Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early Eligibility for TRICARE for Certain Reserve Component Members, 55250-55256 [2015-22815]
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Federal Register / Vol. 80, No. 178 / Tuesday, September 15, 2015 / Rules and Regulations
For plans with a valuation
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3. In appendix C to part 4022, Rate Set
264, as set forth below, is added to the
table.
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Appendix C to Part 4022—Lump Sum
Interest Rates for Private-Sector
Payments
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Authority: 29 U.S.C. 1301(a), 1302(b)(3),
1341, 1344, 1362.
PART 4044—ALLOCATION OF
ASSETS IN SINGLE-EMPLOYER
PLANS
Appendix B to Part 4044—Interest
Rates Used to Value Benefits
5. In appendix B to part 4044, a new
entry for October–December 2015, as set
forth below, is added to the table.
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4. The authority citation for part 4044
continues to read as follows:
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The values of it are:
For valuation dates occurring in the month—
it
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October–December 2015 .....................................................
Issued in Washington, DC, on this 10th day
of September 2015.
Judith Starr,
General Counsel, Pension Benefit Guaranty
Corporation.
[FR Doc. 2015–23231 Filed 9–14–15; 8:45 am]
BILLING CODE 7709–02–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2006–HA–0207]
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RIN 0720–AB15
Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS);
TRICARE Reserve Select; TRICARE
Dental Program; Early Eligibility for
TRICARE for Certain Reserve
Component Members
Office of the Secretary, DoD.
Final rule.
AGENCY:
ACTION:
TRICARE Reserve Select
(TRS) is a premium-based TRICARE
SUMMARY:
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health plan available for purchase
worldwide by qualified members of the
Ready Reserve and by qualified
survivors of TRS members. TRICARE
Dental Program (TDP) is a premiumbased TRICARE dental plan available
for purchase worldwide by qualified
Service members. This final rule revises
requirements and procedures for the
TRS program to specify the appropriate
actuarial basis for calculating premiums
in addition to making other minor
clarifying administrative changes. For a
member who is involuntarily separated
from the Selected Reserve under other
than adverse conditions this final rule
provides a time-limited exception that
allows TRS coverage in effect to
continue for up to 180 days after the
date on which the member is separated
from the Selected Reserve and TDP
coverage in effect to continue for no less
than 180 days after the separation date.
It also expands early TRICARE
eligibility for certain Reserve
Component members from a maximum
of 90 days to a maximum of 180 days
prior to activation in support of a
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contingency operation for more than 30
days.
DATES:
This rule is effective October 15,
2015.
FOR FURTHER INFORMATION CONTACT:
Brian Smith, Defense Health Agency,
TRICARE Health Plan Division,
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 20,
2007 (72 FR 46380). That interim final
rule addressed provisions of the
National Defense Authorization Act for
Fiscal Year 2007 (NDAA–07) (Pub. L.
109–364),which expanded eligibility for
the TRICARE Reserve Select program to
include all Selected Reservists except
those individuals either enrolled or
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eligible to enroll in the Federal
Employees Health Benefits program.
Before finalizing the interim final
rule, a proposed rule was published in
the Federal Register on August 27, 2014
(79 FR 51127). The proposed rule
addressed provisions of the National
Defense Authorization Act for Fiscal
Year 2009 (NDAA–09) (Pub. L. 110–
417), the National Defense
Authorization Act for Fiscal Year 2010
(NDAA–10) (Pub. L. 111–84), and the
National Defense Authorization Act for
Fiscal Year 2013 (NDAA–13) (Pub. L.
112–239). First, section 704 of NDAA–
09 specifies that the appropriate
actuarial basis for calculating premiums
for TRS shall utilize the actual cost of
providing benefits to members and their
dependents during preceding calendar
years. Second, section 702 of NDAA–10
expands early eligibility for Reserve
Component members issued delayedeffective-date active duty orders from a
maximum of 90 days to a maximum of
180 days prior to activation in support
of a contingency for more than 30 days.
Third, for a member who is
involuntarily separated from the
Selected Reserve under other than
adverse conditions as characterized by
the Secretary concerned, section 701 of
NDAA–13 provides a time-limited
exception that allows TRS coverage
already in effect at time of separation to
continue for up to 180 days after the
date on which the member is separated
from the Selected Reserve and TDP
coverage already in effect at time of
separation to continue for no less than
180 days after the separation date. This
exception expires December 31, 2018.
Finally, the proposed rule addressed
additional administrative clarifications
to 32 CFR 199.24, which implements
TRS.
This final rule addresses and finalizes
the provisions in both the interim final
rule and the proposed rule.
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B. Public Comments
An interim final rule was published
in the Federal Register on August 20,
2007 and we received 4 comments (one
comment was a duplicate submission).
A proposed rule was published in the
Federal Register on August 27, 2014
and we received 1 comment. We thank
those who provided comments. Specific
matters raised by those who submitted
comments are summarized below.
II. Provisions of the Rule Regarding
Early TRICARE Eligibility
1. Provisions of Proposed Rule.
Section 199.3(b)(5) implements section
702 of NDAA–10, which specifies that
Reserve Component members issued
delayed-effective-date orders for service
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in support of a contingency operation,
and their family members, are eligible
for TRICARE on the date the orders are
issued, up to a maximum of 180 days
prior to the date on which the period of
active duty of more than 30 consecutive
days is to begin. Previously, members
and their family members could become
eligible for TRICARE up to a maximum
of 90 days prior to the date on which the
period of active duty in support of a
contingency operation of more than 30
consecutive days is to begin.
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
proposed rule.
III. Provisions of the Rule Regarding
the TRICARE Dental Program
A summary of the relevant proposed
rule provision is presented, followed by
an analysis of major public comments,
and by a summary of the final rule
provisions.
1. Provisions of Proposed Final Rule.
So that the existing provisions of
§ 199.13(c)(3)(ii)(E)(2) would not be
confused with the new paragraph
described below, we proposed to clarify
that the continued coverage described in
this paragraph is actually survivor
coverage. We also proposed to reinsert
the provision that the government will
pay both the government and the
beneficiary’s portion of the premium
share during the three-year period of
continued survivor enrollment, which
was inadvertently deleted by a previous
amendment to the regulation.
We proposed to add new
§ 199.13(c)(3)(ii)(E)(5) that implements
the provisions in section 701 of NDAA–
13 concerning TDP. A time-limited
exception is added to the general rule
that TDP coverage shall terminate for
members who no longer qualify for TDP.
This exception specifies that if a
member is involuntarily separated from
the Selected Reserve under other than
adverse conditions, as characterized by
the Secretary concerned, and TDP
coverage was in effect for the member
and/or the family on the last day of his
or her membership in the Selected
Reserve, the TDP coverage that was in
effect, whether member coverage and/or
family coverage, may terminate no
earlier than 180 days after the date on
which the member is separated from the
Selected Reserve. This exception
expires December 31, 2018.
2. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
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3. Provisions of the Final Rule. The
final rule is consistent with the
proposed rule.
IV. Provisions of the Rule Regarding the
TRICARE Reserve Select Program
Many of our proposed clarifications
update the rules for TRS (§ 199.24) and,
as appropriate, bring the rules in closer
alignment and sequencing with the very
similar TRICARE Retired Reserve
program (§ 199.25).
A. Establishment of the TRICARE
Reserve Select Program (§ 199.24(a))
1. Provisions of Interim Final Rule.
This paragraph describes the nature,
purpose, statutory basis, scope, and
major features of TRICARE Reserve
Select, a premium-based medical
coverage program that was made
available worldwide to certain members
of the Selected Reserve and their family
members. TRICARE Reserve Select is
authorized by 10 U.S.C. 1076d.
2. Provisions of the Proposed Rule.
We proposed to remove the existing
terminology at § 199.24(a)(4) and to
redesignate § 199.24(a)(5) as
§ 199.24(a)(4). We proposed to clarify
that certain special programs
established in 32 CFR part 199 are not
available to members covered under
TRS (§ 199.24(a)(4)(i)(B)).
We proposed to clarify the wording
for submitting an initial payment of the
appropriate premium along with the
request to purchase coverage
(§ 199.24(a)(4)(iii)) and to make it
consistent throughout this section. We
proposed to clarify that 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 active
duty service members’ dependents who
are not enrolled in TRICARE Prime
(§ 199.24(a)(4)(iv)).
3. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
4. Provisions of the Final Rule. The
final rule is consistent with the interim
final rule and the proposed rule.
B. Qualifications for TRICARE Reserve
Select Coverage (§ 199.24(b))
1. Provisions of Interim Final Rule. In
the interim final rule, paragraph (b)
addressed TRICARE Reserve Select
premiums (§ 199.24(b)). It continued
that members are charged premiums for
coverage under TRICARE Reserve Select
that represent 28 percent of the total
annual premium amount that the
Assistant Secretary of Defense, Health
Affairs (ASD(HA)) determines on an
appropriate actuarial basis as being
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appropriate for coverage under the
TRICARE Standard (and Extra) benefit
for the TRICARE Reserve Select eligible
population. Premiums are to be paid
monthly, except as otherwise
established as part of the administrative
implementation of TRICARE Reserve
Select.
Annual rates for the first year
TRICARE Reserve Select was offered
(2005) were based on the calendar year
annual premiums for the Blue Cross and
Blue Shield Standard Service Benefit
Plan under the Federal Employees
Health Benefits Program, a nationwide
plan closely resembling TRICARE
Standard (and Extra) coverage, with an
adjustment based on estimated
differences in covered populations, as
determined by the ASD(HA).
Based on an analysis of demographic
differences between Blue Cross and
Blue Shield members and beneficiaries
eligible for TRICARE Reserve Select, the
adjustment amount in calendar year
2005 represented a 32 percent reduction
from the Blue Cross and Blue Shield
annual premium for member-only
coverage and represented an 8 percent
reduction from the Blue Cross and Blue
Shield annual premium for member and
family coverage. (The difference in the
percentage reductions between member
only and member and family premiums
is due to the disproportionately high
number of high cost, single, elderly
retiree federal employees covered by
Blue Cross and Blue Shield memberonly coverage).
TRICARE Reserve Select monthly
premium rates are established and
updated annually, on a calendar year
basis, to maintain an appropriate
relationship with the annual changes in
Blue Cross and Blue Shield premiums,
or by other adjustment methodology
determined to be appropriate by the
ASD(HA) for each of the two types of
coverage, member-only coverage and
member and family coverage, on a
calendar year basis. The monthly rate
for each month of a calendar year is one
twelfth of the annual rate for that
calendar year.
In addition to these annual premium
changes, premium adjustments may also
be made prospectively for any calendar
year to reflect any significant program
changes or any actual experience in the
costs of administering the TRICARE
Reserve Select Program.
A surviving family member of a
Reserve Component service member
who qualified for TRICARE Reserve
Select coverage as described in
paragraph (c)(3) of this section will pay
premium rates as follows. The premium
amount shall be at the member-only rate
if there is only one surviving family
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member to be covered by TRICARE
Reserve Select and at the member and
family rate if there are two or more
survivors to be covered.
2. Provisions of the Proposed Rule.
We proposed to redesignate § 199.24(c)
as § 199.24(b) so that it precedes the
section on TRICARE Reserve Select
premiums for clarity and maintains
parallel sequencing with § 199.25.
Section 10144(b) of title 10, U.S.C.
provides that the Secretary concerned
may designate a category of members
within the Individual Ready Reserve
(IRR) of each Reserve Component who
are subject to being ordered to active
duty involuntarily in accordance with
section 12304 of title 10, U.S.C. We
proposed to clarify that since a member
of the IRR who has volunteered to serve
in such mobilization category is eligible
for benefits (other than pay and training)
as are normally available to members of
the Selected Reserve, these members
may also qualify for TRS
(§ 199.24(b)(1)(i)).
We proposed to clarify the exclusion
involving the Federal Employees Health
Benefits (FEHB) program. Section
199.24(b)(1)(ii) specifies that an
otherwise qualified member of the
Ready Reserve qualifies to purchase
TRS 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 Employees Health
Benefits’’ program. For purposes of the
FEHB program, the terms ‘‘enrolled,’’
‘‘enroll’’ and ‘‘enrollee’’ are defined in
§ 890.101 of title 5, CFR. We proposed
to clarify that the member (or certain
involuntarily separated former member)
no longer qualifies for TRS coverage
when the member has been eligible for
active coverage in a health benefits plan
under the FEHB program for more than
60 days (§ 199.24(b)(1)(ii)). This affords
the member sufficient time to make
arrangements for health coverage other
than TRS and avoid any days without
having health coverage being in force.
We proposed to clarify that
qualification for TRS survivor coverage
applies regardless of type of coverage in
effect on the day of the TRS member’s
death (§ 199.24(b)(2)).
3. Analysis of Major Public
Comments. One commenter suggested
that we eliminate the exclusion
regarding the FEHB program rather than
clarify it.
Response. The exclusion is statutory;
the Department of Defense has no
authority to eliminate it.
4. Provisions of the Final Rule. Note
in the proposed rule that we proposed
to redesignate paragraph (c) as
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paragraph (b) so that the section on
Qualifications for TRICARE Reserve
Select coverage would precede the
section on TRICARE Reserve Select
premiums for clarity purposes and to
maintain consistent sequencing with
§ 199.25. Then we proposed to replace
the content in the section on Eligibility
for (qualifying to purchase) TRICARE
Reserve Select coverage that appeared in
the interim final rule in its entirety with
the newly revised section on
Qualifications for TRICARE Reserve
Select coverage. Therefore, the final rule
is consistent with the proposed rule.
C. TRICARE Reserve Select Premiums
(§ 199.24(c))
1. Provisions of Interim Final Rule. In
the interim final rule, § 199.24(c)
addressed Eligibility for (qualifying to
purchase) TRICARE Reserve Select
coverage. It reflected the statutory
conditions under which members of a
Reserve component may qualify to
purchase TRICARE Reserve Select
coverage.
2. Provisions of the Proposed Rule.
We proposed to redesignate § 199.24(b)
as § 199.24(c) so that it follows the
section on Qualifications for TRICARE
Reserve Select coverage for clarity
purposes and maintains consistent
sequencing with § 199.25. We also
proposed to clarify that the Director,
Healthcare Operations in the Defense
Health Agency may establish
procedures for administrative
implementation related to premiums
(§ 199.24(c)).
Section 199.24(c)(1) implements
section 704 of NDAA–09, which
requires that monthly premiums be
determined by utilizing the actual
reported cost of providing benefits to
TRS members and their dependents
during preceding calendar years.
Section 704 of NDAA–09 specified that
actual TRS cost data from calendar years
2006 and 2007 be utilized in the
determination of premium rates for
calendar year 2009. This established
pattern has been followed to determine
premium rates for all calendar years
starting with 2009 (§ 199.24(c)(1)).
Further, we proposed to amend
§ 199.24(c) by deleting all former
provisions involving the relationship
between premium rates for TRS and
premium rates for the Blue Cross and
Blue Shield Standard Service Benefit
Plan under the Federal Employees
Health Benefits program.
3. Analysis of Major Public
Comments. Three military service
organizations commented on the
methodology described in the interim
final rule to be used for annual TRS
premium updates that was based on
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annual changes in premiums in the Blue
Cross/Blue Shield plan offered
nationwide by the Federal Employees
Health Benefits program. Rather than
applying the same percentage increases
to TRS premiums that were observed in
the federal Blue Cross/Blue Shield
nationwide plan, each commenting
organization requested that the annual
TRS premium increases not exceed the
percentage increase in military basic
pay.
Response. Section 704 of NDAA–09
added 10 U.S.C. 1076 d(d)(3)(B) to
specify that the appropriate actuarial
basis for calculating premiums for TRS
shall utilize the actual cost of providing
benefits to members and their
dependents during preceding calendar
years. The final rule is consistent with
this statutory requirement.
4. Provisions of the Final Rule. Note
in the proposed rule that we proposed
to redesignate paragraph (b) as
paragraph (c) so that the section on
TRICARE Reserve Select premiums
would follow the section on
Qualifications for TRICARE Reserve
Select coverage for clarity purposes and
to maintain consistent sequencing with
§ 199.25). Then we proposed to replace
the content on TRICARE Reserve Select
premiums that appeared in the interim
final rule in its entirety with the newly
revised section on TRICARE Reserve
Select premiums in order to implement
section 704 of NDAA–09. That had the
effect of removing all of the former
provisions involving the relationship
between premium rates for TRS and
premium rates for the Blue Cross and
Blue Shield Standard Service Benefit
Plan under the Federal Employees
Health Benefits program will appear in
the amended § 199.24(c). The final rule
is consistent with the proposed rule.
D. Procedures (§ 199.24(d))
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1. Provisions of Interim Final Rule
The interim final rule addressed
procedures for TRS coverage.
2. Provisions of the Proposed Rule.
We proposed to clarify that the Director,
Healthcare Operations in the Defense
Health Agency may establish
procedures for TRS (§ 199.24(d)).
We proposed to clarify that either
reserve members or survivors qualified
under § 199.24(b) may follow applicable
procedures throughout this section
regarding TRS coverage. We proposed to
clarify the rule about immediate family
members who may be included in
family coverage under TRS
(§ 199.24(d)(1)), which is further
supported by the proposed definition
for immediate family member included
in § 199.24(g).
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We proposed to clarify continuation
coverage by removing the previous
requirement that the member had to be
the sponsor of the other TRICARE
coverage in order to qualify for
continuation coverage (§ 199.24(d)(1)(i)).
In circumstances when the spouse of the
Reserve Component member is the
sponsor for purposes of the other
TRICARE coverage, it would be clear
that the qualified member would be able
to purchase TRS coverage with an
effective date immediately following the
date of termination of coverage under
another TRICARE program regardless
whether it was the Reserve Component
member or the spouse who was the
sponsor of the other TRICARE coverage.
We proposed rules to implement the
provisions in section 701 of NDAA–13
concerning TRS coverage
(§ 199.24(d)(3)(i)). Similar to the TDP,
this provision would apply to members
involuntarily separated from the
Selected Reserve if, and only if, the
member was covered by TRS on the last
day of his or her membership in the
Selected Reserve. However, the
termination date of TRS is characterized
slightly differently from the TDP
provision because TRS may terminate
up to 180 days after the date on which
the member is separated from the
Selected Reserve. This delayed
termination exception applies regardless
of type of TRS coverage actually in
effect at the time. This exception expires
December 31, 2018.
We proposed to clarify the rule that
procedures may be established for TRS
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 (§ 199.24(d)(3)).
Suspension/termination of coverage for
the TRS member/survivor will result in
suspension/termination of coverage for
the member’s/survivor’s family
members in TRS, except as described in
§ 199.24 (d)(1)(iv). We also proposed to
clarify that procedures may be
established for the suspension to be
lifted upon request before final
termination is applied.
3. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
4. Provisions of the Final Rule. The
final rule is consistent with the interim
final rule and the proposed rule.
E. Preemption of State Laws
(§ 199.24(e))
1. Provisions of Interim Final Rule. In
the interim final rule, paragraph (e)
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55253
addressed Relationship to Continued
Health Care Benefits Program (CHCBP)
(§ 199.24(e)). Based on a statutory
amendment concerning CHCBP, the
Final Rule published September 16,
2011 (76 FR 57637–57641) removed
paragraph (e) in its entirety and
replaced it with the placeholder (e)
Reserved to maintain numerical
sequencing.
3. Provisions of the Proposed Rule.
We proposed to remove the previous
§ 199.24(e) Reserved and redesignate
§ 199.24(f) as § 199.24(e). No other
changes are proposed this section.
4. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
5. Provisions of the Final Rule. The
final rule is consistent with the
proposed rule.
F. Administration (§ 199.25(f))
1. Provisions of Interim Final Rule. In
the interim final rule, paragraph (f)
addressed Preemption of State laws
(§ 199.25(f)).
2. Provisions of the Proposed Rule.
We proposed to redesignate § 199.24(g)
as § 199.24(f). We proposed to clarify
this provision by removing the phrase,
‘‘based on extraordinary circumstances’’
as a limitation on authority to grant
exceptions to requirements of the
section and to clarify that the Director,
Healthcare Operations in the Defense
Health Agency has authority to grant
such exceptions and establish
administrative rules and procedures for
TRS.
3. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
4. Provisions of the Final Rule. The
final rule is consistent with the
proposed rule.
G. Terminology (§ 199.25(g))
1. Provisions of Interim Final Rule. In
the interim final rule, paragraph (g)
addressed Administration (§ 199.25(g)).
2. Provisions of the Proposed Rule.
We proposed to redesignate paragraph
(g) as paragraph (f) and to add a new
paragraph (g) regarding terminology.
This would also remove the terminology
under § 199.25(a)(4).
3. Analysis of Major Public
Comments. No public comments were
received relating to this section of the
rule.
4. Provisions of the Final Rule. The
final rule is consistent with the
proposed rule.
V. Costs
Fiscal year 2014 through 2019 costs
are anticipated to be $7,735,728.00:
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Fiscal year
Government
cost
PART 199—[AMENDED]
1. The authority citation for part 199
continues to read as follows:
■
2014
2015
2016
2017
2018
2019
......................................
......................................
......................................
......................................
......................................
......................................
$1,296,884
1,373,929
1,455,633
1,542,277
1,634,096
432,909
Total FY14–FY19 ..............
7,735,728
Authority: 5 U.S.C. 301; 10 U.S.C. chapter
55.
2. Amend § 199.3 by revising
paragraph (b)(5)(iii)(B) to read as
follows:
■
§ 199.3
VI. Regulatory Procedures
Executive Orders 12866 and 13563
require certain regulatory assessments
for any significant regulatory action that
would result in an annual effect on the
economy of $100 million or more, or
have other substantial impacts. The
Congressional Review Act establishes
certain procedures for major rules,
defined as those with similar major
impacts. The Regulatory Flexibility Act
(RFA) requires that each Federal agency
prepare, and make available for public
comment, a regulatory flexibility
analysis when the agency issues a
regulation that would have significant
impact on a substantial number of small
entities. This final rule is not subject to
any of these requirements because it
will not have any of these substantial
impacts. However, this rule has been
designated a ‘‘significant regulatory
action,’’ although not economically
significant, under section 3(f) of
Executive Order 12866. Accordingly,
the rule has been reviewed by the Office
of Management and Budget (OMB).
This rule will not impose additional
information collection requirements on
the public under the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501–
3511).
We have examined the impact(s) of
the final rule under Executive Order
13132 and it does not have policies that
have federalism implications that will
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. The preemption
provisions in the rule conform to law
and long-established TRICARE policy.
Therefore, consultation with State and
local officials is not required.
mstockstill on DSK4VPTVN1PROD with RULES
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health
insurance, Military personnel.
Accordingly, the interim final rule
published at 72 FR 46380 on August 20,
2007, amending 32 CFR part 199 is
adopted as a final rule with the
following changes:
VerDate Sep<11>2014
19:08 Sep 14, 2015
Eligibility.
*
Jkt 235001
*
*
*
*
(b) * * *
(5) * * *
(iii) * * *
(B) 180 days before the date on which
the period of active duty is to begin.
*
*
*
*
*
■ 3. Amend § 199.13 by revising
paragraph (c)(3)(ii)(E)(2) introductory
text and adding paragraph (c)(3)(ii)(E)(5)
to read as follows:
§ 199.13
TRICARE Dental Program.
*
*
*
*
*
(c) * * *
(3) * * *
(ii) * * *
(E) * * *
(2) Survivor eligibility. Eligible
dependents of active duty members who
die while on active duty for a period of
more than 30 days and eligible
dependents of members of the Ready
Reserve (i.e., Selected Reserve or
Individual Ready Reserve, as specified
in 10 U.S.C. 10143 and 10144(b)
respectively) who die, shall be eligible
for survivor enrollment in the TDP.
During the period of survivor
enrollment, the government will pay
both the government and the eligible
dependent’s portion of the premium
share. This survivor enrollment shall be
up to (3) three years from the date of the
member’s death, except that, in the case
of a dependent of the deceased who is
described in 10 U.S.C. 1072(2)(D) or (I),
the period of survivor enrollment shall
be the longer of the following periods
beginning on the date of the member’s
death:
*
*
*
*
*
(5) TRICARE Dental Program coverage
shall terminate for members who no
longer qualify for the TRICARE Dental
Program as specified in paragraph (c)(2)
of this section, with one exception. If a
member is involuntarily separated from
the Selected Reserve under other than
adverse conditions, as characterized by
the Secretary concerned, and TRICARE
Dental Program coverage is in effect for
the member and/or the family on the
last day of his or her membership in the
Selected Reserve; then the TRICARE
Dental Program coverage that was
actually in effect may terminate no
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Fmt 4700
Sfmt 4700
earlier than 180 days after the date on
which the member is separated from the
Selected Reserve. This exception
expires December 31, 2018.
*
*
*
*
*
■ 4. Amend § 199.24 as follows.
■ a. Remove paragraph (a)(4).
■ b. Redesignate paragraph (a)(5) as
paragraph (a)(4).
■ c. Revise newly redesignated
paragraphs (a)(4)(i)(B), (a)(4)(iii), and
(a)(4)(iv).
■ d. Redesignate paragraphs (b) and (c)
as paragraphs (c) and (b), respectively.
■ e. Revise newly redesignated
paragraphs (b) and (c).
■ f. Revise paragraph (d).
■ g. Redesignate paragraphs (f) and (g)
as paragraphs (e) and (f), respectively.
■ h. Revise newly redesignated
paragraph (f).
■ i. Add new paragraph (g).
The revisions and additions read as
follows:
§ 199.24
TRICARE Reserve Select.
(a) * * *
(4) * * *
(i) * * *
(B) Certain special programs
established in 32 CFR part 199 are not
available to members covered under
TRICARE Reserve Select. These include
the Extended Care Health Option
(§ 199.5), the Special Supplemental
Food Program (see § 199.23), and the
Supplemental Health Care Program
(§ 199.16), except when referred by a
Military Treatment Facility (MTF)
provider for incidental consults and the
MTF provider maintains clinical control
over the episode of care. The TRICARE
Dental Program (§ 199.13) is
independent of this program and is
otherwise available to all members of
the Selected Reserve and their eligible
family members whether or not they
purchase TRICARE Reserve Select
coverage. The Continued Health Care
Benefits Program (§ 199.20) is also
independent of this program and is
otherwise available to all members who
qualify.
*
*
*
*
*
(iii) Procedures. Under TRICARE
Reserve Select, Reserve Component
members who fulfilled all of the
statutory qualifications may purchase
either the member-only type of coverage
or the member-and-family type of
coverage by submitting a completed
request in the appropriate format along
with an initial payment of the
applicable premium. Rules and
procedures for purchasing coverage and
paying applicable premiums are
prescribed in this section.
(iv) Benefits. When their coverage
becomes effective, TRICARE Reserve
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Federal Register / Vol. 80, No. 178 / Tuesday, September 15, 2015 / Rules and Regulations
Select beneficiaries receive the
TRICARE Standard (and Extra) benefit
including access to military treatment
facility services and pharmacies, as
described in §§ 199.17 and 199.21.
TRICARE Reserve Select coverage
features the deductible and cost share
provisions of the TRICARE Standard
(and Extra) plan applicable to active
duty family members for both the
member and the member’s covered
family members (paragraph (a)(4)(iv) of
this section). 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 active duty service members’
dependents who are not enrolled in
TRICARE Prime as described in
§ 199.17(d)(1)(i)(D).
(b) Qualifications for TRICARE
Reserve Select coverage—(1) Ready
Reserve member. A Ready Reserve
member qualifies to purchase TRICARE
Reserve Select coverage if the Service
member meets both the following
criteria:
(i) Is a member of the Selected
Reserve of the Ready Reserve of the
Armed Forces, or a member of the
Individual Ready Reserve of the Armed
Forces who has volunteered to be
ordered to active duty pursuant to the
provisions of 10 U.S.C. 12304 in
accordance with section 10 U.S.C.
10144(b); and
(ii) Is not enrolled in, or eligible to
enroll in, a health benefits plan under
5 U.S.C. chapter 89. That statute has
been implemented under 5 CFR part 890
as the Federal Employees Health
Benefits (FEHB) program. For purposes
of the FEHB program, the terms
‘‘enrolled,’’ ‘‘enroll’’ and ‘‘enrollee’’ are
defined in 5 CFR 890.101. Further, the
member (or certain former member
involuntarily separated) no longer
qualifies for TRICARE Reserve Select
when the member (or former member)
has been eligible for coverage to be
effective in a health benefits plan under
the FEHB program for more than 60
days.
(2) TRICARE Reserve Select survivor.
If a qualified Service member dies while
in a period of TRICARE Reserve Select
coverage, the immediate family
member(s) of such member is qualified
to purchase new or continue existing
TRICARE Reserve Select coverage for up
to six months beyond the date of the
member’s death as long as they meet the
definition of immediate family members
as specified in paragraph (g)(2) of this
section. This applies regardless of type
of coverage in effect on the day of the
TRICARE Reserve Select member’s
death.
VerDate Sep<11>2014
19:08 Sep 14, 2015
Jkt 235001
(c) TRICARE Reserve Select
premiums. Members are charged
premiums for coverage under TRICARE
Reserve Select that represent 28 percent
of the total annual premium amount
that the Director, Defense Health
Agency determines on an appropriate
actuarial basis as being appropriate for
coverage under the TRICARE Standard
(and Extra) benefit for the TRICARE
Reserve Select eligible population.
Premiums are to be paid monthly,
except as otherwise provided through
administrative implementation,
pursuant to procedures established by
the 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.
TRICARE Reserve Select monthly
premium rates shall be established and
updated annually on a calendar year
basis for each of the two types of
coverage, member-only and memberand-family as described in paragraph
(d)(1) of this section. Starting with
calendar year 2009, the appropriate
actuarial basis for purposes of this
paragraph (c) shall be determined for
each calendar year by utilizing the
actual reported cost of providing
benefits under this section to members
and their dependents during the
calendar years preceding such calendar
year. Reported actual TRS cost data
from calendar years 2006 and 2007 was
used to determine premium rates for
calendar year 2009. This established
pattern will be followed to determine
premium rates for all calendar years
subsequent to 2009.
(2) Premium adjustments. In addition
to the determinations described in
paragraph (c)(1) of this section,
premium adjustments may be made
prospectively for any calendar year to
reflect any significant program changes
or any actual experience in the costs of
administering TRICARE Reserve Select.
(3) Survivor premiums. A surviving
family member of a Reserve Component
service member who qualified for
TRICARE Reserve Select coverage as
described in paragraph (b)(2) of this
section will pay premium rates as
follows. The premium amount shall be
at the member-only rate if there is only
one surviving family member to be
covered by TRICARE Reserve Select and
at the member and family rate if there
are two or more survivors to be covered.
(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
PO 00000
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55255
member to purchase one of two types of
coverage: Member-only coverage or
member and family coverage. Immediate
family members of a qualified member
as specified in paragraph (g)(2) of this
section may be included in such family
coverage. To purchase either type of
TRICARE Reserve Select coverage for
effective dates of coverage described
below, members and survivors qualified
under either paragraph (b)(1) or (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.
(i) Continuation coverage. Procedures
may be established for a qualified
member or qualified survivor to
purchase TRICARE Reserve Select
coverage with an effective date
immediately following the date of
termination of coverage under another
TRICARE program.
(ii) Qualifying life event. Procedures
may be established for a qualified
member or qualified survivor to
purchase TRICARE Reserve Select
coverage on the occasion of a qualifying
life event that changes the immediate
family composition (e.g., birth,
adoption, divorce, etc.) that is eligible
for coverage under TRICARE Reserve
Select. The effective date for TRICARE
Reserve Select coverage will coincide
with the date 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.
(iii) Open enrollment. Procedures may
be established for a qualified member to
purchase TRICARE Reserve Select
coverage at any time. The effective date
of coverage will coincide with the first
day of a month.
(iv) Survivor coverage under TRICARE
Reserve Select. Procedures may be
established for a surviving family
member of a Reserve Component service
member who qualified for TRICARE
Reserve Select coverage as described in
paragraph (b)(2) of this section to
purchase new TRICARE Reserve Select
coverage or continue existing TRICARE
Reserve Select coverage for up to six
months beyond the date of the member’s
death. The effective date of coverage
will be the day following the date of the
member’s death.
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55256
Federal Register / Vol. 80, No. 178 / Tuesday, September 15, 2015 / Rules and Regulations
(2) Changing type of coverage.
Procedures may be established for
TRICARE Reserve Select members to
request to change type of coverage
during open enrollment as described in
paragraph (d)(1)(iii) of this section or on
the occasion of a qualifying life event
that changes immediate family
composition as described in paragraph
(d)(1)(ii) of this section by submitting a
completed request in the appropriate
format.
(3) Suspension and termination.
Suspension/termination of coverage for
the TRS member/survivor will result in
suspension/termination of coverage for
the member’s/survivor’s family
members in TRICARE Reserve Select,
except as described in paragraph
(d)(1)(iv) of this section. Procedures may
be established for coverage to be
suspended or terminated as follows.
(i) Coverage shall terminate when
members or survivors no longer qualify
for TRICARE Reserve Select as specified
in paragraph (b) of this section, with one
exception. If a member is involuntarily
separated from the Selected Reserve
under other than adverse conditions, as
characterized by the Secretary
concerned, and is covered by TRICARE
Reserve Select on the last day of his or
her membership in the Selected
Reserve, then TRICARE Reserve Select
coverage may terminate up to 180 days
after the date on which the member was
separated from the Selected Reserve.
This applies regardless of type of
coverage. This exception expires
December 31, 2018.
(ii) Coverage may terminate for
members, former members, and
survivors who gain coverage under
another TRICARE program.
(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 (iv)
of this section, TRICARE Reserve Select
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.
(4) Processing. Upon receipt of a
completed request in the appropriate
format, enrollment actions will be
processed into DEERS in accordance
with established procedures.
VerDate Sep<11>2014
19:08 Sep 14, 2015
Jkt 235001
(5) Periodic revision. Periodically,
certain features, rules or procedures of
TRICARE Reserve Select may be
revised. If such revisions will have a
significant effect on members’ 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.
*
*
*
*
*
(f) Administration. The Director,
Healthcare Operations in the Defense
Health Agency may establish other rules
and procedures for the effective
administration of TRICARE Reserve
Select, and may authorize exceptions to
requirements of this section, if
permitted by law.
(g) Terminology. The following terms
are applicable to the TRICARE Reserve
Select program.
(1) Coverage. This term means the
medical benefits covered under the
TRICARE Standard or Extra programs as
further outlined in other sections of 32
CFR part 199 whether delivered in
military treatment facilities or
purchased from civilian sources.
(2) Immediate family member. This
term means spouse (except former
spouses) as defined in § 199.3(b)(2)(i), or
child as defined in § 199.3(b)(2)(ii).
(3) Qualified member. This term
means a member who has satisfied all
the criteria that must be met before the
member is authorized for TRS coverage.
(4) 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 TRS coverage.
Dated: September 4, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2015–22815 Filed 9–14–15; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 117
[Docket No. USCG–2015–0873]
Drawbridge Operation Regulation;
Snake River, Burbank, WA
Coast Guard, DHS.
Notice of deviation from
drawbridge regulation.
AGENCY:
ACTION:
The Coast Guard has issued a
temporary deviation from the operating
schedule that governs the Burlington
SUMMARY:
PO 00000
Frm 00036
Fmt 4700
Sfmt 4700
Northern Santa Fe (BNSF) Railway
Bridge across the Snake River, mile 1.5,
at Burbank, WA. The deviation is
necessary to accommodate maintenance
to replace movable rail joints. This
deviation allows the bridge to remain in
the closed-to-navigation position during
maintenance activities.
DATES: This deviation is effective from
7 a.m. on September 28, 2015 until 7
p.m. on October 1, 2015.
ADDRESSES: The docket for this
deviation, [USCG–2015–0873] is
available at https://www.regulations.gov.
Type the docket number in the
‘‘SEARCH’’ box and click ‘‘SEARCH.’’
Click on Open Docket Folder on the line
associated with this deviation. You may
also visit the Docket Management
Facility in Room W12–140 on the
ground floor of the Department of
Transportation West Building, 1200
New Jersey Avenue SE., Washington,
DC 20590, between 9 a.m. and 5 p.m.,
Monday through Friday, except Federal
holidays.
FOR FURTHER INFORMATION CONTACT: If
you have questions on this temporary
deviation, call or email Mr. Steven
Fischer, Bridge Administrator,
Thirteenth Coast Guard District;
telephone 206–220–7282, email d13-pfd13bridges@uscg.mil. If you have
questions on viewing the docket, call
Cheryl Collins, Program Manager,
Docket Operations, telephone 202–366–
9826.
SUPPLEMENTARY INFORMATION: BNSF has
requested that the BNSF Snake River
Bridge across the Snake River, mile 1.5,
remain in the closed-to-navigation
position to vessel traffic to perform
railroad bridge maintenance. During this
maintenance period, movable rail joints
will be replaced at both ends of the lift
span. The BNSF Snake River Bridge,
mile 1.5, provides 14.1 feet of vertical
clearance above Columbia River Datum
0.0 while in the closed position. The
normal operating schedule for the BNSF
Snake River Bridge 3.08 operates in
accordance with 33 CFR 117.1058, and
is automated and is normally
maintained in the fully open-tonavigation position.
The deviation allows the lift span of
the BNSF Snake River Bridge across the
Snake River, mile 1.5, to remain in the
closed-to-navigation position, and need
not open for maritime traffic from 7 a.m.
to 3 p.m. on September 28, 2015; from
7 a.m. to 7 p.m. on September 29, 2015;
from 7 a.m. to 3 p.m. on September 30,
2015; and from 7 a.m. to 7 p.m. on
October 1, 2015. During the active
maintenance, BNSF will lower the lift
span in closed-to-navigation position.
Waterway usage on this part of the
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]]>Agencies
[Federal Register Volume 80, Number 178 (Tuesday, September 15, 2015)]
[Rules and Regulations]
[Pages 55250-55256]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-22815]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2006-HA-0207]
RIN 0720-AB15
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early
Eligibility for TRICARE for Certain Reserve Component Members
AGENCY: Office of the Secretary, DoD.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: TRICARE Reserve Select (TRS) is a premium-based TRICARE health
plan available for purchase worldwide by qualified members of the Ready
Reserve and by qualified survivors of TRS members. TRICARE Dental
Program (TDP) is a premium-based TRICARE dental plan available for
purchase worldwide by qualified Service members. This final rule
revises requirements and procedures for the TRS program to specify the
appropriate actuarial basis for calculating premiums in addition to
making other minor clarifying administrative changes. For a member who
is involuntarily separated from the Selected Reserve under other than
adverse conditions this final rule provides a time-limited exception
that allows TRS coverage in effect to continue for up to 180 days after
the date on which the member is separated from the Selected Reserve and
TDP coverage in effect to continue for no less than 180 days after the
separation date. It also expands early TRICARE eligibility for certain
Reserve Component members from a maximum of 90 days to a maximum of 180
days prior to activation in support of a contingency operation for more
than 30 days.
DATES: This rule is effective October 15, 2015.
FOR FURTHER INFORMATION CONTACT: Brian Smith, Defense Health Agency,
TRICARE Health Plan Division, 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 20, 2007 (72 FR 46380). That interim final rule addressed
provisions of the National Defense Authorization Act for Fiscal Year
2007 (NDAA-07) (Pub. L. 109-364),which expanded eligibility for the
TRICARE Reserve Select program to include all Selected Reservists
except those individuals either enrolled or
[[Page 55251]]
eligible to enroll in the Federal Employees Health Benefits program.
Before finalizing the interim final rule, a proposed rule was
published in the Federal Register on August 27, 2014 (79 FR 51127). The
proposed rule addressed provisions of the National Defense
Authorization Act for Fiscal Year 2009 (NDAA-09) (Pub. L. 110-417), the
National Defense Authorization Act for Fiscal Year 2010 (NDAA-10) (Pub.
L. 111-84), and the National Defense Authorization Act for Fiscal Year
2013 (NDAA-13) (Pub. L. 112-239). First, section 704 of NDAA-09
specifies that the appropriate actuarial basis for calculating premiums
for TRS shall utilize the actual cost of providing benefits to members
and their dependents during preceding calendar years. Second, section
702 of NDAA-10 expands early eligibility for Reserve Component members
issued delayed-effective-date active duty orders from a maximum of 90
days to a maximum of 180 days prior to activation in support of a
contingency for more than 30 days. Third, for a member who is
involuntarily separated from the Selected Reserve under other than
adverse conditions as characterized by the Secretary concerned, section
701 of NDAA-13 provides a time-limited exception that allows TRS
coverage already in effect at time of separation to continue for up to
180 days after the date on which the member is separated from the
Selected Reserve and TDP coverage already in effect at time of
separation to continue for no less than 180 days after the separation
date. This exception expires December 31, 2018. Finally, the proposed
rule addressed additional administrative clarifications to 32 CFR
199.24, which implements TRS.
This final rule addresses and finalizes the provisions in both the
interim final rule and the proposed rule.
B. Public Comments
An interim final rule was published in the Federal Register on
August 20, 2007 and we received 4 comments (one comment was a duplicate
submission). A proposed rule was published in the Federal Register on
August 27, 2014 and we received 1 comment. We thank those who provided
comments. Specific matters raised by those who submitted comments are
summarized below.
II. Provisions of the Rule Regarding Early TRICARE Eligibility
1. Provisions of Proposed Rule. Section 199.3(b)(5) implements
section 702 of NDAA-10, which specifies that Reserve Component members
issued delayed-effective-date orders for service in support of a
contingency operation, and their family members, are eligible for
TRICARE on the date the orders are issued, up to a maximum of 180 days
prior to the date on which the period of active duty of more than 30
consecutive days is to begin. Previously, members and their family
members could become eligible for TRICARE up to a maximum of 90 days
prior to the date on which the period of active duty in support of a
contingency operation of more than 30 consecutive days is to begin.
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 proposed rule.
III. Provisions of the Rule Regarding the TRICARE Dental Program
A summary of the relevant proposed rule provision is presented,
followed by an analysis of major public comments, and by a summary of
the final rule provisions.
1. Provisions of Proposed Final Rule. So that the existing
provisions of Sec. 199.13(c)(3)(ii)(E)(2) would not be confused with
the new paragraph described below, we proposed to clarify that the
continued coverage described in this paragraph is actually survivor
coverage. We also proposed to reinsert the provision that the
government will pay both the government and the beneficiary's portion
of the premium share during the three-year period of continued survivor
enrollment, which was inadvertently deleted by a previous amendment to
the regulation.
We proposed to add new Sec. 199.13(c)(3)(ii)(E)(5) that implements
the provisions in section 701 of NDAA- 13 concerning TDP. A time-
limited exception is added to the general rule that TDP coverage shall
terminate for members who no longer qualify for TDP. This exception
specifies that if a member is involuntarily separated from the Selected
Reserve under other than adverse conditions, as characterized by the
Secretary concerned, and TDP coverage was in effect for the member and/
or the family on the last day of his or her membership in the Selected
Reserve, the TDP coverage that was in effect, whether member coverage
and/or family coverage, may terminate no earlier than 180 days after
the date on which the member is separated from the Selected Reserve.
This exception expires December 31, 2018.
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 proposed rule.
IV. Provisions of the Rule Regarding the TRICARE Reserve Select Program
Many of our proposed clarifications update the rules for TRS (Sec.
199.24) and, as appropriate, bring the rules in closer alignment and
sequencing with the very similar TRICARE Retired Reserve program (Sec.
199.25).
A. Establishment of the TRICARE Reserve Select Program (Sec.
199.24(a))
1. Provisions of Interim Final Rule. This paragraph describes the
nature, purpose, statutory basis, scope, and major features of TRICARE
Reserve Select, a premium-based medical coverage program that was made
available worldwide to certain members of the Selected Reserve and
their family members. TRICARE Reserve Select is authorized by 10 U.S.C.
1076d.
2. Provisions of the Proposed Rule. We proposed to remove the
existing terminology at Sec. 199.24(a)(4) and to redesignate Sec.
199.24(a)(5) as Sec. 199.24(a)(4). We proposed to clarify that certain
special programs established in 32 CFR part 199 are not available to
members covered under TRS (Sec. 199.24(a)(4)(i)(B)).
We proposed to clarify the wording for submitting an initial
payment of the appropriate premium along with the request to purchase
coverage (Sec. 199.24(a)(4)(iii)) and to make it consistent throughout
this section. We proposed to clarify that 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 active duty
service members' dependents who are not enrolled in TRICARE Prime
(Sec. 199.24(a)(4)(iv)).
3. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
4. Provisions of the Final Rule. The final rule is consistent with
the interim final rule and the proposed rule.
B. Qualifications for TRICARE Reserve Select Coverage (Sec. 199.24(b))
1. Provisions of Interim Final Rule. In the interim final rule,
paragraph (b) addressed TRICARE Reserve Select premiums (Sec.
199.24(b)). It continued that members are charged premiums for coverage
under TRICARE Reserve Select that represent 28 percent of the total
annual premium amount that the Assistant Secretary of Defense, Health
Affairs (ASD(HA)) determines on an appropriate actuarial basis as being
[[Page 55252]]
appropriate for coverage under the TRICARE Standard (and Extra) benefit
for the TRICARE Reserve Select eligible population. Premiums are to be
paid monthly, except as otherwise established as part of the
administrative implementation of TRICARE Reserve Select.
Annual rates for the first year TRICARE Reserve Select was offered
(2005) were based on the calendar year annual premiums for the Blue
Cross and Blue Shield Standard Service Benefit Plan under the Federal
Employees Health Benefits Program, a nationwide plan closely resembling
TRICARE Standard (and Extra) coverage, with an adjustment based on
estimated differences in covered populations, as determined by the
ASD(HA).
Based on an analysis of demographic differences between Blue Cross
and Blue Shield members and beneficiaries eligible for TRICARE Reserve
Select, the adjustment amount in calendar year 2005 represented a 32
percent reduction from the Blue Cross and Blue Shield annual premium
for member-only coverage and represented an 8 percent reduction from
the Blue Cross and Blue Shield annual premium for member and family
coverage. (The difference in the percentage reductions between member
only and member and family premiums is due to the disproportionately
high number of high cost, single, elderly retiree federal employees
covered by Blue Cross and Blue Shield member-only coverage).
TRICARE Reserve Select monthly premium rates are established and
updated annually, on a calendar year basis, to maintain an appropriate
relationship with the annual changes in Blue Cross and Blue Shield
premiums, or by other adjustment methodology determined to be
appropriate by the ASD(HA) for each of the two types of coverage,
member-only coverage and member and family coverage, on a calendar year
basis. The monthly rate for each month of a calendar year is one
twelfth of the annual rate for that calendar year.
In addition to these annual premium changes, premium adjustments
may also be made prospectively for any calendar year to reflect any
significant program changes or any actual experience in the costs of
administering the TRICARE Reserve Select Program.
A surviving family member of a Reserve Component service member who
qualified for TRICARE Reserve Select coverage as described in paragraph
(c)(3) of this section will pay premium rates as follows. The premium
amount shall be at the member-only rate if there is only one surviving
family member to be covered by TRICARE Reserve Select and at the member
and family rate if there are two or more survivors to be covered.
2. Provisions of the Proposed Rule. We proposed to redesignate
Sec. 199.24(c) as Sec. 199.24(b) so that it precedes the section on
TRICARE Reserve Select premiums for clarity and maintains parallel
sequencing with Sec. 199.25.
Section 10144(b) of title 10, U.S.C. provides that the Secretary
concerned may designate a category of members within the Individual
Ready Reserve (IRR) of each Reserve Component who are subject to being
ordered to active duty involuntarily in accordance with section 12304
of title 10, U.S.C. We proposed to clarify that since a member of the
IRR who has volunteered to serve in such mobilization category is
eligible for benefits (other than pay and training) as are normally
available to members of the Selected Reserve, these members may also
qualify for TRS (Sec. 199.24(b)(1)(i)).
We proposed to clarify the exclusion involving the Federal
Employees Health Benefits (FEHB) program. Section 199.24(b)(1)(ii)
specifies that an otherwise qualified member of the Ready Reserve
qualifies to purchase TRS 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 Employees Health Benefits'' program. For purposes
of the FEHB program, the terms ``enrolled,'' ``enroll'' and
``enrollee'' are defined in Sec. 890.101 of title 5, CFR. We proposed
to clarify that the member (or certain involuntarily separated former
member) no longer qualifies for TRS coverage when the member has been
eligible for active coverage in a health benefits plan under the FEHB
program for more than 60 days (Sec. 199.24(b)(1)(ii)). This affords
the member sufficient time to make arrangements for health coverage
other than TRS and avoid any days without having health coverage being
in force.
We proposed to clarify that qualification for TRS survivor coverage
applies regardless of type of coverage in effect on the day of the TRS
member's death (Sec. 199.24(b)(2)).
3. Analysis of Major Public Comments. One commenter suggested that
we eliminate the exclusion regarding the FEHB program rather than
clarify it.
Response. The exclusion is statutory; the Department of Defense has
no authority to eliminate it.
4. Provisions of the Final Rule. Note in the proposed rule that we
proposed to redesignate paragraph (c) as paragraph (b) so that the
section on Qualifications for TRICARE Reserve Select coverage would
precede the section on TRICARE Reserve Select premiums for clarity
purposes and to maintain consistent sequencing with Sec. 199.25. Then
we proposed to replace the content in the section on Eligibility for
(qualifying to purchase) TRICARE Reserve Select coverage that appeared
in the interim final rule in its entirety with the newly revised
section on Qualifications for TRICARE Reserve Select coverage.
Therefore, the final rule is consistent with the proposed rule.
C. TRICARE Reserve Select Premiums (Sec. 199.24(c))
1. Provisions of Interim Final Rule. In the interim final rule,
Sec. 199.24(c) addressed Eligibility for (qualifying to purchase)
TRICARE Reserve Select coverage. It reflected the statutory conditions
under which members of a Reserve component may qualify to purchase
TRICARE Reserve Select coverage.
2. Provisions of the Proposed Rule. We proposed to redesignate
Sec. 199.24(b) as Sec. 199.24(c) so that it follows the section on
Qualifications for TRICARE Reserve Select coverage for clarity purposes
and maintains consistent sequencing with Sec. 199.25. We also proposed
to clarify that the Director, Healthcare Operations in the Defense
Health Agency may establish procedures for administrative
implementation related to premiums (Sec. 199.24(c)).
Section 199.24(c)(1) implements section 704 of NDAA-09, which
requires that monthly premiums be determined by utilizing the actual
reported cost of providing benefits to TRS members and their dependents
during preceding calendar years. Section 704 of NDAA-09 specified that
actual TRS cost data from calendar years 2006 and 2007 be utilized in
the determination of premium rates for calendar year 2009. This
established pattern has been followed to determine premium rates for
all calendar years starting with 2009 (Sec. 199.24(c)(1)). Further, we
proposed to amend Sec. 199.24(c) by deleting all former provisions
involving the relationship between premium rates for TRS and premium
rates for the Blue Cross and Blue Shield Standard Service Benefit Plan
under the Federal Employees Health Benefits program.
3. Analysis of Major Public Comments. Three military service
organizations commented on the methodology described in the interim
final rule to be used for annual TRS premium updates that was based on
[[Page 55253]]
annual changes in premiums in the Blue Cross/Blue Shield plan offered
nationwide by the Federal Employees Health Benefits program. Rather
than applying the same percentage increases to TRS premiums that were
observed in the federal Blue Cross/Blue Shield nationwide plan, each
commenting organization requested that the annual TRS premium increases
not exceed the percentage increase in military basic pay.
Response. Section 704 of NDAA-09 added 10 U.S.C. 1076 d(d)(3)(B) to
specify that the appropriate actuarial basis for calculating premiums
for TRS shall utilize the actual cost of providing benefits to members
and their dependents during preceding calendar years. The final rule is
consistent with this statutory requirement.
4. Provisions of the Final Rule. Note in the proposed rule that we
proposed to redesignate paragraph (b) as paragraph (c) so that the
section on TRICARE Reserve Select premiums would follow the section on
Qualifications for TRICARE Reserve Select coverage for clarity purposes
and to maintain consistent sequencing with Sec. 199.25). Then we
proposed to replace the content on TRICARE Reserve Select premiums that
appeared in the interim final rule in its entirety with the newly
revised section on TRICARE Reserve Select premiums in order to
implement section 704 of NDAA-09. That had the effect of removing all
of the former provisions involving the relationship between premium
rates for TRS and premium rates for the Blue Cross and Blue Shield
Standard Service Benefit Plan under the Federal Employees Health
Benefits program will appear in the amended Sec. 199.24(c). The final
rule is consistent with the proposed rule.
D. Procedures (Sec. 199.24(d))
1. Provisions of Interim Final Rule
The interim final rule addressed procedures for TRS coverage.
2. Provisions of the Proposed Rule. We proposed to clarify that the
Director, Healthcare Operations in the Defense Health Agency may
establish procedures for TRS (Sec. 199.24(d)).
We proposed to clarify that either reserve members or survivors
qualified under Sec. 199.24(b) may follow applicable procedures
throughout this section regarding TRS coverage. We proposed to clarify
the rule about immediate family members who may be included in family
coverage under TRS (Sec. 199.24(d)(1)), which is further supported by
the proposed definition for immediate family member included in Sec.
199.24(g).
We proposed to clarify continuation coverage by removing the
previous requirement that the member had to be the sponsor of the other
TRICARE coverage in order to qualify for continuation coverage (Sec.
199.24(d)(1)(i)). In circumstances when the spouse of the Reserve
Component member is the sponsor for purposes of the other TRICARE
coverage, it would be clear that the qualified member would be able to
purchase TRS coverage with an effective date immediately following the
date of termination of coverage under another TRICARE program
regardless whether it was the Reserve Component member or the spouse
who was the sponsor of the other TRICARE coverage.
We proposed rules to implement the provisions in section 701 of
NDAA-13 concerning TRS coverage (Sec. 199.24(d)(3)(i)). Similar to the
TDP, this provision would apply to members involuntarily separated from
the Selected Reserve if, and only if, the member was covered by TRS on
the last day of his or her membership in the Selected Reserve. However,
the termination date of TRS is characterized slightly differently from
the TDP provision because TRS may terminate up to 180 days after the
date on which the member is separated from the Selected Reserve. This
delayed termination exception applies regardless of type of TRS
coverage actually in effect at the time. This exception expires
December 31, 2018.
We proposed to clarify the rule that procedures may be established
for TRS 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.
199.24(d)(3)). Suspension/termination of coverage for the TRS member/
survivor will result in suspension/termination of coverage for the
member's/survivor's family members in TRS, except as described in Sec.
199.24 (d)(1)(iv). We also proposed to clarify that procedures may be
established for the suspension to be lifted upon request before final
termination is applied.
3. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
4. Provisions of the Final Rule. The final rule is consistent with
the interim final rule and the proposed rule.
E. Preemption of State Laws (Sec. 199.24(e))
1. Provisions of Interim Final Rule. In the interim final rule,
paragraph (e) addressed Relationship to Continued Health Care Benefits
Program (CHCBP) (Sec. 199.24(e)). Based on a statutory amendment
concerning CHCBP, the Final Rule published September 16, 2011 (76 FR
57637-57641) removed paragraph (e) in its entirety and replaced it with
the placeholder (e) Reserved to maintain numerical sequencing.
3. Provisions of the Proposed Rule. We proposed to remove the
previous Sec. 199.24(e) Reserved and redesignate Sec. 199.24(f) as
Sec. 199.24(e). No other changes are proposed this section.
4. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
5. Provisions of the Final Rule. The final rule is consistent with
the proposed rule.
F. Administration (Sec. 199.25(f))
1. Provisions of Interim Final Rule. In the interim final rule,
paragraph (f) addressed Preemption of State laws (Sec. 199.25(f)).
2. Provisions of the Proposed Rule. We proposed to redesignate
Sec. 199.24(g) as Sec. 199.24(f). We proposed to clarify this
provision by removing the phrase, ``based on extraordinary
circumstances'' as a limitation on authority to grant exceptions to
requirements of the section and to clarify that the Director,
Healthcare Operations in the Defense Health Agency has authority to
grant such exceptions and establish administrative rules and procedures
for TRS.
3. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
4. Provisions of the Final Rule. The final rule is consistent with
the proposed rule.
G. Terminology (Sec. 199.25(g))
1. Provisions of Interim Final Rule. In the interim final rule,
paragraph (g) addressed Administration (Sec. 199.25(g)).
2. Provisions of the Proposed Rule. We proposed to redesignate
paragraph (g) as paragraph (f) and to add a new paragraph (g) regarding
terminology. This would also remove the terminology under Sec.
199.25(a)(4).
3. Analysis of Major Public Comments. No public comments were
received relating to this section of the rule.
4. Provisions of the Final Rule. The final rule is consistent with
the proposed rule.
V. Costs
Fiscal year 2014 through 2019 costs are anticipated to be
$7,735,728.00:
[[Page 55254]]
------------------------------------------------------------------------
Government
Fiscal year cost
------------------------------------------------------------------------
2014.................................................... $1,296,884
2015.................................................... 1,373,929
2016.................................................... 1,455,633
2017.................................................... 1,542,277
2018.................................................... 1,634,096
2019.................................................... 432,909
---------------
Total FY14-FY19....................................... 7,735,728
------------------------------------------------------------------------
VI. Regulatory Procedures
Executive Orders 12866 and 13563 require certain regulatory
assessments for any significant regulatory action that would result in
an annual effect on the economy of $100 million or more, or have other
substantial impacts. The Congressional Review Act establishes certain
procedures for major rules, defined as those with similar major
impacts. The Regulatory Flexibility Act (RFA) requires that each
Federal agency prepare, and make available for public comment, a
regulatory flexibility analysis when the agency issues a regulation
that would have significant impact on a substantial number of small
entities. This final rule is not subject to any of these requirements
because it will not have any of these substantial impacts. However,
this rule has been designated a ``significant regulatory action,''
although not economically significant, under section 3(f) of Executive
Order 12866. Accordingly, the rule has been reviewed by the Office of
Management and Budget (OMB).
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3511).
We have examined the impact(s) of the final rule under Executive
Order 13132 and it does not have policies that have federalism
implications that will 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. The preemption provisions in the rule conform to
law and long-established TRICARE policy. Therefore, consultation with
State and local officials is not required.
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health insurance, Military personnel.
Accordingly, the interim final rule published at 72 FR 46380 on
August 20, 2007, amending 32 CFR part 199 is adopted as a final rule
with the following changes:
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. 199.3 by revising paragraph (b)(5)(iii)(B) to read as
follows:
Sec. 199.3 Eligibility.
* * * * *
(b) * * *
(5) * * *
(iii) * * *
(B) 180 days before the date on which the period of active duty is
to begin.
* * * * *
0
3. Amend Sec. 199.13 by revising paragraph (c)(3)(ii)(E)(2)
introductory text and adding paragraph (c)(3)(ii)(E)(5) to read as
follows:
Sec. 199.13 TRICARE Dental Program.
* * * * *
(c) * * *
(3) * * *
(ii) * * *
(E) * * *
(2) Survivor eligibility. Eligible dependents of active duty
members who die while on active duty for a period of more than 30 days
and eligible dependents of members of the Ready Reserve (i.e., Selected
Reserve or Individual Ready Reserve, as specified in 10 U.S.C. 10143
and 10144(b) respectively) who die, shall be eligible for survivor
enrollment in the TDP. During the period of survivor enrollment, the
government will pay both the government and the eligible dependent's
portion of the premium share. This survivor enrollment shall be up to
(3) three years from the date of the member's death, except that, in
the case of a dependent of the deceased who is described in 10 U.S.C.
1072(2)(D) or (I), the period of survivor enrollment shall be the
longer of the following periods beginning on the date of the member's
death:
* * * * *
(5) TRICARE Dental Program coverage shall terminate for members who
no longer qualify for the TRICARE Dental Program as specified in
paragraph (c)(2) of this section, with one exception. If a member is
involuntarily separated from the Selected Reserve under other than
adverse conditions, as characterized by the Secretary concerned, and
TRICARE Dental Program coverage is in effect for the member and/or the
family on the last day of his or her membership in the Selected
Reserve; then the TRICARE Dental Program coverage that was actually in
effect may terminate no earlier than 180 days after the date on which
the member is separated from the Selected Reserve. This exception
expires December 31, 2018.
* * * * *
0
4. Amend Sec. 199.24 as follows.
0
a. Remove paragraph (a)(4).
0
b. Redesignate paragraph (a)(5) as paragraph (a)(4).
0
c. Revise newly redesignated paragraphs (a)(4)(i)(B), (a)(4)(iii), and
(a)(4)(iv).
0
d. Redesignate paragraphs (b) and (c) as paragraphs (c) and (b),
respectively.
0
e. Revise newly redesignated paragraphs (b) and (c).
0
f. Revise paragraph (d).
0
g. Redesignate paragraphs (f) and (g) as paragraphs (e) and (f),
respectively.
0
h. Revise newly redesignated paragraph (f).
0
i. Add new paragraph (g).
The revisions and additions read as follows:
Sec. 199.24 TRICARE Reserve Select.
(a) * * *
(4) * * *
(i) * * *
(B) Certain special programs established in 32 CFR part 199 are not
available to members covered under TRICARE Reserve Select. These
include the Extended Care Health Option (Sec. 199.5), the Special
Supplemental Food Program (see Sec. 199.23), and the Supplemental
Health Care Program (Sec. 199.16), except when referred by a Military
Treatment Facility (MTF) provider for incidental consults and the MTF
provider maintains clinical control over the episode of care. The
TRICARE Dental Program (Sec. 199.13) is independent of this program
and is otherwise available to all members of the Selected Reserve and
their eligible family members whether or not they purchase TRICARE
Reserve Select coverage. The Continued Health Care Benefits Program
(Sec. 199.20) is also independent of this program and is otherwise
available to all members who qualify.
* * * * *
(iii) Procedures. Under TRICARE Reserve Select, Reserve Component
members who fulfilled all of the statutory qualifications may purchase
either the member-only type of coverage or the member-and-family type
of coverage by submitting a completed request in the appropriate format
along with an initial payment of the applicable premium. Rules and
procedures for purchasing coverage and paying applicable premiums are
prescribed in this section.
(iv) Benefits. When their coverage becomes effective, TRICARE
Reserve
[[Page 55255]]
Select beneficiaries receive the TRICARE Standard (and Extra) benefit
including access to military treatment facility services and
pharmacies, as described in Sec. Sec. 199.17 and 199.21. TRICARE
Reserve Select coverage features the deductible and cost share
provisions of the TRICARE Standard (and Extra) plan applicable to
active duty family members for both the member and the member's covered
family members (paragraph (a)(4)(iv) of this section). 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 active
duty service members' dependents who are not enrolled in TRICARE Prime
as described in Sec. 199.17(d)(1)(i)(D).
(b) Qualifications for TRICARE Reserve Select coverage--(1) Ready
Reserve member. A Ready Reserve member qualifies to purchase TRICARE
Reserve Select coverage if the Service member meets both the following
criteria:
(i) Is a member of the Selected Reserve of the Ready Reserve of the
Armed Forces, or a member of the Individual Ready Reserve of the Armed
Forces who has volunteered to be ordered to active duty pursuant to the
provisions of 10 U.S.C. 12304 in accordance with section 10 U.S.C.
10144(b); and
(ii) Is not enrolled in, or eligible to enroll in, a health
benefits plan under 5 U.S.C. chapter 89. That statute has been
implemented under 5 CFR part 890 as the Federal Employees Health
Benefits (FEHB) program. For purposes of the FEHB program, the terms
``enrolled,'' ``enroll'' and ``enrollee'' are defined in 5 CFR 890.101.
Further, the member (or certain former member involuntarily separated)
no longer qualifies for TRICARE Reserve Select when the member (or
former member) has been eligible for coverage to be effective in a
health benefits plan under the FEHB program for more than 60 days.
(2) TRICARE Reserve Select survivor. If a qualified Service member
dies while in a period of TRICARE Reserve Select coverage, the
immediate family member(s) of such member is qualified to purchase new
or continue existing TRICARE Reserve Select coverage for up to six
months beyond the date of the member's death as long as they meet the
definition of immediate family members as specified in paragraph (g)(2)
of this section. This applies regardless of type of coverage in effect
on the day of the TRICARE Reserve Select member's death.
(c) TRICARE Reserve Select premiums. Members are charged premiums
for coverage under TRICARE Reserve Select that represent 28 percent of
the total annual premium amount that the Director, Defense Health
Agency determines on an appropriate actuarial basis as being
appropriate for coverage under the TRICARE Standard (and Extra) benefit
for the TRICARE Reserve Select eligible population. Premiums are to be
paid monthly, except as otherwise provided through administrative
implementation, pursuant to procedures established by the 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. TRICARE Reserve Select monthly
premium rates shall be established and updated annually on a calendar
year basis for each of the two types of coverage, member-only and
member- and-family as described in paragraph (d)(1) of this section.
Starting with calendar year 2009, the appropriate actuarial basis for
purposes of this paragraph (c) shall be determined for each calendar
year by utilizing the actual reported cost of providing benefits under
this section to members and their dependents during the calendar years
preceding such calendar year. Reported actual TRS cost data from
calendar years 2006 and 2007 was used to determine premium rates for
calendar year 2009. This established pattern will be followed to
determine premium rates for all calendar years subsequent to 2009.
(2) Premium adjustments. In addition to the determinations
described in paragraph (c)(1) of this section, premium adjustments may
be made prospectively for any calendar year to reflect any significant
program changes or any actual experience in the costs of administering
TRICARE Reserve Select.
(3) Survivor premiums. A surviving family member of a Reserve
Component service member who qualified for TRICARE Reserve Select
coverage as described in paragraph (b)(2) of this section will pay
premium rates as follows. The premium amount shall be at the member-
only rate if there is only one surviving family member to be covered by
TRICARE Reserve Select and at the member and family rate if there are
two or more survivors to be covered.
(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 a
qualified member as specified in paragraph (g)(2) of this section may
be included in such family coverage. To purchase either type of TRICARE
Reserve Select coverage for effective dates of coverage described
below, members and survivors qualified under either paragraph (b)(1) or
(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.
(i) Continuation coverage. Procedures may be established for a
qualified member or qualified survivor to purchase TRICARE Reserve
Select coverage with an effective date immediately following the date
of termination of coverage under another TRICARE program.
(ii) Qualifying life event. Procedures may be established for a
qualified member or qualified survivor to purchase TRICARE Reserve
Select coverage on the occasion of a qualifying life event that changes
the immediate family composition (e.g., birth, adoption, divorce, etc.)
that is eligible for coverage under TRICARE Reserve Select. The
effective date for TRICARE Reserve Select coverage will coincide with
the date 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.
(iii) Open enrollment. Procedures may be established for a
qualified member to purchase TRICARE Reserve Select coverage at any
time. The effective date of coverage will coincide with the first day
of a month.
(iv) Survivor coverage under TRICARE Reserve Select. Procedures may
be established for a surviving family member of a Reserve Component
service member who qualified for TRICARE Reserve Select coverage as
described in paragraph (b)(2) of this section to purchase new TRICARE
Reserve Select coverage or continue existing TRICARE Reserve Select
coverage for up to six months beyond the date of the member's death.
The effective date of coverage will be the day following the date of
the member's death.
[[Page 55256]]
(2) Changing type of coverage. Procedures may be established for
TRICARE Reserve Select members to request to change type of coverage
during open enrollment as described in paragraph (d)(1)(iii) of this
section or on the occasion of a qualifying life event that changes
immediate family composition as described in paragraph (d)(1)(ii) of
this section by submitting a completed request in the appropriate
format.
(3) Suspension and termination. Suspension/termination of coverage
for the TRS member/survivor will result in suspension/termination of
coverage for the member's/survivor's family members in TRICARE Reserve
Select, except as described in paragraph (d)(1)(iv) of this section.
Procedures may be established for coverage to be suspended or
terminated as follows.
(i) Coverage shall terminate when members or survivors no longer
qualify for TRICARE Reserve Select as specified in paragraph (b) of
this section, with one exception. If a member is involuntarily
separated from the Selected Reserve under other than adverse
conditions, as characterized by the Secretary concerned, and is covered
by TRICARE Reserve Select on the last day of his or her membership in
the Selected Reserve, then TRICARE Reserve Select coverage may
terminate up to 180 days after the date on which the member was
separated from the Selected Reserve. This applies regardless of type of
coverage. This exception expires December 31, 2018.
(ii) Coverage may terminate for members, former members, and
survivors who gain coverage under another TRICARE program.
(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 (iv) of this section, TRICARE
Reserve Select 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.
(4) Processing. Upon receipt of a completed request in the
appropriate format, enrollment actions will be processed into DEERS in
accordance with established procedures.
(5) Periodic revision. Periodically, certain features, rules or
procedures of TRICARE Reserve Select may be revised. If such revisions
will have a significant effect on members' 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.
* * * * *
(f) Administration. The Director, Healthcare Operations in the
Defense Health Agency may establish other rules and procedures for the
effective administration of TRICARE Reserve Select, and may authorize
exceptions to requirements of this section, if permitted by law.
(g) Terminology. The following terms are applicable to the TRICARE
Reserve Select program.
(1) Coverage. This term means the medical benefits covered under
the TRICARE Standard or Extra programs as further outlined in other
sections of 32 CFR part 199 whether delivered in military treatment
facilities or purchased from civilian sources.
(2) Immediate family member. This term means spouse (except former
spouses) as defined in Sec. 199.3(b)(2)(i), or child as defined in
Sec. 199.3(b)(2)(ii).
(3) Qualified member. This term means a member who has satisfied
all the criteria that must be met before the member is authorized for
TRS coverage.
(4) 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 TRS coverage.
Dated: September 4, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-22815 Filed 9-14-15; 8:45 am]
BILLING CODE 5001-06-P
