Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select for Members of the Selected Reserve, 46380-46386 [E7-16300]
Download as PDF
<![CDATA[
46380
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
have in light of the particular nature of
the disaster or emergency. Sections
208.4, 208.6, 208.7 and 210.5 of title 31
CFR do not apply to the establishment
of accounts or issuance of payments
pursuant to this section. For example,
the waivers set forth in § 208.4 are not
applicable in situations where Treasury
is establishing accounts for the express
purpose of allowing for the delivery by
EFT of Federal payments to disaster
victims. The requirement in §§ 208.6
and 210.5 that a Federal non-vendor
electronic payment be deposited to a
deposit account in the name of the
recipient does not apply to accounts
established pursuant to § 208.11, nor are
agencies required to notify check
recipients and newly-eligible payment
recipients of options available to them,
as is normally required under § 208.7.
Further, Treasury will be able to deliver
payments to accounts established
pursuant to § 208.11, notwithstanding
any other instructions from the payment
recipient.
Request for Comment on Plain Language
On June 1, 1998, the President issued
a memorandum directing each agency in
the Executive branch to write its rules
in plain language. This directive is
effective for all new proposed and final
rulemaking documents issued on or
after January 1, 1999. We invite
comment on how to make this final rule
clearer. For example, you may wish to
discuss: (1) Whether we have organized
the material to suit your needs; (2)
whether the requirements of this final
rule are clear; or (3) whether there is
something else we could do to make this
rule easier to understand.
Regulatory Planning and Review
The final rule does not meet the
criteria for a ‘‘significant regulatory
action’’ as defined in Executive Order
12866. Therefore, the regulatory review
procedures contained therein do not
apply.
rfrederick on PROD1PC67 with RULES
Regulatory Flexibility Act Analysis
Because no notice of proposed
rulemaking was required for this final
rule, the provisions of the Regulatory
Flexibility Act (5 U.S.C. 601 et. seq.) do
not apply.
List of Subjects in 31 CFR Part 208
Accounting, Automated Clearing
House, Banks, Banking, Electronic funds
transfer, Financial institutions,
Government payments.
Adoption of the Amendment
For the reasons set out in the
preamble, under the authority of 5
I
14:16 Aug 17, 2007
Dated: August 14, 2007.
Kenneth R. Papaj,
Commissioner.
[FR Doc. 07–4053 Filed 8–17–07; 8:45 am]
BILLING CODE 4810–35–M
Jkt 211001
Jody
Donehoo, TRICARE Management
Activity, TRICARE Operations,
telephone (703) 681–0039.
Questions regarding payment of
specific claims under the TRICARE
allowable charge method should be
addressed to the appropriate TRICARE
contractor.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2006–HA–0207]
RIN 0720–AB15
Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS);
TRICARE Reserve Select for Members
of the Selected Reserve
Office of the Secretary, DoD.
Interim final rule with comment
AGENCY:
ACTION:
Regulatory Analyses
VerDate Aug<31>2005
U.S.C. 301 the interim rule amending 31
CFR Part 208 published at 71 FR 44584
is adopted as a final rule without
change.
period.
SUMMARY: This interim final rule revises
requirements and procedures for
TRICARE Reserve Select and
restructures eligibility to include all
Selected Reservists, except for those
individuals either enrolled or eligible to
enroll in a health benefit plan under
Chapter 89 of Title 5, United States
Code. The rule is being published as an
interim final rule with comment period
in order to comply with statutory
effective dates.
DATES: Effective Date: This rule is
effective October 1, 2007. Submit
comments on or before September 19,
2007.
You may submit comments,
identified by docket number and or RIN
number and title, by any of the
following methods: Federal
eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
Mail: Federal Docket Management
System Office, 1160 Defense Pentagon,
Washington, DC 20301–1160.
Instructions: All submissions received
must include the agency name and
docket number or Regulatory
Information Number (RIN) for this
Federal Register document. The general
policy for comments and other
submissions from members of the public
is to make these submissions available
for public viewing on the Internet at
https://regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
ADDRESSES:
PO 00000
Frm 00008
Fmt 4700
Sfmt 4700
A previous interim final rule was
published in the Federal Register on
March 16, 2005, (70 FR 12798–12805)
that established requirements and
procedures to implement TRICARE
Reserve Select under section 701 of the
Ronald W. Reagan National Defense
Authorization Act for Fiscal Year 2005
(NDAA–05) (Pub. L. 108–375). Section
701 of NDAA–05 authorized premiumbased medical coverage for certain
members of the Selected Reserve and
their family members. By April 2005,
Selected Reserve members who served
on active duty in support of a
contingency operation and fulfilled
other statutory qualifications could
purchase TRICARE Reserve Select
coverage for periods proportional to
their period of active duty.
A second interim final rule was
published in the Federal Register on
June 21, 2006, (71 FR 35527–35537).
That interim final rule revised
requirements and procedures for
TRICARE Reserve Select pursuant to
sections 701 and 702 of the National
Defense Authorization Act for Fiscal
Year 2006 (NDAA–06) (Pub. L. 109–
163). Section 701 enhanced the existing
TRICARE Reserve Select program.
Section 702 added two new tiers of
premium sharing by the government (50
percent and 85 percent member portion)
to the existing premium tier (28 percent
member portion), making TRICARE
Reserve Select available to all Selected
Reservists.
Before a final rule could be issued
subsequent to the interim final rule
published in the Federal Register on
June 21, 2006, (71 FR 35527–35537) for
the TRICARE Reserve Select program,
Section 706 of the NDAA–07 amended
the statutory provisions in sections 701
and 702 of the NDAA–06 which were
implemented in the interim final rule.
Therefore, this interim rule addresses
provisions of the National Defense
Authorization Act for Fiscal Year 2007
(NDAA–07) (Pub. L. 109–364). First,
section 706 of the NDAA–07 expands
the availability of the 28 percent
premium tier to all Selected Reservists
with one exception. Those individuals
either enrolled or eligible to enroll in a
E:\FR\FM\20AUR1.SGM
20AUR1
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
rfrederick on PROD1PC67 with RULES
health benefit plan under Chapter 89 of
Title 5, United States Code are
specifically excepted from eligibility
under this legislation. Second, this
section eliminates fixed length periods
of coverage. Third, this section
eliminates the 50 percent and 85
percent premium tiers to reflect the
repeal of Section 1076b of Title 10,
United States Code, in its entirety.
The law authorizing the TRICARE
Reserve Select program uses the term
‘‘eligibility’’ to identify conditions
under which a Reserve component
member may purchase coverage. For
purposes of program administration, the
terms ‘‘qualifying’’ or ‘‘qualified’’ shall
generally be used in lieu of such terms
as ‘‘eligibility’’ or ‘‘eligible’’ to refer to
a Reserve component member who
meets the program requirements
allowing purchase of TRICARE Reserve
Select coverage.
The latter interim rule (June 21, 2006)
introduced certain terminology for
TRICARE Reserve Select intended to
reflect critical elements that distinguish
it from other long-established TRICARE
health programs. For instance, the
effective date of eligibility for TRICARE
has long been understood to mean that
the eligible individual may obtain care
under the military health system as of
that date. However, that is not what it
means in the context of TRICARE
Reserve Select. To avoid the inevitable
misunderstanding, this rule uses the
term ‘‘qualify’’ to mean that the member
has satisfied all the ‘‘qualifications’’ that
must be met before the member is
authorized to purchase coverage. Only
then may the member purchase
coverage by submitting a completed
request in the appropriate format along
with payment of the applicable one
month premium. The term ‘‘coverage’’
indicates the benefit of TRICARE
covering claims submitted by TRICARE
authorized providers, hospitals, and
suppliers for payment of covered
services, supplies, and equipment.
II. TRICARE Reserve Select Program
A. Establishment of the TRICARE
Reserve Select Program (paragraph
199.24(a)). This paragraph describes the
nature, purpose, statutory basis, scope,
and major features of TRICARE Reserve
Select, a premium-based medical
coverage program that was made
available worldwide to certain members
of the Selected Reserve and their family
members. TRICARE Reserve Select is
authorized by 10 U.S.C. 1076d.
The major features of the program
include the following. TRICARE Reserve
Select coverage is available for purchase
by any Selected Reserve member if the
member fulfills all of the statutory
VerDate Aug<31>2005
14:16 Aug 17, 2007
Jkt 211001
qualifications. The amount of the
premium that members pay is
prescribed by the Secretary of Defense
as one premium for member-only
coverage and a second premium for
member and family coverage. The
statute eliminates the former tiered
premium rate structure of TRICARE
Reserve Select. Additionally, TRICARE
rules apply unless otherwise specified;
certain special TRICARE programs are
not part of TRICARE Reserve Select,
including the Extended Care Health
Option (ECHO) program, the Special
Supplemental Food Program (also
known as the Women, Infants, and
Children—Overseas Program), and the
Supplemental Health Care Program,
except when referred by a Military
Treatment Facility (MTF) provider for
incidental consults and the MTF
provider maintains clinical control over
the episode of care. The TRICARE
Dental Program is already available
under 10 U.S.C. 1076a to all members of
the Selected Reserve and their family
members whether or not they purchase
TRICARE Reserve Select coverage.
Under TRICARE Reserve Select,
Selected Reserve members who fulfill
all of the statutory qualifications may
purchase either the member-only type of
coverage or the member and family type
of coverage by submitting a completed
request in the appropriate format along
with payment of the applicable monthly
premium at the time of enrollment.
When their coverage becomes effective,
TRICARE Reserve Select beneficiaries
receive the TRICARE Standard (and
Extra) benefit. TRICARE Reserve Select
features the deductible and cost share
provisions of the TRICARE Standard
(and Extra) plan for active duty family
members (ADFM) for both the member
and covered family members.
B. TRICARE Reserve Select premiums
(paragraph 199.24(b)). Members are
charged premiums for coverage under
TRICARE Reserve Select that represent
28 percent of the total annual premium
amount that the Assistant Secretary of
Defense, Health Affairs (ASD(HA))
determines on an appropriate actuarial
basis as being appropriate for coverage
under the TRICARE Standard (and
Extra) benefit for the TRICARE Reserve
Select eligible population. Premiums are
to be paid monthly, except as otherwise
established as part of the administrative
implementation of TRICARE Reserve
Select.
Annual rates for the first year
TRICARE Reserve Select was offered
(2005) were based on the calendar year
annual premiums for the Blue Cross and
Blue Shield Standard Service Benefit
Plan under the Federal Employees
Health Benefits Program, a nationwide
PO 00000
Frm 00009
Fmt 4700
Sfmt 4700
46381
plan closely resembling TRICARE
Standard (and Extra) coverage, with an
adjustment based on estimated
differences in covered populations, as
determined by the ASD(HA).
Based on an analysis of demographic
differences between Blue Cross and
Blue Shield members and beneficiaries
eligible for TRICARE Reserve Select, the
adjustment amount in calendar year
2005 represented a 32 percent reduction
from the Blue Cross and Blue Shield
annual premium for member-only
coverage and represented an 8 percent
reduction from the Blue Cross and Blue
Shield annual premium for member and
family coverage. (The difference in the
percentage reductions between memberonly and member 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 memberonly coverage).
TRICARE Reserve Select monthly
premium rates are established and
updated annually, on a calendar year
basis, to maintain an appropriate
relationship with the annual changes in
Blue Cross and Blue Shield premiums,
or by other adjustment methodology
determined to be appropriate by the
ASD(HA) for each of the two types of
coverage, member-only coverage and
member and family coverage, on a
calendar year basis. The monthly rate
for each month of a calendar year is onetwelfth of the annual rate for that
calendar year.
In addition to these annual premium
changes, premium adjustments may also
be made prospectively for any calendar
year to reflect any significant program
changes or any actual experience in the
costs of administering the TRICARE
Reserve Select Program.
A surviving family member of a
Reserve Component service member
who qualified for TRICARE Reserve
Select coverage as described in
paragraph (c)(3) of this section will pay
premium rates as follows. The premium
amount shall be at the member-only rate
if there is only one surviving family
member to be covered by TRICARE
Reserve Select and at the member and
family rate if there are two or more
survivors to be covered.
C. Eligibility for qualifying to
purchase TRICARE Reserve Select
coverage (paragraph 199.24(c)). This
paragraph defines the statutory
conditions under which members of a
Reserve component may qualify to
purchase TRICARE Reserve Select
coverage. Section 706 of NDAA–07
restructures the availability of the 28
percent premium tier by requiring only
two qualifying conditions.
E:\FR\FM\20AUR1.SGM
20AUR1
rfrederick on PROD1PC67 with RULES
46382
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
The qualifying condition to be ‘‘a
member of the Selected Reserve of the
Ready Reserve of a reserve component
of the armed forces,’’ remains in force
while all of the other former qualifying
conditions are eliminated. The
member’s Service personnel office is
responsible for keeping the Defense
Enrollment Eligibility Reporting System
(DEERS) current with eligibility data.
One exclusionary qualifying
condition is added that excludes ‘‘a
member who is enrolled, or is eligible
to enroll, in a health benefits plan under
chapter 89 of title 5 U.S.C,’’ from
purchasing TRICARE Reserve Select
coverage.
If a member of the Selected Reserve
dies while in a period of TRICARE
Reserve Select coverage, the family
member(s) may purchase new or
continue existing TRICARE Reserve
Select coverage for up to six months
beyond the date of the member’s death
upon payment of monthly premiums.
D. Procedures (paragraph 199.24(d)).
—Purchasing Coverage. A qualified
member, including surviving family
members, may purchase one of two
types of coverage: member-only
coverage or member and family
coverage. Immediate family members
of the Reserve component member, as
defined in section 199.3(b)(2)(i)
(except former spouses) and 199.3
(b)(2)(ii) of this Part, may be included
in such family coverage. To purchase
either type of TRICARE Reserve Select
coverage for effective dates of
coverage described below, Reserve
component members qualified under
paragraph 199.24(c) must complete
and submit a request in the
appropriate format, along with an
initial payment of the monthly
premium share required under
paragraph 199.24(b), to the
appropriate TRICARE contractor in
accordance with deadlines and other
procedures established by the
ASD(HA).
—Continuation Coverage. Deadlines and
other procedures may be established
for a qualified member to purchase
TRICARE Reserve Select coverage
with an effective date immediately
following the date of termination of
coverage under another TRICARE
program in which the member is the
sponsor.
—Qualifying Life Event. Deadlines and
other procedures may be established
for a qualified member to purchase
TRICARE Reserve Select coverage on
the occasion of a qualifying life event
that changes the immediate family
composition (e.g., birth, adoption,
divorce, etc.) that is eligible for
VerDate Aug<31>2005
14:16 Aug 17, 2007
Jkt 211001
coverage under TRICARE Reserve
Select. The effective date for
TRICARE Reserve Select coverage will
be the date of the qualifying life event.
It is the responsibility of the member
to provide his or her personnel office
with the necessary evidence required
to substantiate the change in
immediate family composition.
Personnel officials will update DEERS
in the usual manner. The appropriate
TRICARE contractor will then take
appropriate action upon receipt of the
completed request in the appropriate
format along with payment of the
applicable monthly premium.
—Open Enrollment. Deadlines and other
procedures may be established for a
qualified member to purchase
TRICARE Reserve Select coverage at
any time. The effective date of
coverage will coincide with the first
day of a month.
—Survivor coverage under TRICARE
Reserve Select. Deadlines and other
procedures may be established for a
surviving family member of a Reserve
Component service member who
qualified for TRICARE Reserve Select
coverage as described in paragraph
(c)(3) of this section to purchase new
TRICARE Reserve Select coverage or
continue existing TRICARE Reserve
Select coverage for up to six months
beyond the date of the member’s
death. The effective date of coverage
will be the day following the date of
the member’s death.
—Changing type of coverage. TRICARE
Reserve Select members may request
to change type of coverage during
open enrollment or on the occasion of
a qualifying life event that changes
immediate family composition as
described above by submitting a
completed request in the appropriate
format.
—Termination. Termination of coverage
for the member will result in
termination of coverage for the
member’s family members in
TRICARE Reserve Select, except for
qualified survivors of Reserve
component members covered by
TRICARE Reserve Select at the time of
death.
—Coverage will terminate whenever a
member ceases to meet the
qualifications for the program or a
request for termination in the
appropriate format is received in
accordance with established
procedures.
—Coverage may terminate for members
who gain coverage under another
TRICARE program in which the
member is the sponsor.
—Failure to make a premium payment
in a timely manner may result in
PO 00000
Frm 00010
Fmt 4700
Sfmt 4700
termination of coverage for the
member and any covered family
members and will result in denial of
claims for services received after the
effective date of termination.
—The member may request termination
of coverage at any time by submitting
a completed request in the
appropriate format in accordance with
established deadlines and procedures.
Members whose coverage under
TRICARE Reserve Select terminates
upon their request or for failure to pay
premiums will not be allowed to
purchase coverage again under
TRICARE Reserve Select for a period
of one year following the effective
date of termination.
—Coverage for survivors as described
herein shall terminate six months
after the date of death of the covered
Reserve component member.
—Processing. Upon receipt of a
completed request in the appropriate
format the appropriate TRICARE
contractor will process enrollment
actions into DEERS in accordance
with deadlines and other procedures
established by the ASD(HA).
—Periodic revision. Periodically, certain
features, rules or procedures of
TRICARE Reserve Select may be
revised. If such revisions will have a
significant effect on members’ costs or
access to care, members may be given
the opportunity to change their type
of coverage.
E. Relationship to Continued Health
Care Benefits Program (CHCBP)
(paragraph 199.24(e)). This paragraph
addresses the relationship between
TRICARE Reserve Select and the
CHCBP. CHCBP is a program that
(among other things) allows members
released from active duty to purchase
continued health care coverage through
TRICARE. Coverage under TRICARE
Reserve Select counts as coverage under
a health benefit plan for purposes of
individuals qualifying for the Continued
Health Care Benefits Program (CHCBP)
under section 199.20(d)(1)(ii)(B) or
section 199.20(d)(1)(iii)(B) of this Part.
Some members and family members
will be eligible for TRICARE Reserve
Select, and may also be eligible for
CHCBP at the time of release from active
duty.
This paragraph of the regulation
provides that if a member purchases
TRICARE Reserve Select coverage that is
later terminated, the member or the
covered family members may then
purchase CHCBP coverage for whatever
period is remaining of the original 18month eligibility. For example, in the
case that TRICARE Reserve Select
coverage that is terminated because of
E:\FR\FM\20AUR1.SGM
20AUR1
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
rfrederick on PROD1PC67 with RULES
transfer or discharge of a member from
the Selected Reserve (such as through a
reduction in force or base closure) is
within 18 months of release from active
duty, the member could choose to
continue health care coverage under
CHCBP for the remainder of the period
at the applicable CHCBP premiums.
F. Preemption of State laws
(paragraph 199.24(f)). This paragraph
explains that the preemptions of State
and local laws established for the
TRICARE program also apply to
TRICARE Reserve Select. Any State or
local law or regulation pertaining to
health insurance, prepaid health plans,
or other health care delivery,
administration, and financing methods
is preempted and does not apply in
connection with TRICARE Reserve
Select.
This includes State and local laws
imposing premium taxes on health
insurance carriers, underwriters or other
plan managers, or similar taxes on such
entities. Preemption does not apply to
taxes, fees, or other payments on net
income or profit realized by such
entities in the conduct of business
relating to DoD health services
contracts, if those taxes, fees or other
payments are applicable to a broad
range of business activity. For the
purposes of assessing the effect of
Federal preemption of State and local
taxes and fees in connection with DoD
health services contracts, interpretations
shall be consistent with those applicable
to the Federal Employees Health
Benefits Program under 5 U.S.C. 8909(f).
G. Administration (paragraph
199.24(g)). This paragraph provides that
the ASD(HA) may establish other rules
and procedures necessary for the
effective administration of TRICARE
Reserve Select.
III. Regulatory Procedures
Executive Order 12866 requires
certain regulatory assessments for any
significant regulatory action that would
result in an annual effect on the
economy of $100 million or more, or
have other substantial impacts. The
Congressional Review Act establishes
certain procedures for major rules,
defined as those with similar major
impacts. The Regulatory Flexibility Act
(RFA) requires that each Federal agency
prepare, and make available for public
comment, a regulatory flexibility
analysis when the agency issues a
regulation that would have significant
impact on a substantial number of small
entities. This interim final rule is not
subject to any of those requirements
because it would not have any of these
substantial impacts. Any substantial
impacts associated with implementation
VerDate Aug<31>2005
14:42 Aug 17, 2007
Jkt 211001
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–
3511).
We have examined the impact(s) of
the interim final rule under Executive
Order 13132 and it does not have
policies that have federalism
implications that would have
substantial direct effects on the States,
on the relationship between the national
government and the States, or on the
distribution of power and
responsibilities among the various
levels of government, therefore,
consultation with State and local
officials is not required.
This rule is being published as an
interim final rule with comment period
contrary to the normal procedure of
soliciting public comment under a
proposed rule first, in order to comply
with the requirements of the John
Warner National Defense Authorization
Act for Fiscal Year 2007, Public Law
109–364, section 706, which was
enacted on January 6, 2007. This section
provides in pertinent part that ‘‘The
Secretary of Defense shall ensure that
health care under TRICARE Standard is
provided under section 1076d of title
10, United States Code, as amended by
this section beginning not later than
October 1, 2007.’’ In order to comply
with the statutorily mandated start date,
this rule is being published as an
interim final rule, with an effective date
of October, 1, 2007. Public comments
are welcome and will be considered
before publication of the final rule.
List of Subjects in 32 CFR part 199
Claims, handicapped, health
insurance, and military personnel.
I Accordingly, 32 CFR part 199 is
amended as follows:
PART 199—[AMENDED]
1. The authority citation for part 199
continues to read as follows:
I
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
2. Section 199.2(b) is amended by
revising the definition of ‘‘TRICARE
Reserve Select’’ to read as follows:
I
PO 00000
Frm 00011
Fmt 4700
Sfmt 4700
§ 199.2
46383
Definitions.
*
*
*
*
*
(b) * * *
TRICARE Reserve Select. The program
established under 10 U.S.C. 1076d and
§ 199.24 of this Part.
I 3. Section 199.24 is revised to read as
follows:
§ 199.24
TRICARE Reserve Select.
(a) Establishment. TRICARE Reserve
Select is established for the purpose of
offering TRICARE Standard and Extra
health coverage to qualified members of
the Selected Reserve and their
immediate family members.
(1) Purpose. TRICARE Reserve Select
is a premium-based health plan that is
available for purchase by members of
the Selected Reserve and certain
survivors of Selected Reserve members
as specified in paragraph (c) of this
section.
(2) Statutory Authority. TRICARE
Reserve Select is authorized by 10
U.S.C. 1076d.
(3) Scope of the Program. TRICARE
Reserve Select is applicable in the 50
United States, the District of Columbia,
Puerto Rico, and, to the extent
practicable, other areas where members
of the Selected Reserve serve. In
locations other than the 50 states of the
United States and the District of
Columbia, the Assistant Secretary of
Defense (Health Affairs) may authorize
modifications to the program rules and
procedures as may be appropriate to the
area involved.
(4) Terminology. Certain terminology
is introduced for TRICARE Reserve
Select intended to reflect critical
elements that distinguish it from other
long-established TRICARE health
programs. For instance, the effective
date of eligibility for TRICARE has long
been understood to mean that the
eligible individual may obtain care
under the military health system as of
that date. However, that is not what it
means in the context of TRICARE
Reserve Select. To avoid the inevitable
misunderstanding, this regulation uses
the term ‘‘qualify’’ to mean that the
member has satisfied all the
‘‘qualifications’’ that must be met before
the member is authorized to purchase
coverage. Only then may the member
purchase coverage by submitting a
completed request in the appropriate
format along with payment of the
applicable one month premium. The
term ‘‘coverage’’ indicates the benefit of
TRICARE Standard or Extra covering
claims submitted for payment of
covered services, supplies, and
equipment furnished by TRICARE
authorized providers, hospitals, and
suppliers.
E:\FR\FM\20AUR1.SGM
20AUR1
rfrederick on PROD1PC67 with RULES
46384
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
(5) Major Features of TRICARE
Reserve Select. The major features of the
program include the following:
(i) TRICARE rules applicable.
(A) Unless specified in this section or
otherwise prescribed by the ASD(HA),
provisions of 32 CFR Part 199 apply to
TRICARE Reserve Select.
(B) Certain special programs
established in 32 CFR Part 199 are not
available to members covered under
TRICARE Reserve Select. These include
the Extended Care Health Option
Program (see § 199.5), the Special
Supplemental Food Program (see
§ 199.23), and the Supplemental Health
Care Program (see § 199.16) except
when referred by a Military Treatment
Facility (MTF) provider for incidental
consults and the MTF provider
maintains clinical control over the
episode of care. The TRICARE Dental
Program (see § 199.13) is independent of
this program and is otherwise available
to all members of the Selected Reserve
and their eligible family members
whether or not they purchase TRICARE
Reserve Select coverage.
(ii) Premiums. TRICARE Reserve
Select coverage is available for purchase
by any Selected Reserve member if the
member fulfills all of the statutory
qualifications. A member of the Selected
Reserve covered under TRICARE
Reserve Select shall pay 28 percent of
the total amount that the ASD(HA)
determines on an appropriate actuarial
basis as being appropriate for that
coverage. There is one premium rate for
member-only coverage and one
premium rate for member and family
coverage.
(iii) Procedures. Under TRICARE
Reserve Select, Reserve component
members who fulfilled all of the
statutory qualifications may purchase
either the member-only type of coverage
or the member and family type of
coverage by submitting a completed
request in the appropriate format along
with payment of the applicable one
month premium. Rules and procedures
for purchasing coverage and paying
applicable premiums are prescribed in
this section.
(iv) Benefits. When their coverage
becomes effective, TRICARE Reserve
Select beneficiaries receive the
TRICARE Standard (and Extra) benefit
including access to military treatment
facility services and pharmacies, as
described in § 199.17 of this Part.
TRICARE Reserve Select coverage
features the deductible and cost share
provisions of the TRICARE Standard
(and Extra) plan for active duty family
members for both the member and the
member’s covered family members. The
VerDate Aug<31>2005
14:16 Aug 17, 2007
Jkt 211001
TRICARE Standard (and Extra) plan is
described in § 199.17 of this Part.
(b) TRICARE Reserve Select
premiums. Members are charged
premiums for coverage under TRICARE
Reserve Select that represent 28 percent
of the total annual premium amount
that the Assistant Secretary of Defense,
Health Affairs (ASD(HA)) determines on
an appropriate actuarial basis as being
appropriate for coverage under the
TRICARE Standard (and Extra) benefit
for the TRICARE Reserve Select eligible
population. Premiums are to be paid
monthly, except as otherwise provided
through administrative implementation,
pursuant to procedures established by
the ASD(HA).
(1) Annual establishment of rates. (i)
TRICARE Reserve Select monthly
premium rates shall be established and
updated annually on a calendar year
basis to maintain an appropriate
relationship with the annual changes in
premiums for the Blue Cross and Blue
Shield Standard Service Benefit Plan
under the Federal Employees Health
Benefits Program, a nationwide plan
closely resembling TRICARE Standard
(and Extra) coverage, or by other
adjustment methodology determined to
be appropriate by the ASD(HA) for each
of the two types of coverage, memberonly and member and family as
described in paragraphs (d)(2) of this
section.
(ii) Annual rates for the first year
TRICARE Reserve Select was offered
(calendar year 2005) were based on the
Federal Blue Cross and Blue Shield
annual premiums, with adjustments
based on estimated differences in
covered populations, as determined by
the ASD(HA).
(2) Premium adjustments. In addition
to the determinations described in
paragraph (b)(1) of this section,
premium adjustments may be made
prospectively for any calendar year to
reflect any significant program changes
or any actual experience in the costs of
administering the TRICARE Reserve
Select Program.
(3) Survivor coverage under TRICARE
Reserve Select. A surviving family
member of a Reserve Component service
member who qualified for TRICARE
Reserve Select coverage as described in
paragraph (c)(3) of this section will pay
premium rates as follows. The premium
amount shall be at the member-only rate
if there is only one surviving family
member to be covered by TRICARE
Reserve Select and at the member and
family rate if there are two or more
survivors to be covered.
(c) Eligibility for (qualifying to
purchase) TRICARE Reserve Select
coverage—(1) General. The law
PO 00000
Frm 00012
Fmt 4700
Sfmt 4700
authorizing the TRICARE Reserve Select
program uses the term ‘‘eligibility’’ to
identify conditions under which a
Reserve component member may
purchase coverage. For purposes of
program administration, the terms
‘‘qualifying’’ or ‘‘qualified’’ shall
generally be used in lieu of such terms
as ‘‘eligibility’’ or ‘‘eligible’’ to refer to
a Reserve component member who
meets the program requirements
allowing purchase of TRICARE Reserve
Select coverage. The member’s Service
personnel office is responsible for
keeping DEERS current with eligibility
data.
(2) Member Purchase. A member who
is a member of a Reserve component of
the Armed Forces qualifies to purchase
TRICARE Reserve Select coverage if the
member meets both the following
conditions:
(i) Is a member of the Selected
Reserve of the Ready Reserve.
(ii) Is not enrolled in, or eligible to
enroll in, a health benefits plan under
Chapter 89 of Title 5, U.S.C.
(3) Survivor coverage under TRICARE
Reserve Select. If a member of the
Selected Reserve dies while in a period
of TRICARE Reserve Select coverage,
the family member(s) may purchase new
or continue existing TRICARE Reserve
Select coverage for up to six months
beyond the date of the member’s death.
(d) Procedures—(1) Purchasing
Coverage. A qualified member may
purchase one of two types of coverage:
member-only coverage or member and
family coverage. Immediate family
members of the Reserve component
member, as defined in § 199.3(b)(2)(i)
(except former spouses) and § 199.3
(b)(2)(ii) of this Part, may be included in
such family coverage. To purchase
either type of TRICARE Reserve Select
coverage for effective dates of coverage
described below, Reserve component
members qualified under § 199.24(c)
must submit a request in the appropriate
format, along with an initial payment of
the applicable monthly premium
required by paragraph (b) of this section
to the appropriate TRICARE contractor
in accordance with deadlines and other
procedures established by the ASD(HA).
(i) Continuation Coverage. Deadlines
and other procedures may be
established for a qualified member to
purchase TRICARE Reserve Select
coverage with an effective date
immediately following the date of
termination of coverage under another
TRICARE program in which the member
is the sponsor.
(ii) Qualifying Life Event. Deadlines
and other procedures may be
established for a qualified member to
purchase TRICARE Reserve Select
E:\FR\FM\20AUR1.SGM
20AUR1
rfrederick on PROD1PC67 with RULES
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
coverage on the occasion of a qualifying
life event that changes the immediate
family composition (e.g., birth,
adoption, divorce, etc.) that is eligible
for coverage under TRICARE Reserve
Select. The effective date for TRICARE
Reserve Select coverage will be the date
of the qualifying life event. It is the
responsibility of the member to provide
his or her personnel office with the
necessary evidence required to
substantiate the change in immediate
family composition. Personnel officials
will update DEERS in the usual manner.
The appropriate TRICARE contractor
will then take appropriate action upon
receipt of the completed request in the
appropriate format along with payment
of the applicable one month premium.
(iii) Open Enrollment. Deadlines and
other procedures may be established for
a qualified member to purchase
TRICARE Reserve Select coverage at any
time. The effective date of coverage will
coincide with the first day of a month.
(iv) Survivor coverage under TRICARE
Reserve Select. Deadlines and other
procedures may be established for a
surviving family member of a Reserve
Component service member who
qualified for TRICARE Reserve Select
coverage as described in paragraph
(c)(3) of this section to purchase new
TRICARE Reserve Select coverage or
continue existing TRICARE Reserve
Select coverage for up to six months
beyond the date of the member’s death.
The effective date of coverage will be
the day following the date of the
member’s death.
(2) Changing type of coverage.
TRICARE Reserve Select members may
request to change type of coverage
during open enrollment or on the
occasion of a qualifying life event that
changes immediate family composition
as described in paragraph (d)(1)(ii) of
this section by submitting a completed
request in the appropriate format.
(3) Termination. Termination of
coverage for the member will result in
termination of coverage for the
member’s family members in TRICARE
Reserve Select, except as described in
paragraphs (d)(1)(iv) of this section. The
termination will become effective in
accordance with procedures established
by the ASD(HA). Members whose
coverage under TRICARE Reserve Select
terminates under paragraph (d)(3)(iii) or
(iv) of this section will not be allowed
to purchase coverage again under
TRICARE Reserve Select for a period of
one year following the effective the date
of termination.
(i) Coverage shall terminate for
members who no longer qualify for
TRICARE Reserve Select as specified in
paragraph (c) of this section, including
VerDate Aug<31>2005
14:16 Aug 17, 2007
Jkt 211001
when the member’s service in the
Selected Reserve terminates.
(ii) Coverage may terminate for
members who gain coverage under
another TRICARE program in which the
member is the sponsor.
(iii) Coverage may terminate for
members who fail to make a premium
payment in accordance with procedures
established by the ASD(HA).
(iv) Members may request termination
of coverage at any time by submitting a
completed request in the appropriate
format in accordance with established
deadlines and procedures.
(v) Coverage for survivors as
described in paragraph (d)(1)(iv) of this
section shall terminate six months after
the date of death of the covered Reserve
component member.
(4) Processing. Upon receipt of a
completed request in the appropriate
format, the appropriate TRICARE
contractor will process enrollment
actions into DEERS in accordance with
deadlines and other procedures
established by the ASD(HA).
(5) Periodic revision. Periodically,
certain features, rules or procedures of
TRICARE Reserve Select may be
revised. If such revisions will have a
significant effect on members’ costs or
access to care, members may be given
the opportunity to change their type of
coverage or terminate coverage
coincident with the revisions.
(e) Relationship to Continued Health
Care Benefits Program. Coverage under
TRICARE Reserve Select counts as
coverage under a health benefit plan for
purposes of individuals qualifying for
the Continued Health Care Benefits
Program (CHCBP) under section
199.20(d)(1)(ii)(B) or section
199.20(d)(1)(iii)(B) of this Part. If at the
time a member who qualifies under
paragraph (c) of this section purchases
coverage in TRICARE Reserve Select,
and the member was also eligible to
enroll in the Continued Health Care
Benefits Program (CHCBP) under
section 199.20(d)(1)(i) of this Part
(except to the extent eligibility in
CHCBP was affected by enrollment in
TRICARE Reserve Select), enrollment in
TRICARE Reserve Select will be deemed
to also constitute preliminary
enrollment in CHCBP. If for any reason
the member’s coverage under TRICARE
Reserve Select terminates before the
date that is 18 months after discharge or
release from the most recent period of
active duty upon which CHCBP
eligibility was based, the member or the
member’s family members eligible to be
included in CHCBP coverage may,
within 30 days of the effective date of
the termination of TRICARE Reserve
Select coverage, begin CHCBP coverage
PO 00000
Frm 00013
Fmt 4700
Sfmt 4700
46385
by following the applicable procedures
to purchase CHCBP coverage. 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 (f)(1) of this section,
any State or local law or regulation
pertaining to health insurance, prepaid
health plans, or other health care
delivery, administration, and financing
methods is preempted and does not
apply in connection with TRICARE
Reserve Select. Any such law, or
regulation pursuant to such law, is
without any force or effect, and State or
local governments have no legal
authority to enforce them in relation to
TRICARE Reserve Select. (However, the
Department of Defense may, by contract,
establish legal obligations on the part of
DoD contractors to conform with
requirements similar to or identical to
requirements of State or local laws or
regulations with respect to TRICARE
Reserve Select).
(3) The preemption of State and local
laws set forth in paragraph (f)(2) of this
section includes State and local laws
imposing premium taxes on health
insurance carriers or underwriters or
other plan managers, or similar taxes on
such entities. Such laws are laws
relating to health insurance, prepaid
health plans, or other health care
delivery or financing methods, within
the meaning of 10 U.S.C. 1103.
Preemption, however, does not apply to
taxes, fees, or other payments on net
income or profit realized by such
entities in the conduct of business
relating to DoD health services
contracts, if those taxes, fees or other
payments are applicable to a broad
range of business activity. For the
purposes of assessing the effect of
Federal preemption of State and local
taxes and fees in connection with DoD
health services contracts, interpretations
shall be consistent with those applicable
E:\FR\FM\20AUR1.SGM
20AUR1
46386
Federal Register / Vol. 72, No. 160 / Monday, August 20, 2007 / Rules and Regulations
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: August 14, 2007.
L.M. Bynum,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E7–16300 Filed 8–17–07; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 100
[Docket No. CGD05–07–063]
RIN 1625–AA08
Special Local Regulations for Marine
Events; Spa Creek and Severn River,
Annapolis, MD
Coast Guard, DHS.
ACTION: Temporary final rule.
rfrederick on PROD1PC67 with RULES
AGENCY:
SUMMARY: The Coast Guard is
establishing temporary special local
regulations during the ‘‘Annapolis
Triathlon’’, an event to be held
September 9, 2007 on the waters of Spa
Creek and the Severn River at
Annapolis, MD. These special local
regulations are necessary to provide for
the safety of life on navigable waters
during the event. This action is
intended to temporarily restrict vessel
traffic in a portion of the Severn River
and Spa Creek during the Annapolis
Triathlon swimming event.
DATES: This rule is effective from 6 a.m.
to 10:30 a.m. on September 9, 2007.
ADDRESSES: Documents indicated in this
preamble as being available in the
docket are part of docket CGD05–07–
063 and are available for inspection or
copying at Commander (dpi), Fifth
Coast Guard District, 431 Crawford
Street, Portsmouth, Virginia 23704–5004
between 9 a.m. and 2 p.m., Monday
through Friday, except Federal holidays.
FOR FURTHER INFORMATION CONTACT: Mr.
Ronald Houck, Marine Event
Coordinator, Coast Guard Sector
Baltimore, at (410) 576–2674 or e-mail
at Ronald.L.Houck@uscg.mil.
SUPPLEMENTARY INFORMATION:
Regulatory Information
We did not publish a notice of
proposed rulemaking (NPRM) for this
VerDate Aug<31>2005
14:16 Aug 17, 2007
Jkt 211001
regulation. Under 5 U.S.C. 553(b)(B), the
Coast Guard finds that good cause exists
for not publishing an NPRM. The
publishing of an NPRM would be
impracticable and contrary to public
interest since immediate action is
needed to minimize potential danger to
the participants and the public during
the event. The necessary information to
determine whether the marine event
poses a threat to persons and vessels
was not provided with sufficient time to
publish an NPRM. The danger posed by
the large volume of marine traffic in the
Annapolis harbor area makes special
local regulations necessary to provide
for the safety of swimmers, event
support vessels, spectator craft and
other vessels transiting the event area.
For the safety concerns noted, it is in
the public interest to have these
regulations in effect during the event.
The Coast Guard will issue broadcast
notice to mariners to advise vessel
operators of navigational restrictions.
On-scene Coast Guard and local law
enforcement vessels will also provide
actual notice to mariners.
Under 5 U.S.C. 553(d)(3), the Coast
Guard finds that good cause exists for
making this rule effective less than 30
days after publication in the Federal
Register. Delaying the effective date
would be contrary to the public interest,
since immediate action is needed to
ensure the safety of the event
participants, support vessels, spectator
craft and other vessels transiting the
event area. However advance
notification will be made to users of
Annapolis harbor via marine
information broadcasts, local notice to
mariners, commercial radio stations and
area newspapers.
Background and Purpose
On September 9, 2007, the City of
Annapolis and the Annapolis Triathlon
Club will sponsor the ‘‘Annapolis
Triathlon’’. The swimming segment of
the event will consist of approximately
1500 swimmers competing across a one
mile course located within Annapolis
Harbor, at the entrance of Spa Creek and
extending outward to the Severn River.
The competition will begin at the
Annapolis City dock. The participants
will swim along an oval shaped course
and across to the finish line located at
the Annapolis City dock, swimming
approximately one-mile, contained
within the inner Annapolis Harbor area.
Approximately 30 support vessels will
accompany the swimmers. Due to the
need for vessel control during the
swimming event, the Coast Guard will
temporarily restrict vessel traffic in the
event area to provide for the safety of
PO 00000
Frm 00014
Fmt 4700
Sfmt 4700
participants, support craft and other
transiting vessels.
Discussion of Rule
The Coast Guard is establishing
temporary special local regulations on
specified waters of the Severn River and
Spa Creek at Annapolis, Maryland. The
temporary special local regulations will
be in effect from 6 a.m. to 10:30 a.m. on
September 9, 2007. The effect will be to
restrict general navigation in the
regulated area during the event. Except
for persons or vessels authorized by the
Coast Guard Patrol Commander, no
person or vessel may enter or remain in
the regulated area. Vessel traffic may be
allowed to transit the regulated area at
slow speed as the swim progresses,
when the Coast Guard Patrol
Commander determines it is safe to do
so. The Patrol Commander will notify
the public of specific enforcement times
by Marine Radio Safety Broadcast.
These regulations are needed to control
vessel traffic during the event to
enhance the safety of participants,
spectators and transiting vessels.
Regulatory Evaluation
This rule is not a ‘‘significant
regulatory action’’ under section 3(f) of
Executive Order 12866, Regulatory
Planning and Review, and does not
require an assessment of potential costs
and benefits under section 6(a)(3) of that
Order. The Office of Management and
Budget has not reviewed it under that
Order. We expect the economic impact
of this rule to be so minimal that a full
Regulatory Evaluation is unnecessary.
Although this regulation restricts
vessel traffic from transiting a portion of
the Severn River and Spa Creek during
the event, the effect of this regulation
will not be significant due to the limited
duration that the regulated area will be
in effect and the extensive advance
notifications that will be made to the
maritime community via marine
information broadcasts, area
newspapers and radio stations so
mariners can adjust their plans
accordingly.
Small Entities
Under the Regulatory Flexibility Act
(5 U.S.C. 601–612), we have considered
whether this rule would have a
significant economic impact on a
substantial number of small entities.
The term ‘‘small entities’’ comprises
small businesses, not-for-profit
organizations that are independently
owned and operated and are not
dominant in their fields, and
governmental jurisdictions with
populations of less than 50,000.
E:\FR\FM\20AUR1.SGM
20AUR1
]]>Agencies
[Federal Register Volume 72, Number 160 (Monday, August 20, 2007)]
[Rules and Regulations]
[Pages 46380-46386]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-16300]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2006-HA-0207]
RIN 0720-AB15
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Reserve Select for Members of the Selected Reserve
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This interim final rule revises requirements and procedures
for TRICARE Reserve Select and restructures eligibility to include all
Selected Reservists, except for those individuals either enrolled or
eligible to enroll in a health benefit plan under Chapter 89 of Title
5, United States Code. The rule is being published as an interim final
rule with comment period in order to comply with statutory effective
dates.
DATES: Effective Date: This rule is effective October 1, 2007. Submit
comments on or before September 19, 2007.
ADDRESSES: You may submit comments, identified by docket number and or
RIN number and title, by any of the following methods: Federal
eRulemaking Portal: https://www.regulations.gov. Follow the instructions
for submitting comments. Mail: Federal Docket Management System Office,
1160 Defense Pentagon, Washington, DC 20301-1160. Instructions: All
submissions received must include the agency name and docket number or
Regulatory Information Number (RIN) for this Federal Register document.
The general policy for comments and other submissions from members of
the public is to make these submissions available for public viewing on
the Internet at https://regulations.gov as they are received without
change, including any personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: Jody Donehoo, TRICARE Management
Activity, TRICARE Operations, telephone (703) 681-0039.
Questions regarding payment of specific claims under the TRICARE
allowable charge method should be addressed to the appropriate TRICARE
contractor.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
A previous interim final rule was published in the Federal Register
on March 16, 2005, (70 FR 12798-12805) that established requirements
and procedures to implement TRICARE Reserve Select under section 701 of
the Ronald W. Reagan National Defense Authorization Act for Fiscal Year
2005 (NDAA-05) (Pub. L. 108-375). Section 701 of NDAA-05 authorized
premium-based medical coverage for certain members of the Selected
Reserve and their family members. By April 2005, Selected Reserve
members who served on active duty in support of a contingency operation
and fulfilled other statutory qualifications could purchase TRICARE
Reserve Select coverage for periods proportional to their period of
active duty.
A second interim final rule was published in the Federal Register
on June 21, 2006, (71 FR 35527-35537). That interim final rule revised
requirements and procedures for TRICARE Reserve Select pursuant to
sections 701 and 702 of the National Defense Authorization Act for
Fiscal Year 2006 (NDAA-06) (Pub. L. 109-163). Section 701 enhanced the
existing TRICARE Reserve Select program. Section 702 added two new
tiers of premium sharing by the government (50 percent and 85 percent
member portion) to the existing premium tier (28 percent member
portion), making TRICARE Reserve Select available to all Selected
Reservists.
Before a final rule could be issued subsequent to the interim final
rule published in the Federal Register on June 21, 2006, (71 FR 35527-
35537) for the TRICARE Reserve Select program, Section 706 of the NDAA-
07 amended the statutory provisions in sections 701 and 702 of the
NDAA-06 which were implemented in the interim final rule.
Therefore, this interim rule addresses provisions of the National
Defense Authorization Act for Fiscal Year 2007 (NDAA-07) (Pub. L. 109-
364). First, section 706 of the NDAA-07 expands the availability of the
28 percent premium tier to all Selected Reservists with one exception.
Those individuals either enrolled or eligible to enroll in a
[[Page 46381]]
health benefit plan under Chapter 89 of Title 5, United States Code are
specifically excepted from eligibility under this legislation. Second,
this section eliminates fixed length periods of coverage. Third, this
section eliminates the 50 percent and 85 percent premium tiers to
reflect the repeal of Section 1076b of Title 10, United States Code, in
its entirety.
The law authorizing the TRICARE Reserve Select program uses the
term ``eligibility'' to identify conditions under which a Reserve
component member may purchase coverage. For purposes of program
administration, the terms ``qualifying'' or ``qualified'' shall
generally be used in lieu of such terms as ``eligibility'' or
``eligible'' to refer to a Reserve component member who meets the
program requirements allowing purchase of TRICARE Reserve Select
coverage.
The latter interim rule (June 21, 2006) introduced certain
terminology for TRICARE Reserve Select intended to reflect critical
elements that distinguish it from other long-established TRICARE health
programs. For instance, the effective date of eligibility for TRICARE
has long been understood to mean that the eligible individual may
obtain care under the military health system as of that date. However,
that is not what it means in the context of TRICARE Reserve Select. To
avoid the inevitable misunderstanding, this rule uses the term
``qualify'' to mean that the member has satisfied all the
``qualifications'' that must be met before the member is authorized to
purchase coverage. Only then may the member purchase coverage by
submitting a completed request in the appropriate format along with
payment of the applicable one month premium. The term ``coverage''
indicates the benefit of TRICARE covering claims submitted by TRICARE
authorized providers, hospitals, and suppliers for payment of covered
services, supplies, and equipment.
II. TRICARE Reserve Select Program
A. Establishment of the TRICARE Reserve Select Program (paragraph
199.24(a)). This paragraph describes the nature, purpose, statutory
basis, scope, and major features of TRICARE Reserve Select, a premium-
based medical coverage program that was made available worldwide to
certain members of the Selected Reserve and their family members.
TRICARE Reserve Select is authorized by 10 U.S.C. 1076d.
The major features of the program include the following. TRICARE
Reserve Select coverage is available for purchase by any Selected
Reserve member if the member fulfills all of the statutory
qualifications. The amount of the premium that members pay is
prescribed by the Secretary of Defense as one premium for member-only
coverage and a second premium for member and family coverage. The
statute eliminates the former tiered premium rate structure of TRICARE
Reserve Select. Additionally, TRICARE rules apply unless otherwise
specified; certain special TRICARE programs are not part of TRICARE
Reserve Select, including the Extended Care Health Option (ECHO)
program, the Special Supplemental Food Program (also known as the
Women, Infants, and Children--Overseas Program), and the Supplemental
Health Care Program, except when referred by a Military Treatment
Facility (MTF) provider for incidental consults and the MTF provider
maintains clinical control over the episode of care. The TRICARE Dental
Program is already available under 10 U.S.C. 1076a to all members of
the Selected Reserve and their family members whether or not they
purchase TRICARE Reserve Select coverage.
Under TRICARE Reserve Select, Selected Reserve members who fulfill
all of the statutory qualifications may purchase either the member-only
type of coverage or the member and family type of coverage by
submitting a completed request in the appropriate format along with
payment of the applicable monthly premium at the time of enrollment.
When their coverage becomes effective, TRICARE Reserve Select
beneficiaries receive the TRICARE Standard (and Extra) benefit. TRICARE
Reserve Select features the deductible and cost share provisions of the
TRICARE Standard (and Extra) plan for active duty family members (ADFM)
for both the member and covered family members.
B. TRICARE Reserve Select premiums (paragraph 199.24(b)). Members
are charged premiums for coverage under TRICARE Reserve Select that
represent 28 percent of the total annual premium amount that the
Assistant Secretary of Defense, Health Affairs (ASD(HA)) determines on
an appropriate actuarial basis as being appropriate for coverage under
the TRICARE Standard (and Extra) benefit for the TRICARE Reserve Select
eligible population. Premiums are to be paid monthly, except as
otherwise established as part of the administrative implementation of
TRICARE Reserve Select.
Annual rates for the first year TRICARE Reserve Select was offered
(2005) were based on the calendar year annual premiums for the Blue
Cross and Blue Shield Standard Service Benefit Plan under the Federal
Employees Health Benefits Program, a nationwide plan closely resembling
TRICARE Standard (and Extra) coverage, with an adjustment based on
estimated differences in covered populations, as determined by the
ASD(HA).
Based on an analysis of demographic differences between Blue Cross
and Blue Shield members and beneficiaries eligible for TRICARE Reserve
Select, the adjustment amount in calendar year 2005 represented a 32
percent reduction from the Blue Cross and Blue Shield annual premium
for member-only coverage and represented an 8 percent reduction from
the Blue Cross and Blue Shield annual premium for member and family
coverage. (The difference in the percentage reductions between member-
only and member 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 member-only coverage).
TRICARE Reserve Select monthly premium rates are established and
updated annually, on a calendar year basis, to maintain an appropriate
relationship with the annual changes in Blue Cross and Blue Shield
premiums, or by other adjustment methodology determined to be
appropriate by the ASD(HA) for each of the two types of coverage,
member-only coverage and member and family coverage, on a calendar year
basis. The monthly rate for each month of a calendar year is one-
twelfth of the annual rate for that calendar year.
In addition to these annual premium changes, premium adjustments
may also be made prospectively for any calendar year to reflect any
significant program changes or any actual experience in the costs of
administering the TRICARE Reserve Select Program.
A surviving family member of a Reserve Component service member who
qualified for TRICARE Reserve Select coverage as described in paragraph
(c)(3) of this section will pay premium rates as follows. The premium
amount shall be at the member-only rate if there is only one surviving
family member to be covered by TRICARE Reserve Select and at the member
and family rate if there are two or more survivors to be covered.
C. Eligibility for qualifying to purchase TRICARE Reserve Select
coverage (paragraph 199.24(c)). This paragraph defines the statutory
conditions under which members of a Reserve component may qualify to
purchase TRICARE Reserve Select coverage. Section 706 of NDAA-07
restructures the availability of the 28 percent premium tier by
requiring only two qualifying conditions.
[[Page 46382]]
The qualifying condition to be ``a member of the Selected Reserve
of the Ready Reserve of a reserve component of the armed forces,''
remains in force while all of the other former qualifying conditions
are eliminated. The member's Service personnel office is responsible
for keeping the Defense Enrollment Eligibility Reporting System (DEERS)
current with eligibility data.
One exclusionary qualifying condition is added that excludes ``a
member who is enrolled, or is eligible to enroll, in a health benefits
plan under chapter 89 of title 5 U.S.C,'' from purchasing TRICARE
Reserve Select coverage.
If a member of the Selected Reserve dies while in a period of
TRICARE Reserve Select coverage, the family member(s) may purchase new
or continue existing TRICARE Reserve Select coverage for up to six
months beyond the date of the member's death upon payment of monthly
premiums.
D. Procedures (paragraph 199.24(d)).
--Purchasing Coverage. A qualified member, including surviving family
members, may purchase one of two types of coverage: member-only
coverage or member and family coverage. Immediate family members of the
Reserve component member, as defined in section 199.3(b)(2)(i) (except
former spouses) and 199.3 (b)(2)(ii) of this Part, may be included in
such family coverage. To purchase either type of TRICARE Reserve Select
coverage for effective dates of coverage described below, Reserve
component members qualified under paragraph 199.24(c) must complete and
submit a request in the appropriate format, along with an initial
payment of the monthly premium share required under paragraph
199.24(b), to the appropriate TRICARE contractor in accordance with
deadlines and other procedures established by the ASD(HA).
--Continuation Coverage. Deadlines and other procedures may be
established for a qualified member to purchase TRICARE Reserve Select
coverage with an effective date immediately following the date of
termination of coverage under another TRICARE program in which the
member is the sponsor.
--Qualifying Life Event. Deadlines and other procedures may be
established for a qualified member to purchase TRICARE Reserve Select
coverage on the occasion of a qualifying life event that changes the
immediate family composition (e.g., birth, adoption, divorce, etc.)
that is eligible for coverage under TRICARE Reserve Select. The
effective date for TRICARE Reserve Select coverage will be the date of
the qualifying life event. It is the responsibility of the member to
provide his or her personnel office with the necessary evidence
required to substantiate the change in immediate family composition.
Personnel officials will update DEERS in the usual manner. The
appropriate TRICARE contractor will then take appropriate action upon
receipt of the completed request in the appropriate format along with
payment of the applicable monthly premium.
--Open Enrollment. Deadlines and other procedures may be established
for a qualified member to purchase TRICARE Reserve Select coverage at
any time. The effective date of coverage will coincide with the first
day of a month.
--Survivor coverage under TRICARE Reserve Select. Deadlines and other
procedures may be established for a surviving family member of a
Reserve Component service member who qualified for TRICARE Reserve
Select coverage as described in paragraph (c)(3) of this section to
purchase new TRICARE Reserve Select coverage or continue existing
TRICARE Reserve Select coverage for up to six months beyond the date of
the member's death. The effective date of coverage will be the day
following the date of the member's death.
--Changing type of coverage. TRICARE Reserve Select members may request
to change type of coverage during open enrollment or on the occasion of
a qualifying life event that changes immediate family composition as
described above by submitting a completed request in the appropriate
format.
--Termination. Termination of coverage for the member will result in
termination of coverage for the member's family members in TRICARE
Reserve Select, except for qualified survivors of Reserve component
members covered by TRICARE Reserve Select at the time of death.
--Coverage will terminate whenever a member ceases to meet the
qualifications for the program or a request for termination in the
appropriate format is received in accordance with established
procedures.
--Coverage may terminate for members who gain coverage under another
TRICARE program in which the member is the sponsor.
--Failure to make a premium payment in a timely manner may result in
termination of coverage for the member and any covered family members
and will result in denial of claims for services received after the
effective date of termination.
--The member may request termination of coverage at any time by
submitting a completed request in the appropriate format in accordance
with established deadlines and procedures. Members whose coverage under
TRICARE Reserve Select terminates upon their request or for failure to
pay premiums will not be allowed to purchase coverage again under
TRICARE Reserve Select for a period of one year following the effective
date of termination.
--Coverage for survivors as described herein shall terminate six months
after the date of death of the covered Reserve component member.
--Processing. Upon receipt of a completed request in the appropriate
format the appropriate TRICARE contractor will process enrollment
actions into DEERS in accordance with deadlines and other procedures
established by the ASD(HA).
--Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on members' costs or access to care,
members may be given the opportunity to change their type of coverage.
E. Relationship to Continued Health Care Benefits Program (CHCBP)
(paragraph 199.24(e)). This paragraph addresses the relationship
between TRICARE Reserve Select and the CHCBP. CHCBP is a program that
(among other things) allows members released from active duty to
purchase continued health care coverage through TRICARE. Coverage under
TRICARE Reserve Select counts as coverage under a health benefit plan
for purposes of individuals qualifying for the Continued Health Care
Benefits Program (CHCBP) under section 199.20(d)(1)(ii)(B) or section
199.20(d)(1)(iii)(B) of this Part. Some members and family members will
be eligible for TRICARE Reserve Select, and may also be eligible for
CHCBP at the time of release from active duty.
This paragraph of the regulation provides that if a member
purchases TRICARE Reserve Select coverage that is later terminated, the
member or the covered family members may then purchase CHCBP coverage
for whatever period is remaining of the original 18-month eligibility.
For example, in the case that TRICARE Reserve Select coverage that is
terminated because of
[[Page 46383]]
transfer or discharge of a member from the Selected Reserve (such as
through a reduction in force or base closure) is within 18 months of
release from active duty, the member could choose to continue health
care coverage under CHCBP for the remainder of the period at the
applicable CHCBP premiums.
F. Preemption of State laws (paragraph 199.24(f)). This paragraph
explains that the preemptions of State and local laws established for
the TRICARE program also apply to TRICARE Reserve Select. Any State or
local law or regulation pertaining to health insurance, prepaid health
plans, or other health care delivery, administration, and financing
methods is preempted and does not apply in connection with TRICARE
Reserve Select.
This includes State and local laws imposing premium taxes on health
insurance carriers, underwriters or other plan managers, or similar
taxes on such entities. Preemption does not apply to taxes, fees, or
other payments on net income or profit realized by such entities in the
conduct of business relating to DoD health services contracts, if those
taxes, fees or other payments are applicable to a broad range of
business activity. For the purposes of assessing the effect of Federal
preemption of State and local taxes and fees in connection with DoD
health services contracts, interpretations shall be consistent with
those applicable to the Federal Employees Health Benefits Program under
5 U.S.C. 8909(f).
G. Administration (paragraph 199.24(g)). This paragraph provides
that the ASD(HA) may establish other rules and procedures necessary for
the effective administration of TRICARE Reserve Select.
III. Regulatory Procedures
Executive Order 12866 requires certain regulatory assessments for
any significant regulatory action that would result in an annual effect
on the economy of $100 million or more, or have other substantial
impacts. The Congressional Review Act establishes certain procedures
for major rules, defined as those with similar major impacts. The
Regulatory Flexibility Act (RFA) requires that each Federal agency
prepare, and make available for public comment, a regulatory
flexibility analysis when the agency issues a regulation that would
have significant impact on a substantial number of small entities. This
interim final rule is not subject to any of those requirements because
it would not have any of these substantial impacts. Any substantial
impacts associated with implementation of TRICARE Reserve Select are
already determined by statute and are outside any discretionary action
of DoD or effect of this regulation.
This rule, however, does address novel policy issues relating to
implementation of a new medical benefits program for members of the
armed forces. Thus, this rule has been reviewed by the Office of
Management and Budget under E.O. 12866.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3511).
We have examined the impact(s) of the interim final rule under
Executive Order 13132 and it does not have policies that have
federalism implications that would have substantial direct effects on
the States, on the relationship between the national government and the
States, or on the distribution of power and responsibilities among the
various levels of government, therefore, consultation with State and
local officials is not required.
This rule is being published as an interim final rule with comment
period contrary to the normal procedure of soliciting public comment
under a proposed rule first, in order to comply with the requirements
of the John Warner National Defense Authorization Act for Fiscal Year
2007, Public Law 109-364, section 706, which was enacted on January 6,
2007. This section provides in pertinent part that ``The Secretary of
Defense shall ensure that health care under TRICARE Standard is
provided under section 1076d of title 10, United States Code, as
amended by this section beginning not later than October 1, 2007.'' In
order to comply with the statutorily mandated start date, this rule is
being published as an interim final rule, with an effective date of
October, 1, 2007. Public comments are welcome and will be considered
before publication 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 revising the definition of ``TRICARE
Reserve Select'' to read as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
TRICARE Reserve Select. The program established under 10 U.S.C.
1076d and Sec. 199.24 of this Part.
0
3. Section 199.24 is revised to read as follows:
Sec. 199.24 TRICARE Reserve Select.
(a) Establishment. TRICARE Reserve Select is established for the
purpose of offering TRICARE Standard and Extra health coverage to
qualified members of the Selected Reserve and their immediate family
members.
(1) Purpose. TRICARE Reserve Select is a premium-based health plan
that is available for purchase by members of the Selected Reserve and
certain survivors of Selected Reserve members as specified in paragraph
(c) of this section.
(2) Statutory Authority. TRICARE Reserve Select is authorized by 10
U.S.C. 1076d.
(3) Scope of the Program. TRICARE Reserve Select is applicable in
the 50 United States, the District of Columbia, Puerto Rico, and, to
the extent practicable, other areas where members of the Selected
Reserve serve. In locations other than the 50 states of the United
States and the District of Columbia, the Assistant Secretary of Defense
(Health Affairs) may authorize modifications to the program rules and
procedures as may be appropriate to the area involved.
(4) Terminology. Certain terminology is introduced for TRICARE
Reserve Select intended to reflect critical elements that distinguish
it from other long-established TRICARE health programs. For instance,
the effective date of eligibility for TRICARE has long been understood
to mean that the eligible individual may obtain care under the military
health system as of that date. However, that is not what it means in
the context of TRICARE Reserve Select. To avoid the inevitable
misunderstanding, this regulation uses the term ``qualify'' to mean
that the member has satisfied all the ``qualifications'' that must be
met before the member is authorized to purchase coverage. Only then may
the member purchase coverage by submitting a completed request in the
appropriate format along with payment of the applicable one month
premium. The term ``coverage'' indicates the benefit of TRICARE
Standard or Extra covering claims submitted for payment of covered
services, supplies, and equipment furnished by TRICARE authorized
providers, hospitals, and suppliers.
[[Page 46384]]
(5) Major Features of TRICARE Reserve Select. The major features of
the program include the following:
(i) TRICARE rules applicable.
(A) Unless specified in this section or otherwise prescribed by the
ASD(HA), provisions of 32 CFR Part 199 apply to TRICARE Reserve Select.
(B) Certain special programs established in 32 CFR Part 199 are not
available to members covered under TRICARE Reserve Select. These
include the Extended Care Health Option Program (see Sec. 199.5), the
Special Supplemental Food Program (see Sec. 199.23), and the
Supplemental Health Care Program (see Sec. 199.16) except when
referred by a Military Treatment Facility (MTF) provider for incidental
consults and the MTF provider maintains clinical control over the
episode of care. The TRICARE Dental Program (see Sec. 199.13) is
independent of this program and is otherwise available to all members
of the Selected Reserve and their eligible family members whether or
not they purchase TRICARE Reserve Select coverage.
(ii) Premiums. TRICARE Reserve Select coverage is available for
purchase by any Selected Reserve member if the member fulfills all of
the statutory qualifications. A member of the Selected Reserve covered
under TRICARE Reserve Select shall pay 28 percent of the total amount
that the ASD(HA) determines on an appropriate actuarial basis as being
appropriate for that coverage. There is one premium rate for member-
only coverage and one premium rate for member and family coverage.
(iii) Procedures. Under TRICARE Reserve Select, Reserve component
members who fulfilled all of the statutory qualifications may purchase
either the member-only type of coverage or the member and family type
of coverage by submitting a completed request in the appropriate format
along with payment of the applicable one month premium. Rules and
procedures for purchasing coverage and paying applicable premiums are
prescribed in this section.
(iv) Benefits. When their coverage becomes effective, TRICARE
Reserve Select beneficiaries receive the TRICARE Standard (and Extra)
benefit including access to military treatment facility services and
pharmacies, as described in Sec. 199.17 of this Part. TRICARE Reserve
Select coverage features the deductible and cost share provisions of
the TRICARE Standard (and Extra) plan for active duty family members
for both the member and the member's covered family members. The
TRICARE Standard (and Extra) plan is described in Sec. 199.17 of this
Part.
(b) TRICARE Reserve Select premiums. Members are charged premiums
for coverage under TRICARE Reserve Select that represent 28 percent of
the total annual premium amount that the Assistant Secretary of
Defense, Health Affairs (ASD(HA)) determines on an appropriate
actuarial basis as being appropriate for coverage under the TRICARE
Standard (and Extra) benefit for the TRICARE Reserve Select eligible
population. Premiums are to be paid monthly, except as otherwise
provided through administrative implementation, pursuant to procedures
established by the ASD(HA).
(1) Annual establishment of rates. (i) TRICARE Reserve Select
monthly premium rates shall be established and updated annually on a
calendar year basis to maintain an appropriate relationship with the
annual changes in premiums for the Blue Cross and Blue Shield Standard
Service Benefit Plan under the Federal Employees Health Benefits
Program, a nationwide plan closely resembling TRICARE Standard (and
Extra) coverage, or by other adjustment methodology determined to be
appropriate by the ASD(HA) for each of the two types of coverage,
member-only and member and family as described in paragraphs (d)(2) of
this section.
(ii) Annual rates for the first year TRICARE Reserve Select was
offered (calendar year 2005) were based on the Federal Blue Cross and
Blue Shield annual premiums, with adjustments based on estimated
differences in covered populations, as determined by the ASD(HA).
(2) Premium adjustments. In addition to the determinations
described in paragraph (b)(1) of this section, premium adjustments may
be made prospectively for any calendar year to reflect any significant
program changes or any actual experience in the costs of administering
the TRICARE Reserve Select Program.
(3) Survivor coverage under TRICARE Reserve Select. A surviving
family member of a Reserve Component service member who qualified for
TRICARE Reserve Select coverage as described in paragraph (c)(3) of
this section will pay premium rates as follows. The premium amount
shall be at the member-only rate if there is only one surviving family
member to be covered by TRICARE Reserve Select and at the member and
family rate if there are two or more survivors to be covered.
(c) Eligibility for (qualifying to purchase) TRICARE Reserve Select
coverage--(1) General. The law authorizing the TRICARE Reserve Select
program uses the term ``eligibility'' to identify conditions under
which a Reserve component member may purchase coverage. For purposes of
program administration, the terms ``qualifying'' or ``qualified'' shall
generally be used in lieu of such terms as ``eligibility'' or
``eligible'' to refer to a Reserve component member who meets the
program requirements allowing purchase of TRICARE Reserve Select
coverage. The member's Service personnel office is responsible for
keeping DEERS current with eligibility data.
(2) Member Purchase. A member who is a member of a Reserve
component of the Armed Forces qualifies to purchase TRICARE Reserve
Select coverage if the member meets both the following conditions:
(i) Is a member of the Selected Reserve of the Ready Reserve.
(ii) Is not enrolled in, or eligible to enroll in, a health
benefits plan under Chapter 89 of Title 5, U.S.C.
(3) Survivor coverage under TRICARE Reserve Select. If a member of
the Selected Reserve dies while in a period of TRICARE Reserve Select
coverage, the family member(s) may purchase new or continue existing
TRICARE Reserve Select coverage for up to six months beyond the date of
the member's death.
(d) Procedures--(1) Purchasing Coverage. A qualified member may
purchase one of two types of coverage: member-only coverage or member
and family coverage. Immediate family members of the Reserve component
member, as defined in Sec. 199.3(b)(2)(i) (except former spouses) and
Sec. 199.3 (b)(2)(ii) of this Part, may be included in such family
coverage. To purchase either type of TRICARE Reserve Select coverage
for effective dates of coverage described below, Reserve component
members qualified under Sec. 199.24(c) must submit a request in the
appropriate format, along with an initial payment of the applicable
monthly premium required by paragraph (b) of this section to the
appropriate TRICARE contractor in accordance with deadlines and other
procedures established by the ASD(HA).
(i) Continuation Coverage. Deadlines and other procedures may be
established for a qualified member to purchase TRICARE Reserve Select
coverage with an effective date immediately following the date of
termination of coverage under another TRICARE program in which the
member is the sponsor.
(ii) Qualifying Life Event. Deadlines and other procedures may be
established for a qualified member to purchase TRICARE Reserve Select
[[Page 46385]]
coverage on the occasion of a qualifying life event that changes the
immediate family composition (e.g., birth, adoption, divorce, etc.)
that is eligible for coverage under TRICARE Reserve Select. The
effective date for TRICARE Reserve Select coverage will be the date of
the qualifying life event. It is the responsibility of the member to
provide his or her personnel office with the necessary evidence
required to substantiate the change in immediate family composition.
Personnel officials will update DEERS in the usual manner. The
appropriate TRICARE contractor will then take appropriate action upon
receipt of the completed request in the appropriate format along with
payment of the applicable one month premium.
(iii) Open Enrollment. Deadlines and other procedures may be
established for a qualified member to purchase TRICARE Reserve Select
coverage at any time. The effective date of coverage will coincide with
the first day of a month.
(iv) Survivor coverage under TRICARE Reserve Select. Deadlines and
other procedures may be established for a surviving family member of a
Reserve Component service member who qualified for TRICARE Reserve
Select coverage as described in paragraph (c)(3) of this section to
purchase new TRICARE Reserve Select coverage or continue existing
TRICARE Reserve Select coverage for up to six months beyond the date of
the member's death. The effective date of coverage will be the day
following the date of the member's death.
(2) Changing type of coverage. TRICARE Reserve Select members may
request to change type of coverage during open enrollment or on the
occasion of a qualifying life event that changes immediate family
composition as described in paragraph (d)(1)(ii) of this section by
submitting a completed request in the appropriate format.
(3) Termination. Termination of coverage for the member will result
in termination of coverage for the member's family members in TRICARE
Reserve Select, except as described in paragraphs (d)(1)(iv) of this
section. The termination will become effective in accordance with
procedures established by the ASD(HA). Members whose coverage under
TRICARE Reserve Select terminates under paragraph (d)(3)(iii) or (iv)
of this section will not be allowed to purchase coverage again under
TRICARE Reserve Select for a period of one year following the effective
the date of termination.
(i) Coverage shall terminate for members who no longer qualify for
TRICARE Reserve Select as specified in paragraph (c) of this section,
including when the member's service in the Selected Reserve terminates.
(ii) Coverage may terminate for members who gain coverage under
another TRICARE program in which the member is the sponsor.
(iii) Coverage may terminate for members who fail to make a premium
payment in accordance with procedures established by the ASD(HA).
(iv) Members may request termination of coverage at any time by
submitting a completed request in the appropriate format in accordance
with established deadlines and procedures.
(v) Coverage for survivors as described in paragraph (d)(1)(iv) of
this section shall terminate six months after the date of death of the
covered Reserve component member.
(4) Processing. Upon receipt of a completed request in the
appropriate format, the appropriate TRICARE contractor will process
enrollment actions into DEERS in accordance with deadlines and other
procedures established by the ASD(HA).
(5) Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on members' costs or access to care,
members may be given the opportunity to change their type of coverage
or terminate coverage coincident with the revisions.
(e) Relationship to Continued Health Care Benefits Program.
Coverage under TRICARE Reserve Select counts as coverage under a health
benefit plan for purposes of individuals qualifying for the Continued
Health Care Benefits Program (CHCBP) under section 199.20(d)(1)(ii)(B)
or section 199.20(d)(1)(iii)(B) of this Part. If at the time a member
who qualifies under paragraph (c) of this section purchases coverage in
TRICARE Reserve Select, and the member was also eligible to enroll in
the Continued Health Care Benefits Program (CHCBP) under section
199.20(d)(1)(i) of this Part (except to the extent eligibility in CHCBP
was affected by enrollment in TRICARE Reserve Select), enrollment in
TRICARE Reserve Select will be deemed to also constitute preliminary
enrollment in CHCBP. If for any reason the member's coverage under
TRICARE Reserve Select terminates before the date that is 18 months
after discharge or release from the most recent period of active duty
upon which CHCBP eligibility was based, the member or the member's
family members eligible to be included in CHCBP coverage may, within 30
days of the effective date of the termination of TRICARE Reserve Select
coverage, begin CHCBP coverage by following the applicable procedures
to purchase CHCBP coverage. The period of coverage will be as provided
in Sec. 199.20(d)(6) of this Part.
(f) Preemption of State laws. (1) Pursuant to 10 U.S.C. 1103, the
Department of Defense has determined that in the administration of
chapter 55 of title 10, U.S. Code, preemption of State and local laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods is necessary to achieve important
Federal interests, including but not limited to the assurance of
uniform national health programs for military families and the
operation of such programs, at the lowest possible cost to the
Department of Defense, that have a direct and substantial effect on the
conduct of military affairs and national security policy of the United
States. This determination is applicable to contracts that implement
this section.
(2) Based on the determination set forth in paragraph (f)(1) of
this section, any State or local law or regulation pertaining to health
insurance, prepaid health plans, or other health care delivery,
administration, and financing methods is preempted and does not apply
in connection with TRICARE Reserve Select. Any such law, or regulation
pursuant to such law, is without any force or effect, and State or
local governments have no legal authority to enforce them in relation
to TRICARE Reserve Select. (However, the Department of Defense may, by
contract, establish legal obligations on the part of DoD contractors to
conform with requirements similar to or identical to requirements of
State or local laws or regulations with respect to TRICARE Reserve
Select).
(3) The preemption of State and local laws set forth in paragraph
(f)(2) of this section includes State and local laws imposing premium
taxes on health insurance carriers or underwriters or other plan
managers, or similar taxes on such entities. Such laws are laws
relating to health insurance, prepaid health plans, or other health
care delivery or financing methods, within the meaning of 10 U.S.C.
1103. Preemption, however, does not apply to taxes, fees, or other
payments on net income or profit realized by such entities in the
conduct of business relating to DoD health services contracts, if those
taxes, fees or other payments are applicable to a broad range of
business activity. For the purposes of assessing the effect of Federal
preemption of State and local taxes and fees in connection with DoD
health services contracts, interpretations shall be consistent with
those applicable
[[Page 46386]]
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: August 14, 2007.
L.M. Bynum,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E7-16300 Filed 8-17-07; 8:45 am]
BILLING CODE 5001-06-P
