32116 Federal Register / Vol. 78, No. 103 / Wednesday, May 29, 2013 / Rules and Regulations 

(65 FR 67249 (Nov. 9, 2000)), and 

determined that it does not have ‘‘tribal 

implications’’ as defined in that order. 

This rule does not have substantial 

direct effects on one or more Indian 

tribes, on the relationship between the 

federal government and Indian tribes, or 

on the distribution of power and 

responsibilities between the federal 

government and Indian tribes. 

List of Subjects in 29 CFR Part 1926 

Cranes and derricks, Construction 

industry, Electric power, Occupational 

safety and health. 

Authority and Signature 

David Michaels, Ph.D., MPH, 

Assistant Secretary of Labor for 

Occupational Safety and Health, U.S. 

Department of Labor, 200 Constitution 

Ave. NW., Washington, DC 20210, 

authorized the preparation of this 

notice. OSHA is issuing this final rule 

under the following authorities: 29 

U.S.C. 653, 655, 657; 40 U.S.C. 3701 et 

seq.; 5 U.S.C. 553; Secretary of Labor’s 

Order No. 1–2012 (77 FR 3912, Jan. 25, 

2012); and 29 CFR part 1911. 

Signed at Washington, DC, on May 22, 

2013. 

David Michaels 

Assistant Secretary of Labor for Occupational 

Safety and Health. 

Amendments to Standards 

For the reasons stated in the preamble 

of this rule, OSHA amends 29 CFR part 

1926 as follows: 

PART 1926—[AMENDED] 

Subpart V—Power Transmission and 

Distribution 

■ 1. Revise the authority citation for 

subpart V to read as follows: 

Authority: 40 U.S.C. 3701; 29 U.S.C. 653, 

655, 657; Secretary of Labor’s Order Nos. 12– 

71 (36 FR 8754); 8–76 (41 FR 25059); 9–83 

(48 FR 35736), 1–90 (55 FR 9033), 5–2007 (72 

FR 31159), or 1–2012 (77 FR 3912), as 

applicable. Section 1926.951 also is issued 

under 29 CFR part 1911. 

■ 2. Amend § 1926.952 by revising 

paragraph (c)(2) to read as follows: 

§ 1926.952 Mechanical equipment. 

* * * * * 

(c) * * * 

(2) Use of digger derricks must 

comply with § 1910.269 (in addition to 

29 CFR part 1926, subpart O) whenever 

29 CFR part 1926, subpart CC, excludes 

such use in accordance with 

§ 1926.1400(c)(4). 

* * * * * 

Subpart CC—Cranes and Derricks in 

Construction 

■ 3. Revise the authority citation for 

subpart CC to read as follows: 

Authority: 40 U.S.C. 3701; 29 U.S.C. 653, 

655, 657; and Secretary of Labor’s Order No. 

5–2007 (72 FR 31159) or 1–2012 (77 FR 

3912), as applicable; and 29 CFR part 1911. 

■ 4. Amend § 1926.1400 by revising 

paragraph (c)(4) to read as follows: 

§ 1926.1400 Scope. 

* * * * * 

(c) * * * 

(4) Digger derricks when used for 

augering holes for poles carrying electric 

or telecommunication lines, placing and 

removing the poles, and for handling 

associated materials for installation on, 

or removal from, the poles, or when 

used for any other work subject to 

subpart V of this part. To be eligible for 

this exclusion, digger-derrick use in 

work subject to subpart V of this part 

must comply with all of the provisions 

of that subpart, and digger-derrick use 

in construction work for 

telecommunication service (as defined 

at § 1910.268(s)(40)) must comply with 

all of the provisions of § 1910.268. 

* * * * * 

[FR Doc. 2013–12665 Filed 5–28–13; 8:45 am] 

BILLING CODE 4510–26–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

RIN 0720–AB48 

[Docket ID: DOD–2011–HA–0029] 

TRICARE Young Adult 

AGENCY: Office of the Secretary, DoD. 

ACTION: Final rule. 

SUMMARY: This final rule implements 

Section 702 of the Ike Skelton National 

Defense Authorization Act for Fiscal 

Year 2011 (NDAA for FY11). It 

establishes the TRICARE Young Adult 

(TYA) program to provide an extended 

TRICARE Program coverage opportunity 

to most unmarried children under the 

age of 26 of uniformed services 

sponsors. The TYA program is a 

premium-based program. 

DATES: This rule is effective June 28, 

2013. 

FOR FURTHER INFORMATION CONTACT: 

Mark Ellis, TRICARE Management 

Activity, TRICARE Policy and 

Operations Directorate, 7700 Arlington 

Boulevard, Suite 5101, Falls Church, VA 

22042–5101, telephone (703) 681–0039. 

SUPPLEMENTARY INFORMATION:

I. Introduction and Background 

A. Overview 

An interim final rule was published 

in the Federal Register on April 27, 

2011 (76 FR 23479–23485) that 

established the TYA program by 

implementing Section 702 of the Ike 

Skelton NDAA for FY 2011 (Pub. L. 

111–383). The TYA program provides 

TRICARE Program coverage to 

unmarried children under the age of 26 

of TRICARE-eligible sponsors who no 

longer meet the age requirements for 

TRICARE eligibility (age 21, or 23 if 

enrolled in a full-time course of study 

at an approved institution of higher 

learning, and the sponsor provides more 

than 50 percent of the student’s 

financial support), and who are not 

eligible for medical coverage from an 

eligible employer-sponsored plan based 

on their individual employment status 

(as defined in section 5000A(f)(2) of the 

Internal Revenue Code of 1986). If 

qualified, they can purchase TRICARE 

Standard/Extra or TRICARE Prime 

benefits coverage. The particular 

TRICARE option available depends on 

the uniformed service sponsor’s 

eligibility and the availability of the 

TRICARE option in the dependent’s 

geographic location. 

B. Public Comments 

The interim final rule was published 

in the Federal Register on April 27, 

2011. One online comment was received 

via www.regulations.gov. We thank the 

commenter for the comments. Specific 

matters raised by those comments are 

summarized below. 

II. Provisions of the Rule Regarding the 

TYA Program 

A. Establishment of the TYA Program 

(§ 199.26(a)) 

1. Provisions of Interim Final Rule. 

This paragraph describes the nature, 

purpose, statutory basis, scope, and 

major features of TYA, a full cost, 

premium-based TRICARE Program 

coverage made available for purchase 

worldwide. TYA is similar to young 

adult coverage under the Patient 

Protection and Affordable Care Act, but 

reflects a number of differences between 

TRICARE, a statutorily-created DoD 

health benefits program and typical 

civilian health care plans. Among these 

is that TYA is a full cost premium based 

program; it is limited to unmarried 

dependent children of TRICARE-eligible 

sponsors; and the dependent child must 

not be eligible for medical coverage 

from an eligible employer-sponsored 

plan based on their individual 


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employment status (an exclusion that 

does not expire on January 1, 2014, but 

is permanent). TYA is codified in Title 

10, United States Code, Section 1110b. 

The major features of the program 

include making TYA coverage available 

for purchase at a premium which will 

represent the full cost, including 

reasonable administrative costs, as 

determined on an appropriate actuarial 

basis for coverage. There will be various 

premiums depending on whether the 

dependent’s sponsor is active duty, 

retired, or eligible under another option 

such as TRICARE Reserve Select (TRS) 

or TRICARE Retired Reserve (TRR), and 

the adult dependent’s desired health 

coverage—TRICARE Standard/Extra or, 

for those eligible and where available, 

TRICARE Prime. The rules and 

procedures otherwise outlined in Part 

199 of 32 CFR which implements 

Chapter 55 of Title 10, U.S. Code, 

relating to the operation and 

administration of the TRICARE program 

based on the sponsor’s status and health 

coverage plan will apply for cost-shares, 

deductibles, and catastrophic caps upon 

purchasing TYA coverage. Young adult 

dependents of members on active duty 

orders written, or otherwise continuous, 

for more than 30 days are eligible for 

benefits under the TRICARE Extended 

Care Health Option (ECHO) program 

under § 199.5 of this Part. The TRICARE 

Dental Program (§ 199.13 of this Part) 

and the TRICARE Retiree Dental 

Program (§ 199.22 of this Part) are not 

included as part of TYA. 

Under TYA, qualified young adult 

dependents may purchase individual 

TRICARE Program 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 TRICARE 

Program coverage becomes effective, a 

TYA purchaser receives the TRICARE 

benefits according to the rules governing 

the TRICARE Program that the 

dependent qualified for and selected 

based on the uniformed services 

sponsor’s status (active duty, retired, 

Selected Reserve, or Retired Reserve) 

and the availability of a desired TYA 

option in his or her geographic location. 

The rules and procedures otherwise 

outlined in the TRICARE Regulation 

(Part 199) relating to the operation and 

administration of the TRICARE 

programs will apply for cost-shares, 

deductibles, and catastrophic caps upon 

purchasing TYA coverage. The young 

adult dependent’s cost-shares, 

deductibles, and catastrophic caps will 

be based on the sponsor’s status (active 

duty, retired, Selected Reserve, or 

Retired Reserve) and whether the 

dependent has purchased TRICARE 

Standard/Extra or Prime coverage. TYA 

dependents are provided access priority 

for care in military treatment facilities 

based on their uniformed services 

sponsor’s status and the selection of a 

TYA option. 

The Continued Health Care Benefits 

Program (CHCBP) (see § 199.20) shall be 

made available to all young adult 

dependents after aging out of the TYA 

program or who otherwise lose their 

eligibility for the TYA program, whether 

due to a change in the status of the 

young adult and/or the status of their 

sponsor. CHCBP participants are not 

eligible for military treatment facility 

(MTF) care other than in emergencies. 

2. Analysis of Major Public 

Comments: One comment noted support 

for the TYA program because it will 

undoubtedly increase health insurance 

coverage for those who may have gone 

uninsured. 

Response: We acknowledge the 

commenter’s statement as consistent 

with the purposes of the TYA program. 

3. Provisions of the Final Rule. 

In § 199.26(a), we clarified that the 

uniformed service sponsors must be 

TRICARE eligible to qualify their 

eligible dependents to purchase TYA 

coverage. We also clarified the criteria 

for TRICARE eligibility up to the age of 

23. 

In § 199.26(a)(4)(i)(D), we deleted a 

potentially misleading reference to 

§ 199.3 of this Part. Eligibility and 

qualifications for the TYA program as 

defined in § 199.3 of this Part will be 

clarified in § 199.26(b). 

We clarified in § 199.26(a)(4)(i)(D)(2) 

that TRICARE Prime coverage may be 

available for purchase by dependents of 

sponsors who are retired members if 

otherwise qualified, but not dependents 

of sponsors who are in the Retired 

Reserve if their sponsor participates in 

TRR. Dependents of retired members in 

the Retired Reserve are only eligible to 

purchase TRICARE Standard/Extra 

coverage. Also, it was an error to state 

that the retired member must be eligible 

for a TRICARE Prime plan as a 

qualification for the young adult 

dependent to be eligible to purchase 

TRICARE Prime coverage. Dependents 

of retired members other than members 

of the Retired Reserve may purchase 

TRICARE Prime coverage if otherwise 

qualified even if the retired sponsor is 

not eligible for or enrolled in TRICARE 

Prime. 

B. Qualifications for TYA coverage 

(§ 199.26(b)) 

1. Provisions of the Interim Final 

Rule. This paragraph defines the 

statutory conditions under which 

unmarried children of TRICARE-eligible 

sponsors qualify as young adult 

dependents under the TYA program. To 

qualify as a young adult dependent, the 

dependent must be under the age of 26, 

not be otherwise eligible for another 

TRICARE Program, and not be eligible 

for medical coverage from an eligible 

employer-sponsored plan based on their 

individual employment status (as 

defined in section 5000A(f)(2) of the 

Internal Revenue Code of 1986). The 

dependents’ sponsor is responsible for 

keeping the Defense Enrollment 

Eligibility Reporting System (DEERS) 

current with eligibility data through the 

sponsor’s Service personnel office. 

Using information from the DEERS, 

TRICARE contractors have the 

responsibility to validate a dependent’s 

qualifications to purchase TYA 

coverage. 

2. Analysis of Major Public 

Comments. No public comments were 

received relating to this section of the 

rule. 

3. Provisions of the Final Rule. In 

§ 199.26(b)(1)(i), we clarified that former 

dependents under the Transitional 

Compensation Program (TCP) under 10 

U.S.C 1059 as defined in 

§ 199.3(b)(2)(iii) of this Part are not 

eligible to purchase TYA coverage 

because TRICARE coverage for these 

former dependents under the TCP is not 

authorized by chapter 55 of title 10 

United States Code (U.S.C.), nor by 

section 1145a of 10 U.S.C, but rather by 

section 1059 of 10 U.S.C. 

In that same paragraph, we clarify that 

dependents of North Atlantic Treaty 

Organization (NATO) sponsors as 

defined in § 199.3(a) of this Part are not 

eligible to purchase TYA coverage 

because NATO treaties do not 

specifically address young adult 

coverage. 

C. TYA premiums (§ 199.26(c)) 

1. Provisions of Interim Final Rule. 

Qualified young adult dependents are 

charged premiums for coverage under 

TYA that represent the full cost of 

providing TRICARE benefits under this 

program, including the reasonable costs 

of administration of the program. The 

total annual premium amounts shall be 

determined by the Assistant Secretary of 

Defense for Health Affairs (ASD(HA)) 

using an appropriate actuarial basis and 

are established and updated annually, 

on a calendar year basis, by the 

ASD(HA) for qualified young adult 

dependents. A premium shall be 

charged for each individual qualified 

young adult dependent regardless of 

whether a sponsoring member has more 

than one young adult dependent child 

who qualifies or purchases coverage 

under the TYA program. The cost shares 


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32118 Federal Register / Vol. 78, No. 103 / Wednesday, May 29, 2013 / Rules and Regulations 

for TRICARE Standard/Extra or Prime 

programs in which the adult child is 

enrolled shall be based on the status of 

the dependent’s sponsor. Because of the 

differences in cost-shares among the 

programs and status of the sponsor, 

there will be a different premium for 

TRICARE Standard/Extra and TRICARE 

Prime, including the Uniformed 

Services Family Health Plan. 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. 

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 TYA as determined by the 

ASD(HA). TYA premiums shall be 

based on the actual costs of providing 

benefits to TYA dependents during the 

preceding years if the population of 

young adult dependents enrolled in 

TYA is large enough during those 

preceding years to be considered 

actuarially appropriate. Until such time 

that actual costs from those preceding 

years become available, TYA premiums 

shall be based on the actual costs during 

the preceding calendar years for 

providing benefits to the population of 

dependents over the age 21 until 

reaching age 26 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. 

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. 

D. Procedures (§ 199.26(d)) 

1. Provisions of Interim Final Rule. 

The Director, TRICARE Management 

Activity (TMA) will establish 

procedures for administration of TYA. 

These will include procedures to 

purchase individual coverage, such as a 

request in an approved format, along 

with an initial payment of the 

applicable premium. Applicants must 

also certify that they meet the statutory 

qualifications to purchase coverage 

under this program. Additional 

procedures will be established for a 

qualified young adult dependent to 

purchase TYA coverage with an 

effective date immediately following the 

last effective date of coverage under 

which they previously qualified in 

another TRICARE option. 

There will be open enrollment so that 

a qualified young adult dependent may 

purchase TYA coverage at any time. The 

effective date of coverage for TRICARE 

Standard/Extra will coincide with the 

first day of a month after the date the 

application and required payment is 

received. The effective date of coverage 

for TRICARE Prime will be the first day 

of the second month after the month in 

which application and required 

payment is received. There will be a 

limited period for retroactive coverage. 

A qualified young adult dependent may 

elect to start coverage under the 

TRICARE Standard/Extra plan effective 

with the statutory start date of January 

1, 2011, if the dependent was eligible as 

of that date. If retroactive coverage is 

elected then retroactive premiums must 

be paid back to the statutory start date 

of January 1, 2011. If no retroactive 

coverage is elected or the retroactive 

premiums are not paid within the time 

prescribed, then coverage will not be 

retroactive and coverage will apply only 

prospectively beginning on the first day 

of the month after the date of the 

application. There shall be no 

retroactive coverage offered under any 

TRICARE Prime plan. No purchase of 

retroactive coverage may take place after 

September 30, 2011. 

With respect to termination of 

coverage, a loss of eligibility or 

entitlement for medical benefits of the 

sponsor will result in termination of 

coverage for the dependent’s TYA 

coverage on the same date as the 

sponsor, unless otherwise authorized. 

Upon the death of an active duty 

sponsor, young adult dependents may 

purchase TYA coverage until reaching 

age 26. If a Selected Reserve (Sel Res) 

or Retired Reserve member ends TRS or 

TRR coverage, respectively, eligibility 

for the young adult dependent to 

purchase coverage under TYA also 

ends. If a Sel Res sponsor dies while 

enrolled in TRS, the otherwise eligible 

young adult dependent can purchase 

TYA coverage up to 6 months after the 

death of the sponsor. If a Retired 

Reserve sponsor dies while enrolled in 

TRR, the otherwise eligible young adult 

dependent may continue to purchase 

TYA coverage until the date on which 

the deceased sponsor would have 

turned age 60. If the Retired Reserve 

sponsor was not enrolled in TRR at the 

time of death, there is no eligibility to 

purchase TYA coverage until the 

sponsor would have turned age 60. As 

of the date on which the deceased 

retired sponsor would have turned age 

60, the young adult dependent qualifies 

as a survivor of a deceased retired 

sponsor and can purchase TYA coverage 

until reaching age 26. Coverage will 

terminate whenever a dependent ceases 

to meet the qualifications for the 

program. Claims will be denied effective 

with the termination date. In addition, 

covered dependents may terminate 

coverage at any time by submitting a 

completed request in the appropriate 

format. Dependents whose coverage 

under TYA terminates for failure to pay 

premiums in accordance with program 

requirements will not be allowed to 

purchase coverage again under TYA for 

a period of one year following the date 

of their coverage termination. This 

ineligibility period shall be known as a 

‘‘lockout’’ period. A request for a waiver 

of the ‘‘lockout’’ period may be granted 

by the Director, TRICARE Management 

Activity, based on extraordinary 

circumstances beyond the control of the 

young adult dependent which resulted 

in inability to make payments in 

accordance with program requirements. 

The Director may allow a 90-day grace 

period for payment to be made. 

However, if payment is not made by the 

90th day, then coverage will be deemed 

to have terminated as of the last day of 

the month in which an appropriate 

payment was made and no claims may 

be paid for care rendered after the date 

of termination. Upon termination of 

eligibility to purchase TYA coverage, 

qualified dependents may purchase 

coverage under the CHCBP for up to 36 

months except if locked out of TYA. 

Upon application and payment of 

appropriate premiums, a young adult 

dependent who has already purchased 

coverage under any of the options 

offered under TYA may change to 

another TRICARE option for which the 

dependent is eligible. Eligibility is based 

on the sponsor’s status and the 

dependent’s geographic location. 

2. Analysis of Major Public 

Comments. No public comments were 

received relating to this section of the 

rule. 

3. Provisions of the Final Rule. In 

§ 199.26(d)(2)(i)(A), we deleted 

eligibility to purchase TYA coverage by 

former dependents in the Transitional 

Compensation Program under 10 U.S.C 

1059 and under § 199.3(b)(2)(iii) of this 

Part. We added eligibility to purchase 

TYA coverage for dependents of former 

active duty members covered under the 

Transitional Assistance Management 

Program (TAMP) who are otherwise 

qualified. 

We added a new § 199.26(d)(2)(iii) to 

add that young adult dependents 

currently enrolled in TYA may have 

their TRICARE coverage terminated 

when the sponsor’s status changes (for 

example, from active duty to retired 


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Federal Register / Vol. 78, No. 103 / Wednesday, May 29, 2013 / Rules and Regulations 32119 

status). Young adult dependents have 30 

thirty days to re-establish their TYA 

coverage without a break in coverage 

and must re-qualify for TYA coverage 

for which they are then eligible. 

In § 199.26(d)(2) and subordinate 

paragraphs, we clarified the rule that 

procedures may be established for TYA 

coverage to be suspended up to one year 

followed by final termination for young 

adult dependents if they fail to make 

premium payments in accordance with 

established procedures or otherwise 

request suspension/termination of 

coverage. Procedures may be established 

for the suspension to be lifted upon 

request before final termination is 

applied. Procedures may also be 

established for the suspension to be 

lifted upon request for undue hardship 

as defined by § 199.26(g) before final 

termination is applied. 

In § 199.26(d)(5), we added that upon 

a change in sponsor status, young adult 

dependents currently enrolled in TYA 

coverage may have their coverage 

automatically transferred to another 

TRICARE option consistent with the 

sponsor’s new status. Recurring TYA 

premiums may be automatically 

adjusted by the servicing contractor. 

E. Preemption of State Laws 

(§ 199.26(e)) 

1. Provisions of Interim Final Rule. 

This paragraph provides that the 

preemptions of State and local laws 

established for the TRICARE program 

also apply to TYA. 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 TYA. 

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 (§ 199.26(f)) 

1. Provisions of Interim Final Rule. 

This paragraph provides that the 

Director, TRICARE Management 

Activity, may establish other 

administrative processes and 

procedures necessary for the effective 

administration of TYA. 

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. 

G. Terminology (§ 199.26(g)) 

1. Provisions of Interim Final Rule. 

New paragraph. 

2. Analysis of Major Public 

Comments. No public comments were 

received relating to this section of the 

rule. 

3. Provisions of the Final Rule. Added 

definition of undue hardship as it 

relates to suspension and termination of 

TYA coverage. 

III. Regulatory Procedures 

Executive Order 12866, ‘‘Regulatory 

Planning and Review’’ and Executive 

Order 13563, ‘‘Improving Regulation 

and Regulatory Review’’ 

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. This 

rule will not. This final rule will not 

have an impact on the economy greater 

than $100 million annually. 

Congressional Review Act 

The Congressional Review Act 

establishes certain procedures for major 

rules, defined as those with similar 

major impacts. This final rule will not 

have a major impact as that term is used 

under the Congressional Review Act. 

Section 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 section, of $100 million in any 

one year. 

Public Law 96–354, ‘‘Regulatory 

Flexibility Act’’ 

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 will not have a 

significant impact on a substantial 

number of small entities. 

Paperwork Reduction Act of 1995 

This rule will impose additional 

information collection requirements on 

the public under the under the 

provisions of the Paperwork Reduction 

Act (44 U.S.C. Chapter 35) in the form 

of a TYA application form. Comments 

were solicited via the interim final rule 

published on April 27, 2011 (76 FR 

23479–23485). No comments were 

received. OMB approved the TYA 

application form and assigned the 

collection of information OMB Control 

Number 0720–0049. 

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. 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, 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. Section 199.26 is revised to read as 

follows: 

§ 199.26 TRICARE Young Adult. 

(a) Establishment. The TRICARE 

Young Adult (TYA) program offers the 

medical benefits provided under the 

TRICARE Program to qualified 

unmarried adult children of TRICAREeligible uniformed service sponsors who 

do not otherwise have eligibility for 

medical coverage under a TRICARE 

Program at age 21 (23 if enrolled in a 

full-time course of study at an approved 

institution of higher learning, and the 

sponsor provides over 50 percent of the 

student’s financial support), and are 

under age 26. 

(1) Purpose. As specified in paragraph 

(c) of this section, TYA is a premiumbased health option that is available for 

purchase by any qualified adult child as 

that term is defined in paragraph (b) of 

this section. The TYA program allows a 

qualified adult child to purchase 

TRICARE coverage. 

(2) Statutory authority. TYA is 

authorized by 10 U.S.C. 1110b. 

(3) Scope of the program. TYA is 

geographically applicable to the same 

extent as specified in § 199.1(b)(1). 

(4) Major features of TYA. (i) 

TRICARE rules applicable. 

(A) Unless specified in this section or 

otherwise prescribed by the Assistant 

Secretary of Defense (Health Affairs) 


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32120 Federal Register / Vol. 78, No. 103 / Wednesday, May 29, 2013 / Rules and Regulations 

(ASD (HA)), provisions of this part 

apply to TYA. 

(B) The TRICARE Dental Program 

(§ 199.13) and the TRICARE Retiree 

Dental Program (§ 199.22) are not 

covered under TYA. 

(C) TRICARE Standard is available to 

all TYA-eligible young adult 

dependents. TYA enrollees in TRICARE 

Standard may use TRICARE Extra 

(under § 199.17(e)). 

(D) TRICARE Prime is available to 

TYA-eligible young adult dependents, 

provided that TRICARE Prime 

(including the Uniformed Services 

Family Health Plan) is available in the 

geographic location where the TYA 

enrollee resides. This applies to TYAeligible: 

(1) Dependents of sponsors on active 

duty orders written, or otherwise 

continuously, for more than 30 days or 

covered by TAMP (under § 199.3(e)); 

(2) Dependents of sponsors who are 

retired members other than retired 

members of the Retired Reserve; and 

(3) Survivors of members who died 

while on active duty for more than 30 

days or while receiving retired or 

retainer pay. 

(ii) Premiums. TYA coverage is a 

premium based program that an eligible 

young adult dependent may purchase. 

There is only individual coverage, and 

a premium shall be charged for each 

dependent even if there is more than 

one qualified dependent in the 

uniformed service sponsor’s family that 

qualifies for TYA coverage. Dependents 

qualifying for TYA status can purchase 

individual TRICARE Standard/Extra or 

TRICARE Prime coverage (as applicable) 

according to the rules governing the 

TRICARE option for which they are 

qualified on the basis of their uniformed 

service sponsor’s TRICARE-eligible 

status (active duty, retired, Selected 

Reserve, or Retired Reserve) and the 

availability of a desired option in their 

geographic location. Premiums shall be 

determined in accordance with 

paragraph (c) of this section. 

(iii) Procedures. Under TYA, qualified 

dependents under paragraph (b) of this 

section may purchase individual TYA 

coverage by submitting a completed 

request in the appropriate format along 

with an initial payment of the 

applicable premium. Procedures for 

purchasing coverage and paying 

applicable premiums are prescribed in 

paragraph (d) of this section. 

(iv) Benefits. When their TYA 

coverage becomes effective, qualified 

beneficiaries receive the benefit of the 

TRICARE option that they selected, 

including, if applicable, access to 

military treatment facilities and 

pharmacies. TYA coverage features the 

per service cost share, deductible and 

catastrophic cap provisions based on 

program selected, i.e., the TRICARE 

Standard/Extra program or the TRICARE 

Prime program, as well as the status of 

their military sponsor. Access to 

military treatment facilities under the 

system of access priorities in 

§ 199.17(d)(1) is also based on the 

program selected as well as the status of 

the military sponsor. Premiums are not 

credited to deductibles or catastrophic 

caps. 

(v) Transition period. During fiscal 

year 2011, the TYA program will 

include only TRICARE Standard 

program coverage. 

(b) Eligibility for TRICARE Young 

Adult coverage.—(1) Young Adult 

Dependent. A young adult dependent 

qualifies to purchase TYA coverage if 

the dependent meets the following 

criteria: 

(i) Would be a dependent child under 

10 U.S.C. 1072, but for exceeding the 

age limit under that section (abused 

dependents and NATO dependents are 

not eligible for TYA coverage); and 

(ii) Is a dependent under the age of 26; 

and 

(iii) Is not enrolled, or eligible to 

enroll, for medical coverage in an 

eligible employer-sponsored health plan 

as defined in section 5000A(f)(2) of the 

Internal Revenue Code of 1986; and 

(iv) Is not otherwise eligible under 

§ 199.3; and 

(v) Is not a member of the uniformed 

services. 

(2) The dependents’ sponsor is 

responsible for keeping the Defense 

Enrollment Eligibility Reporting System 

(DEERS) current with eligibility data 

through the sponsor’s Service personnel 

office. Using information from the 

DEERS, the TRICARE regional 

contractors have the responsibility to 

validate a dependent’s qualifications to 

purchase TYA coverage. 

(c) TRICARE Young Adult premiums. 

Qualified young adult dependents are 

charged premiums for coverage under 

TYA that represent the full cost of the 

program, including reasonable 

administrative costs, as determined by 

the ASD(HA) utilizing an appropriate 

actuarial basis for the provision of 

TRICARE benefits for the TYA-eligible 

beneficiary population. Separate 

premiums shall be established for 

TRICARE Standard and Prime plans. 

There may also be separate premiums 

based on the uniformed services 

sponsor’s status. 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. 

(1) Annual establishment of rates.—(i) 

Monthly premium rates shall be 

established and updated annually on a 

calendar year basis by the ASD(HA) for 

TYA individual coverage. 

(ii) The appropriate actuarial basis 

used for calculating premium rates shall 

be one that most closely approximates 

the actual cost of providing care to a 

similar demographic population (based 

on age and health plans) as those 

enrolled in TYA, as determined by the 

ASD(HA). TYA premiums shall be 

based on the actual costs of providing 

benefits to TYA dependents during the 

preceding years if the population of 

TYA enrollees is large enough during 

those preceding years to be considered 

actuarially appropriate. Until such time 

that actual costs from those preceding 

years become available, TYA premiums 

shall be based on the actual costs during 

the preceding calendar years for 

providing benefits to the population of 

similarly aged dependents to make the 

underlying group actuarially 

appropriate. An adjustment may be 

applied to cover overhead costs for 

administration of the program. 

(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 

mandated by legislative enactment, 

including but not limited to significant 

new programs or benefits. 

(d) Procedures. The Director, 

TRICARE Management Activity may 

establish procedures for the following. 

(1) Purchasing coverage. Procedures 

may be established for a qualified 

dependent to purchase individual 

coverage. To purchase TYA coverage for 

effective dates of coverage described 

below, qualified dependents 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 

dependent to purchase TYA coverage 

with an effective date immediately 

following the date of termination of 

coverage under another TRICARE 

program. Application for continuation 

coverage must be made within 30 days 

of the date of termination of coverage 

under another TRICARE program. 

(ii) Open enrollment. Procedures may 

be established for a qualified dependent 

to purchase TYA coverage at any time. 

The effective date of coverage will 

coincide with the first day of a month. 

(iii) Retroactive coverage. A qualified 

young adult dependent may elect 

retroactive TRICARE Standard coverage 

effective as of January 1, 2011, if 


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Federal Register / Vol. 78, No. 103 / Wednesday, May 29, 2013 / Rules and Regulations 32121 

dependent was eligible as of that date. 

If retroactive coverage is elected, 

retroactive premiums must be paid for 

the time period between January 1, 

2011, and the date of the election. If no 

retroactive coverage is elected or the 

retroactive premiums are not paid 

within the time prescribed, coverage 

will not be retroactive and coverage will 

apply only prospectively under the 

procedures set forth for open 

enrollment. No purchase of retroactive 

coverage may take place after September 

30, 2011. Coverage under TRICARE 

Prime may not be made retroactively. 

(2) Suspension and termination. 

Procedures may be established for TYA 

coverage to be suspended and/or 

terminated as follows. 

(i) Loss of eligibility or entitlement for 

coverage by the sponsor will result in 

termination of the dependent’s TYA 

coverage unless otherwise specified. 

The effective date of the sponsor’s loss 

of eligibility for care will also be the 

effective date of termination of benefits 

under the TYA program unless specified 

otherwise. 

(A) Active duty military sponsor. TYA 

coverage ends effective the date of 

military sponsor’s separation from 

military service, unless the dependent 

would be eligible under section 199.3(e) 

of this Part but for the dependent’s age, 

for the duration of the Transitional 

Assistance Management Program 

(TAMP) eligibility or until reaching age 

26, whichever comes first. Upon the 

death of an active duty sponsor, 

dependents eligible for Transitional 

Survivor coverage may purchase TYA 

coverage if otherwise qualified. 

(B) Selected Reserve (Sel Res) 

Sponsor. Sel Res sponsors must be 

currently enrolled in TRICARE Reserve 

Select (TRS) before a young adult 

dependent is eligible to purchase TYA. 

If TRS coverage is terminated by the 

sponsor, TYA coverage ends effective 

the same termination date as the 

sponsor. If the Sel Res sponsor dies 

while enrolled in TRS, the young adult 

dependent is eligible to purchase TYA 

coverage for six months after the date of 

death of the Sel Res sponsor, if 

otherwise qualified. 

(C) Retired Reserve Sponsor. Retired 

Reserve members not yet eligible for 

retired or retainer pay must be enrolled 

in TRICARE Retired Reserve (TRR) to 

establish TYA eligibility for their young 

adult dependents. If TRR coverage is 

terminated by the sponsor, the TYA 

coverage for the young adult dependent 

ends effective the same date as the 

sponsor’s termination of coverage under 

TRR. If the retired reserve sponsor dies 

while enrolled in TRR, the young adult 

dependent may continue to purchase 

TYA coverage until the date on which 

the deceased member would have 

attained age 60, if otherwise qualified. If 

the Retired Reserve member dies and is 

not enrolled in TRR, there is no 

eligibility for TYA coverage until the 

sponsor would have reached age 60. On 

the date the Retired Reserve member 

would have reached 60, a young adult 

dependent who otherwise qualifies for 

TYA qualifies as a dependent of a 

deceased retired sponsor and can 

purchase TYA coverage. 

(ii) Failure of a young adult 

dependent to maintain the eligibility 

qualifications in paragraph (b) of this 

section shall result in the termination of 

coverage under the TYA program. The 

effective date of termination shall be the 

date upon which the adult young 

dependent failed to meet any of the 

prerequisite qualifications. If a 

subsequent change in circumstances reestablishes eligibility (such as losing 

eligibility for an eligible employersponsored plan), the young adult 

dependent may re-enroll for coverage 

under the TYA program. 

(iii) Coverage may also be terminated 

due to a change in the sponsor’s status, 

and the young adult dependent must requalify and reapply for TYA coverage 

within 30 days of termination to 

preclude a gap in coverage. 

(iv) Termination of coverage results in 

denial of claims for services with a date 

of service after the effective date of 

termination. 

(v) Coverage may be suspended and 

finally terminated for young adult 

dependents upon request at any time by 

submitting a completed request in the 

appropriate format in accordance with 

established procedures. 

(vi) Coverage may be suspended and 

finally terminated for young adult 

dependents who fail to make premium 

payments within established 

procedures. 

(vii) Under paragraph (d)(2)(v) or 

(d)(2)(vi) of this section, TYA coverage 

may be first suspended for a period 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. Procedures may 

also be established for the suspension to 

be lifted before final termination is 

applied upon request for undue 

hardship as defined by § 199.26(g). 

(3) Eligibility for the Continued Health 

Care Benefit Program. Upon termination 

of eligibility to purchase TYA coverage, 

dependents may purchase coverage for 

up to 36 months through the Continued 

Health Care Benefit Program under 

§ 199.20 unless locked out of TYA. 

(4) Changing coverage. Upon 

application and payment of appropriate 

premiums, qualified dependents already 

enrolled in and who are current in their 

premium payments may elect to change 

to another TRICARE program for which 

the qualified dependent is eligible based 

on the sponsor’s eligibility and the 

geographic location of the qualified 

young adult dependent. Upon change in 

sponsor status (for example, active duty 

to retired status), TYA coverage may be 

automatically transferred to the 

appropriate TRICARE option consistent 

with the sponsor’s new status. Recurring 

TYA premiums may be adjusted 

accordingly. Administrative processes 

may be established for changes in 

program enrollment; however, no 

change shall be effective until the 

applicable premium has been paid. 

(e) Preemption of State laws.—The 

preemption provisions of § 199.17(a)(7) 

are applicable to the TYA program. 

(f) Administration. The Director, 

TRICARE Management Activity may 

establish other processes, policies and 

procedures for the effective 

administration of the TYA Program and 

may authorize exceptions to 

requirements of this section, if 

permitted by law. 

(g) Terminology. The following term 

applies to the TYA program: 

Undue hardship. This term involves a 

situation that the TYA dependent could 

neither have prevented nor avoided by 

taking reasonable and timely action. The 

ASD(HA) may provide further 

guidelines regarding use of this term. 

Dated: May 10, 2013. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2013–12412 Filed 5–28–13; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 165 

[Docket Number USCG–2013–0276] 

RIN 1625–AA00 

When Pigs Fly Fireworks Display; San 

Diego, CA 

AGENCY: Coast Guard, DHS. 

ACTION: Temporary final rule. 

SUMMARY: The Coast Guard is 

establishing a safety zone on the 

navigable waters of the San Diego Bay 

in support of the When Pigs Fly 

Fireworks Display on June 11, 2013 


tkelley on DSK3SPTVN1PROD with RULES