Select, and may authorize
exceptions to requirements of this
section, if permitted by law, based on
extraordinary circumstances.
Dated: March 11, 2005.
Jeannette Owings-Ballard,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 05–5219 Filed 3–15–05; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 117
[CGD01–04–129]
RIN 1625–AA09
Drawbridge Operation Regulations:
Townsend Gut, ME
Coast Guard, DHS.
Temporary final rule.
AGENCY:
ACTION:
SUMMARY: The Coast Guard has
temporarily changed the drawbridge
operation regulations that govern the
operation of the SR 27 Bridge, at mile
0.7, across Townsend Gut, between
Boothbay Harbor and Southport, Maine.
This temporary rule requires the bridge
to open at specific times between 6 a.m.
and 6 p.m., each day, from March 14,
2005 through November 30, 2005.
PO 00000
Frm 00019
Fmt 4700
Sfmt 4700
12805
Additionally, this temporary rule would
also allow four 4-day closures during
the effective period of this rule when
the bridge may remain in the closed
position. This action is necessary to
help facilitate rehabilitation
construction at the bridge.
DATES: This rule is effective on March
14, 2005, through November 30, 2005.
ADDRESSES: Comments and material
received from the public, as well as
documents indicated in this preamble as
being available in the docket, are part of
docket (CGD01–04–129) and are
available for inspection or copying at
the First Coast Guard District, Bridge
Branch Office, 408 Atlantic Avenue,
Boston, Massachusetts, 02110, between
7 a.m. and 3 p.m., Monday through
Friday, except Federal holidays.
FOR FURTHER INFORMATION CONTACT: Mr.
John W. McDonald, Project Officer, First
Coast Guard District, (617) 223–8364.
SUPPLEMENTARY INFORMATION:
Regulatory Information
On January 5, 2005, we published a
notice of proposed rulemaking (NPRM)
entitled Drawbridge Operation
Regulations, Townsend Gut, Maine, in
the Federal Register (70 FR 773).
We received no comments in response
to the notice of proposed rulemaking.
No public hearing was requested and
none was held.
Under 5 U.S.C. 553(b)(B), the Coast
Guard finds that good cause exists for
making this rule effective less than 30
days after publication in the Federal
Register.
The Coast Guard believes making this
final rule effective less than 30 days
after publication is reasonable because
the bridge rehabilitation construction is
necessary vital work that needs to be
performed as soon as possible.
Any delay in making this final rule
effective would not be in the best
interest of public or safety because
performing this work during the nonwinter months March 14, 2005 through
November 30, 2005, is the best time
period during which construction
personnel may work in a more safe and
productive manner to help restore the
SR 27 Bridge to a more safe and reliable
operational status.
Background and Purpose
The SR 27 Bridge has a vertical
clearance of 10 feet at mean high water,
and 19 feet at mean low water in the
closed position. The existing
drawbridge operating regulations under
33 CFR 117.5 require the bridge to open
on signal at all times.
The bridge owner, Maine Department
of Transportation, has requested a
E:\FR\FM\16MRR1.SGM
16MRR1
]]>Agencies
[Federal Register Volume 70, Number 50 (Wednesday, March 16, 2005)]
[Rules and Regulations]
[Pages 12798-12805]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-5219]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN-0720-AA90
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Reserve Select for Certain Members of the Selected
Reserve; Transitional Assistance Management Program; Early Eligibility
for TRICARE for Certain Reserve Component Members
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This interim final rule establishes requirements and
procedures for implementation of TRICARE Reserve Select. It also
revises requirements and procedures for the Transitional Assistance
Management Program. In addition, it establishes
[[Page 12799]]
requirements and procedures for implementation of the earlier TRICARE
eligibility for certain reserve component members. The rule is being
published as an interim final rule with comment period in order to
comply with statutory effective dates.
DATES: This rule is effective April 15, 2005. Submit comments on or
before May 16, 2005.
ADDRESSES: Because of staff and resource limitations, we cannot accept
comments by facsimile (FAX) transmission or e-mail. Mail written
comments to the following address ONLY: TRICARE Management Activity,
TRICARE Operations/Strategic Initiatives Division, Sky 5 Suite 810,
5111 Leesburg Pike, Falls Church, VA 22041-3206; Attention: Jody
Donehoo, Program Analyst.
FOR FURTHER INFORMATION CONTACT: Jody Donehoo, Office of the Assistant
Secretary of Defense (Health Affairs), telephone (703) 681-0039.
Questions regarding payment of specific claims under the TRICARE
allowable charge method should be addressed to the appropriate TRICARE
contractor.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
The Ronald W. Reagan National Defense Authorization Act for Fiscal
Year 2005 (NDAA-05) (Pub. L. 108-375) contains several provisions to
enhance health care benefits for reservists and their family members.
Three of the provisions are addressed in this interim final rule.
First, section 701 provides for premium-based medical coverage for
certain members of the Selected Reserve and their eligible family
members. Section 706 makes permanent the temporary revisions to the
Transitional Assistance Management Program, enacted in section 704 of
the National Defense Authorization Act for Fiscal Year 2004 (NDAA-04)
(Pub. L. 108-136) and section 1117 of the Emergency Supplemental
Appropriations Act for the Reconstruction of Iraq and Afghanistan, 2004
(Emergency Supplemental) (Pub. L. 108-106). Section 703 makes permanent
the earlier TRICARE eligibility for certain reserve component members
authorized by section 703 of NDAA-04 and section 1116 of the Emergency
Supplemental.
These provisions represent significant enhancements to the health
care benefits available to reservists and their eligible family
members. They focus particularly on reservists and guardsmen activated
in support of a contingency operation after September 11, 2001. Prior
to the statutory changes enacted since November 2003, reservists and
their families received TRICARE health care benefits when activated for
more than 30 consecutive days. Now, TRICARE benefits begin up to 90
days prior to activation for those who receive delayed-effective-date
orders, and coverage is extended to a full 180 days after a period of
active service in support of a contingency operation. These changes
provide for an easier transition to and from civilian life. And, for
those who served in support of a contingency operation and who commit
to continued service in the Selected Reserve, a new health benefits
program will allow them to obtain through TRICARE health coverage
comparable to that available to full-time civilian employees of the
Department of Defense. This new program is called ``TRICARE Reserve
Select.'' It is subject to a number of specific statutory requirements,
which are outlined in this regulation.
II. Provisions of the Rule Regarding the Tricare Reserve Select Program
A. Establishment of the TRICARE Reserve Select Program (paragraph
199.24(a)). This paragraph describes the nature, purpose, statutory
basis, scope, and major features of TRICARE Reserve Select, a premium-
based medical coverage program that will be available to certain
members of the Selected Reserve and their dependents. TRICARE Reserve
Select is authorized by 10 U.S.C. 1076d, and is applicable worldwide.
The major features of the program include the following: TRICARE rules
apply unless otherwise specified; certain special TRICARE programs are
not part of TRICARE Reserve Select, including the Supplemental Health
Care Program, the Extended Health Care Option (ECHO) program, and the
Special Supplemental Food Program (also known as the Women, Infants,
and Children--Overseas Program). The TRICARE Dental Program is already
available under 10 U.S.C. 1076a to all members of the Selected Reserve
and their family members whether or not they enroll in TRICARE Reserve
Select. Under TRICARE Reserve Select, eligible Selected Reserve members
may enroll for self-only or self and family coverage. When their
enrollment becomes effective, TRICARE Reserve Select beneficiaries
receive the TRICARE Standard benefit. TRICARE Reserve Select features
the deductible and cost share provisions of the TRICARE Standard plan
for active duty family members (ADFM) for both the member and eligible
family members.
B. Eligibility for enrollment in TRICARE Reserve Select (paragraph
199.24(b)). This paragraph defines who is eligible to enroll in TRICARE
Reserve Select, based on statutory provisions. To be eligible, a person
must be a member of a reserve component of the armed forces, who serves
on active duty for 90 consecutive days or more related to a contingency
operation on or after September 11, 2001, and, on or before the date of
release from active duty, agrees to serve continuously in the Selected
Reserve for a period of one or more whole years following release from
active duty, and, if not already a member of the Selected Reserve,
actually begins serving in the Selected Reserve prior to the date upon
which TRICARE Reserve Select coverage is effective. The member must
meet the qualifications for continued service in the Selected Reserve
as determined by the member's reserve component. If the member was
released from active duty on or before April 26, 2005, the member has
until October 28, 2005, to sign an agreement to serve continuously in
the Selected Reserve for a period of one or more whole years in order
to be eligible to enroll in TRICARE Reserve Select. This temporary
opportunity (until October 28, 2005) applies to current members of the
Selected Reserve, and also to former members who served in support of a
contingency after 9/11, rejoin the Selected Reserve, and enter into an
agreement for continued service. In conformance with section
701(b)(2)(B) of the NDAA-05, the Department will take reasonable steps
to the maximum extent practicable to notify reservists released from
active duty on or before April 26, 2005, who may be eligible for
TRICARE Reserve Select and provide them information on the opportunity
and procedures for entering into an agreement together with a clear
explanation of the benefits that the member is eligible to receive
under TRICARE Reserve Select as a result of entering into such
agreement. Eligible family members of eligible reserve members enrolled
in TRICARE Reserve Select are also eligible for enrollment in TRICARE
Reserve Select. Eligibility determinations are the responsibility of
the Reserve Components of the Armed Services.
C. TRICARE Reserve Select enrollment procedures (paragraph
199.24(c)). In order to be covered under TRICARE Reserve Select,
eligible reserve component members released from active duty after
April 26, 2005, must enter into an agreement prior to being released to
serve continuously in the reserves for a period of one or more
[[Page 12800]]
whole years following such date, and the member must meet the
qualifications for continuous service in the Selected Reserve as
determined by the member's reserve component. The member must then
enroll by signing the appropriate TRICARE enrollment form and
submitting the initial monthly premium to the appropriate TRICARE
contractor, not later than 30 days prior to the end of their
Transitional Assistance Management Program benefit period. A member may
elect self-only or self and family coverage, and may enroll for one
year of TRICARE Reserve Select coverage for every 90 days of continuous
active-duty service, to the extent that the member agrees to continue
service in the Selected Reserves for the same number of years after
coverage begins. Members released from active duty on or before April
26, 2005 may enroll in TRICARE Reserve Select upon execution of the
agreement to serve continuously in the Selected Reserve. Coverage
becomes effective the later of the end of TAMP coverage or the
effective date of the agreement to serve in the Selected Reserve.
Except for members released from active duty on or before April 26,
2005, enrollment in TRICARE Reserve Select must be accomplished prior
to the expiration of Transition Assistance Management Program (TAMP)
benefits, and coverage begins at the expiration of TAMP benefits and
runs continuously until eligibility expires or is otherwise terminated.
When enrollment is terminated or the member is otherwise disenrolled, a
member may not re-enroll unless recalled to active duty and the member
re-qualifies for this benefit.
For eligible members, the decision to enroll in TRICARE Reserve
Select or to decline enrollment is a one-time choice. If it is
declined, or if coverage is taken for a period less than the maximum
period of eligibility, coverage may not be initiated or extended later,
nor may any period of eligibility be saved until later. Thus, for
example, if a member served for one year in support of a contingency
operation, the member earns potential eligibility for the next four
years if the member agrees to continue service in the Selected Reserves
for four years. However, if that member elects to continue service in
the Selected Reserve for only two years, the member will qualify for
only two years of TRICARE Reserve Select coverage. This two-year
coverage period cannot be extended later, even if the member later
extends Selected Reserve service for two more years. The only way to
extend TRICARE Reserve Select coverage beyond the period determined
when the one-time choice is made is by re-qualifying through another
period of active duty service in support of a contingency operation.
If, while enrolled in TRICARE Reserve Select a member is recalled
to active duty for a period of more than 30 consecutive days, TRICARE
Reserve Select coverage is superseded by active duty military health
benefits for the member and the member's immediate family, but the
coverage period continues to run. When the member is released from
active duty, TRICARE Reserve Select coverage will resume for the member
and the member's immediate family provided the member had been enrolled
in family coverage on the date TRICARE Reserve Select coverage was
superseded by active duty health benefits. TRICARE Reserve Select
coverage will continue until the member's eligibility expires, is
otherwise terminated, or the member is disenrolled. Following the
member's release from active duty, TRICARE Reserve Select coverage will
be further superseded by TAMP benefits, if applicable. In addition,
TRICARE Reserve Select coverage is also superseded, if applicable, by
any period of early TRICARE coverage based on delayed-effective-date
orders or by a new enrollment, as a result of re-qualifying through
another period of active duty service in support of a contingency
operation. During any period in which TRICARE Reserve Select coverage
is superseded, no premium payments for TRICARE Reserve Select are due
for the period being superseded.
Under certain circumstances, reserve members may change their
TRICARE Reserve Select type of coverage. After initial enrollment, the
reserve member may not change from self-only to self and family
enrollment, or change from self and family enrollment to self-only
enrollment, except on the occasion of certain events affecting the
family, such as the birth of a child, the marriage or divorce of the
sponsor, the legal adoption of a child, or placement by a court of a
child as a legal ward in the sponsor's home, or certain events
affecting family health coverage, such as an employment change of the
member or spouse. It is the responsibility of the TRS member to provide
the necessary evidence required regarding the circumstances permitting
the change in enrollment to the appropriate TRICARE contractor. The
Director, TRICARE Management Activity shall issue guidelines as
necessary to implement these provisions. All such changes are effective
prospectively.
Failure to make a premium payment in a timely manner will result in
permanent disenrollment of the member and the member's immediate family
and denial of claims for services received on or after the effective
date of disenrollment, which is the end of the last month for which the
premium was paid. Members and their immediate family will not be
allowed to re-enroll, unless the member qualifies for a new period of
eligibility.
A reserve member whose service in the Selected Reserve ends is
automatically disenrolled, along with the member's eligible family
members, based on the date the member terminated service in the
Selected Reserve.
D. TRICARE Reserve Select premiums (paragraph 199.24(d)). Annual
premiums are charged for coverage under TRICARE Reserve Select.
Premiums are to be paid monthly, except as otherwise established as
part of the administrative implementation of TRICARE Reserve Select.
The monthly premium rates are established and updated annually on a
calendar year basis and are effective on the first of January each
year, for the two types of coverage--self-only and self and family. The
rates are based on 28 percent of the total estimated amount reasonable
for coverage under the TRICARE Standard benefit for the TRICARE Reserve
Select eligible population, as determined by the Assistant Secretary of
Defense (Health Affairs) (ASD(HA)) on an appropriate actuarial basis.
The monthly rate for each month of a calendar year is one-twelfth of
the annual rate for that calendar year, rounded to the nearest dollar.
Annual rates are based on the annual premiums for the Blue Cross
and Blue Shield Standard Service Benefit Plan under the Federal
Employees Health Benefits Program, a nationwide plan closely resembling
TRICARE Standard coverage, with adjustments based on demographic
differences in covered populations, as determined by the ASD(HA). Based
on an analysis of demographic differences between Blue Cross and Blue
Shield participants and beneficiaries eligible for TRICARE Reserve
Select, the adjustment amount is for purposes of calendar year 2005 a
32 percent reduction from the Blue Cross and Blue Shield annual premium
for self-only coverage and an 8 percent reduction from the Blue Cross
and Blue Shield annual premium for self and family coverage. (The
difference in the percentage reductions between self-only and self and
family premiums is due to the disproportionately high number of high
cost, single, elderly retiree federal employees covered by Blue Cross
and Blue Shield self-only coverage.)
[[Page 12801]]
Premiums will be adjusted annually to maintain an appropriate
relationship with the annual changes in Blue Cross and Blue Shield
premiums.
In addition to these annual premium changes, premium adjustments
may also be made prospectively for any calendar year to reflect any
significant program changes or any actual experience in the costs of
administering the TRICARE Reserve Select Program.
For calendar year 2005, the annual premium for self-only coverage
is $900 (monthly premium $75), and the annual premium for self and
family coverage is $2,796 (monthly premium $233). These premiums will
change effective January 2006.
E. Relationship to Continued Health Care Benefits Program (CHCBP)
(paragraph 199.24(e)). This paragraph addresses the relationship
between TRICARE Reserve Select and the CHCBP. CHCBP is a program that
(among other things) allows members released from active duty to
purchase continued health care coverage through TRICARE. This coverage
is available for a period of 18 months. Some members at the time of
release from active duty will be eligible for either TRICARE Reserve
Select or CHCBP. This paragraph of the regulation provides that if a
member enrolls in TRICARE Reserve Select, but later is disenrolled, the
member or the covered family members may then activate CHCBP coverage
for whatever period is remaining of the original 18 month eligibility.
For example, in the case that TRICARE Reserve Select enrollment is
ended because of discharge from the Selected Reserve (such as through a
reduction in force or base closure) of a member within 18 months of
release from active duty, the member could choose to continue health
care coverage under CHCBP for the remainder of the period at the
applicable CHCBP premiums.
F. Preemption of State laws (paragraph 199.24(f)). This paragraph
explains that the preemptions of State and local laws established for
the TRICARE program also apply to TRICARE Reserve Select. Any State or
local law or regulation pertaining to health insurance, prepaid health
plans, or other health care delivery, administration, and financing
methods is preempted and does not apply in connection with TRICARE
Reserve Select. This includes State and local laws imposing premium
taxes on health insurance carriers or underwriters or other plan
managers, or similar taxes on such entities. Preemption does not apply
to taxes, fees, or other payments on net income or profit realized by
such entities in the conduct of business relating to DoD health
services contracts, if those taxes, fees or other payments are
applicable to a broad range of business activity. For the purposes of
assessing the effect of Federal preemption of State and local taxes and
fees in connection with DoD health services contracts, interpretations
shall be consistent with those applicable to the Federal Employees
Health Benefits Program under 5 U.S.C. 8909(f).
G. Administration (paragraph 199.24(g)). This paragraph provides
that the ASD(HA) may establish other rules and procedures necessary for
the effective administration of TRICARE Reserve Select.
III. Provisions of the Rule Regarding the Transitional Assistance
Management Program
A. Eligibility under the Transitional Assistance Management Program
(TAMP) (paragraph 199.3(e)). Section 706 of NDAA-05 makes permanent
revisions to the Transitional Assistance Management Program, which was
temporarily revised by section 704 of NDAA-04 and section 1117 of the
Emergency Supplemental. Based on these enactments, several categories
of armed forces members are eligible for transitional health care after
serving on active duty. These include:
1. A member who is involuntarily separated from active duty;
2. A member of a reserve component who is separated from active
duty to which called or ordered in support of a contingency operation
if the active duty is active duty for a period of more than 30
consecutive days;
3. A member who is separated from active duty for which the member
is involuntarily retained under 10 U.S.C. 12305 in support of a
contingency operation; or
4. A member who is separated from active duty served pursuant to a
voluntary agreement of the member to remain on active duty for a period
of less than one year in support of a contingency operation.
(2) A spouse (as described in paragraph (b)(2)(i) of this section
except for former spouses) and child (as described in paragraph
(b)(2)(ii) of this section) of a member described in paragraph (e)(1)
of this section is also eligible for TAMP benefits under TRICARE.
The spouse and children of the member are also eligible for TAMP
benefits. TAMP benefits begin the day after the member is separated
from active duty, and end 180 days later. Eligibility is determined by
the armed forces.
B. Beneficiary liability under TAMP. (paragraph 199.4(f)(2)(vi)).
This paragraph establishes that TAMP beneficiaries (including the
member) are subject to the TRICARE Standard deductible and cost sharing
rules applicable to active duty family members.
IV. Provisions of the Rule Regarding Early Eligibility for Tricare for
Certain Reserve Component Members
A. Eligibility (paragraph 199.3(b)(5)). This paragraph incorporates
requirements and procedures for implementation of the earlier temporary
TRICARE eligibility for certain reserve component members authorized by
section 703 of NDAA-04 and section 1116 of the Emergency Supplemental,
which provisions were made permanent by section 703 of NDAA-05. Under
this paragraph reserve component members issued delayed-effective-date
orders for service in support of a contingency operation, and their
family members, are eligible for TRICARE on the date the orders are
issued, up to 90 days prior to the date on which the period of active
duty of more than 30 consecutive days is to begin.
V. Regulatory Procedures
Executive Order 12866 requires certain regulatory assessments for
any significant regulatory action that would result in an annual effect
on the economy of $100 million or more, or have other substantial
impacts. The Congressional Review Act establishes certain procedures
for major rules, defined as those with similar major impacts. The
Regulatory Flexibility Act (RFA) requires that each Federal agency
prepare, and make available for public comment, a regulatory
flexibility analysis when the agency issues a regulation that would
have significant impact on a substantial number of small entities. This
interim final rule is not subject to any of those requirements because
it would not have any of these substantial impacts. Any substantial
impacts associated with implementation of TRICARE Reserve Select are
already determined by statute and are outside any discretionary action
of DoD or effect of this regulation.
This rule, however, does address novel policy issues relating to
implementation of a new medical benefits program for members of the
armed forces. Thus, this rule has been reviewed by the Office of
Management and Budget under E.O. 12866.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-
[[Page 12802]]
3511). Information needed for TRICARE Reserve Select is obtained from
active duty military service records.
This rule is being issued as an interim final rule, with comment
period, as an exception to our standard practice of soliciting public
comments prior to issuance. This is because Congress has established an
April 26, 2005 effective date for eligible members' entitlement to
TRICARE Reserve Select. The 180-day TAMP coverage period and the
delayed effect date orders pre-mobilization eligibility period
entitlements became effective on the date of enactment. This rule
changes the regulation to conform to the statutory entitlement. Based
on these statutory requirements, the ASD(HA) has determined that
following the standard practice in this case would be unnecessary,
impractical, and contrary to the public interest.
Public comments are invited. All comments will be carefully
considered. A discussion of the major issues received by public
comments will be included with the issuance of the final rule.
List of Subjects in 32 CFR Part 199
Claims, handicapped, health insurance, and military personnel.
0
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
0
2. Section 199.2(b) is amended by adding the following two definitions
and placing them in alphabetical order to read as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
Transitional Assistance Management Program (TAMP). The program
established under 10 U.S.C. Sec. 1145(a) and Sec. 199.3(e) of this
part.
* * * * *
TRICARE Reserve Select. The program established under 10 U.S.C.
Sec. 1076d and Sec. 199.24 of this part.
* * * * *
0
3. Section 199.3 is amended by adding new paragraph (b)(5) and revising
paragraph (e) to read as follows:
Sec. 199.3 Eligibility.
* * * * *
(b) * * *
(5) Reserve Component Members Issued Delayed-Effective-Date Orders.
(i) Member. A member of a reserve component of the armed forces who
is ordered to active duty for a period of more than 30 consecutive days
in support of a contingency operation under a provision of law referred
to in section 101(a)(13)(B) of Title 10, United States Code, that
provides for active-duty service to begin on a date after the date of
the issuance of the order.
(ii) Dependents. CHAMPUS eligible dependents under this paragraph
(b)(5) are those identified in paragraphs (b)(2)(i) (except former
spouses) and (b)(2)(ii) of this section.
(iii) Effective date. The eligibility established by paragraphs
(b)(5)(i) and (ii) of this section shall begin on or after November 6,
2003, and shall be effective on the later of the date that is:
(A) The date of issuance of the order referred to in paragraph
(b)(5)(i) of this section; or
(B) 90 days before the date on which the period of active duty is
to begin.
(iv) Termination date. The eligibility established by paragraphs
(b)(5)(i) and (ii) of this section ends upon entry of the member onto
active duty (at which time CHAMPUS eligibility for the dependents of
the member is established under paragraph (b)(2) of this section) or
upon cancellation or amendment of the orders referred to in paragraph
(b)(5)(i) of this section such that they no longer meet the
requirements of that paragraph (b)(5)(i).
* * * * *
(e) Eligibility under the Transitional Assistance Management
Program (TAMP).
(1) A member of the armed forces is eligible for transitional
health care if the member is:
(i) A member who is involuntarily separated from active duty.
(ii) A member of a Reserve component who is separated from active
duty to which called or ordered in support of a contingency operation
if the active duty is active duty for a period of more than 30
consecutive days.
(iii) A member who is separated from active duty for which the
member is involuntarily retained under 10 U.S.C. 12305 in support of a
contingency operation; or
(iv) A member who is separated from active duty served pursuant to
a voluntary agreement of the member to remain on active duty for a
period of less than 1 year in support of a contingency operation.
(2) A spouse (as described in paragraph (b)(2)(i) of this section
except former spouses) and child (as described in paragraph (b)(2)(ii)
of this section) of a member described in paragraph (e)(1) of this
section is also eligible for TAMP benefits under TRICARE.
(3) TAMP benefits under TRICARE begin on the day after the member
is separated from active duty, and, if such separation occurred on or
after November 6, 2003, and end 180 days after such date. TRICARE
benefits available to both the member and eligible family members are
generally those available to family members of members of the uniformed
services under this Part. Each branch of service will determine
eligibility for its members and eligible family members and provide
data to DEERS.
* * * * *
0
4. Section 199.4 is amended by adding new paragraph (f)(2)(vi) to read
as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(f) * * *
(2) * * *
(vi) Transitional Assistance Management Program (TAMP). Members of
the Armed Forces (and their family members) who are eligible for TAMP
under paragraph 199.3(e) of this Part are subject to the same
beneficiary or sponsor liability as family members of members of the
uniformed services described in this paragraph (f)(2).
* * * * *
0
5. Section 199.24 is added to read as follows:
Sec. 199.24 TRICARE standard coverage for certain selected reserve
members.
(a) Establishment. TRICARE Reserve Select is established for the
purpose of offering TRICARE health benefits to eligible members of the
Selected Reserve and their immediate family.
(1) Purpose. TRICARE Reserve Select is a premium-based medical
coverage program that will be available to certain members of the
Selected Reserve and their immediate family as specified in paragraph
(b) of this section.
(2) Statutory Authority. TRICARE Reserve Select is authorized by 10
U.S.C. 1076d.
(3) Scope of the Program. TRICARE Reserve Select is applicable in
the 50 United States, the District of Columbia, Puerto Rico, and, to
the extent practicable, other areas where members of the Selected
Reserve serve. In locations other than the 50 states of the United
States and the District of Columbia, the Assistant Secretary of Defense
may authorize modifications to the program rules and procedures as may
be appropriate to the area involved.
(4) Major Features of TRICARE Reserve Select. The major features of
the program include the following:
(i) TRICARE rules applicable. (A) Unless specified in this section
or
[[Page 12803]]
otherwise prescribed by the Assistant Secretary of Defense (Health
Affairs) (ASD(HA)), provisions of 32 CFR Part 199 apply to TRICARE
Reserve Select.
(B) Certain special programs established in 32 CFR Part 199 are not
available to enrollees in TRICARE Reserve Select. These include the
Supplemental Health Care Program (see Sec. 199.16), the Extended
Health Care Option Program (see Sec. 199.5), and the Special
Supplemental Food Program (see Sec. 199.23). The TRICARE Dental
Program (see Sec. 199.13) is independent of this program and is
otherwise available to all members of the Selected Reserve and their
dependents whether or not they are enrolled in TRICARE Reserve Select.
(ii) Enrollment system. Under TRICARE Reserve Select, eligible
Reserve component members may enroll for self-only or self and family
coverage. Rules and procedures for enrollment and payment of applicable
premiums are prescribed in this section. When their enrollment becomes
effective TRICARE Reserve Select beneficiaries receive the TRICARE
Standard benefit, as described in Sec. 199.17.
(iii) Benefits. Eligible persons may be enrolled in TRICARE Reserve
Select, which features the deductible and cost share provisions of the
TRICARE Standard plan for active duty family members for both the
member and the member's dependents. The TRICARE Standard plan is
described in Sec. 199.17.
(b) Eligibility for enrollment in TRICARE Reserve Select. (1)
Eligibility. Individuals are eligible for enrollment in TRICARE Reserve
Select who meet the eligibility criteria defined in paragraphs
(b)(1)(i), (b)(1)(ii), or (b)(1)(iii) of this section.
(i) Members released from active duty after April 26, 2005. A
member released from active duty after April 26, 2005 that is a member
of a Reserve component of the Armed Forces is eligible for TRICARE
Reserve Select if the member:
(A) Is called or ordered to active duty for a period of more than
30 days on or after September 11, 2001 under a provision of law
referred to in 10 U.S.C. 101(a)(13)(B).
(B) Serves continuously on active duty for 90 days or more pursuant
to such call or order to active duty (unless such continuous service on
active duty is less than 90 days solely due to an injury, illness, or
disease incurred or aggravated while deployed, as provided in 10 U.S.C.
1076d(b(2)(A));.
(C) Is released from active duty after April 26, 2005.
(D) On or before the date of release from active duty, agrees to
serve continuously in the Selected Reserve for a period of 1 or more
years upon release from active duty; and
(E) Meets the qualifications for continued membership in the
Selected Reserve as determined by the member's Reserve component.
(ii) Members released from active duty on or before April 26, 2005.
A member or former member of a Reserve component of the Armed Forces
who was released from active duty on or before April 26, 2005 is
eligible for TRICARE Reserve Select if the member:
(A) Was called or ordered to active duty for a period of more than
30 days on or after September 11, 2001 under a provision of law
referred to in 10 U.S.C. 101(a)(13)(B).
(B) Served continuously on active duty for 90 days or more pursuant
to such call or order to active duty (unless such continuous service on
active duty is less than 90 days solely due to an injury, illness, or
disease incurred or aggravated while deployed, as provided in 10 U.S.C.
1076d(b(2)(A)).
(C) Was released from active duty on or before April 26, 2005.
(D) Prior to enrollment in TRICARE Reserve Select, signs an
agreement no later than October 28, 2005 to serve continuously in the
Selected Reserved for a period of 1 or more years; and
(E) Meets the qualifications for continued membership in the
Selected Reserve as determined by the member's Reserve component.
(iii) Immediate family of reserve members. While an eligible member
of a Reserve component is enrolled in TRICARE Reserve Select,
dependents of such member, as defined in paragraphs (b)(2)(i) (except
former spouses) and (b)(2)(ii) of this section are eligible to be
enrolled for the same period as the member.
(2) Additional procedures applicable to eligibility. The Reserve
components are responsible for determining members' duty status,
periods of obligation, and other military personnel matters that are
pertinent to establishing eligibility for TRICARE Reserve Select.
(c) TRICARE Reserve Select enrollment procedures. (1) Enrollment
required. In order to be covered under TRICARE Reserve Select, eligible
Reserve component members must complete and submit the applicable
TRICARE enrollment form, and an initial premium required by paragraph
(d) of this section. Enrollment is accomplished by submission of an
application to the appropriate TRICARE Contractor in accordance with
procedures established by the ASD(HA).
(2) Election of type of coverage. A member of a Reserve component
who is eligible for enrollment under paragraph (b) of this section may
elect self-only or self and family coverage. Family members who may be
included in such family coverage are dependents referred to in
paragraph (b)(1)(iii) of this section.
(3) Period of coverage. Except eligible members released from
active duty on or before April 26, 2005, a member must before being
released from active duty enter into an agreement to serve continuously
in the Selected Reserve, and the member must meet the qualifications
for continued service in the Selected Reserve as determined by the
member's Reserve component. The member must then enroll in TRICARE
Reserve Select prior to 30 days before the expiration of Transition
Assistance Management Program (TAMP) benefits under Sec. 199.3(e) of
this part.
(i) Except members released from active duty on or before April 26,
2005, coverage begins at the expiration of TAMP benefits under Sec.
199.3(e) of this part and runs continuously until eligibility expires
or is otherwise terminated, or the member is disenrolled. (See
paragraphs (c)(4)(i), (5), or (6) of this section.) When enrollment is
terminated, a member may not re-enroll unless recalled to active duty
and the member re-qualifies for a new period of benefits under
paragraph (b) of this section.
(ii) For members released from active duty on or before April 26,
2005, coverage begins on the date that is the later of the expiration
of TAMP benefits under Sec. 199.3(e) or the effective date of the
member's agreement referred to in paragraph (b)(1)(ii)(D) of this
section.
(iii) When a member enrolled in TRICARE Reserve Select is recalled
to active duty for a period of more than 30 days TRICARE Reserve Select
coverage is superseded by active duty military medical benefits for the
member and for any family member enrolled in TRICARE Reserve Select,
but the coverage period continues to run. When the member is released
from active duty, TRICARE Reserve Select coverage will resume for the
member (and the member's family members provided the member had been
enrolled in self and family coverage on the date TRICARE Reserve Select
coverage was superseded by active duty health benefits). TRICARE
Reserve Select coverage will continue until the member's eligibility
expires or is otherwise terminated, or the member is disenrolled. (See
paragraphs (c)(4)(i), (5), or (6) of this section.) Following the
member's release from active duty, TRICARE Reserve Select coverage will
also be superseded by TAMP benefits under Sec. 199.3(e) of this Part,
if applicable. In
[[Page 12804]]
addition, TRICARE Reserve Select coverage is also superseded, if
applicable, by any period of early TRICARE coverage based on delayed
effective date orders under Sec. 199.3(b)(5) of this Part or by a new
enrollment, as a result of re-qualifying through another period of
active duty service in support of a contingency operation under Sec.
199.24(c) of this Part. During any period in which TRICARE Reserve
Select coverage is superseded, no premium payments for TRICARE Reserve
Select are due.
(iv) Members who are eligible for TRICARE Reserve Select under
paragraph (b) of this section may enroll for one year of TRICARE
Reserve Select coverage for every 90 days of continuous active-duty
service, subject to the limitation in paragraph (c)(3)(v) of this
section. If such continuous service on active duty is less than 90 days
solely due to an injury, illness, or disease incurred or aggravated
while deployed, then the otherwise eligible member may enroll for one
year of TRICARE Reserve Select coverage, as provided in 10 U.S.C.
1076d(b(2)(A).
(v) The number of years for which the member and family are
eligible under paragraph (c)(3)(iv) of this section may not exceed the
number of whole years for which the member agrees to continue service
in the Selected Reserves before coverage begins, per the service
agreement entered into under paragraph (b)(1) of this section. The
number of years established by the member's agreement that was entered
into prior to beginning coverage under TRICARE Reserve Select may not
later be changed, even if that number of years was fewer than the
maximum number of years that the member could have established in the
agreement. The number of years of coverage may only be changed if the
member is recalled to active duty and the member re-qualifies for a new
period of benefits under paragraph (b) of this section.
(vi) When a member's eligibility is terminated or the member is
disenrolled from TRICARE Reserve Select under paragraphs (c)(4)(i),
(5), or (6) of this section, the member may not re-enroll unless
recalled to active duty and the member re-qualifies for a new period of
benefits under paragraph (b) of this section.
(4) Changes to type of coverage. Under certain circumstances,
reserve members may change their TRICARE Reserve Select type of
coverage.
(i) Disenrollment. Reserve members may disenroll from the program
at any time by notifying the appropriate TRICARE office. Disenrollment
of the member will result in automatic disenrollment of the member's
family members in TRICARE Reserve Select.
(ii) Change from self and family type of coverage to self-only type
of coverage. After initial enrollment, sponsors may change type of
coverage from self and family to self-only only when an event occurs
that changes the composition of the family, such as divorce, legal
separation, or death of a family member, or changes in family
employment or health coverage status. The change will become effective
in accordance with procedures established by the ASD(HA).
(iii) Change from self-only type of coverage to self and family
type of coverage. After initial enrollment, the reserve member may
change type of coverage from self-only to self and family only when an
event occurs that changes the composition of the family, such as the
birth of a child, marriage of the sponsor, legal adoption of a child,
or placement by a court of a child as a legal ward in the sponsor's
home, or certain events affecting family health coverage, such as an
employment change. The change will become effective in accordance with
procedures established by the ASD(HA).
(5) Effect of failure to pay applicable premiums. Failure by
enrollees to make a premium payment as required in a timely manner will
result in automatic disenrollment from TRICARE Reserve Select and
denial of payment of claims for services provided on or after the first
day of the month for which the premium payment was not paid.
Beneficiaries disenrolled due to lack of premium payments will not be
allowed to re-enroll, absent the member acquiring a new period of
eligibility based upon qualifying active duty service after the date of
disenrollment. Disenrollment of the member for failure to pay
applicable premiums will also result in automatic disenrollment of the
member and the member's family members from TRICARE Reserve Select.
(6) Ineligibility. A reserve member who ceases to be eligible for
TRICARE Reserve Select as specified in paragraph (b) of this section or
whose eligibility is terminated based on termination of the member's
service in the Selected Reserve shall be disenrolled and shall no
longer be eligible. Disenrollment of the member due to ineligibility
will result in automatic disenrollment of the member's family members
in TRICARE Reserve Select.
(7) Effective date of disenrollment. Disenrollments become
effective:
(i) In the case of disenrollment due to ineligibility (other than
relating to the death of a member), on the date of ineligibility.
(ii) In the case of disenrollment due to nonpayment of premiums, at
the end of the last month for which premiums were paid.
(iii) In all other cases, at the end of the month in which the
event causing disenrollment occurred.
(8) Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on participants' costs or access to
care, beneficiaries may be given the opportunity to change their
enrollment status coincident with the revisions.
(d) TRICARE Reserve Select premiums. Premiums shall be charged for
coverage under TRICARE Reserve Select. Premiums are to be paid monthly,
except as otherwise provided through administrative implementation,
pursuant to procedures established by the ASD(HA).
(1) Establishment of rates. (i) TRICARE Reserve Select monthly
premium rates are established annually on a calendar year basis by the
ASD(HA) for the two types of coverage--self-only and self and family.
The annual rates are based on 28 percent of the total estimated amount
(rounded to the nearest dollar) reasonable for health care coverage for
the TRICARE Reserve Select eligible population under the TRICARE
Standard benefit, as determined by the ASD(HA) on an appropriate
actuarial basis. The monthly rate for each month of a calendar year is
one-twelfth of the annual rate for that calendar year, rounded to the
nearest dollar.
(ii) Initial annual rates are based on the annual premiums for the
Blue Cross and Blue Shield Standard Service Benefit Plan under the
Federal Employees Health Benefits Program, a nationwide plan closely
resembling TRICARE Standard coverage, with an adjustment based on
estimated differences in covered populations, as determined by the
ASD(HA).
(2) Premium adjustments. In addition to the determinations
described in paragraph (d)(1) of this section, premium adjustments may
be made prospectively for any calendar year to reflect any significant
program changes or any actual experience in the costs of administering
the TRICARE Reserve Select Program.
(3) Premium rates for calendar year 2005. (i) For calendar year
2005, the annual premium for self-only coverage under TRICARE Reserve
Select is $900.
(ii) For calendar year 2005, the annual premium for self and family
coverage under TRICARE Reserve Select is $2,796.
[[Page 12805]]
(e) Relationship to Continued Health Care Benefits Program. If at
the time a member enrolls in TRICARE Reserve Select, or resumes TRICARE
Reserve Select coverage after a period in which coverage was superseded
under paragraph (c)(3)(iii) of this section, the member was also
eligible to enroll in the Continued Health Care Benefits Program
(CHCBP) under Sec. 199.20(d)(1)(i) of this part (except to the extent
eligibility in CHCBP was affected by enrollment in TRICARE Reserve
Select), enrollment in TRICARE Reserve Select will be deemed to also
constitute preliminary enrollment in CHCBP. If for any reason the
member becomes disenrolled from TRICARE Reserve Select before the date
that is 18 months after discharge or release from the most recent
period of active duty upon which CHCBP eligibility was based, the
member or the member's family members eligible to be included in CHCBP
coverage may, within 30 days of the effective date of the
disenrollment, begin CHCBP coverage by paying the applicable premium.
The period of coverage will be as provided in Sec. 199.20(d)(6) of
this part.
(f) Preemption of State laws. (1) Pursuant to 10 U.S.C. 1103, the
Department of Defense has determined that in the administration of
chapter 55 of title 10, U.S. Code, preemption of State and local laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods is necessary to achieve important
Federal interests, including but not limited to the assurance of
uniform national health programs for military families and the
operation of such programs at the lowest possible cost to the
Department of Defense, that have a direct and substantial effect on the
conduct of military affairs and national security policy of the United
States. This determination is applicable to contracts that implement
this section.
(2) Based on the determination set forth in paragraph (e)(1) of
this section, any State or local law or regulation pertaining to health
insurance, prepaid health plans, or other health care delivery,
administration, and financing methods is preempted and does not apply
in connection with TRICARE Reserve Select. Any such law, or regulation
pursuant to such law, is without any force or effect, and State or
local governments have no legal authority to enforce them in relation
to TRICARE Reserve Select. (However, the Department of Defense may, by
contract, establish legal obligations on the part of DoD contractors to
conform with requirements similar to or identical to requirements of
State or local laws or regulations with respect to TRICARE Reserve
Select.)
(3) The preemption of State and local laws set forth in paragraph
(e)(2) of this section includes State and local laws imposing premium
taxes on health insurance carriers or underwriters or other plan
managers, or similar taxes on such entities. Such laws are laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods, within the meaning of 10 U.S.C.
1103. Preemption, however, does not apply to taxes, fees, or other
payments on net income or profit realized by such entities in the
conduct of business relating to DoD health services contracts, if those
taxes, fees or other payments are applicable to a broad range of
business activity. For the purposes of assessing the effect of Federal
preemption of State and local taxes and fees in connection with DoD
health services contracts, interpretations shall be consistent with
those applicable to the Federal Employees Health Benefits Program under
5 U.S.C. 8909(f).
(g) Administration. The ASD(HA) may establish other rules and
procedures for the effective administration of TRICARE Reserve Select,
and may authorize exceptions to requirements of this section, if
permitted by law, based on extraordinary circumstances.
Dated: March 11, 2005.
Jeannette Owings-Ballard,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-5219 Filed 3-15-05; 8:45 am]
BILLING CODE 5001-06-P
