78698 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 

* * * * * 

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 

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 (§ 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 


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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 

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 

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. 

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 

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. 

—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 

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. 

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] 

■ 1. The authority citation for part 199 

continues to read as follows: 

Authority: 5 U.S.C. 301; 10 U.S.C. chapter 

55. 

■ 2. 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 

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 


tkelley on DSK3SPTVN1PROD with RULES
Federal Register / Vol. 79, No. 250 / Wednesday, December 31, 2014 / Rules and Regulations 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 

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 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Final rule. 

SUMMARY: 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: 

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 


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