Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Retired Reserve, 78698-78703 [2014-30282]
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Federal Register / Vol. 79, No. 250 / Wednesday, December 31, 2014 / Rules and Regulations
of the additional first year depreciation
deduction claimed for the asset that is
attributable to the disposed portion; and
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Martin V. Franks,
Chief, Publications and Regulations Branch,
Legal Processing Division, Associate Chief
Counsel (Procedure and Administration).
[FR Doc. 2014–30186 Filed 12–30–14; 8:45 am]
BILLING CODE 4830–01–P
DEPARTMENT OF DEFENSE
Office of the Secretary
B. Public Comments
32 CFR Part 199
[DoD–2010–HA–0068]
RIN 0720–AB39
Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS);
TRICARE Retired Reserve
A. Establishment of the TRICARE
Retired Reserve Program (§ 199.25(a))
TRICARE Retired Reserve
(TRR) is a premium-based TRICARE
health plan available for purchase
worldwide by qualified members of the
Retired Reserve and by qualified
survivors of TRR members. This final
rule responds to public comments
received to an interim final rule that
was published in the Federal Register
on August 6, 2010 (75 FR 47452–47457).
That rule established requirements and
procedures to implement the TRR
program in fulfillment of section 705 of
the National Defense Authorization Act
for Fiscal Year 2010 (NDAA–10) (Pub. L.
111–84). This final rule also revises
requirements and procedures as
indicated.
SUMMARY:
This rule is effective January 30,
2015.
Jody
Donehoo, Defense Health Agency,
TRICARE Health Plan, telephone (703)
681–0039. Questions regarding payment
of specific claims under the TRICARE
allowable charge method should be
addressed to the appropriate TRICARE
contractor.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
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I. Introduction and Background
A. Overview
An interim final rule was published
in the Federal Register on August 6,
2010 (75 FR 47452–47457), that
established requirements and
procedures to implement the TRICARE
Retired Reserve program in fulfillment
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The interim final rule was published
in the Federal Register on August 6,
2010. We received 92 online comments.
We thank those who provided
comments. Specific matters raised by
those who submitted comments are
summarized below.
II. Provisions of the Rule Regarding the
TRICARE Retired Reserve Program
Office of the Secretary,
Department of Defense.
ACTION: Final rule.
AGENCY:
DATES:
of section 705 of the National Defense
Authorization Act for Fiscal Year 2010
(NDAA–10) (Pub. L. 111–84). Section
705 added new section 1076e to Title
10, United States Code. Section 1076e
allows members of the Retired Reserve
who are qualified for non-regular
retirement, but are not yet 60 years of
age, as well as certain survivors to
qualify to purchase medical coverage
equivalent to the TRICARE Standard
(and Extra) benefit unless that member
is either enrolled in, or eligible to enroll
in, a health benefits plan under Chapter
89 of Title 5, United States Code.
1. Provisions of Interim Final Rule.
This paragraph describes the nature,
purpose, statutory basis, scope, and
major features of TRICARE Retired
Reserve, a premium-based medical
coverage program that was made
available for purchase worldwide by
certain members of the Retired Reserve,
their family members and their
surviving family members. TRICARE
Retired Reserve is authorized by 10
U.S.C. 1076e.
The major features of the program
include making coverage available for
purchase by any Retired Reserve
member who is qualified for non-regular
retirement, but is not yet 60 years of age,
unless that member is either enrolled in,
or eligible to enroll in, a health benefit
plan under Chapter 89 of Title 5, United
States Code, as well as certain survivors
of Retired Reserve members as specified
below. The amount of the premium that
qualified members and qualified
survivors pay is prescribed by the
Assistant Secretary of Defense for
Health Affairs (ASD(HA)) and
determined using an appropriate
actuarial basis. There is one premium
for member-only coverage and a second
premium for member and family
coverage. Additionally, TRICARE rules
outlined in Part 199 of Title 32 of the
CFR relating to the TRICARE Standard
and Extra programs apply unless
otherwise specified.
Under TRICARE Retired Reserve,
qualified members (or their qualified
survivors) may purchase either the
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member-only type of coverage or the
member and family type of coverage by
submitting a completed request in the
appropriate format along with an initial
payment of the applicable premium at
the time of enrollment. When their
coverage becomes effective, TRICARE
Retired Reserve beneficiaries receive the
TRICARE Standard (and Extra) benefit.
TRICARE Retired Reserve features the
deductible and cost sharing provisions
of the TRICARE Standard (and Extra)
plan for retired members and
dependents of retired members. Both
the member and the member’s covered
family members are provided access
priority for care in military treatment
facilities on the same basis as retired
members and their family members who
are not enrolled in TRICARE Prime.
2. Analysis of Major Public
Comments. Three commenters
suggested alternative plans to include a
Preferred Provider Organization (PPO)
with group discount until age 60;
eligibility for Reserve Retirees to use the
Department of Veterans Affairs health
care benefits and services; and a tier
system that would allow a member to
reduce premiums by choosing higher
deductibles. Another commenter
suggested a tier system with higher
deductibles or different options for cost
shares and deductibles.
Three commenters requested the
implementation/passing of the TRR
benefit. One commenter inquired how
TRR fits into ‘‘Health Care Reform’’
making health care affordable for every
citizen.
Response. In regards to the comments
suggesting alternative plans, we
observed that the specific provisions of
the law governing TRR does not allow
implementation of alternative plans as
suggested. In fulfillment of law, TRR is
a premium-based TRICARE health plan
that features the cost sharing,
deductible, and catastrophic cap
provisions of TRICARE Standard (and
Extra) as they pertain to retirees and
their family members.
TRICARE Extra is similar to a PPO.
TRICARE Standard beneficiaries,
including TRR members and their
covered family members, are using
TRICARE Extra when they receive care
from a provider in the TRICARE
Network. TRICARE Extra features cost
shares that are five percent lower than
TRICARE Standard cost shares. All
Department of Veterans Affairs hospitals
and clinics nationwide currently are in
the TRICARE Network through active
agreements with TRICARE contractors.
Multiple premium tiers with various
levels of deductibles would not be
allowed by the statutory provisions that
require TRR to be offered under one
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program with one monthly premium
rate for individual coverage and one
monthly premium rate for family
coverage.
In regards to the comments requesting
the implementation/passing of the TRR
benefit, Section 705 of the NDAA for FY
2010 was enacted into law on October
28, 2009; it was implemented by interim
final rule effective August 6, 2010; and
TRR officially launched September 1,
2010 with health care coverage available
beginning October 1, 2010.
In regards to the Affordable Care Act
comment, the statutory provisions of
that Act did not amend any of the
statutes that govern the military health
system. Nonetheless, we have projected
for a small influx of qualified members
of the Retired Reserve into TRR
beginning in 2014 when the new
mandates for individuals to have health
insurance coverage go into effect under
the Act.
It should be noted that legislative
action subsequent to enactment of
Affordable Care Act resulted in
TRICARE establishing a program called
TRICARE Young Adult. Similar to
young adult coverage under the
Affordable Care Act, TRICARE Young
Adult offers full-cost, premium-based
TRICARE coverage for purchase by
qualified young adults who have a
parent with TRICARE coverage. See the
TRICARE Young Adult Interim Final
Rule published in the Federal Register
on April 27, 2011 (76 FR 23479–23485)
for details.
3. Provisions of the Final Rule. We
clarified that certain special programs
established in 32 CFR part 199 are not
available to members covered under
TRICARE Retired Reserve
(§ 199.25(a)(4)(i)(B)). We clarified that
TRICARE Retired Reserve coverage
features the deductible, cost sharing,
and catastrophic cap provisions of the
TRICARE Standard (and Extra) plan
applicable to retired members and
dependents of retired members
(§ 199.25(a)(4)(iv)). We corrected the
cross-reference to § 199.17(d)(1)(i)(E) of
this part regarding access priority for
care in military treatment facilities for
the member and the member’s covered
family members (§ 199.25(a)(4)(iv)).
Otherwise, the final rule is consistent
with the interim final rule (75 FR
47452–47457, August 6, 2010).
B. Qualifications for TRICARE Retired
Reserve Coverage (§ 199.25(b))
1. Provisions of Interim Final Rule.
This paragraph defines the statutory
conditions under which members of a
Reserve Component may qualify to
purchase TRICARE Retired Reserve
coverage. The Reserve Components of
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the armed forces have the responsibility
to determine and validate a member’s
qualifications to purchase TRICARE
Retired Reserve coverage. The member’s
Service personnel office is responsible
for keeping the Defense Enrollment
Eligibility Reporting System (DEERS)
current with eligibility data.
A member qualifies to purchase
TRICARE Retired Reserve coverage if
the member meets both of the following
conditions:
(a) Is a member of the Retired Reserve
of a Reserve component of the armed
forces who is qualified for a non-regular
retirement at age 60 under chapter 1223
of title 10, U.S.C., but is not age 60; and
(b) is not enrolled, or eligible to
enroll, in a health benefits plan under
chapter 89 of title 5, U.S.C.
If a qualified member of the Retired
Reserve dies while in a period of
TRICARE Retired Reserve coverage, the
immediate family member(s) of such
member shall remain qualified to
continue existing or purchase new
TRICARE Retired Reserve coverage until
the date on which the deceased member
of the Retired Reserve would have
attained age 60 as long as they meet the
definition of immediate family member
specified below. This applies regardless
of whether either member-only coverage
or member and family coverage was in
effect on the day of the TRICARE
Retired Reserve member’s death.
2. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
3. Provisions of the Final Rule. We
clarified the exclusion involving the
Federal Employee Health Benefits
(FEHB) program. Section 199.25(b)(1)(ii)
specifies that a member of the Retired
Reserve qualifies to purchase TRICARE
Retired Reserve coverage if the member
is not enrolled in, or eligible to enroll
in, a health benefits plan under chapter
89 of title 5, U.S.C. That statute has been
implemented under part 890 of title 5,
CFR as the ‘‘Federal Employee Health
Benefits’’ program. For purposes of the
FEHB program, the terms ‘‘enrolled,’’
‘‘enroll’’ and ‘‘enrollee’’ are defined in
section 890.101 of title 5, CFR.
Otherwise, the final rule is consistent
with the interim final rule.
C. TRICARE Retired Reserve Premiums
(§ 199.25(c))
1. Provisions of Interim Final Rule.
Members are charged premiums for
coverage under TRICARE Retired
Reserve that represent the full cost of
providing the TRICARE Standard (and
Extra) benefit under this program. The
total annual premium amounts shall be
determined by the ASD(HA) using an
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appropriate actuarial basis and are
established and updated annually, on a
calendar year basis, by the ASD(HA) for
qualified members of the Retired
Reserve for each of the two types of
coverage, member-only coverage and
member-and-family coverage. Premiums
are to be paid monthly. The monthly
rate for each month of a calendar year
is one-twelfth of the annual rate for that
calendar year.
A surviving family member of a
Retired Reserve member who qualified
for TRICARE Retired Reserve coverage
as described herein will pay premium
rates at the member-only rate if there is
only one surviving family member to be
covered by TRICARE Retired Reserve
and at the member and family rate if
there are two or more survivors to be
covered.
The appropriate actuarial basis used
for calculating premium rates shall be
one that most closely approximates the
actual cost of providing care to the same
demographic population as those
enrolled in TRICARE Retired Reserve as
determined by the ASD(HA). TRICARE
Retired Reserve premiums shall be
based on the actual costs of providing
benefits to TRICARE Retired Reserve
members and their family members
during the preceding years if the
population of Retired Reserve members
enrolled in TRICARE Retired Reserve is
large enough during those preceding
years to be considered actuarially
appropriate. Until such time that actual
costs from those preceding years
become available, TRICARE Retired
Reserve premiums shall be based on the
actual costs during the preceding
calendar years for providing benefits to
the population of retired members and
their family members in the same age
categories as the Retired Reserve
population in order to make the
underlying group actuarially
appropriate.
An adjustment may be applied to
cover overhead costs for administration
of the program by the government.
Additionally, premium adjustments
may be made to cover the prospective
costs of any significant program changes
or any actual experience in the costs of
administering the TRICARE Retired
Reserve program.
For the portion of calendar year 2010
during which the program is in effect,
the monthly premium for member-only
coverage will be $388.31/month (annual
premium $4,659.72/year), and the
monthly premium for member and
family coverage will be $976.41/month
(annual premium $11,716.92/year). The
2010 premiums are based on the actual
costs during calendar years 2007 and
2008 for providing benefits to the
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population of retired members and their
family members in the same age
categories as the Retired Reserve
population in order to make the
underlying group actuarially
appropriate. The historical costs were
trended forward to 2010 and a twopercent adjustment was applied to cover
overhead costs for administration of the
program by the government.
2. Analysis of Major Public
Comments. Seventy-six of the
commenters expressed that the
premiums were too high. Six
commenters requested that the TRR
premium-rate calculations be
investigated or reviewed. One
commenter suggested a separate
premium be established for memberplus-spouse-only. One commenter
requested employers be allowed to pay
members’ monthly TRR premiums. One
commenter suggested that TRR should
not cost one third more than Continued
Health Care Benefit Program. One
commenter requested the Fiscal Year
2012 premium rates.
Response. We recognize that the
premiums were much higher than many
expected. In fulfillment of law, TRR
premiums represent the full cost of
delivering the benefit without the
Department of Defense absorbing any of
the cost. In other words, the Department
cannot cover or share any of the cost of
the premiums by law; TRR members pay
full-cost premiums.
TRR premiums were determined on
an appropriate actuarial basis using
actual costs during preceding calendar
years for providing benefits to the
population of retired members and their
family members in the same age
categories as the Retired Reserve
population in order to make the
underlying group actuarially
appropriate. In other words, the datadriven premiums were derived from
highly relevant actual TRICARE cost
data. This approach is very similar to
the approach we used for TRICARE
Reserve Select (TRS) in fulfillment of
applicable law; however, premiums
payable by members in TRS represent
only twenty-eight percent of the actual
cost of TRS coverage delivered in
preceding years.
We endeavored to be very open and
transparent with the detailed
information that we provided in the
preamble of the interim final rule about
the establishment of TRR premiums.
Nonetheless, we would be glad to
participate in a Congressionally-directed
request or a request under proper and
applicable authority as appropriate to
study the actuarial approach used to
establish the TRR premium rates.
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In regard to the comment about a
separate premium for member plus
spouse only, we were required by law
to establish only two monthly premium
rates: One rate for TRR member-only
coverage and one rate for TRR member
and family coverage.
In regard to the comment about
allowing employers to pay members’
monthly TRR premiums, law requires
members to pay premiums for their
purchased TRR coverage.
In regard to the comment comparing
TRR premiums to premiums for the
Continued Health Care Benefit Program,
note that these are two separate and
distinct programs under law and
regulation with different requirements
for premium establishment for each. A
final rule was published September 16,
2011 (76 FR 57637–41) that describes
the applicable requirements for
establishing Continued Health Care
Benefit Program premiums.
In regards to the question about the
fiscal year 2012 premiums, the Assistant
Secretary of Defense for Health Affairs
established the calendar year 2012
premiums as required by regulation on
August 24, 2011 and posted them as
Health Affairs Policy 11–013 on the
Health Affairs Web site,
www.health.mil. For calendar year 2012,
the TRR premium for member-only
coverage was $419.72/month (annual
premium $5,036.64/year), which
represented a 2.9% increase over the
2011 rate. The 2012 premium for TRR
member and family coverage was
$1,024.43/month (annual premium
$12,293.16/year), which represented a
0.4% increase over the 2011 rate. The
2012 premiums were based on the
actual costs during calendar years 2009
and 2010 for providing benefits to the
population of retired members and their
family members in the same age
categories as the Retired Reserve
population in order to make the
underlying group actuarially
appropriate. The historical costs were
trended forward to 2012 and a two
percent adjustment was applied to cover
overhead costs for administration of the
program by the government.
The calendar year 2013 premiums
were established and posted on the
Health Affairs Web site,
www.health.mil, on September 13, 2011
as Health Affairs Policy 12–008.
We also clarified that the Director,
Healthcare Operations in the Defense
Health Agency may establish
procedures for administrative
implementation related to premiums
(§ 199.25(c)).
3. Provisions of the Final Rule. We
made one minor administrative
clarification that premiums are to be
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paid monthly, except as otherwise
provided through administrative
implementation, pursuant to procedures
established by the Director, Healthcare
Operations in the Defense Health
Agency (§ 199.25(c)). We added a crossreference to paragraph (d)(1) of this
section where each of the two types of
coverage, member-only coverage and
member-and-family coverage are
described (§ 199.25(c)(1)). Otherwise,
the final rule is consistent with the
interim final rule.
D. Procedures (§ 199.25(d))
1. Provisions of Interim Final Rule.
The Director, TRICARE Management
Activity (TMA), may establish
procedures for the following:
—Purchasing Coverage. Procedures may
be established for a qualified member,
including surviving family members,
to purchase one of two types of
coverage: Member-only coverage or
member-and-family coverage.
Immediate family members of the
Retired Reserve member may be
included in such family coverage. To
purchase either type of TRICARE
Retired Reserve coverage, Retired
Reserve members or their survivors
qualified as above must complete and
submit a request in the appropriate
format, along with an initial payment of
the applicable premium required above.
—Continuation Coverage. Procedures
may be established for a qualified
member or qualified survivor to
purchase TRICARE Retired Reserve
coverage with an effective date
immediately following the date of
termination of coverage under another
TRICARE program.
—Qualifying Life Event. Procedures may
be established for a qualified member
or qualified survivor to purchase
TRICARE Retired Reserve coverage on
the occasion of a qualifying life event
that changes the immediate family
composition (e.g., birth, death,
adoption, divorce, etc.). The effective
date for TRICARE Retired Reserve
coverage will coincide with the day of
the qualifying life event. It is the
responsibility of the member to
provide personnel officials with the
necessary evidence required to
substantiate the change in immediate
family composition. Personnel
officials will update DEERS in the
usual manner. Appropriate action will
be taken upon receipt of the
completed request in the appropriate
format along with an initial payment
of the applicable premium in
accordance with established
procedures.
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—Open Enrollment. Procedures may be
established for a qualified member or
qualified survivor to purchase
TRICARE Retired Reserve coverage at
any time. The effective date of
coverage will coincide with the first
day of a month.
—Survivor coverage under TRICARE
Retired Reserve. Procedures may be
established for a surviving family
member of a Retired Reserve member
who qualified for TRICARE Retired
Reserve coverage as described above
to continue existing or to purchase
new TRICARE Retired Reserve
coverage. Procedures similar to those
for qualifying life events may be
established for a qualified surviving
family member to purchase new or
continuing coverage with an effective
date coinciding with the day of the
member’s death. Procedures similar to
those for open enrollment may be
established for a qualified surviving
family member to purchase new
coverage at any time with an effective
date coinciding with the first day of
a month.
—Changing type of coverage.
Procedures may be established for
TRICARE Retired Reserve members or
qualified survivors to request to
change type of coverage during open
enrollment or on the occasion of a
qualifying life event that changes
immediate family composition as
described above by submitting a
completed request in the appropriate
format.
—Termination. Termination of coverage
for the member will result in
termination of coverage for the
member’s family members in
TRICARE Retired Reserve, except for
qualified survivors as described
above.
—Coverage will terminate whenever a
member (or qualified survivors)
ceases to meet the qualifications for
the program. For purposes of this
section, the member no longer
qualifies for TRICARE Retired Reserve
when the member has been eligible
for more than 60 days for coverage in
a health benefits plan under Chapter
89 of Title 5, U.S.C. This affords the
member sufficient time to make
arrangements for health coverage and
avoid any lapses in health coverage.
Further, coverage shall terminate
when the Retired Reserve member
attains the age of 60 or, if survivor
coverage is in effect, when the
deceased Retired Reserve member
would have attained the age of 60.
—Coverage may terminate for members
who gain coverage under another
TRICARE program.
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—Failure to make a premium payment
in a timely manner in accordance
with established procedures will
result in termination of coverage for
the member and any covered family
members and will result in denial of
claims for services with a date of
service after the effective date of
termination.
—Procedures may be established for
covered members and survivors to
request termination of coverage at any
time by submitting a completed
request in the appropriate format.
—Members whose coverage under
TRICARE Retired Reserve terminates
upon their request or for failure to pay
premiums will not be allowed to
purchase coverage under TRICARE
Retired Reserve to begin again for a
period of one year following the
effective date of termination.
—Processing. Upon receipt of a
completed request in the appropriate
format, the appropriate enrollment
actions will be processed into DEERS
in accordance with established
procedures.
—Periodic revision. Periodically, certain
features, rules or procedures of
TRICARE Retired Reserve may be
revised. If such revisions will have a
significant effect on members’ or
survivors’ costs or access to care,
members or survivors may be given
the opportunity to change their type
of coverage or terminate coverage
coincident with the revisions.
2. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
3. Provisions of the Final Rule. We
clarified that the Director, Healthcare
Operations in the Defense Health
Agency may establish procedures for
TRR (§ 199.25(d)). We added a crossreference for immediate family members
of the Retired Reserve member that may
be included in such family coverage
(§ 199.25(d)(1)).
We clarified the rule that procedures
may be established for TRR coverage to
be suspended for up to one year
followed by final termination for
members or qualified survivors if they
fail to make premium payments in
accordance with established procedures
or otherwise if they request suspension/
termination of coverage (§ 199.25(d)(3)).
Suspension/termination of coverage for
the TRR member/survivor will result in
suspension/termination of coverage for
the member’s/survivor’s family
members in TRICARE Retired Reserve,
except as described in § 199.25
(d)(1)(iv). Procedures may be
established for the suspension to be
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lifted upon request before final
termination is applied.
E. Preemption of State Laws
(§ 199.25(e))
1. Provisions of Interim Final Rule.
This paragraph explains that the
preemptions of State and local laws
established for the TRICARE program
also apply to TRICARE Retired Reserve.
Any State or local law or regulation
pertaining to health insurance, prepaid
health plans, or other health care
delivery, administration, and financing
methods is preempted and does not
apply in connection with TRICARE
Retired Reserve.
This includes State and local laws
imposing premium taxes on health
insurance carriers, underwriters or other
plan managers, or similar taxes on such
entities. Preemption does not apply to
taxes, fees, or other payments on net
income or profit realized by such
entities in the conduct of business
relating to DoD health services
contracts, if those taxes, fees or other
payments are applicable to a broad
range of business activity. For the
purposes of assessing the effect of
Federal preemption of State and local
taxes and fees in connection with DoD
health services contracts, interpretations
shall be consistent with those applicable
to the Federal Employees Health
Benefits Program under 5 U.S.C. 8909(f).
2. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
3. Provisions of the Final Rule. The
final rule is consistent with the interim
final rule.
F. Administration (§ 199.25(f))
1. Provisions of Interim Final Rule.
This paragraph provides that the
Director, TRICARE Management
Activity, may establish other rules and
procedures necessary for the effective
administration of TRICARE Retired
Reserve and may authorize exceptions
to requirements of this section, if
permitted by law, based on
extraordinary circumstances.
2. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
3. Provisions of the Final Rule. We
clarified this provision by removing the
phrase, ‘‘based on extraordinary
circumstances’’ and clarified that the
Director, Healthcare Operations in the
Defense Health Agency has authority to
perform this activity.
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G. Terminology (§ 199.25(g))
1. Provisions of Interim Final Rule.
The following terms are applicable to
the TRICARE Retired Reserve program.
—Coverage. This term means the
medical benefits covered under the
TRICARE Standard or Extra programs
as further outlined in other sections of
part 199 of Title 32 of the Code of
Federal Regulations, whether
delivered in military treatment
facilities or purchased from civilian
sources.
—Immediate family member. This term
means spouse (except former spouse)
as defined in § 199.3(b)(2)(i) of this
part, or child as defined in § 199.3
(b)(2)(ii).
—Qualified member. This term means a
member who has satisfied all the
criteria that must be met before the
member is authorized for TRR
coverage.
—Qualified survivor. This term means
an immediate family member who has
satisfied all the criteria that must be
met before the survivor is authorized
for TRR coverage.
2. Analysis of Major Public
Comments. One commenter wondered if
the enrollment eligibility of divorced
spouses that have been granted a
portion of a reserve member’s retirement
benefits had been addressed.
Response. We mentioned that spouses
of qualified Retired Reserve members
(but not former spouses) are included in
TRR member and family coverage. This
can be found in this terminology
section.
3. Provisions of the Final Rule. The
final rule is consistent with the interim
final rule.
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.
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3511)
This rule will not impose additional
information collection requirements on
the public under the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501–
3511).
Executive Order 13132, ‘‘Federalism’’
We have examined the impact(s) of
the final rule under Executive Order
13132 and it does not have policies that
have federalism implications that would
have substantial direct effects on the
States, on the relationship between the
national government and the States, or
on the distribution of power and
responsibilities among the various
levels of government, therefore,
consultation with State and local
officials is not required.
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, Handicapped, Health
insurance, and Military personnel.
Accordingly, 32 CFR part 199 is
amended as follows:
PART 199—[AMENDED]
1. The authority citation for part 199
continues to read as follows:
■
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Public Law
96–354, ‘‘Regulatory Flexibility Act’’ (5
U.S.C. 601)
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III. Regulatory Procedures
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
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
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16:08 Dec 30, 2014
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2. Amend § 199.25 to read as follows.
a. Revise paragraphs (a)(4)(i)(B) and
(a)(4)(iv).
■ b. Revise paragraph (b)(1)(ii).
■ c. Revise paragraphs (c) introductory
text and (c)(1)(i).
■ d. Revise paragraphs (d) introductory
text, (d)(1) introductory text, (d)(3)
introductory text, (d)(3)(iii), (d)(3)(iv).
and (d)(3)(v).
■ e. Revise paragraph (f).
The revisions read as follows:
■
■
§ 199.25
TRICARE Retired Reserve.
(a) * * *
(4) * * *
(i) * * *
(B) Certain special programs
established in 32 CFR part 199 are not
available to members covered under
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Frm 00014
Fmt 4700
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TRICARE Retired Reserve. The
Extended Health Care Option (ECHO)
program (sec. 199.5) is not included.
The Supplemental Health Care Program
(sec. 199.16) is not included, except
when a TRICARE Retired Reserve
covered beneficiary is referred by a
Military Treatment Facility (MTF)
provider for incidental consults and the
MTF provider maintains clinical control
over the episode of care. The TRICARE
Retiree Dental Program (sec. 199.13) is
independent of this program and is
otherwise available to all members who
qualify for the TRICARE Retiree Dental
Program whether or not they purchase
TRICARE Retired Reserve coverage. The
Continued Health Care Benefits Program
(sec. 199.13) is also independent of this
program and is otherwise available to all
members who qualify for the Continued
Health Care Benefits Program.
*
*
*
*
*
(iv) Benefits. When their coverage
becomes effective, TRICARE Retired
Reserve beneficiaries receive the
TRICARE Standard (and Extra) benefit
including access to military treatment
facilities on a space available basis and
pharmacies, as described in § 199.17 of
this part. TRICARE Retired Reserve
coverage features the deductible, cost
sharing, and catastrophic cap provisions
of the TRICARE Standard (and Extra)
plan applicable to retired members and
dependents of retired members. Both
the member and the member’s covered
family members are provided access
priority for care in military treatment
facilities on the same basis as retired
members and their dependents who are
not enrolled in TRICARE Prime as
described in § 199.17(d)(1)(i)(E).
(b) * * *
(1) * * *
(ii) Is not enrolled in, or eligible to
enroll in, a health benefits plan under
chapter 89 of title 5, U.S.C. That statute
has been implemented under part 890 of
title 5, CFR as the Federal Employee
Health Benefits (FEHB) program. For
purposes of the FEHB program, the
terms ‘‘enrolled,’’ ‘‘enroll’’ and
‘‘enrollee’’ are defined in § 890.101 of
title 5, CFR.
*
*
*
*
*
(c) TRICARE Retired Reserve
premiums. Members are charged
premiums for coverage under TRICARE
Retired Reserve that represent the full
cost of the program as determined by
the Director, Defense Health Agency
utilizing an appropriate actuarial basis
for the provision of the benefits
provided under the TRICARE Standard
and Extra programs for the TRICARE
Retired Reserve eligible beneficiary
population. Premiums are to be paid
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Federal Register / Vol. 79, No. 250 / Wednesday, December 31, 2014 / Rules and Regulations
monthly, except as otherwise provided
through administrative implementation,
pursuant to procedures established by
the Director, Healthcare Operations in
the Defense Health Agency. The
monthly rate for each month of a
calendar year is one-twelfth of the
annual rate for that calendar year.
(1) Annual establishment of rates.—(i)
TRICARE Retired Reserve monthly
premium rates shall be established and
updated annually on a calendar year
basis by the ASD(HA) for each of the
two types of coverage, member-only
coverage and member-and-family
coverage as described in paragraph
(d)(1) of this section.
*
*
*
*
*
(d) Procedures. The Director,
Healthcare Operations in the Defense
Health Agency, may establish
procedures for the following.
(1) Purchasing Coverage. Procedures
may be established for a qualified
member to purchase one of two types of
coverage: Member-only coverage or
member and family coverage. Immediate
family members of the Retired Reserve
member as specified in paragraph (g)(2)
of this section may be included in such
family coverage. To purchase either type
of TRICARE Retired Reserve coverage
for effective dates of coverage described
below, Retired Reserve members and
survivors qualified under either
paragraph (b)(1) or (b)(2) of this section
must submit a request in the appropriate
format, along with an initial payment of
the applicable premium required by
paragraph (c) of this section in
accordance with established procedures.
*
*
*
*
*
(3) Suspension and Termination.
Suspension/termination of coverage for
the TRR member/survivor will result in
suspension/termination of coverage for
the member’s/survivor’s family
members in TRICARE Retired Reserve,
except as described in paragraph
(d)(1)(iv) of this section. Procedures may
be established for coverage to be
suspended and/or terminated as
follows.
*
*
*
*
*
(iii) Coverage may be suspended and
finally terminated for members/
survivors who fail to make premium
payments in accordance with
established procedures.
(iv) Coverage may be suspended and
finally terminated for members/
survivors upon request at any time by
submitting a completed request in the
appropriate format in accordance with
established procedures.
(v) Under paragraph (d)(3)(iii) or
(d)(3)(iv) of this section, TRICARE
Retired Reserve coverage may first be
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16:08 Dec 30, 2014
Jkt 235001
suspended for a period of up to one year
followed by final termination.
Procedures may be established for the
suspension to be lifted upon request
before final termination is applied.
*
*
*
*
*
(f) Administration. The Director,
Healthcare Operations in the Defense
Health Agency may establish other rules
and procedures for the effective
administration of TRICARE Retired
Reserve, and may authorize exceptions
to requirements of this section, if
permitted by law.
*
*
*
*
*
Dated: December 22, 2014.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2014–30282 Filed 12–30–14; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2013–HA–0164]
RIN 0720–AB61
TRICARE; Coverage of Care Related to
Non-Covered Initial Surgery or
Treatment
Office of the Secretary,
Department of Defense.
ACTION: Final rule.
AGENCY:
This final rule revises the
limitations on certain TRICARE basic
program benefits. More specifically, it
allows coverage for otherwise covered
services and supplies required in the
treatment of complications (unfortunate
sequelae), as well as medically
necessary and appropriate follow-on
care, resulting from a non-covered
incident of treatment provided pursuant
to a properly granted Supplemental
Health Care Program waiver. This final
rule amends two provisions of the
TRICARE regulations which limits
coverage for the treatment of
complications resulting from a noncovered incident of treatment, and
which expressly excludes from coverage
in the Basic Program services and
supplies related to a non-covered
condition or treatment.
DATES: This final rule is effective
January 30, 2015.
FOR FURTHER INFORMATION CONTACT:
Thomas Doss (703) 681–7512.
SUPPLEMENTARY INFORMATION:
SUMMARY:
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Fmt 4700
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78703
Executive Summary
A. Purpose of Regulatory Action
Need for the Regulatory Action
This final rule is necessary for
consistency with existing regulatory
provisions and to protect TRICARE
beneficiaries from incurring
unnecessary financial hardships arising
from the current regulatory restrictions
that prohibit TRICARE coverage of the
treatment of complications resulting
from certain non-covered medical
procedures. On occasion, an authorized
official of a uniformed service may
request from the Director, Defense
Health Agency (DHA) a waiver of
TRICARE regulatory restrictions or
limitations, when the waiver is
necessary to assure adequate availability
of health care services to the active duty
member. In those cases when a waiver
has been properly granted under
§ 199.16(f), this rule grants benefits
coverage for otherwise covered services
and supplies required for treating
complications arising from the noncovered incident of treatment provided
in the private sector pursuant to the
waiver. Additionally, with respect to
care that is related to a non-covered
initial surgery or treatment, the final
rule seeks to eliminate any confusion
regarding what services and supplies
will be covered by TRICARE and under
what circumstances they will be
covered.
Legal Authority for the Regulatory
Action
This regulation is finalized under the
authorities of 10 U.S.C. 1073, which
authorizes the Secretary of Defense to
administer the medical and dental
benefits provided in 10 U.S.C. chapter
55. The Department is authorized to
provide medically necessary and
appropriate treatment for mental and
physical illnesses, injuries and bodily
malfunctions, including hospitalization,
outpatient care, drugs, treatment of
medical and surgical conditions and
other types of health care outlined in 10
U.S.C. 1077(a). Although section 1077
defines benefits to be provided in the
Military Treatment Facilities (MTFs),
these benefits are incorporated by
reference into the benefits provided in
the civilian health care sector to active
duty family members and retirees and
their dependents through sections 1079
and 1086 respectively.
B. Summary of the Final Rule
The final rule amends the existing
special benefit provision regarding
complications (unfortunate sequelae)
resulting from non-covered initial
E:\FR\FM\31DER1.SGM
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]]>Agencies
[Federal Register Volume 79, Number 250 (Wednesday, December 31, 2014)]
[Rules and Regulations]
[Pages 78698-78703]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-30282]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD-2010-HA-0068]
RIN 0720-AB39
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Retired Reserve
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: TRICARE Retired Reserve (TRR) is a premium-based TRICARE
health plan available for purchase worldwide by qualified members of
the Retired Reserve and by qualified survivors of TRR members. This
final rule responds to public comments received to an interim final
rule that was published in the Federal Register on August 6, 2010 (75
FR 47452-47457). That rule established requirements and procedures to
implement the TRR program in fulfillment of section 705 of the National
Defense Authorization Act for Fiscal Year 2010 (NDAA-10) (Pub. L. 111-
84). This final rule also revises requirements and procedures as
indicated.
DATES: This rule is effective January 30, 2015.
FOR FURTHER INFORMATION CONTACT: Jody Donehoo, Defense Health Agency,
TRICARE Health Plan, telephone (703) 681-0039. Questions regarding
payment of specific claims under the TRICARE allowable charge method
should be addressed to the appropriate TRICARE contractor.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
A. Overview
An interim final rule was published in the Federal Register on
August 6, 2010 (75 FR 47452-47457), that established requirements and
procedures to implement the TRICARE Retired Reserve program in
fulfillment of section 705 of the National Defense Authorization Act
for Fiscal Year 2010 (NDAA-10) (Pub. L. 111-84). Section 705 added new
section 1076e to Title 10, United States Code. Section 1076e allows
members of the Retired Reserve who are qualified for non-regular
retirement, but are not yet 60 years of age, as well as certain
survivors to qualify to purchase medical coverage equivalent to the
TRICARE Standard (and Extra) benefit unless that member is either
enrolled in, or eligible to enroll in, a health benefits plan under
Chapter 89 of Title 5, United States Code.
B. Public Comments
The interim final rule was published in the Federal Register on
August 6, 2010. We received 92 online comments. We thank those who
provided comments. Specific matters raised by those who submitted
comments are summarized below.
II. Provisions of the Rule Regarding the TRICARE Retired Reserve
Program
A. Establishment of the TRICARE Retired Reserve Program (Sec.
199.25(a))
1. Provisions of Interim Final Rule. This paragraph describes the
nature, purpose, statutory basis, scope, and major features of TRICARE
Retired Reserve, a premium-based medical coverage program that was made
available for purchase worldwide by certain members of the Retired
Reserve, their family members and their surviving family members.
TRICARE Retired Reserve is authorized by 10 U.S.C. 1076e.
The major features of the program include making coverage available
for purchase by any Retired Reserve member who is qualified for non-
regular retirement, but is not yet 60 years of age, unless that member
is either enrolled in, or eligible to enroll in, a health benefit plan
under Chapter 89 of Title 5, United States Code, as well as certain
survivors of Retired Reserve members as specified below. The amount of
the premium that qualified members and qualified survivors pay is
prescribed by the Assistant Secretary of Defense for Health Affairs
(ASD(HA)) and determined using an appropriate actuarial basis. There is
one premium for member-only coverage and a second premium for member
and family coverage. Additionally, TRICARE rules outlined in Part 199
of Title 32 of the CFR relating to the TRICARE Standard and Extra
programs apply unless otherwise specified.
Under TRICARE Retired Reserve, qualified members (or their
qualified survivors) may purchase either the member-only type of
coverage or the member and family type of coverage by submitting a
completed request in the appropriate format along with an initial
payment of the applicable premium at the time of enrollment. When their
coverage becomes effective, TRICARE Retired Reserve beneficiaries
receive the TRICARE Standard (and Extra) benefit. TRICARE Retired
Reserve features the deductible and cost sharing provisions of the
TRICARE Standard (and Extra) plan for retired members and dependents of
retired members. Both the member and the member's covered family
members are provided access priority for care in military treatment
facilities on the same basis as retired members and their family
members who are not enrolled in TRICARE Prime.
2. Analysis of Major Public Comments. Three commenters suggested
alternative plans to include a Preferred Provider Organization (PPO)
with group discount until age 60; eligibility for Reserve Retirees to
use the Department of Veterans Affairs health care benefits and
services; and a tier system that would allow a member to reduce
premiums by choosing higher deductibles. Another commenter suggested a
tier system with higher deductibles or different options for cost
shares and deductibles.
Three commenters requested the implementation/passing of the TRR
benefit. One commenter inquired how TRR fits into ``Health Care
Reform'' making health care affordable for every citizen.
Response. In regards to the comments suggesting alternative plans,
we observed that the specific provisions of the law governing TRR does
not allow implementation of alternative plans as suggested. In
fulfillment of law, TRR is a premium-based TRICARE health plan that
features the cost sharing, deductible, and catastrophic cap provisions
of TRICARE Standard (and Extra) as they pertain to retirees and their
family members.
TRICARE Extra is similar to a PPO. TRICARE Standard beneficiaries,
including TRR members and their covered family members, are using
TRICARE Extra when they receive care from a provider in the TRICARE
Network. TRICARE Extra features cost shares that are five percent lower
than TRICARE Standard cost shares. All Department of Veterans Affairs
hospitals and clinics nationwide currently are in the TRICARE Network
through active agreements with TRICARE contractors.
Multiple premium tiers with various levels of deductibles would not
be allowed by the statutory provisions that require TRR to be offered
under one
[[Page 78699]]
program with one monthly premium rate for individual coverage and one
monthly premium rate for family coverage.
In regards to the comments requesting the implementation/passing of
the TRR benefit, Section 705 of the NDAA for FY 2010 was enacted into
law on October 28, 2009; it was implemented by interim final rule
effective August 6, 2010; and TRR officially launched September 1, 2010
with health care coverage available beginning October 1, 2010.
In regards to the Affordable Care Act comment, the statutory
provisions of that Act did not amend any of the statutes that govern
the military health system. Nonetheless, we have projected for a small
influx of qualified members of the Retired Reserve into TRR beginning
in 2014 when the new mandates for individuals to have health insurance
coverage go into effect under the Act.
It should be noted that legislative action subsequent to enactment
of Affordable Care Act resulted in TRICARE establishing a program
called TRICARE Young Adult. Similar to young adult coverage under the
Affordable Care Act, TRICARE Young Adult offers full-cost, premium-
based TRICARE coverage for purchase by qualified young adults who have
a parent with TRICARE coverage. See the TRICARE Young Adult Interim
Final Rule published in the Federal Register on April 27, 2011 (76 FR
23479-23485) for details.
3. Provisions of the Final Rule. We clarified that certain special
programs established in 32 CFR part 199 are not available to members
covered under TRICARE Retired Reserve (Sec. 199.25(a)(4)(i)(B)). We
clarified that TRICARE Retired Reserve coverage features the
deductible, cost sharing, and catastrophic cap provisions of the
TRICARE Standard (and Extra) plan applicable to retired members and
dependents of retired members (Sec. 199.25(a)(4)(iv)). We corrected
the cross-reference to Sec. 199.17(d)(1)(i)(E) of this part regarding
access priority for care in military treatment facilities for the
member and the member's covered family members (Sec.
199.25(a)(4)(iv)). Otherwise, the final rule is consistent with the
interim final rule (75 FR 47452-47457, August 6, 2010).
B. Qualifications for TRICARE Retired Reserve Coverage (Sec.
199.25(b))
1. Provisions of Interim Final Rule. This paragraph defines the
statutory conditions under which members of a Reserve Component may
qualify to purchase TRICARE Retired Reserve coverage. The Reserve
Components of the armed forces have the responsibility to determine and
validate a member's qualifications to purchase TRICARE Retired Reserve
coverage. The member's Service personnel office is responsible for
keeping the Defense Enrollment Eligibility Reporting System (DEERS)
current with eligibility data.
A member qualifies to purchase TRICARE Retired Reserve coverage if
the member meets both of the following conditions:
(a) Is a member of the Retired Reserve of a Reserve component of
the armed forces who is qualified for a non-regular retirement at age
60 under chapter 1223 of title 10, U.S.C., but is not age 60; and
(b) is not enrolled, or eligible to enroll, in a health benefits
plan under chapter 89 of title 5, U.S.C.
If a qualified member of the Retired Reserve dies while in a period
of TRICARE Retired Reserve coverage, the immediate family member(s) of
such member shall remain qualified to continue existing or purchase new
TRICARE Retired Reserve coverage until the date on which the deceased
member of the Retired Reserve would have attained age 60 as long as
they meet the definition of immediate family member specified below.
This applies regardless of whether either member-only coverage or
member and family coverage was in effect on the day of the TRICARE
Retired Reserve member's death.
2. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
3. Provisions of the Final Rule. We clarified the exclusion
involving the Federal Employee Health Benefits (FEHB) program. Section
199.25(b)(1)(ii) specifies that a member of the Retired Reserve
qualifies to purchase TRICARE Retired Reserve coverage if the member is
not enrolled in, or eligible to enroll in, a health benefits plan under
chapter 89 of title 5, U.S.C. That statute has been implemented under
part 890 of title 5, CFR as the ``Federal Employee Health Benefits''
program. For purposes of the FEHB program, the terms ``enrolled,''
``enroll'' and ``enrollee'' are defined in section 890.101 of title 5,
CFR. Otherwise, the final rule is consistent with the interim final
rule.
C. TRICARE Retired Reserve Premiums (Sec. 199.25(c))
1. Provisions of Interim Final Rule. Members are charged premiums
for coverage under TRICARE Retired Reserve that represent the full cost
of providing the TRICARE Standard (and Extra) benefit under this
program. The total annual premium amounts shall be determined by the
ASD(HA) using an appropriate actuarial basis and are established and
updated annually, on a calendar year basis, by the ASD(HA) for
qualified members of the Retired Reserve for each of the two types of
coverage, member-only coverage and member-and-family coverage. Premiums
are to be paid monthly. The monthly rate for each month of a calendar
year is one-twelfth of the annual rate for that calendar year.
A surviving family member of a Retired Reserve member who qualified
for TRICARE Retired Reserve coverage as described herein will pay
premium rates at the member-only rate if there is only one surviving
family member to be covered by TRICARE Retired Reserve and at the
member and family rate if there are two or more survivors to be
covered.
The appropriate actuarial basis used for calculating premium rates
shall be one that most closely approximates the actual cost of
providing care to the same demographic population as those enrolled in
TRICARE Retired Reserve as determined by the ASD(HA). TRICARE Retired
Reserve premiums shall be based on the actual costs of providing
benefits to TRICARE Retired Reserve members and their family members
during the preceding years if the population of Retired Reserve members
enrolled in TRICARE Retired Reserve is large enough during those
preceding years to be considered actuarially appropriate. Until such
time that actual costs from those preceding years become available,
TRICARE Retired Reserve premiums shall be based on the actual costs
during the preceding calendar years for providing benefits to the
population of retired members and their family members in the same age
categories as the Retired Reserve population in order to make the
underlying group actuarially appropriate.
An adjustment may be applied to cover overhead costs for
administration of the program by the government. Additionally, premium
adjustments may be made to cover the prospective costs of any
significant program changes or any actual experience in the costs of
administering the TRICARE Retired Reserve program.
For the portion of calendar year 2010 during which the program is
in effect, the monthly premium for member-only coverage will be
$388.31/month (annual premium $4,659.72/year), and the monthly premium
for member and family coverage will be $976.41/month (annual premium
$11,716.92/year). The 2010 premiums are based on the actual costs
during calendar years 2007 and 2008 for providing benefits to the
[[Page 78700]]
population of retired members and their family members in the same age
categories as the Retired Reserve population in order to make the
underlying group actuarially appropriate. The historical costs were
trended forward to 2010 and a two-percent adjustment was applied to
cover overhead costs for administration of the program by the
government.
2. Analysis of Major Public Comments. Seventy-six of the commenters
expressed that the premiums were too high. Six commenters requested
that the TRR premium-rate calculations be investigated or reviewed. One
commenter suggested a separate premium be established for member-plus-
spouse-only. One commenter requested employers be allowed to pay
members' monthly TRR premiums. One commenter suggested that TRR should
not cost one third more than Continued Health Care Benefit Program. One
commenter requested the Fiscal Year 2012 premium rates.
Response. We recognize that the premiums were much higher than many
expected. In fulfillment of law, TRR premiums represent the full cost
of delivering the benefit without the Department of Defense absorbing
any of the cost. In other words, the Department cannot cover or share
any of the cost of the premiums by law; TRR members pay full-cost
premiums.
TRR premiums were determined on an appropriate actuarial basis
using actual costs during preceding calendar years for providing
benefits to the population of retired members and their family members
in the same age categories as the Retired Reserve population in order
to make the underlying group actuarially appropriate. In other words,
the data-driven premiums were derived from highly relevant actual
TRICARE cost data. This approach is very similar to the approach we
used for TRICARE Reserve Select (TRS) in fulfillment of applicable law;
however, premiums payable by members in TRS represent only twenty-eight
percent of the actual cost of TRS coverage delivered in preceding
years.
We endeavored to be very open and transparent with the detailed
information that we provided in the preamble of the interim final rule
about the establishment of TRR premiums. Nonetheless, we would be glad
to participate in a Congressionally-directed request or a request under
proper and applicable authority as appropriate to study the actuarial
approach used to establish the TRR premium rates.
In regard to the comment about a separate premium for member plus
spouse only, we were required by law to establish only two monthly
premium rates: One rate for TRR member-only coverage and one rate for
TRR member and family coverage.
In regard to the comment about allowing employers to pay members'
monthly TRR premiums, law requires members to pay premiums for their
purchased TRR coverage.
In regard to the comment comparing TRR premiums to premiums for the
Continued Health Care Benefit Program, note that these are two separate
and distinct programs under law and regulation with different
requirements for premium establishment for each. A final rule was
published September 16, 2011 (76 FR 57637-41) that describes the
applicable requirements for establishing Continued Health Care Benefit
Program premiums.
In regards to the question about the fiscal year 2012 premiums, the
Assistant Secretary of Defense for Health Affairs established the
calendar year 2012 premiums as required by regulation on August 24,
2011 and posted them as Health Affairs Policy 11-013 on the Health
Affairs Web site, www.health.mil. For calendar year 2012, the TRR
premium for member-only coverage was $419.72/month (annual premium
$5,036.64/year), which represented a 2.9% increase over the 2011 rate.
The 2012 premium for TRR member and family coverage was $1,024.43/month
(annual premium $12,293.16/year), which represented a 0.4% increase
over the 2011 rate. The 2012 premiums were based on the actual costs
during calendar years 2009 and 2010 for providing benefits to the
population of retired members and their family members in the same age
categories as the Retired Reserve population in order to make the
underlying group actuarially appropriate. The historical costs were
trended forward to 2012 and a two percent adjustment was applied to
cover overhead costs for administration of the program by the
government.
The calendar year 2013 premiums were established and posted on the
Health Affairs Web site, www.health.mil, on September 13, 2011 as
Health Affairs Policy 12-008.
We also clarified that the Director, Healthcare Operations in the
Defense Health Agency may establish procedures for administrative
implementation related to premiums (Sec. 199.25(c)).
3. Provisions of the Final Rule. We made one minor administrative
clarification that premiums are to be paid monthly, except as otherwise
provided through administrative implementation, pursuant to procedures
established by the Director, Healthcare Operations in the Defense
Health Agency (Sec. 199.25(c)). We added a cross-reference to
paragraph (d)(1) of this section where each of the two types of
coverage, member-only coverage and member-and-family coverage are
described (Sec. 199.25(c)(1)). Otherwise, the final rule is consistent
with the interim final rule.
D. Procedures (Sec. 199.25(d))
1. Provisions of Interim Final Rule. The Director, TRICARE
Management Activity (TMA), may establish procedures for the following:
--Purchasing Coverage. Procedures may be established for a qualified
member, including surviving family members, to purchase one of two
types of coverage: Member-only coverage or member-and-family coverage.
Immediate family members of the Retired Reserve member may be
included in such family coverage. To purchase either type of TRICARE
Retired Reserve coverage, Retired Reserve members or their survivors
qualified as above must complete and submit a request in the
appropriate format, along with an initial payment of the applicable
premium required above.
--Continuation Coverage. Procedures may be established for a qualified
member or qualified survivor to purchase TRICARE Retired Reserve
coverage with an effective date immediately following the date of
termination of coverage under another TRICARE program.
--Qualifying Life Event. Procedures may be established for a qualified
member or qualified survivor to purchase TRICARE Retired Reserve
coverage on the occasion of a qualifying life event that changes the
immediate family composition (e.g., birth, death, adoption, divorce,
etc.). The effective date for TRICARE Retired Reserve coverage will
coincide with the day of the qualifying life event. It is the
responsibility of the member to provide personnel officials with the
necessary evidence required to substantiate the change in immediate
family composition. Personnel officials will update DEERS in the usual
manner. Appropriate action will be taken upon receipt of the completed
request in the appropriate format along with an initial payment of the
applicable premium in accordance with established procedures.
[[Page 78701]]
--Open Enrollment. Procedures may be established for a qualified member
or qualified survivor to purchase TRICARE Retired Reserve coverage at
any time. The effective date of coverage will coincide with the first
day of a month.
--Survivor coverage under TRICARE Retired Reserve. Procedures may be
established for a surviving family member of a Retired Reserve member
who qualified for TRICARE Retired Reserve coverage as described above
to continue existing or to purchase new TRICARE Retired Reserve
coverage. Procedures similar to those for qualifying life events may be
established for a qualified surviving family member to purchase new or
continuing coverage with an effective date coinciding with the day of
the member's death. Procedures similar to those for open enrollment may
be established for a qualified surviving family member to purchase new
coverage at any time with an effective date coinciding with the first
day of a month.
--Changing type of coverage. Procedures may be established for TRICARE
Retired Reserve members or qualified survivors to request to change
type of coverage during open enrollment or on the occasion of a
qualifying life event that changes immediate family composition as
described above by submitting a completed request in the appropriate
format.
--Termination. Termination of coverage for the member will result in
termination of coverage for the member's family members in TRICARE
Retired Reserve, except for qualified survivors as described above.
--Coverage will terminate whenever a member (or qualified survivors)
ceases to meet the qualifications for the program. For purposes of this
section, the member no longer qualifies for TRICARE Retired Reserve
when the member has been eligible for more than 60 days for coverage in
a health benefits plan under Chapter 89 of Title 5, U.S.C. This affords
the member sufficient time to make arrangements for health coverage and
avoid any lapses in health coverage. Further, coverage shall terminate
when the Retired Reserve member attains the age of 60 or, if survivor
coverage is in effect, when the deceased Retired Reserve member would
have attained the age of 60.
--Coverage may terminate for members who gain coverage under another
TRICARE program.
--Failure to make a premium payment in a timely manner in accordance
with established procedures will result in termination of coverage for
the member and any covered family members and will result in denial of
claims for services with a date of service after the effective date of
termination.
--Procedures may be established for covered members and survivors to
request termination of coverage at any time by submitting a completed
request in the appropriate format.
--Members whose coverage under TRICARE Retired Reserve terminates upon
their request or for failure to pay premiums will not be allowed to
purchase coverage under TRICARE Retired Reserve to begin again for a
period of one year following the effective date of termination.
--Processing. Upon receipt of a completed request in the appropriate
format, the appropriate enrollment actions will be processed into DEERS
in accordance with established procedures.
--Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Retired Reserve may be revised. If such revisions
will have a significant effect on members' or survivors' costs or
access to care, members or survivors may be given the opportunity to
change their type of coverage or terminate coverage coincident with the
revisions.
2. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
3. Provisions of the Final Rule. We clarified that the Director,
Healthcare Operations in the Defense Health Agency may establish
procedures for TRR (Sec. 199.25(d)). We added a cross-reference for
immediate family members of the Retired Reserve member that may be
included in such family coverage (Sec. 199.25(d)(1)).
We clarified the rule that procedures may be established for TRR
coverage to be suspended for up to one year followed by final
termination for members or qualified survivors if they fail to make
premium payments in accordance with established procedures or otherwise
if they request suspension/termination of coverage (Sec.
199.25(d)(3)). Suspension/termination of coverage for the TRR member/
survivor will result in suspension/termination of coverage for the
member's/survivor's family members in TRICARE Retired Reserve, except
as described in Sec. 199.25 (d)(1)(iv). Procedures may be established
for the suspension to be lifted upon request before final termination
is applied.
E. Preemption of State Laws (Sec. 199.25(e))
1. Provisions of Interim Final Rule. This paragraph explains that
the preemptions of State and local laws established for the TRICARE
program also apply to TRICARE Retired Reserve. Any State or local law
or regulation pertaining to health insurance, prepaid health plans, or
other health care delivery, administration, and financing methods is
preempted and does not apply in connection with TRICARE Retired
Reserve.
This includes State and local laws imposing premium taxes on health
insurance carriers, underwriters or other plan managers, or similar
taxes on such entities. Preemption does not apply to taxes, fees, or
other payments on net income or profit realized by such entities in the
conduct of business relating to DoD health services contracts, if those
taxes, fees or other payments are applicable to a broad range of
business activity. For the purposes of assessing the effect of Federal
preemption of State and local taxes and fees in connection with DoD
health services contracts, interpretations shall be consistent with
those applicable to the Federal Employees Health Benefits Program under
5 U.S.C. 8909(f).
2. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
3. Provisions of the Final Rule. The final rule is consistent with
the interim final rule.
F. Administration (Sec. 199.25(f))
1. Provisions of Interim Final Rule. This paragraph provides that
the Director, TRICARE Management Activity, may establish other rules
and procedures necessary for the effective administration of TRICARE
Retired Reserve and may authorize exceptions to requirements of this
section, if permitted by law, based on extraordinary circumstances.
2. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
3. Provisions of the Final Rule. We clarified this provision by
removing the phrase, ``based on extraordinary circumstances'' and
clarified that the Director, Healthcare Operations in the Defense
Health Agency has authority to perform this activity.
[[Page 78702]]
G. Terminology (Sec. 199.25(g))
1. Provisions of Interim Final Rule. The following terms are
applicable to the TRICARE Retired Reserve program.
--Coverage. This term means the medical benefits covered under the
TRICARE Standard or Extra programs as further outlined in other
sections of part 199 of Title 32 of the Code of Federal Regulations,
whether delivered in military treatment facilities or purchased from
civilian sources.
--Immediate family member. This term means spouse (except former
spouse) as defined in Sec. 199.3(b)(2)(i) of this part, or child as
defined in Sec. 199.3 (b)(2)(ii).
--Qualified member. This term means a member who has satisfied all the
criteria that must be met before the member is authorized for TRR
coverage.
--Qualified survivor. This term means an immediate family member who
has satisfied all the criteria that must be met before the survivor is
authorized for TRR coverage.
2. Analysis of Major Public Comments. One commenter wondered if the
enrollment eligibility of divorced spouses that have been granted a
portion of a reserve member's retirement benefits had been addressed.
Response. We mentioned that spouses of qualified Retired Reserve
members (but not former spouses) are included in TRR member and family
coverage. This can be found in this terminology section.
3. Provisions of the Final Rule. The final rule is consistent with
the interim final rule.
III. 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.
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3511).
Executive Order 13132, ``Federalism''
We have examined the impact(s) of the final rule under Executive
Order 13132 and it does not have policies that have federalism
implications that would have substantial direct effects on the States,
on the relationship between the national government and the States, or
on the distribution of power and responsibilities among the various
levels of government, therefore, consultation with State and local
officials is not required.
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, Handicapped, Health insurance, and 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. Amend Sec. 199.25 to read as follows.
0
a. Revise paragraphs (a)(4)(i)(B) and (a)(4)(iv).
0
b. Revise paragraph (b)(1)(ii).
0
c. Revise paragraphs (c) introductory text and (c)(1)(i).
0
d. Revise paragraphs (d) introductory text, (d)(1) introductory text,
(d)(3) introductory text, (d)(3)(iii), (d)(3)(iv). and (d)(3)(v).
0
e. Revise paragraph (f).
The revisions read as follows:
Sec. 199.25 TRICARE Retired Reserve.
(a) * * *
(4) * * *
(i) * * *
(B) Certain special programs established in 32 CFR part 199 are not
available to members covered under TRICARE Retired Reserve. The
Extended Health Care Option (ECHO) program (sec. 199.5) is not
included. The Supplemental Health Care Program (sec. 199.16) is not
included, except when a TRICARE Retired Reserve covered beneficiary is
referred by a Military Treatment Facility (MTF) provider for incidental
consults and the MTF provider maintains clinical control over the
episode of care. The TRICARE Retiree Dental Program (sec. 199.13) is
independent of this program and is otherwise available to all members
who qualify for the TRICARE Retiree Dental Program whether or not they
purchase TRICARE Retired Reserve coverage. The Continued Health Care
Benefits Program (sec. 199.13) is also independent of this program and
is otherwise available to all members who qualify for the Continued
Health Care Benefits Program.
* * * * *
(iv) Benefits. When their coverage becomes effective, TRICARE
Retired Reserve beneficiaries receive the TRICARE Standard (and Extra)
benefit including access to military treatment facilities on a space
available basis and pharmacies, as described in Sec. 199.17 of this
part. TRICARE Retired Reserve coverage features the deductible, cost
sharing, and catastrophic cap provisions of the TRICARE Standard (and
Extra) plan applicable to retired members and dependents of retired
members. Both the member and the member's covered family members are
provided access priority for care in military treatment facilities on
the same basis as retired members and their dependents who are not
enrolled in TRICARE Prime as described in Sec. 199.17(d)(1)(i)(E).
(b) * * *
(1) * * *
(ii) Is not enrolled in, or eligible to enroll in, a health
benefits plan under chapter 89 of title 5, U.S.C. That statute has been
implemented under part 890 of title 5, CFR as the Federal Employee
Health Benefits (FEHB) program. For purposes of the FEHB program, the
terms ``enrolled,'' ``enroll'' and ``enrollee'' are defined in Sec.
890.101 of title 5, CFR.
* * * * *
(c) TRICARE Retired Reserve premiums. Members are charged premiums
for coverage under TRICARE Retired Reserve that represent the full cost
of the program as determined by the Director, Defense Health Agency
utilizing an appropriate actuarial basis for the provision of the
benefits provided under the TRICARE Standard and Extra programs for the
TRICARE Retired Reserve eligible beneficiary population. Premiums are
to be paid
[[Page 78703]]
monthly, except as otherwise provided through administrative
implementation, pursuant to procedures established by the Director,
Healthcare Operations in the Defense Health Agency. The monthly rate
for each month of a calendar year is one-twelfth of the annual rate for
that calendar year.
(1) Annual establishment of rates.--(i) TRICARE Retired Reserve
monthly premium rates shall be established and updated annually on a
calendar year basis by the ASD(HA) for each of the two types of
coverage, member-only coverage and member-and-family coverage as
described in paragraph (d)(1) of this section.
* * * * *
(d) Procedures. The Director, Healthcare Operations in the Defense
Health Agency, may establish procedures for the following.
(1) Purchasing Coverage. Procedures may be established for a
qualified member to purchase one of two types of coverage: Member-only
coverage or member and family coverage. Immediate family members of the
Retired Reserve member as specified in paragraph (g)(2) of this section
may be included in such family coverage. To purchase either type of
TRICARE Retired Reserve coverage for effective dates of coverage
described below, Retired Reserve members and survivors qualified under
either paragraph (b)(1) or (b)(2) of this section must submit a request
in the appropriate format, along with an initial payment of the
applicable premium required by paragraph (c) of this section in
accordance with established procedures.
* * * * *
(3) Suspension and Termination. Suspension/termination of coverage
for the TRR member/survivor will result in suspension/termination of
coverage for the member's/survivor's family members in TRICARE Retired
Reserve, except as described in paragraph (d)(1)(iv) of this section.
Procedures may be established for coverage to be suspended and/or
terminated as follows.
* * * * *
(iii) Coverage may be suspended and finally terminated for members/
survivors who fail to make premium payments in accordance with
established procedures.
(iv) Coverage may be suspended and finally terminated for members/
survivors upon request at any time by submitting a completed request in
the appropriate format in accordance with established procedures.
(v) Under paragraph (d)(3)(iii) or (d)(3)(iv) of this section,
TRICARE Retired Reserve coverage may first be suspended for a period of
up to one year followed by final termination. Procedures may be
established for the suspension to be lifted upon request before final
termination is applied.
* * * * *
(f) Administration. The Director, Healthcare Operations in the
Defense Health Agency may establish other rules and procedures for the
effective administration of TRICARE Retired Reserve, and may authorize
exceptions to requirements of this section, if permitted by law.
* * * * *
Dated: December 22, 2014.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2014-30282 Filed 12-30-14; 8:45 am]
BILLING CODE 5001-06-P
