TRICARE; Continued Health Care Benefit Program Expansion, 57637-57641 [2011-23760]
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Federal Register / Vol. 76, No. 180 / Friday, September 16, 2011 / Rules and Regulations
agency must issue a rule justifying the
exemption.
The new systems of records may
include investigatory materials
compiled in connection with the
Commission’s enforcement of the
federal securities laws, in connection
with potential or actual incidents of
workplace violence, or in connections
with complaints, inquiries or requests
from the public. The Commission and
investors will benefit from the
amendments, because in their absence
the potential access to or disclosure of
the investigatory materials in these
systems of records could seriously
undermine the effective enforcement of
the Federal securities laws, and could
jeopardize the safety and security of
Commission employees in the
workplace.
We recognize that the proposed
amendments may impose costs on
individuals who may wish to obtain
access to records that contain
investigatory materials in these systems
of records. We have no way of
estimating the potential number of
individuals who might in the future
desire such access. Nevertheless, the
benefits of exempting those records
from public access are compelling, and
they clearly justify the costs of the
exemption. In addition, Congress was
aware of such potential costs when they
promulgated the specific exemption in 5
U.S.C. 552a(k)(2). The Commission
discussed these costs and benefits in the
proposing release and received no
comments on them.
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Regulatory Flexibility Act Certification
Pursuant to the requirements of the
Regulatory Flexibility Act, 5 U.S.C. 601–
612, SEC certified that these regulations
would not significantly affect a
substantial number of small entities.
The rule imposes no duties or
obligations on small entities. Further, in
accordance with the provisions of the
Paperwork Reduction Act of 1995, 44
U.S.C. 3501, SEC has determined that
this rule would not impose new
recordkeeping, application, reporting, or
other types of information collection
requirements. The Commission
provided this certification in the
proposing release and received no
comments.
List of Subjects in 17 CFR Part 200
Administrative practice and
procedure; Privacy.
Text of Amendments
For the reasons set out in the
preamble, Title 17, Chapter II, of the
Code of Federal Regulations is amended
as follows:
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PART 200—ORGANIZATION;
CONDUCT AND ETHICS; AND
INFORMATION AND REQUESTS
1. The authority citation for Part 200
is amended by adding authority for
§ 200.312 in numerical order to read as
follows:
■
57637
By the Commission.
Dated: September 12, 2011.
Elizabeth M. Murphy,
Secretary.
[FR Doc. 2011–23732 Filed 9–15–11; 8:45 am]
BILLING CODE 8011–01–P
Authority: 15 U.S.C. 77o, 77s, 77sss, 78d,
78d–1, 78d–2, 78w, 78ll(d), 78mm, 80a–37,
80b–11, and 7202, unless otherwise noted.
DEPARTMENT OF DEFENSE
*
Office of the Secretary
*
*
*
*
Section 200.312 is also issued under 5
U.S.C. 552a(k).
*
*
*
*
32 CFR Part 199
*
[DOD–2009–HA–0068]
Subpart H—Regulations Pertaining to
the Privacy of Individuals and Systems
of Records Maintained by the
Commission
2. Amend § 200.312 by:
a. Removing ‘‘and’’ at the end of
paragraph (a)(5);
■ b. Removing the period at the end of
paragraph (a)(6) and adding a semicolon
in its place;
■ c. Adding paragraphs (a)(7), (a)(8) and
(a)(9);
■ d. Revising paragraph (b); and
■ e. Removing the authority citation at
the end of the section.
The additions and revision read as
follows.
■
■
§ 200.312
Specific exemptions.
*
*
*
*
*
(a) * * *
(7) Tips, Complaints, and Referrals
(TCR) Records;
(8) SEC Security in the Workplace
Incident Records; and
(9) Investor Response Information
System (IRIS).
(b) Pursuant to 5 U.S.C. 552a(k)(5), the
system of records containing the
Commission’s Disciplinary and Adverse
Actions, Employee Conduct, and Labor
Relations Files shall be exempt from
sections (c)(3), (d), (e)(1), (e)(4)(G), (H),
and (I), and (f) of the Privacy Act, 5
U.S.C. 552a(c)(3), (d), (e)(1), (e)(4)(G),
(e)(4)(H), and (e)(4)(I), and (f), and 17
CFR 200.303, 200.304, and 200.306
insofar as they contain investigatory
material compiled to determine an
individual’s suitability, eligibility, and
qualifications for Federal civilian
employment or access to classified
information, but only to the extent that
the disclosure of such material would
reveal the identity of a source who
furnished information to the
Government under an express promise
that the identity of the source would be
held in confidence, or, prior to
September 27, 1975, under an implied
promise that the identity of the source
would be held in confidence.
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RIN 0720–AB30
TRICARE; Continued Health Care
Benefit Program Expansion
Office of the Secretary,
Department of Defense.
ACTION: Final rule.
AGENCY:
This final rule executes the
expansion of section 1078a of title 10,
United States Code (U.S.C). With the
recent expansions of Military Health
System (MHS) coverage, particularly
with the Reserve Component (RC)
members, some MHS beneficiaries
would not be eligible to purchase
Continued Health Care Benefit Program
(CHCBP) coverage under certain
circumstances that terminate their MHS
coverage. This provision allows the
Secretary to establish CHCBP eligibility
for any category of MHS beneficiaries
who otherwise would lose MHS
coverage with no continued care
eligibility. Although the proposed rule
listed each authorized category of MHS
beneficiary eligible to receive care, on
further examination this format for the
rule appeared cumbersome and perhaps
confusing. Thus this final rule contains
some organizational changes to simplify
the rule to enhance understanding and
make clear that any category including
future categories of beneficiaries are
entitled to purchase this CHCBP
coverage. This final rule also includes
administrative changes providing
clarification on eligibility notifications
and the CHCBP premium rate
publication process. It updates the
previous final rule published in the
Federal Register on September 30, 1994.
DATES: Effective Date: October 17, 2011.
FOR FURTHER INFORMATION CONTACT: Mr.
Mark Ellis, TRICARE Policy and
Operations, TRICARE Management
Activity, 5111 Leesburg Pike, Suite 810,
Falls Church, VA 22041, telephone
(703) 681–0039.
SUPPLEMENTARY INFORMATION:
SUMMARY:
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I. Introduction and Background
CHCBP is the program that provides
continued health care coverage for
eligible beneficiaries who lose their
MHS eligibility. It was initially
established by Congress in section 4408
of the National Defense Authorization
Act (NDAA) for Fiscal Year (FY) 1993,
Public Law 102–484, which amended
title 10 U.S.C., by adding section 1078a.
The Department of Defense (DoD)
published the initial final rule regarding
CHCBP in the Federal Register on
September 30, 1994, (59 FR 49817). It is
modeled after private sector insurance
programs giving some employees the
ability to continue health insurance
coverage after leaving employment as
authorized by the Consolidated
Omnibus Budget Reconciliation Act
(COBRA) of 1985. ‘‘COBRA Coverage’’
requires the individual to pay up to
100 percent of the program cost plus an
amount to cover administrative
expenses.
Section 713 of the NDAA for FY 2004
expanded the category of persons
authorized coverage to include the
uniformed services that are not armed
forces. A final rule implementing this
change was published in the Federal
Register on September 30, 1994. The
statute was again amended by Section
705 of the NDAA for FY 2008 which
authorized the expansion of persons
eligible for the CHCBP under 10 U.S.C.
1078a to include any person specified
by regulation prescribed by the
Secretary who was authorized coverage
under 10 U.S.C. chapter 55 and who
loses that eligibility. The proposed rule
to implement this change was published
in the Federal Register on November 27,
2009. The intent of the proposed rule
and this final rule is to specify that any
person who is currently authorized
coverage under 10 U.S.C. chapter 55 or
10 U.S.C. 1145(a) and any person who
may in the future be authorized
coverage under chapter 55 of 10 U.S.C.
or 10 U.S.C. 1145(a) and who loses that
eligibility shall be authorized coverage
under the CHCBP.
Currently, CHCBP provides coverage
for certain active duty (AD) service
members and their family members as
well as RC members and their families.
The coverage period is up to 36 months
after the date on which the person first
ceases to be covered under his or her
respective program eligibility. However,
for RC members the coverage is for
18 months from either separation from
AD or when coverage under the
Transitional Assistance Management
Program (TAMP) (10 U.S.C. 1145(a))
ends.
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The 2008 change to 10 U.S.C. 1078a
expands CHCBP to all who the Secretary
specifies in regulation who lose
entitlement or eligibility to health care
services under 10 U.S.C. chapter 55
Therefore, members or former members
of the RC, such as TRICARE Reserve
Select under 10 U.S.C. 1076d or
TRICARE Retired Reserve under 10
U.S.C. Section 1076e coverage under
CHCBP will now run for 18 months after
the date the member ceases to be
eligible for benefits under their
respective Reserve program’s eligibility.
The rule also standardizes the number
of days that a written election by an
eligible beneficiary must be made to
sixty (60) days after loss of entitlement
or eligibility. Previously, those losing
eligibility for TRICARE Reserve Select
had only thirty (30) days to elect CHCBP
coverage. The rule clarifies that
individual locked out of other TRICARE
plans per the other TRICARE program
rules are not eligible to purchase
CHCBP.
II. Public Comments
The proposed rule was published in
the Federal Register on November 27,
2009 (74 FR 62271), for a 60-day
comment period. We received
comments from one individual. We
thank the commenter for his comments.
Specific matters raised are summarized
below.
Comment: One commenter said the
final changes to the CHCBP could be
extremely beneficial to current and
former service members, but that
eligibility for health care for National
Guard/RC members after the member
ceases to be entitled to care under 10
U.S.C. 1074(a) (AD) or 10 U.S.C. 1145(a)
(TAMP) should be extended to at least
24 months to maximize the opportunity
for care. The commenter noted many
health issues that service members are
experiencing in theater need more time
to be fully understood by the member
and to be officially diagnosed. By
extending an additional six months,
service members who may be in denial
about health issues or who may be
having trouble transitioning to ‘‘civilian’’
life would have more time to obtain
medical and dental care.
Response: The period of CHCBP
eligibility after a period of AD or TAMP
is limited by statute to 18 months.
However, the 6 months of TAMP plus
the 18 months of CHCBP allows the
member the opportunity for 24 months
of care.
Comment: One comment asked for
clarity as to how long a ‘‘specific and
limited period of time’’ CHCBP can
continue.
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Response: Eligibility timeframes for
CHCBP vary by beneficiary category and
are outlined in 32 CFR 199.20(d)(1).
Comment: One comment asked who
would be considered a ‘‘certain former
spouse’’ who is eligible for CHCBP.
Response: Eligibility for unremarried
former spouses is outlined in 32 CFR
199.20(d)(1)(iii).
III. Provisions of Final Rule
This rule expands eligibility to
purchase CHCBP coverage for any
beneficiary that loses entitlement or
eligibility for medical care under 10
U.S.C. chapter 55 or 10 U.S.C. 1145(a),
subject to the coverage limits of 10
U.S.C. 1078a.
The final rule incorporates a number
of revisions from the proposed rule to
clarify the expanded coverage adopted
by Congress in section 705 of the NDAA
for FY 2008 to ensure that all future
beneficiaries under 10 U.S.C. chapter 55
or 10 U.S.C. 1145 who lose eligibility for
care under those parts will be eligible to
purchase CHCBP. For example in
relation to coverage of RC personnel and
their family members, the children of
RC personnel who are covered
dependent children under TRS and who
reach the coverage age limit will have
the same CHCBP eligibility as their
counterparts who are children of AD
personnel. As another example, a
surviving spouse and child of a RC
member who dies and who were
covered by TRR will have the
opportunity to obtain CHCBP coverage
for up to three years after TRR coverage
ends.
Administrative Changes
This final 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 to the CHCBP contractor 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. There have been
no changes in this final rule from the
proposed rule on these administrative
matters.
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This final 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 § 199.20.
There have been a few minor changes in
this final rule from the proposed rule on
these editorial matters. These include
reference to the ‘‘TRICARE Standard
program’’ vice the TRICARE basic
program; reference to the ‘‘CHCBP
contractor’’ vice the ‘‘Third Party
Administrator;’’ and reference to
members of the ‘‘uniformed services’’
where the term ‘‘armed forces’’ was
inadvertently used. Finally, the final
rule includes a conforming change to
§ 199.24, deleting the paragraph that
addressed the relationship between TRS
and the CHCBP. That relationship is not
covered by the revised provisions in
§ 199.20, which governs the CHCBP.
This final rule also contains
administrative changes to 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 to
require the use of the enrollment
applications or DD Form as designated
by the Director, TRICARE as well as the
documentation required to verify an
applicant’s eligibility for enrollment.
This final rule contains administrative
changes to other paragraphs of Title 32
Code of Federal Regulations,
specifically in § 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 § 199.22 as a
special program that is not available to
participants in the CHCBP. In addition,
this final 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:
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The ‘‘Home Health Care Demonstration’’
and the ‘‘Home Health Care—Case
Management Demonstration.’’ There
have been no changes in this final rule
from the proposed rule on these
references.
IV. Regulatory Procedures
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 final rule is not
subject to any of these requirements.
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 tribal
governments, in aggregate, or by the
private sector, of $100 million or more
in any one year.
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.
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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
amended as follows:
PART 199—[AMENDED]
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Public Law
96–354, ‘‘Regulatory Flexibility Act’’
(5 U.S.C. 601)
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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:
■
§ 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 beneficiaries who meet the eligibility
and enrollment criteria as set forth in
paragraph (d)(1) of this section. The
CHCBP is not part of the TRICARE
program. However, as set forth in this
section, it functions under similar rules
and procedures of the TRICARE
Standard program. Because the purpose
of the CHCBP is to provide a
continuation health care benefit for the
Department of Defense and the other
uniformed services (National Oceanic
and Atmospheric Administration
(NOAA), Public Health Service (PHS),
and Coast Guard) beneficiaries losing
eligibility, it will be administered so
that it appears, to the maximum extent
possible, to be part of the TRICARE
Standard program. Medical coverage
under this program will be the same as
the benefits payable under the TRICARE
Standard program. However, unlike the
Standard program there is a cost for
enrollment to the CHCBP and these
premium costs are payable by enrollees
before any care may be provided.
(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 the TRICARE Standard
program.
(d) Eligibility and enrollment. (1)
Eligibility, Enrollment in the CHCBP is
open to any individual, except as noted
in this section, who:
(i) Ceases to meet the requirements for
eligibility under 10 U.S.C. chapter 55 or
10 U.S.C. 1145, and
(ii) Who on the day before they cease
to meet the eligibility requirements for
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such care they were covered under a
health benefit plan under 10 U.S.C.
chapter 55 or transitional healthcare
under 10 U.S.C. 1145, and
(iii) Who would otherwise not be
eligible for any benefits under 10 U.S.C.
chapter 55 or 10 U.S.C. 1145 except for
CHCBP.
(2) Exceptions. The following
individuals are not eligible to enroll in
CHCBP:
(i) Members of uniformed services,
who are discharged or released from
active duty either voluntarily or
involuntarily under conditions that are
adverse.
(ii) Individuals who lost their
eligibility or entitlement to care under
10 U.S.C. chapter 55 or 10 U.S.C. 1145
before October 1, 1994.
(iii) Individuals who are locked out of
other TRICARE programs per that
program’s requirements.
(3) Effective date. Eligibility in the
CHCBP is limited to individuals who
lost their entitlement to benefits under
the MHS on or after October 1, 1994.
The effective date of their coverage
under CHCBP shall begin on the day
after they cease to be eligible for care
under 10 U.S.C. chapter 55 or 10 U.S.C.
1145.
(4) Notification of eligibility.
(i) The Department of Defense and the
other uniformed services (National
Oceanic and Atmospheric
Administration (NOAA), Public Health
Service (PHS), and Coast Guard) will
notify persons in the uniformed services
eligible to receive health benefits under
the CHCBP. 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.
(ii) In the case of a dependent of a
member or former member who become
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
fourteen (14) days after receiving such
information, will inform the dependent
of the dependent’s rights under
10 U.S.C. 1142.
(iii) 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
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spouse’s change in status. The CHCBP
contractor within fourteen (14) days
after receiving such information will
notify the individual of their potential
eligibility for CHCBP.
(5) 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), or a RC
member formerly eligible for care under
10 U.S.C. chapter 55, 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; 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)
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) or an unmarried
dependent of a member or former
member of the uniformed services under
10 U.S.C. 1072(2)(I), 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 10 U.S.C. 1072(2)(I); or
(B) The date that the dependent
receives the notification required in
paragraph (d)(3) 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 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).
(iv) In the case of an unmarried
surviving spouse of a member or former
member of the uniformed services who
on the day before the death of the
member or former member was covered
under 10 U.S.C. chapter 55 or 10 U.S.C.
1145(a), the written election shall be
submitted to the CHCBP contractor
within 60 days of the date of the
member or former member’s death.
(v) A member of the uniformed
services who is eligible for enrollment
under paragraph (d)(1) of this section
may elect self-only or family coverage.
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Family members who may be included
in such family coverage are the spouse
and children of the member.
(vi) All other categories eligible for
enrollment under paragraph (d)(1) of
this section must elect self-only
coverage.
(6) Enrollment. To enroll in the
CHCBP, an eligible individual must
submit the completed enrollment form
designated by the Director, TRICARE as
well as any documentation as requested
on the enrollment form 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.
(7) Period of coverage. Except as
noted below CHCBP coverage may not
extend beyond 18 months from the date
the individual becomes eligible for
CHCBP. Although beneficiaries have
sixty (60) days to elect coverage under
the CHCBP, upon enrolling, the period
of coverage must begin the day after
entitlement or eligibility to a military
health care plan ends as though no
break in coverage had occurred
notwithstanding the date the enrollment
form with any applicable premium is
submitted.
(i) Exceptions:
(A) In the case of a 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) or 10 U.S.C.
1072(2)(I).
(B) In the case of an unremarried
former spouse (as this term is defined in
10 U.S.C. 1072(2)(G) or (H)) of a member
or former member, the date which is 36
months after the later of:
(1) The date on which the final decree
of divorce, dissolution, or annulment
occurs; or
(2) If applicable, the date the one-year
extension of dependency under
10 U.S.C. 1072(2)(H) expires.
(C) In the case of an unremarried
surviving spouse (widow or widower)
(under 10 U.S.C. 1072(2)(B) or (C)) of a
member or former member of the
uniformed services who is not otherwise
eligible for care under 10 U.S.C. chapter
55, the date which is 36 months after
the date the surviving spouse becomes
ineligible under 10 U.S.C chapter 55 or
10 U.S.C. 1145(a).
(D) 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
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CHCBP is unlimited, if the former
spouse:
(1) Has not remarried before the age
of 55 after the marriage to the former
member was dissolved; and
(2) 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
(3) 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
(4) Has a court order for payment of
any portion of the retired or retainer pay
or 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.
(E) 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 may not 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).
(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 § 199.4 are not applicable
to the CHCBP:
(i) Section 199.4(a)(2) concerning
eligibility.
(ii) All provisions regarding
requirements to use facilities of the
uniformed services because CHCBP
enrollees are not eligible to use those
facilities.
(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
Standard.
(g) Claims submission, review, and
payment. The provisions of § 199.7 shall
apply to the CHCBP as they do to
TRICARE Standard except no provisions
regarding nonavailability statements
shall apply.
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Jkt 223001
(h) Double coverage. The provisions
of § 199.8 shall apply to the CHCBP as
they do to TRICARE Standard.
(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
Standard.
(j) Appeal and hearing procedures.
The provisions of § 199.10 shall apply to
the CHCBP as they do to TRICARE
Standard.
(k) Overpayments recovery. The
provisions of § 199.11 shall apply to the
CHCBP as they do to TRICARE
Standard.
(l) Third party recoveries. The
provisions of § 199.12 shall apply to the
CHCBP as they do to TRICARE
Standard.
(m) Provider reimbursement methods.
The provisions of § 199.14 shall apply to
the CHCBP as they do to TRICARE
Standard.
(n) Quality and Utilization Review
Peer Review Organization Program. The
provisions of § 199.15 shall apply to the
CHCBP as they do to TRICARE
Standard.
(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 Standard beneficiaries.
(p) Special programs not applicable.
(1) In general. Special programs
established under this Part that are not
part of the TRICARE Standard 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 but are not limited to:
(i) The Extended Care Health Option
under § 199.5;
(ii) The TRICARE Dental Program or
Retiree Dental Program under § 199.13
and 199.22 respectively;
(iii) The Supplemental Health Care
Program under § 199.16;
(iv) The TRICARE Program under
§ 199.17, except for TRICARE Standard
and Extra programs under that section;
and
(v) The Uniform HMO benefit under
§ 199.18.
(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
PO 00000
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Sfmt 9990
57641
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 thirty (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 (90)
day period for which a premium
payment was received. Enrollees will be
held liable for medical costs incurred
after losing eligibility.
(r) Procedures. The Director,
TRICARE Management Activity, may
establish other rules and procedures for
the administration of the CHCBP.
3. Section 199.24 is amended by
removing and reserving paragraph (e) to
read as follows:
■
§ 199.24
TRICARE Reserve Select.
*
*
*
*
(e) [Reserved]
*
*
*
*
*
*
Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 2011–23760 Filed 9–15–11; 8:45 am]
BILLING CODE 5001–06–P
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[Federal Register Volume 76, Number 180 (Friday, September 16, 2011)]
[Rules and Regulations]
[Pages 57637-57641]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-23760]
=======================================================================
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2009-HA-0068]
RIN 0720-AB30
TRICARE; Continued Health Care Benefit Program Expansion
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule executes the expansion of section 1078a of
title 10, United States Code (U.S.C). With the recent expansions of
Military Health System (MHS) coverage, particularly with the Reserve
Component (RC) members, some MHS beneficiaries would not be eligible to
purchase Continued Health Care Benefit Program (CHCBP) coverage under
certain circumstances that terminate their MHS coverage. This provision
allows the Secretary to establish CHCBP eligibility for any category of
MHS beneficiaries who otherwise would lose MHS coverage with no
continued care eligibility. Although the proposed rule listed each
authorized category of MHS beneficiary eligible to receive care, on
further examination this format for the rule appeared cumbersome and
perhaps confusing. Thus this final rule contains some organizational
changes to simplify the rule to enhance understanding and make clear
that any category including future categories of beneficiaries are
entitled to purchase this CHCBP coverage. This final rule also includes
administrative changes providing clarification on eligibility
notifications and the CHCBP premium rate publication process. It
updates the previous final rule published in the Federal Register on
September 30, 1994.
DATES: Effective Date: October 17, 2011.
FOR FURTHER INFORMATION CONTACT: Mr. Mark Ellis, TRICARE Policy and
Operations, TRICARE Management Activity, 5111 Leesburg Pike, Suite 810,
Falls Church, VA 22041, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
[[Page 57638]]
I. Introduction and Background
CHCBP is the program that provides continued health care coverage
for eligible beneficiaries who lose their MHS eligibility. It was
initially established by Congress in section 4408 of the National
Defense Authorization Act (NDAA) for Fiscal Year (FY) 1993, Public Law
102-484, which amended title 10 U.S.C., by adding section 1078a. The
Department of Defense (DoD) published the initial final rule regarding
CHCBP in the Federal Register on September 30, 1994, (59 FR 49817). It
is modeled after private sector insurance programs giving some
employees the ability to continue health insurance coverage after
leaving employment as authorized by the Consolidated Omnibus Budget
Reconciliation Act (COBRA) of 1985. ``COBRA Coverage'' requires the
individual to pay up to 100 percent of the program cost plus an amount
to cover administrative expenses.
Section 713 of the NDAA for FY 2004 expanded the category of
persons authorized coverage to include the uniformed services that are
not armed forces. A final rule implementing this change was published
in the Federal Register on September 30, 1994. The statute was again
amended by Section 705 of the NDAA for FY 2008 which authorized the
expansion of persons eligible for the CHCBP under 10 U.S.C. 1078a to
include any person specified by regulation prescribed by the Secretary
who was authorized coverage under 10 U.S.C. chapter 55 and who loses
that eligibility. The proposed rule to implement this change was
published in the Federal Register on November 27, 2009. The intent of
the proposed rule and this final rule is to specify that any person who
is currently authorized coverage under 10 U.S.C. chapter 55 or 10
U.S.C. 1145(a) and any person who may in the future be authorized
coverage under chapter 55 of 10 U.S.C. or 10 U.S.C. 1145(a) and who
loses that eligibility shall be authorized coverage under the CHCBP.
Currently, CHCBP provides coverage for certain active duty (AD)
service members and their family members as well as RC members and
their families. The coverage period is up to 36 months after the date
on which the person first ceases to be covered under his or her
respective program eligibility. However, for RC members the coverage is
for 18 months from either separation from AD or when coverage under the
Transitional Assistance Management Program (TAMP) (10 U.S.C. 1145(a))
ends.
The 2008 change to 10 U.S.C. 1078a expands CHCBP to all who the
Secretary specifies in regulation who lose entitlement or eligibility
to health care services under 10 U.S.C. chapter 55 Therefore, members
or former members of the RC, such as TRICARE Reserve Select under 10
U.S.C. 1076d or TRICARE Retired Reserve under 10 U.S.C. Section 1076e
coverage under CHCBP will now run for 18 months after the date the
member ceases to be eligible for benefits under their respective
Reserve program's eligibility. The rule also standardizes the number of
days that a written election by an eligible beneficiary must be made to
sixty (60) days after loss of entitlement or eligibility. Previously,
those losing eligibility for TRICARE Reserve Select had only thirty
(30) days to elect CHCBP coverage. The rule clarifies that individual
locked out of other TRICARE plans per the other TRICARE program rules
are not eligible to purchase CHCBP.
II. Public Comments
The proposed rule was published in the Federal Register on November
27, 2009 (74 FR 62271), for a 60-day comment period. We received
comments from one individual. We thank the commenter for his comments.
Specific matters raised are summarized below.
Comment: One commenter said the final changes to the CHCBP could be
extremely beneficial to current and former service members, but that
eligibility for health care for National Guard/RC members after the
member ceases to be entitled to care under 10 U.S.C. 1074(a) (AD) or 10
U.S.C. 1145(a) (TAMP) should be extended to at least 24 months to
maximize the opportunity for care. The commenter noted many health
issues that service members are experiencing in theater need more time
to be fully understood by the member and to be officially diagnosed. By
extending an additional six months, service members who may be in
denial about health issues or who may be having trouble transitioning
to ``civilian'' life would have more time to obtain medical and dental
care.
Response: The period of CHCBP eligibility after a period of AD or
TAMP is limited by statute to 18 months. However, the 6 months of TAMP
plus the 18 months of CHCBP allows the member the opportunity for 24
months of care.
Comment: One comment asked for clarity as to how long a ``specific
and limited period of time'' CHCBP can continue.
Response: Eligibility timeframes for CHCBP vary by beneficiary
category and are outlined in 32 CFR 199.20(d)(1).
Comment: One comment asked who would be considered a ``certain
former spouse'' who is eligible for CHCBP.
Response: Eligibility for unremarried former spouses is outlined in
32 CFR 199.20(d)(1)(iii).
III. Provisions of Final Rule
This rule expands eligibility to purchase CHCBP coverage for any
beneficiary that loses entitlement or eligibility for medical care
under 10 U.S.C. chapter 55 or 10 U.S.C. 1145(a), subject to the
coverage limits of 10 U.S.C. 1078a.
The final rule incorporates a number of revisions from the proposed
rule to clarify the expanded coverage adopted by Congress in section
705 of the NDAA for FY 2008 to ensure that all future beneficiaries
under 10 U.S.C. chapter 55 or 10 U.S.C. 1145 who lose eligibility for
care under those parts will be eligible to purchase CHCBP. For example
in relation to coverage of RC personnel and their family members, the
children of RC personnel who are covered dependent children under TRS
and who reach the coverage age limit will have the same CHCBP
eligibility as their counterparts who are children of AD personnel. As
another example, a surviving spouse and child of a RC member who dies
and who were covered by TRR will have the opportunity to obtain CHCBP
coverage for up to three years after TRR coverage ends.
Administrative Changes
This final 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 to the CHCBP contractor 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. There have been no changes in this final rule
from the proposed rule on these administrative matters.
[[Page 57639]]
This final 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 Sec. 199.20.
There have been a few minor changes in this final rule from the
proposed rule on these editorial matters. These include reference to
the ``TRICARE Standard program'' vice the TRICARE basic program;
reference to the ``CHCBP contractor'' vice the ``Third Party
Administrator;'' and reference to members of the ``uniformed services''
where the term ``armed forces'' was inadvertently used. Finally, the
final rule includes a conforming change to Sec. 199.24, deleting the
paragraph that addressed the relationship between TRS and the CHCBP.
That relationship is not covered by the revised provisions in Sec.
199.20, which governs the CHCBP.
This final rule also contains administrative changes to 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 to require the use of the enrollment
applications or DD Form as designated by the Director, TRICARE as well
as the documentation required to verify an applicant's eligibility for
enrollment.
This final rule contains administrative changes to other paragraphs
of Title 32 Code of Federal Regulations, specifically in Sec. 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 final
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.'' There have been no changes in this final rule from the
proposed rule on these references.
IV. 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 final rule is not
subject to any of these requirements.
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
tribal governments, in aggregate, or by the private sector, of $100
million or more in any one year.
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.
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 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 199.20 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 beneficiaries who meet the
eligibility and enrollment criteria as set forth in paragraph (d)(1) of
this section. The CHCBP is not part of the TRICARE program. However, as
set forth in this section, it functions under similar rules and
procedures of the TRICARE Standard program. Because the purpose of the
CHCBP is to provide a continuation health care benefit for the
Department of Defense and the other uniformed services (National
Oceanic and Atmospheric Administration (NOAA), Public Health Service
(PHS), and Coast Guard) beneficiaries losing eligibility, it will be
administered so that it appears, to the maximum extent possible, to be
part of the TRICARE Standard program. Medical coverage under this
program will be the same as the benefits payable under the TRICARE
Standard program. However, unlike the Standard program there is a cost
for enrollment to the CHCBP and these premium costs are payable by
enrollees before any care may be provided.
(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 the TRICARE Standard program.
(d) Eligibility and enrollment. (1) Eligibility, Enrollment in the
CHCBP is open to any individual, except as noted in this section, who:
(i) Ceases to meet the requirements for eligibility under 10 U.S.C.
chapter 55 or 10 U.S.C. 1145, and
(ii) Who on the day before they cease to meet the eligibility
requirements for
[[Page 57640]]
such care they were covered under a health benefit plan under 10 U.S.C.
chapter 55 or transitional healthcare under 10 U.S.C. 1145, and
(iii) Who would otherwise not be eligible for any benefits under 10
U.S.C. chapter 55 or 10 U.S.C. 1145 except for CHCBP.
(2) Exceptions. The following individuals are not eligible to
enroll in CHCBP:
(i) Members of uniformed services, who are discharged or released
from active duty either voluntarily or involuntarily under conditions
that are adverse.
(ii) Individuals who lost their eligibility or entitlement to care
under 10 U.S.C. chapter 55 or 10 U.S.C. 1145 before October 1, 1994.
(iii) Individuals who are locked out of other TRICARE programs per
that program's requirements.
(3) Effective date. Eligibility in the CHCBP is limited to
individuals who lost their entitlement to benefits under the MHS on or
after October 1, 1994. The effective date of their coverage under CHCBP
shall begin on the day after they cease to be eligible for care under
10 U.S.C. chapter 55 or 10 U.S.C. 1145.
(4) Notification of eligibility.
(i) The Department of Defense and the other uniformed services
(National Oceanic and Atmospheric Administration (NOAA), Public Health
Service (PHS), and Coast Guard) will notify persons in the uniformed
services eligible to receive health benefits under the CHCBP. 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.
(ii) In the case of a dependent of a member or former member who
become 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 fourteen (14) days after receiving
such information, will inform the dependent of the dependent's rights
under 10 U.S.C. 1142.
(iii) 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 fourteen
(14) days after receiving such information will notify the individual
of their potential eligibility for CHCBP.
(5) 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), or a RC member formerly eligible for care under 10
U.S.C. chapter 55, 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; 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) 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) or an unmarried dependent of a member or former
member of the uniformed services under 10 U.S.C. 1072(2)(I), 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 10 U.S.C. 1072(2)(I); or
(B) The date that the dependent receives the notification required
in paragraph (d)(3) 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 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).
(iv) In the case of an unmarried surviving spouse of a member or
former member of the uniformed services who on the day before the death
of the member or former member was covered under 10 U.S.C. chapter 55
or 10 U.S.C. 1145(a), the written election shall be submitted to the
CHCBP contractor within 60 days of the date of the member or former
member's death.
(v) A member of the uniformed services who is eligible for
enrollment under paragraph (d)(1) 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.
(vi) All other categories eligible for enrollment under paragraph
(d)(1) of this section must elect self-only coverage.
(6) Enrollment. To enroll in the CHCBP, an eligible individual must
submit the completed enrollment form designated by the Director,
TRICARE as well as any documentation as requested on the enrollment
form 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.
(7) Period of coverage. Except as noted below CHCBP coverage may
not extend beyond 18 months from the date the individual becomes
eligible for CHCBP. Although beneficiaries have sixty (60) days to
elect coverage under the CHCBP, upon enrolling, the period of coverage
must begin the day after entitlement or eligibility to a military
health care plan ends as though no break in coverage had occurred
notwithstanding the date the enrollment form with any applicable
premium is submitted.
(i) Exceptions:
(A) In the case of a 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) or 10 U.S.C. 1072(2)(I).
(B) In the case of an unremarried former spouse (as this term is
defined in 10 U.S.C. 1072(2)(G) or (H)) of a member or former member,
the date which is 36 months after the later of:
(1) The date on which the final decree of divorce, dissolution, or
annulment occurs; or
(2) If applicable, the date the one-year extension of dependency
under 10 U.S.C. 1072(2)(H) expires.
(C) In the case of an unremarried surviving spouse (widow or
widower) (under 10 U.S.C. 1072(2)(B) or (C)) of a member or former
member of the uniformed services who is not otherwise eligible for care
under 10 U.S.C. chapter 55, the date which is 36 months after the date
the surviving spouse becomes ineligible under 10 U.S.C chapter 55 or 10
U.S.C. 1145(a).
(D) 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
[[Page 57641]]
CHCBP is unlimited, if the former spouse:
(1) Has not remarried before the age of 55 after the marriage to
the former member was dissolved; and
(2) 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
(3) 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
(4) Has a court order for payment of any portion of the retired or
retainer pay or 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.
(E) 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 may
not 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).
(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 requirements to use facilities of the
uniformed services because CHCBP enrollees are not eligible to use
those facilities.
(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 Standard.
(g) Claims submission, review, and payment. The provisions of Sec.
199.7 shall apply to the CHCBP as they do to TRICARE Standard except 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 Standard.
(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 Standard.
(j) Appeal and hearing procedures. The provisions of Sec. 199.10
shall apply to the CHCBP as they do to TRICARE Standard.
(k) Overpayments recovery. The provisions of Sec. 199.11 shall
apply to the CHCBP as they do to TRICARE Standard.
(l) Third party recoveries. The provisions of Sec. 199.12 shall
apply to the CHCBP as they do to TRICARE Standard.
(m) Provider reimbursement methods. The provisions of Sec. 199.14
shall apply to the CHCBP as they do to TRICARE Standard.
(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 Standard.
(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 Standard beneficiaries.
(p) Special programs not applicable.
(1) In general. Special programs established under this Part that
are not part of the TRICARE Standard 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 but are not limited to:
(i) The Extended Care Health Option under Sec. 199.5;
(ii) The TRICARE Dental Program or Retiree Dental Program under
Sec. 199.13 and 199.22 respectively;
(iii) The Supplemental Health Care Program under Sec. 199.16;
(iv) The TRICARE Program under Sec. 199.17, except for TRICARE
Standard and Extra programs under that section; and
(v) The Uniform HMO benefit under Sec. 199.18.
(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 thirty (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 (90)
day period for which a premium payment was received. Enrollees will be
held liable for medical costs incurred after losing eligibility.
(r) Procedures. The Director, TRICARE Management Activity, may
establish other rules and procedures for the administration of the
CHCBP.
0
3. Section 199.24 is amended by removing and reserving paragraph (e) to
read as follows:
Sec. 199.24 TRICARE Reserve Select.
* * * * *
(e) [Reserved]
* * * * *
Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-23760 Filed 9-15-11; 8:45 am]
BILLING CODE 5001-06-P