TRICARE; Continued Health Care Benefit Program Expansion, 62271-62275 [E9-28358]
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Federal Register / Vol. 74, No. 227 / Friday, November 27, 2009 / Proposed Rules
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3511)
This rule will not impose additional
reporting or recordkeeping requirements
under the Paperwork Reduction Act of
1995.
Executive Order 13132, ‘‘Federalism’’
We have examined the impact of the
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.
TRICARE Prime Remote. All other
provisions of this section shall apply to
administration of the TRICARE program
in the State of Alaska as they apply to
the other 49 States and the District of
Columbia.
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Dated: November 19, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28357 Filed 11–25–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD–2009–HA–0068; RIN 0720–AB30]
List of Subjects in 32 CFR Part 199
32 CFR Part 199
Claims, dental health, health care,
health insurance, individuals with
disabilities, military personnel.
Accordingly, 32 CFR Part 199 is
proposed to be amended as follows:
TRICARE; Continued Health Care
Benefit Program Expansion
PART 199—CIVILIAN HEALTH AND
MEDICAL PROGRAM OF THE
UNIFORMED SERVICES (CHAMPUS)
SUMMARY: This proposed rule executes
the expansion of section 1078a of title
10, United States Code. With the recent
expansions of the Military Health
System (MHS) coverage, particularly
with the Reserve Component members,
some MHS beneficiaries would not be
eligible for CHCBP under certain
circumstances that terminate their MHS
coverage. This provision allows the
Secretary to establish CHCBP eligibility
for any categories of MHS beneficiaries
who otherwise would lose MHS
coverage with no continued care
eligibility. This proposed rule also
includes administrative changes
providing clarification on some issues
and updates the final rule published in
the Federal Register on September 30,
1994, (59 FR 49817).
DATES: Comments must be received on
or before January 26, 2010.
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
ACTION:
1. The authority citation for Part 199
continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
2. Section 199.17 is amended by
revising the second sentence of
paragraph (a)(3), redesignating the
current paragraph (v) as (w), and by
adding a new paragraph (v) to read as
follows:
§ 199.17
TRICARE Program
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(a) * * *
(3) * * * Its geographical applicability
is to all 50 States (except as modified for
the State of Alaska under paragraph (v)
of this section) and the District of
Columbia. * * *
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(v) Administration of the TRICARE
program in the State of Alaska. In view
of the unique geographical and
environmental characteristics impacting
the delivery of health care in the State
of Alaska, administration of the
TRICARE program in the State of Alaska
will not include financial underwriting
of the delivery of health care by a
TRICARE contractor. In addition, the
Assistant Secretary of Defense (Health
Affairs) may limit the availability of
TRICARE Prime in the State of Alaska
to those eligible beneficiaries enrolled to
a military treatment facility (MTF) and
to those eligible beneficiaries under
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Department of Defense.
Proposed rule.
AGENCY:
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for public viewing on the Internet at
https://www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
FOR FURTHER INFORMATION CONTACT:
Kathleen Larkin, 703–681–0039.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
Section 713 of the National Defense
Authorization Act (NDAA) for Fiscal
Year 2004 authorized coverage for
uniformed services rather than armed
services. Section 705 of the NDAA for
Fiscal Year 2008 authorizes the
expansion of persons eligible for the
Continued Health Care Benefit Program
(CHCBP) under Title 10 of the United
States Code, section 1078a. CHCBP is
the program that provides continued
healthcare coverage for MHS
beneficiaries who lose their MHS
eligibility. It is modeled after private
sector ‘‘COBRA Coverage,’’ with the
individual paying 100% of the program
cost plus an amount to cover
administrative expenses. Currently,
CHCBP provides coverage for certain
active duty (AD) service members and
their family members; however, it does
not provide coverage for Reserve
Component (RC) members who have not
been on Active Duty (AD) within the
last 18 months. Furthermore, coverage
under CHCBP is only authorized for 18
months from either separation from AD
or when coverage under the Transitional
Assistance Management Program
(TAMP) (10 U.S.C. 1145) ends. Selected
RC members losing coverage under TRS
do not receive the same extent of
coverage under CHCBP as either
qualified AD members or their family
members.
The change to 10 U.S.C. 1078a
expands CHCBP to include qualified
Reservists. For members of the Selected
Reserves, coverage under CHCBP would
run for 18 months after the date the
member ceases to be entitled to care
under 10 U.S.C. 1076d. In the case of all
other persons, the coverage period is 36
months after the date on which the
person first ceases to be covered under
the military health benefits plan or
transitional health care coverage.
Administrative Changes
CHCBP was directed by Congress in
section 4408 of the National Defense
Authorization Act of Fiscal Year 1993,
Public Law 102–484, which amended
titles 10 U.S.C., by adding section
1078a. The Department of Defense
(DoD) published a final rule regarding
CHCBP in the Federal Register on
September 30, 1994, (59 FR 49817).
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For the majority of beneficiaries,
enrollment in CHCBP is for a specific
and limited period of time. Certain
former spouses, however, may elect to
receive coverage for as long as they wish
(beyond the initial 36-month
enrollment) if they meet certain criteria.
The September 30, 1994, final rule may
have been ambiguous regarding the
criteria for continued CHCBP coverage
for former spouses. If he or she meets
certain criteria specified in this rule,
unlimited enrollment in the CHCBP is
available for a former spouse.
This proposed rule also reflects
administrative changes to accurately
update information regarding the
current CHCBP and TRICARE programs
as follows: Updates the ‘‘CHAMPUS’’
(Civilian Health and Medical Program of
the Uniformed Services) program name
to ‘‘TRICARE’’ when appropriate;
updates the Department of Defense
agency name from ‘‘OCHAMPUS’’ (the
Office of CHAMPUS) to ‘‘TRICARE
Management Activity’’ (TMA); replaces
the reference ‘‘Third Party
Administrator’’ with ‘‘CHCBP
contractor’’ to make it consistent with
the ‘‘contractor’’ term used for TMA
programs; updates ‘‘military health
services system’’ with ‘‘Military Health
System’’; and updates information
regarding the enrollment process both in
terms of the form to be used (DD Form
2837) as well as the documentation
required to verify an applicant’s
eligibility for enrolling.
This proposed rule updates references
to other paragraphs of Section 199.20
by: Changing the title of paragraph (n)
of this section ‘‘Peer Review
Organization Program’’ to ‘‘Quality and
Utilization Review Peer Review
Organization Program;’’ changing the
title of the program in paragraph
(p)(2)(ii) from ‘‘Active Duty Dependents
Dental Plan’’ to ‘‘TRICARE Dental
Program;’’ and by adding to that same
paragraph the ‘‘TRICARE Retiree Dental
Program’’ under Sec. 199.22 as a special
program that is not available to
participants in the CHCBP. In addition,
this proposed rule deletes paragraph
(p)(3) in its entirety, as that subpart
referenced two demonstration projects
that are no longer in existence and
therefore no longer available to CHCBP
participants: The ‘‘Home Health Care
Demonstration’’ and the ‘‘Home Health
Care-Case Management Demonstration.’’
This proposed rule provides for
improved administration of CHCBP by:
Allowing the Department of Defense
and the other Uniformed Services the
ability to delegate to a designee the
responsibility for notifying persons
eligible to receive health benefits under
the CHCBP; requiring supporting
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documentation on any change in status
that would make a child eligible for
CHCBP; allowing notification of a
former spouse’s potential eligibility for
CHCBP to be made by the member,
former member or former spouse;
establishing a 14-day period within
which the CHCBP contractor must
advise former spouses of their potential
eligibility for CHCBP; and discontinuing
the requirement that CHCBP premium
rates be published annually but instead
requiring that the premium rates be
published whenever a change in rate
occurs.
This proposed rule also makes minor
editorial changes in an attempt to
improve understanding of CHCBP
program requirements and processes,
including making grammatical
improvements in the text of Section
199.20.
responsibilities among the various
levels of government, therefore,
consultation with State and local
officials is not required.
II. Regulatory Procedures
PART 199—[AMENDED]
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Public Law
96–354, ‘‘Regulatory Flexibility Act’’ (5
U.S.C. 601)
1. The authority citation for part 199
continues to read as follows:
Executive Order 12866 requires that a
comprehensive regulatory impact
analysis be performed on any
economically significant regulatory
action, defined as one that would result
in an annual effect of $100 million or
more on the national economy or which
would have other substantial 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 which would have a
significant impact on a substantial
number of small entities. This rule is
not an economically significant
regulatory action and will not have a
significant impact on a substantial
number of small entities for purposes of
the RFA, thus this proposed rule is not
subject to any of these requirements.
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3511)
This rule will not impose additional
information collection requirements on
the public. OMB previously cleared the
collection requirements under OMB
Control Number 0704–0364.
Executive Order 13132, ‘‘Federalism’’
We have examined the impact(s) of
the 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
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Sec. 202, Public Law 104–4, ‘‘Unfunded
Mandates Reform Act’’
This rule does not contain unfunded
mandates. It does not contain a Federal
mandate that may result in the
expenditure by State, local and tribunal
governments, in aggregate, or by the
private sector, of $100 million or more
in any one year.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care,
Health insurance, Individuals with
disabilities, Military personnel.
Accordingly, 32 CFR part 199 is
proposed to be amended as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
2. Section 199.20 is revised to read as
follows:
§ 199.20 Continued Health Care Benefit
Program (CHCBP).
(a) Purpose. The CHCBP is a premium
based temporary health care coverage
program that will be available to
qualified beneficiaries (set forth in
paragraph (d)(1) of this section).
Medical coverage under this program
will mirror the benefits offered via the
basic TRICARE program. Premium costs
for this coverage are payable by
enrollees to a Third Party
Administrator. The CHCBP is not part of
the TRICARE program. However, as set
forth in this section, it functions under
most of the rules and procedures of
TRICARE. Because the purpose of the
CHCBP is to provide a continuation
health care benefit for the Department of
Defense and the other uniformed
Services (e.g., NOAA, PHS, and the
Coast Guard) health care beneficiaries
losing eligibility, it will be administered
so that it appears, to the maximum
extent possible, to be part of TRICARE.
(b) General provisions. Except for any
provisions the Director of the TRICARE
Management Activity may exclude, the
general provisions of § 199.1 shall apply
to the CHCBP as they do to TRICARE.
(c) Definitions. Except as may be
specifically provided in this section, to
the extent terms defined in § 199.2 are
relevant to the administration of the
CHCBP, the definitions contained in
that section shall apply to the CHCBP as
they do to TRICARE.
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(d) Eligibility and enrollment. (1)
Eligibility. Enrollment in the CHCBP is
open to the following individuals:
(i) Members of Uniformed Services,
who:
(A) Are discharged or released from
active duty (or full time National Guard
duty), whether voluntarily or
involuntarily, under other than adverse
conditions;
(B) Immediately preceding that
discharge or release, were entitled to
medical and dental care under 10 U.S.C.
1074(a) (except in the case of a member
discharged or released from full-time
National Guard duty); and,
(C) After that discharge or release and
any period of transitional health care
provided under 10 U.S.C. 1145(a) would
not otherwise be eligible for any benefit
under 10 U.S.C. chapter 55.
(ii) A person who:
(A) Ceases to meet requirements for
being considered an unmarried
dependent child of a member or former
member of the armed forces under 10
U.S.C. 1072(2)(D) or an unmarried
dependent of a member of former
member of the uniformed services under
10 U.S.C. 1072(2)(I);
(B) On the day before ceasing to meet
those requirements, was covered under
a health benefits plan under 10 U.S.C.
chapter 55, or transitional health care
under 10 U.S.C. 1145(a) as a dependent
of the member or former member; and,
(C) Would not otherwise be eligible
for any benefits under 10 U.S.C. chapter
55.
(iii) A person who:
(A) Is an unremarried former spouse
of a member or former member of the
uniformed services;
(B) On the day before the date of the
final decree of divorce, dissolution, or
annulment was covered under a health
benefits plan under 10 U.S.C. chapter
55, or transitional health care under 10
U.S.C. 1145(a) as a dependent of the
member or former member; and,
(C) Is not a dependent of the member
or former member under 10 U.S.C.
1072(2)(F) or (G) or ends a one-year
period of dependency under 10 U.S.C.
1072(2)(H).
(iv) An unmarried person who:
(A) Is placed in the legal custody of
a member or former member by a court
or who is placed in the home of a
member or former member by a
recognized placement agency in
anticipation of the legal adoption of the
child; and
(B) Either:
(1) Has not attained the age of 21 if
not in school or age 23 if enrolled in a
full time course of study at an
institution of higher learning; or
(2) Is incapable of self-support
because of a mental or physical
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incapacity which occurred while the
person was considered a dependent of
the member or former member; and
(C) Is dependent on the member or
former member for over one-half of the
person’s support; and
(D) Resides with the member or
former member unless separated by the
necessity of military service or to
receive institutional care as a result of
disability or incapacitation; and
(E) Is not a dependent of a member or
former member as described in
§ 199.3(b)(2).
(2) Effective date. Except for the
special transitional provisions in
paragraph (r) of this section, eligibility
in the CHCBP is limited to individuals
who lost their entitlement to regular
military health services system benefits
on or after October 1, 1994.
(3) Notification of eligibility. (i) The
Department of Defense and the other
Uniformed Services (National Oceanic
and Atmospheric Administration
(NOAA), Public Health Service (PHS),
Coast Guard) will notify persons eligible
to receive health benefits under the
CHCBP.
(ii) In the case of a member who
becomes (or will become) eligible for
continued coverage, the Department of
Defense shall notify the member of their
rights for coverage as part of preseparation counseling conducted under
10 U.S.C. 1142.
(iii) In the case of a dependent of a
member or former member who
becomes eligible for continued coverage
under paragraph (d)(1)(ii) of this
section:
(A) The member or former member
may submit to the CHCBP contractor a
notice with supporting documentation
of the dependent’s change in status
(including the dependent’s name,
address, and such other information
needed); and
(B) The CHCBP contractor, within 14
days after receiving such information,
will inform the dependent of the
dependent’s rights under 10 U.S.C.
1142.
(iv) In the case of a former spouse of
a member or former member who
becomes eligible for continued coverage,
the member, former member or former
spouse may submit to the CHCBP
contractor a notice of the former
spouse’s change in status. The CHCBP
contractor within 14 days after receiving
such information will notify the
individual of their potential eligibility
for CHCBP.
(4) Election of coverage. In order to
obtain coverage under the CHCBP, a
written election by the eligible
beneficiary must be made within a
prescribed time period.
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(i) In the case of a member discharged
or released from active duty (or full-time
National Guard duty), whether
voluntarily or involuntarily, the written
election shall be submitted to the
CHCBP contractor before the end of the
60-day period beginning on the later of:
(A) The date of the discharge or
release of the member from active duty
or full-time National Guard duty; or
(B) The date that the period of
transitional health care applicable to the
member under 10 U.S.C. 1145(a) ends;
or
(C) The date the member receives the
notification required in paragraph
(d)(3)(ii) of this section.
(ii) In the case of a child who ceases
to meet the requirements for being an
unremarried dependent child of a
member or former member under 10
U.S.C. 1072(2)(D), the written election
shall be submitted to the CHCBP
contractor before the end of the 60-day
period beginning on the later of:
(A) the date that the dependent ceases
to meet the definition of a dependent
under 10 U.S.C. 1072(2)(D); or
(B) The date that the dependent
receives the notification required in
paragraph (d)(3)(iii) of this section,
(iii) In the case of former spouse of a
member or former member, the written
election shall be submitted to the
CHCBP contractor before the end of the
60-day period beginning on the later of:
(A) The date as of which the former
spouse first ceases to meet the
requirements for being considered a
dependent under 10 U.S.C. 1072(2); or
(B) Such other date as the Secretary of
Defense may prescribe.
(iv) A member of the armed forces
who is eligible for enrollment under
paragraph (d)(1)(i) of this section may
elect self-only or family coverage.
Family members who may be included
in such family coverage are the spouse
and children of the member.
(v) All other categories eligible for
enrollment under paragraph (d)(1) must
elect self-only coverage.
(5) Enrollment. To enroll in the
CHCBP, an eligible individual must
submit a completed DD Form 2387
‘‘Continued Health Care Benefit
Program (CHCBP) Application,’’
documentation as requested on DD
Form 2387 to verify the applicant’s
eligibility for enrolling in CHCBP, and
payment to cover the quarter’s
premium. The CHCBP contractor may
request additional information and
documentation to confirm the
applicant’s eligibility for CHCBP.
(6) Period of coverage. CHCBP
coverage may not extend beyond:
(i) For a member discharged or
released from active duty (or full-time
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National Guard duty), whether
voluntarily or involuntarily, the date
which is 18 months after the date the
member ceases to be entitled to care
under 10 U.S.C. 1074(a) and any
transitional care under 10 U.S.C. 1145.
(ii) In the case of an child of a member
or former member, the date which is 36
months after the date on which the
person first ceases to meet the
requirements for being considered an
unmarried dependent child under 10
U.S.C. 1072(2)(D).
(iii) In the case of an unremarried
former spouse of a member or former
member, the date which is 36 months
after the later of:
(A) The date on which the final
decree of divorce, dissolution, or
annulment occurs; or
(B) If applicable, the date the one-year
extension of dependency under 10
U.S.C. 1072(2)(H) expires.
(iv) In the case of a former spouse of
a retiree whose marriage was dissolved
after the member retired from the
service, the period of coverage under the
CHCBP is unlimited, if the former
spouse:
(A) Has not remarried before the age
of 55; and
(B) Was enrolled in the CHCBP or
TRICARE as the dependent of a retiree
during the 18-month period before the
date of the divorce, dissolution, or
annulment; and
(C) Is receiving a portion of the retired
or retainer pay of a member or former
member or an annuity based on the
retainer pay of the member; or
(D) Has a court order for payment of
any portion of the retired or retainer
pay; or
(E) Has a written agreement (whether
voluntary or pursuant to a court order)
which provides for an election by the
member or former member to provide an
annuity to the former spouse.
(v) For the beneficiary who becomes
eligible for the CHCBP by ceasing to
meet the requirements for being
considered an unmarried dependent
child of a member or former member,
health care coverage not may extend
beyond the date which is 36 months
after the date the member becomes
ineligible for medical and dental care
under 10 U.S.C. 1074(a) and any
transitional health care under 10 U.S.C.
1145(a).
(vi) Though beneficiaries have sixty
days (60) to elect coverage under the
CHCBP, upon enrolling, the period of
coverage must begin the day after
entitlement to a military health care
plan (including transitional health care
under 10 U.S.C. 1145(a)) ends as though
no break in coverage had occurred.
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(e) CHCBP benefits. (1) In general.
Except as provided in paragraph (e)(2)
of this section, the provisions of § 199.4
shall apply to the CHCBP as they do to
TRICARE.
(2) Exceptions. The following
provisions of Sec. 199.4 are not
applicable to the CHCBP:
(i) Section 199.4 (a)(2) concerning
eligibility.
(ii) All provisions regarding
nonavailability statements or
requirements to use facilities of the
Uniformed Services.
(3) Beneficiary liability. For purposes
of TRICARE deductible and cost-sharing
requirements and catastrophic cap
limits, amounts applicable to the
category of beneficiaries to which the
CHCBP enrollee last belonged shall
continue to apply, except that for
separating active duty members,
amounts applicable to dependents of
active duty members shall apply.
(f) Authorized providers. The
provisions of § 199.6 shall apply to the
CHCBP as they do to TRICARE.
(g) Claims submission, review, and
payment. The provisions of § 199.7 shall
apply to the CHCBP as they do to
TRICARE, except that no provisions
regarding nonavailability statements
shall apply.
(h) Double coverage. The provisions
of § 199.8 shall apply to the CHCBP as
they do to TRICARE.
(i) Administrative remedies for fraud,
abuse, and conflict of interest. The
provisions of § 199.9 shall apply to the
CHCBP as they do to TRICARE.
(j) Appeal and hearing procedures.
The provisions of § 199.10 shall apply to
the CHCBP as they do to TRICARE.
(k) Overpayments recovery. The
provisions of § 199.11 shall apply to the
CHCBP as they do to TRICARE.
(l) Third party recoveries. The
provisions of § 199.12 shall apply to the
CHCBP as they do to TRICARE.
(m) Provider reimbursement methods.
The provisions of § 199.14 shall apply to
the CHCBP as they do to TRICARE.
(n) Quality and Utilization Review
Peer Review Organization Program. The
provisions of § 199.15 shall apply to the
CHCBP as they do to TRICARE.
(o) Preferred provider organization
programs available. Any preferred
provider organization program under
this part that provides for reduced cost
sharing for using designated providers,
such as the ‘‘TRICARE Extra’’ option
under § 199.17, shall be available to
participants in the CHCBP as it is to
TRICARE beneficiaries.
(p) Special programs not applicable.
(1) In general. Special programs
established under this Part that are not
part of the basic TRICARE program
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established pursuant to 10 U.S.C. 1079
and 1086 are not, unless specifically
provided in this section, available to
participants in the CHCBP.
(2) Examples. The special programs
referred to in paragraph (p)(1) of this
section include:
(i) The Program for Persons with
Disabilities under § 199.5;
(ii) The TRICARE Dental Program
under § 199.13;
(iii) The Supplemental Health Care
Program under § 199.16;
(iv) The TRICARE Enrollment
Program under § 199.17, except for
TRICARE Extra program under that
section; and
(v) The TRICARE Retiree Dental
Program under § 199.22.
(q) Premiums. (1) Rates. Premium
rates will be established by the Assistant
Secretary of Defense (Health Affairs) for
two rate groups—individual and family.
Eligible beneficiaries will select the
level of coverage they require at the time
of initial enrollment (either individual
or family) and pay the appropriate
premium payment. The rates are based
on Federal Employees Health Benefits
Program employee and agency
contributions required for a comparable
health benefits plan, plus an
administrative fee. The administrative
fee, not to exceed ten percent of the
basic premium amount, shall be
determined based on actual expected
administrative costs for administration
of the program. Premiums may be
revised annually and shall be published
when the premium amount is changed.
Premiums will be paid by enrollees
quarterly.
(2) Effects of failure to make premium
payments. Failure by enrollees to
submit timely and proper premium
payments will result in denial of
continued enrollment and denial of
payment of medical claims. Premium
payments that are late 30 days or more
past the start of the quarter for which
payment is due will result in the
termination of beneficiary enrollment.
Beneficiaries denied continued
enrollment due to lack of premium
payments will not be allowed to
reenroll. In such a case, benefit coverage
will cease at the end of the ninety-day
(90) period for which a premium
payment was received. Enrollees will be
held liable for medical costs incurred
after losing eligibility.
(r) Transitional provisions. (1) There
will be a sixty-day period of enrollment
for all eligible beneficiaries (outlined in
paragraph (d)(1) of this section) whose
entitlement to regular Military Health
System coverage ended on or after
August 2, 1994, but prior to the CHCBP
implementation on October 1, 1994.
E:\FR\FM\27NOP1.SGM
27NOP1
Federal Register / Vol. 74, No. 227 / Friday, November 27, 2009 / Proposed Rules
(2) Enrollment in the U.S. VIP
program may continue up to October 1,
1994. Policies written prior to October
1, 1994, will remain in effect until the
end of the policy life.
(3) On or after the October 1, 1994,
implementation of the CHCBP,
beneficiaries who enrolled in the U.S.
VIP program prior to October 1, 1994,
may elect to cancel their U.S. VIP policy
and enroll in the CHCBP.
(4) With the exception of persons
enrolled in the U.S. VIP program who
may convert to the CHCBP, individuals
who lost their entitlement to regular
Military Health System coverage prior to
August 2, 1994, are not eligible for the
CHCBP.
(s) Procedures. The Director,
TRICARE Management Activity, may
establish other rules and procedures for
the administration of the Continued
Health Care Benefit Program.
Dated: November 19, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28358 Filed 11–25–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety
Administration
49 CFR Part 599
[Docket No. NHTSA–2009–0120; Notice 1]
RIN 2127–AK67
Requirements and Procedures for
Consumer Assistance To Recycle and
Save Program
jlentini on DSKJ8SOYB1PROD with PROPOSALS
AGENCY: National Highway Traffic
Safety Administration (NHTSA),
Department of Transportation (DOT).
ACTION: Notice of proposed rulemaking.
SUMMARY: This proposed rule would
amend the regulations implementing the
Consumer Assistance to Recycle and
Save (CARS) program, published on July
29, 2009, in the Federal Register, under
the CARS Act. The rule change would
allow disposal facilities an additional 90
days, for a total of 270 days, to crush or
shred a vehicle traded in under the
CARS program. This additional time
would allow the public to benefit from
the availability of lower cost used
vehicle parts from vehicles traded in
under the CARS program and would
provide disposal facilities with an
opportunity to derive more revenue
from those vehicles prior to crushing or
shredding.
VerDate Nov<24>2008
18:16 Nov 25, 2009
Jkt 220001
DATES: Submit comments on or before
December 17, 2009.
ADDRESSES: You may submit comments
electronically [identified by DOT Docket
Number NHTSA–2009–0120] by visiting
the following Web site:
• Federal eRulemaking Portal: Go to
https://www.regulations.gov. Follow the
online instructions for submitting
comments.
Alternatively, you can file comments
using the following methods:
• Mail: Docket Management Facility:
U.S. Department of Transportation, 1200
New Jersey Avenue, SE., West Building
Ground Floor, Room W12–140,
Washington, DC 20590–0001.
• Hand Delivery or Courier: West
Building Ground Floor, Room W12–140,
1200 New Jersey Avenue, SE., between
9 a.m. and 5 p.m. ET, Monday through
Friday, except Federal holidays.
• Fax: (202) 493–2251.
Instructions: For detailed instructions
on submitting comments and additional
information on the rulemaking process,
see the Public Participation heading of
the SUPPLEMENTARY INFORMATION section
of this document. Note that all
comments received will be posted
without change to https://
www.regulations.gov, including any
personal information provided. Please
see the Privacy Act heading below.
Privacy Act: Anyone is able to search
the electronic form of all comments
received into any of our dockets by the
name of the individual submitting the
comment (or signing the comment, if
submitted on behalf of an association,
business, labor union, etc.). You may
review DOT’s complete Privacy Act
Statement in the Federal Register
published on April 11, 2000 (65 FR
19477–78).
Docket: For access to the docket to
read background documents or
comments received, go to https://
www.regulations.gov. Follow the online
instructions for accessing the dockets.
FOR FURTHER INFORMATION CONTACT: For
questions, you may call David Jasinski,
NHTSA Office of Chief Counsel, at (202)
366–5552.
SUPPLEMENTARY INFORMATION:
Current Rule and Proposed Change
This proposed rule would amend the
regulations implementing the Consumer
Assistance to Recycle and Save (CARS)
program, published on July 29, 2009, in
the Federal Register (74 FR 37878),
under the CARS Act (Pub. L. 111–32),
and amended by final rules published
on August 5, 2009 (74 FR 38974), and
September 28, 2009 (74 FR 49338). The
rule change would allow disposal
facilities an additional 90 days, for a
PO 00000
Frm 00019
Fmt 4702
Sfmt 4702
62275
total of 270 days, to crush or shred a
vehicle traded in under the CARS
program. This additional time would
allow the public to benefit from the
availability of lower cost, used vehicle
parts from CARS trade-in vehicles and
would provide disposal facilities with
an opportunity to derive more revenue
from those vehicles prior to crushing or
shredding thereby providing additional
economic benefit from the CARS
program.
Section 1302(c)(2) of the CARS Act
grants the agency discretion to
determine the appropriate time period
in which a disposal facility must crush
a vehicle. The rule currently requires a
disposal facility that receives a vehicle
traded in under the CARS program to
crush or shred the vehicle within 180
days of receipt of the vehicle. 49 CFR
599.401(a)(3). After consulting with
representatives of disposal facilities, the
agency determined that 180 days was an
appropriate amount of time to allow a
disposal facility to possess a car prior to
crushing or shredding. The allowed
time period was determined based upon
an estimate that 250,000 vehicles would
be traded in under the CARS program
and that the program’s duration would
be four months.
Due to the enormous popularity of the
CARS program, the initial $1 billion in
available funds were quickly depleted
and, on August 7, 2009, Congress
provided the CARS program with an
additional $2 billion (Pub. L. 111–47).
On August 25, 2009, approximately one
month after the CARS program began,
the agency stopped accepting new
submissions because the additional
funds were also depleted. By that time,
nearly 700,000 new vehicles had been
sold under the CARS program.
Shortly after new CARS program
transactions ceased and the majority of
the dealers’ transactions were
reimbursed by NHTSA, a representative
of disposal facilities requested a meeting
with NHTSA officials to discuss the
possibility of extending the 180-day
time period for crushing or shredding a
trade-in vehicle. Although disposal
facilities initially expected to receive
250,000 CARS trade-in vehicles spread
out over four months, disposal facilities
actually received nearly 700,000 CARS
trade-in vehicles. Further, the majority
of the CARS trade-in vehicles were
received within less than one month.
At a September 29, 2009, meeting 1
with disposal facility representatives,
agency officials learned that some
disposal facilities were experiencing
1 A memorandum summarizing the meeting has
been placed in the docket. (Docket No. NHTSA–
2009–0120).
E:\FR\FM\27NOP1.SGM
27NOP1
Agencies
[Federal Register Volume 74, Number 227 (Friday, November 27, 2009)]
[Proposed Rules]
[Pages 62271-62275]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-28358]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD-2009-HA-0068; RIN 0720-AB30]
32 CFR Part 199
TRICARE; Continued Health Care Benefit Program Expansion
AGENCY: Department of Defense.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: This proposed rule executes the expansion of section 1078a of
title 10, United States Code. With the recent expansions of the
Military Health System (MHS) coverage, particularly with the Reserve
Component members, some MHS beneficiaries would not be eligible for
CHCBP under certain circumstances that terminate their MHS coverage.
This provision allows the Secretary to establish CHCBP eligibility for
any categories of MHS beneficiaries who otherwise would lose MHS
coverage with no continued care eligibility. This proposed rule also
includes administrative changes providing clarification on some issues
and updates the final rule published in the Federal Register on
September 30, 1994, (59 FR 49817).
DATES: Comments must be received on or before January 26, 2010.
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://www.regulations.gov as they are received without change, including any
personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: Kathleen Larkin, 703-681-0039.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
Section 713 of the National Defense Authorization Act (NDAA) for
Fiscal Year 2004 authorized coverage for uniformed services rather than
armed services. Section 705 of the NDAA for Fiscal Year 2008 authorizes
the expansion of persons eligible for the Continued Health Care Benefit
Program (CHCBP) under Title 10 of the United States Code, section
1078a. CHCBP is the program that provides continued healthcare coverage
for MHS beneficiaries who lose their MHS eligibility. It is modeled
after private sector ``COBRA Coverage,'' with the individual paying
100% of the program cost plus an amount to cover administrative
expenses. Currently, CHCBP provides coverage for certain active duty
(AD) service members and their family members; however, it does not
provide coverage for Reserve Component (RC) members who have not been
on Active Duty (AD) within the last 18 months. Furthermore, coverage
under CHCBP is only authorized for 18 months from either separation
from AD or when coverage under the Transitional Assistance Management
Program (TAMP) (10 U.S.C. 1145) ends. Selected RC members losing
coverage under TRS do not receive the same extent of coverage under
CHCBP as either qualified AD members or their family members.
The change to 10 U.S.C. 1078a expands CHCBP to include qualified
Reservists. For members of the Selected Reserves, coverage under CHCBP
would run for 18 months after the date the member ceases to be entitled
to care under 10 U.S.C. 1076d. In the case of all other persons, the
coverage period is 36 months after the date on which the person first
ceases to be covered under the military health benefits plan or
transitional health care coverage.
Administrative Changes
CHCBP was directed by Congress in section 4408 of the National
Defense Authorization Act of Fiscal Year 1993, Public Law 102-484,
which amended titles 10 U.S.C., by adding section 1078a. The Department
of Defense (DoD) published a final rule regarding CHCBP in the Federal
Register on September 30, 1994, (59 FR 49817).
[[Page 62272]]
For the majority of beneficiaries, enrollment in CHCBP is for a
specific and limited period of time. Certain former spouses, however,
may elect to receive coverage for as long as they wish (beyond the
initial 36-month enrollment) if they meet certain criteria. The
September 30, 1994, final rule may have been ambiguous regarding the
criteria for continued CHCBP coverage for former spouses. If he or she
meets certain criteria specified in this rule, unlimited enrollment in
the CHCBP is available for a former spouse.
This proposed rule also reflects administrative changes to
accurately update information regarding the current CHCBP and TRICARE
programs as follows: Updates the ``CHAMPUS'' (Civilian Health and
Medical Program of the Uniformed Services) program name to ``TRICARE''
when appropriate; updates the Department of Defense agency name from
``OCHAMPUS'' (the Office of CHAMPUS) to ``TRICARE Management Activity''
(TMA); replaces the reference ``Third Party Administrator'' with
``CHCBP contractor'' to make it consistent with the ``contractor'' term
used for TMA programs; updates ``military health services system'' with
``Military Health System''; and updates information regarding the
enrollment process both in terms of the form to be used (DD Form 2837)
as well as the documentation required to verify an applicant's
eligibility for enrolling.
This proposed rule updates references to other paragraphs of
Section 199.20 by: Changing the title of paragraph (n) of this section
``Peer Review Organization Program'' to ``Quality and Utilization
Review Peer Review Organization Program;'' changing the title of the
program in paragraph (p)(2)(ii) from ``Active Duty Dependents Dental
Plan'' to ``TRICARE Dental Program;'' and by adding to that same
paragraph the ``TRICARE Retiree Dental Program'' under Sec. 199.22 as a
special program that is not available to participants in the CHCBP. In
addition, this proposed rule deletes paragraph (p)(3) in its entirety,
as that subpart referenced two demonstration projects that are no
longer in existence and therefore no longer available to CHCBP
participants: The ``Home Health Care Demonstration'' and the ``Home
Health Care-Case Management Demonstration.''
This proposed rule provides for improved administration of CHCBP
by: Allowing the Department of Defense and the other Uniformed Services
the ability to delegate to a designee the responsibility for notifying
persons eligible to receive health benefits under the CHCBP; requiring
supporting documentation on any change in status that would make a
child eligible for CHCBP; allowing notification of a former spouse's
potential eligibility for CHCBP to be made by the member, former member
or former spouse; establishing a 14-day period within which the CHCBP
contractor must advise former spouses of their potential eligibility
for CHCBP; and discontinuing the requirement that CHCBP premium rates
be published annually but instead requiring that the premium rates be
published whenever a change in rate occurs.
This proposed rule also makes minor editorial changes in an attempt
to improve understanding of CHCBP program requirements and processes,
including making grammatical improvements in the text of Section
199.20.
II. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Public
Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)
Executive Order 12866 requires that a comprehensive regulatory
impact analysis be performed on any economically significant regulatory
action, defined as one that would result in an annual effect of $100
million or more on the national economy or which would have other
substantial 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
which would have a significant impact on a substantial number of small
entities. This rule is not an economically significant regulatory
action and will not have a significant impact on a substantial number
of small entities for purposes of the RFA, thus this proposed rule is
not subject to any of these requirements.
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)
This rule will not impose additional information collection
requirements on the public. OMB previously cleared the collection
requirements under OMB Control Number 0704-0364.
Executive Order 13132, ``Federalism''
We have examined the impact(s) of the 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.
Sec. 202, Public Law 104-4, ``Unfunded Mandates Reform Act''
This rule does not contain unfunded mandates. It does not contain a
Federal mandate that may result in the expenditure by State, local and
tribunal governments, in aggregate, or by the private sector, of $100
million or more in any one year.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
Accordingly, 32 CFR part 199 is proposed to be amended as follows:
PART 199--[AMENDED]
1. The authority citation for part 199 continues to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
2. Section 199.20 is revised to read as follows:
Sec. 199.20 Continued Health Care Benefit Program (CHCBP).
(a) Purpose. The CHCBP is a premium based temporary health care
coverage program that will be available to qualified beneficiaries (set
forth in paragraph (d)(1) of this section). Medical coverage under this
program will mirror the benefits offered via the basic TRICARE program.
Premium costs for this coverage are payable by enrollees to a Third
Party Administrator. The CHCBP is not part of the TRICARE program.
However, as set forth in this section, it functions under most of the
rules and procedures of TRICARE. Because the purpose of the CHCBP is to
provide a continuation health care benefit for the Department of
Defense and the other uniformed Services (e.g., NOAA, PHS, and the
Coast Guard) health care beneficiaries losing eligibility, it will be
administered so that it appears, to the maximum extent possible, to be
part of TRICARE.
(b) General provisions. Except for any provisions the Director of
the TRICARE Management Activity may exclude, the general provisions of
Sec. 199.1 shall apply to the CHCBP as they do to TRICARE.
(c) Definitions. Except as may be specifically provided in this
section, to the extent terms defined in Sec. 199.2 are relevant to the
administration of the CHCBP, the definitions contained in that section
shall apply to the CHCBP as they do to TRICARE.
[[Page 62273]]
(d) Eligibility and enrollment. (1) Eligibility. Enrollment in the
CHCBP is open to the following individuals:
(i) Members of Uniformed Services, who:
(A) Are discharged or released from active duty (or full time
National Guard duty), whether voluntarily or involuntarily, under other
than adverse conditions;
(B) Immediately preceding that discharge or release, were entitled
to medical and dental care under 10 U.S.C. 1074(a) (except in the case
of a member discharged or released from full-time National Guard duty);
and,
(C) After that discharge or release and any period of transitional
health care provided under 10 U.S.C. 1145(a) would not otherwise be
eligible for any benefit under 10 U.S.C. chapter 55.
(ii) A person who:
(A) Ceases to meet requirements for being considered an unmarried
dependent child of a member or former member of the armed forces under
10 U.S.C. 1072(2)(D) or an unmarried dependent of a member of former
member of the uniformed services under 10 U.S.C. 1072(2)(I);
(B) On the day before ceasing to meet those requirements, was
covered under a health benefits plan under 10 U.S.C. chapter 55, or
transitional health care under 10 U.S.C. 1145(a) as a dependent of the
member or former member; and,
(C) Would not otherwise be eligible for any benefits under 10
U.S.C. chapter 55.
(iii) A person who:
(A) Is an unremarried former spouse of a member or former member of
the uniformed services;
(B) On the day before the date of the final decree of divorce,
dissolution, or annulment was covered under a health benefits plan
under 10 U.S.C. chapter 55, or transitional health care under 10 U.S.C.
1145(a) as a dependent of the member or former member; and,
(C) Is not a dependent of the member or former member under 10
U.S.C. 1072(2)(F) or (G) or ends a one-year period of dependency under
10 U.S.C. 1072(2)(H).
(iv) An unmarried person who:
(A) Is placed in the legal custody of a member or former member by
a court or who is placed in the home of a member or former member by a
recognized placement agency in anticipation of the legal adoption of
the child; and
(B) Either:
(1) Has not attained the age of 21 if not in school or age 23 if
enrolled in a full time course of study at an institution of higher
learning; or
(2) Is incapable of self-support because of a mental or physical
incapacity which occurred while the person was considered a dependent
of the member or former member; and
(C) Is dependent on the member or former member for over one-half
of the person's support; and
(D) Resides with the member or former member unless separated by
the necessity of military service or to receive institutional care as a
result of disability or incapacitation; and
(E) Is not a dependent of a member or former member as described in
Sec. 199.3(b)(2).
(2) Effective date. Except for the special transitional provisions
in paragraph (r) of this section, eligibility in the CHCBP is limited
to individuals who lost their entitlement to regular military health
services system benefits on or after October 1, 1994.
(3) Notification of eligibility. (i) The Department of Defense and
the other Uniformed Services (National Oceanic and Atmospheric
Administration (NOAA), Public Health Service (PHS), Coast Guard) will
notify persons eligible to receive health benefits under the CHCBP.
(ii) In the case of a member who becomes (or will become) eligible
for continued coverage, the Department of Defense shall notify the
member of their rights for coverage as part of pre-separation
counseling conducted under 10 U.S.C. 1142.
(iii) In the case of a dependent of a member or former member who
becomes eligible for continued coverage under paragraph (d)(1)(ii) of
this section:
(A) The member or former member may submit to the CHCBP contractor
a notice with supporting documentation of the dependent's change in
status (including the dependent's name, address, and such other
information needed); and
(B) The CHCBP contractor, within 14 days after receiving such
information, will inform the dependent of the dependent's rights under
10 U.S.C. 1142.
(iv) In the case of a former spouse of a member or former member
who becomes eligible for continued coverage, the member, former member
or former spouse may submit to the CHCBP contractor a notice of the
former spouse's change in status. The CHCBP contractor within 14 days
after receiving such information will notify the individual of their
potential eligibility for CHCBP.
(4) Election of coverage. In order to obtain coverage under the
CHCBP, a written election by the eligible beneficiary must be made
within a prescribed time period.
(i) In the case of a member discharged or released from active duty
(or full-time National Guard duty), whether voluntarily or
involuntarily, the written election shall be submitted to the CHCBP
contractor before the end of the 60-day period beginning on the later
of:
(A) The date of the discharge or release of the member from active
duty or full-time National Guard duty; or
(B) The date that the period of transitional health care applicable
to the member under 10 U.S.C. 1145(a) ends; or
(C) The date the member receives the notification required in
paragraph (d)(3)(ii) of this section.
(ii) In the case of a child who ceases to meet the requirements for
being an unremarried dependent child of a member or former member under
10 U.S.C. 1072(2)(D), the written election shall be submitted to the
CHCBP contractor before the end of the 60-day period beginning on the
later of:
(A) the date that the dependent ceases to meet the definition of a
dependent under 10 U.S.C. 1072(2)(D); or
(B) The date that the dependent receives the notification required
in paragraph (d)(3)(iii) of this section,
(iii) In the case of former spouse of a member or former member,
the written election shall be submitted to the CHCBP contractor before
the end of the 60-day period beginning on the later of:
(A) The date as of which the former spouse first ceases to meet the
requirements for being considered a dependent under 10 U.S.C. 1072(2);
or
(B) Such other date as the Secretary of Defense may prescribe.
(iv) A member of the armed forces who is eligible for enrollment
under paragraph (d)(1)(i) of this section may elect self-only or family
coverage. Family members who may be included in such family coverage
are the spouse and children of the member.
(v) All other categories eligible for enrollment under paragraph
(d)(1) must elect self-only coverage.
(5) Enrollment. To enroll in the CHCBP, an eligible individual must
submit a completed DD Form 2387 ``Continued Health Care Benefit Program
(CHCBP) Application,'' documentation as requested on DD Form 2387 to
verify the applicant's eligibility for enrolling in CHCBP, and payment
to cover the quarter's premium. The CHCBP contractor may request
additional information and documentation to confirm the applicant's
eligibility for CHCBP.
(6) Period of coverage. CHCBP coverage may not extend beyond:
(i) For a member discharged or released from active duty (or full-
time
[[Page 62274]]
National Guard duty), whether voluntarily or involuntarily, the date
which is 18 months after the date the member ceases to be entitled to
care under 10 U.S.C. 1074(a) and any transitional care under 10 U.S.C.
1145.
(ii) In the case of an child of a member or former member, the date
which is 36 months after the date on which the person first ceases to
meet the requirements for being considered an unmarried dependent child
under 10 U.S.C. 1072(2)(D).
(iii) In the case of an unremarried former spouse of a member or
former member, the date which is 36 months after the later of:
(A) The date on which the final decree of divorce, dissolution, or
annulment occurs; or
(B) If applicable, the date the one-year extension of dependency
under 10 U.S.C. 1072(2)(H) expires.
(iv) In the case of a former spouse of a retiree whose marriage was
dissolved after the member retired from the service, the period of
coverage under the CHCBP is unlimited, if the former spouse:
(A) Has not remarried before the age of 55; and
(B) Was enrolled in the CHCBP or TRICARE as the dependent of a
retiree during the 18-month period before the date of the divorce,
dissolution, or annulment; and
(C) Is receiving a portion of the retired or retainer pay of a
member or former member or an annuity based on the retainer pay of the
member; or
(D) Has a court order for payment of any portion of the retired or
retainer pay; or
(E) Has a written agreement (whether voluntary or pursuant to a
court order) which provides for an election by the member or former
member to provide an annuity to the former spouse.
(v) For the beneficiary who becomes eligible for the CHCBP by
ceasing to meet the requirements for being considered an unmarried
dependent child of a member or former member, health care coverage not
may extend beyond the date which is 36 months after the date the member
becomes ineligible for medical and dental care under 10 U.S.C. 1074(a)
and any transitional health care under 10 U.S.C. 1145(a).
(vi) Though beneficiaries have sixty days (60) to elect coverage
under the CHCBP, upon enrolling, the period of coverage must begin the
day after entitlement to a military health care plan (including
transitional health care under 10 U.S.C. 1145(a)) ends as though no
break in coverage had occurred.
(e) CHCBP benefits. (1) In general. Except as provided in paragraph
(e)(2) of this section, the provisions of Sec. 199.4 shall apply to
the CHCBP as they do to TRICARE.
(2) Exceptions. The following provisions of Sec. 199.4 are not
applicable to the CHCBP:
(i) Section 199.4 (a)(2) concerning eligibility.
(ii) All provisions regarding nonavailability statements or
requirements to use facilities of the Uniformed Services.
(3) Beneficiary liability. For purposes of TRICARE deductible and
cost-sharing requirements and catastrophic cap limits, amounts
applicable to the category of beneficiaries to which the CHCBP enrollee
last belonged shall continue to apply, except that for separating
active duty members, amounts applicable to dependents of active duty
members shall apply.
(f) Authorized providers. The provisions of Sec. 199.6 shall apply
to the CHCBP as they do to TRICARE.
(g) Claims submission, review, and payment. The provisions of Sec.
199.7 shall apply to the CHCBP as they do to TRICARE, except that no
provisions regarding nonavailability statements shall apply.
(h) Double coverage. The provisions of Sec. 199.8 shall apply to
the CHCBP as they do to TRICARE.
(i) Administrative remedies for fraud, abuse, and conflict of
interest. The provisions of Sec. 199.9 shall apply to the CHCBP as
they do to TRICARE.
(j) Appeal and hearing procedures. The provisions of Sec. 199.10
shall apply to the CHCBP as they do to TRICARE.
(k) Overpayments recovery. The provisions of Sec. 199.11 shall
apply to the CHCBP as they do to TRICARE.
(l) Third party recoveries. The provisions of Sec. 199.12 shall
apply to the CHCBP as they do to TRICARE.
(m) Provider reimbursement methods. The provisions of Sec. 199.14
shall apply to the CHCBP as they do to TRICARE.
(n) Quality and Utilization Review Peer Review Organization
Program. The provisions of Sec. 199.15 shall apply to the CHCBP as
they do to TRICARE.
(o) Preferred provider organization programs available. Any
preferred provider organization program under this part that provides
for reduced cost sharing for using designated providers, such as the
``TRICARE Extra'' option under Sec. 199.17, shall be available to
participants in the CHCBP as it is to TRICARE beneficiaries.
(p) Special programs not applicable. (1) In general. Special
programs established under this Part that are not part of the basic
TRICARE program established pursuant to 10 U.S.C. 1079 and 1086 are
not, unless specifically provided in this section, available to
participants in the CHCBP.
(2) Examples. The special programs referred to in paragraph (p)(1)
of this section include:
(i) The Program for Persons with Disabilities under Sec. 199.5;
(ii) The TRICARE Dental Program under Sec. 199.13;
(iii) The Supplemental Health Care Program under Sec. 199.16;
(iv) The TRICARE Enrollment Program under Sec. 199.17, except for
TRICARE Extra program under that section; and
(v) The TRICARE Retiree Dental Program under Sec. 199.22.
(q) Premiums. (1) Rates. Premium rates will be established by the
Assistant Secretary of Defense (Health Affairs) for two rate groups--
individual and family. Eligible beneficiaries will select the level of
coverage they require at the time of initial enrollment (either
individual or family) and pay the appropriate premium payment. The
rates are based on Federal Employees Health Benefits Program employee
and agency contributions required for a comparable health benefits
plan, plus an administrative fee. The administrative fee, not to exceed
ten percent of the basic premium amount, shall be determined based on
actual expected administrative costs for administration of the program.
Premiums may be revised annually and shall be published when the
premium amount is changed. Premiums will be paid by enrollees
quarterly.
(2) Effects of failure to make premium payments. Failure by
enrollees to submit timely and proper premium payments will result in
denial of continued enrollment and denial of payment of medical claims.
Premium payments that are late 30 days or more past the start of the
quarter for which payment is due will result in the termination of
beneficiary enrollment. Beneficiaries denied continued enrollment due
to lack of premium payments will not be allowed to reenroll. In such a
case, benefit coverage will cease at the end of the ninety-day (90)
period for which a premium payment was received. Enrollees will be held
liable for medical costs incurred after losing eligibility.
(r) Transitional provisions. (1) There will be a sixty-day period
of enrollment for all eligible beneficiaries (outlined in paragraph
(d)(1) of this section) whose entitlement to regular Military Health
System coverage ended on or after August 2, 1994, but prior to the
CHCBP implementation on October 1, 1994.
[[Page 62275]]
(2) Enrollment in the U.S. VIP program may continue up to October
1, 1994. Policies written prior to October 1, 1994, will remain in
effect until the end of the policy life.
(3) On or after the October 1, 1994, implementation of the CHCBP,
beneficiaries who enrolled in the U.S. VIP program prior to October 1,
1994, may elect to cancel their U.S. VIP policy and enroll in the
CHCBP.
(4) With the exception of persons enrolled in the U.S. VIP program
who may convert to the CHCBP, individuals who lost their entitlement to
regular Military Health System coverage prior to August 2, 1994, are
not eligible for the CHCBP.
(s) Procedures. The Director, TRICARE Management Activity, may
establish other rules and procedures for the administration of the
Continued Health Care Benefit Program.
Dated: November 19, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-28358 Filed 11-25-09; 8:45 am]
BILLING CODE 5001-06-P