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10 U.S.C. § 1095a (ARMED FORCES)
§ 1095a. Medical care: members held as captives and their dependents
(a) Under regulations prescribed by the President, the Secretary concerned shall pay (by advancement or reimbursement) any person who is a former captive, and any dependent of that person or of a person who is in a captive status, for health care and other expenses related to such care, to the extent that such care—
(1) is incident to the captive status; and
(2) is not covered—
(A) by any other Government medical or health program; or
(B) by insurance.
(b) In the case of any person who is eligible for medical care under section 1074 or 1076 of this title, such regulations shall require that, whenever practicable, such care be provided in a facility of the uniformed services.
(c) In this section:
(1) The terms “captive status” and “former captive” have the meanings given those terms in section 559 of title 37.
(2) The term “dependent” has the meaning given that term in section 551 of that title.
(Added Pub. L. 99–399, title VIII, § 806(c)(1), Aug. 27, 1986, 100 Stat. 886, § 1095; renumbered § 1095a, Pub. L. 100–26, § 7(e)(2), Apr. 21, 1987, 101 Stat. 281; amended Pub. L. 100–526, title I, § 106(b)(1), Oct. 24, 1988, 102 Stat. 2625.)
heading: Amendments
text: 1988—Subsec. (c). Pub. L. 100–526 substituted “The terms ‘captive status’ ” for “ ‘Captive status’ ” in par. (1), and “The term ‘dependent’ ” for “ ‘Dependent’ ” in par. (2).
heading: Effective Date; Regulations
text: Pub. L. 99–399, title VIII, § 806(c)(3), Aug. 27, 1986, 100 Stat. 886, provided that:
“(A) Section 1095 [now 1095a] of title 10, United States Code, as added by paragraph (1), shall apply with respect to any person whose captive status begins after January 21, 1981.
“(B) The President shall prescribe specific regulations regarding the carrying out of such section with respect to persons whose captive status begins during the period beginning on January 21, 1981, and ending on the effective date of that section [Aug. 27, 1986].”
heading: Delegation of Functions
text: Functions of President under this section delegated to Secretary of Defense, see section 3 of Ex. Ord. No. 12598, June 17, 1987, 52 F.R. 23421, set out as a note under section 5569 of Title 5, Government Organization and Employees.
10 U.S.C. § 1095b (ARMED FORCES)
§ 1095b. TRICARE program: contractor payment of certain claims
(a) Payment of Claims.—
(1) The Secretary of Defense may authorize a contractor under the TRICARE program to pay a claim described in paragraph (2) before seeking to recover from a third-party payer the costs incurred by the contractor to provide health care services that are the basis of the claim to a beneficiary under such program.
(2) A claim under this paragraph is a claim—
(A) that is submitted to the contractor by a provider under the TRICARE program for payment for services for health care provided to a covered beneficiary; and
(B) that is identified by the contractor as a claim for which a third-party payer may be liable.
(b) Recovery From Third-Party Payers.—
The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095 of this title.
(c) Definition of Third-Party Payer.—
In this section, the term “third-party payer” has the meaning given that term in section 1095(h) of this title, except that such term excludes primary medical insurers.
(Added Pub. L. 105–261, div. A, title VII, § 711(a)(1), Oct. 17, 1998, 112 Stat. 2058; amended Pub. L. 106–65, div. A, title VII, § 716(c)(2), Oct. 5, 1999, 113 Stat. 692.)
heading: Amendments
text: 1999—Subsec. (b). Pub. L. 106–65 substituted “The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095 of this title.” for “A contractor for the provision of health care services under the TRICARE program that pays a claim described in subsection (a)(2) shall have the right to collect from the third-party payer the costs incurred by such contractor on behalf of the covered beneficiary. The contractor shall have the same right to collect such costs under this subsection as the right of the United States to collect costs under section 1095 of this title.”
10 U.S.C. § 1095d (ARMED FORCES)
§ 1095d. TRICARE program: waiver of certain deductibles
(a) Waiver Authorized.—
The Secretary of Defense may waive the deductible payable for medical care provided under the TRICARE program to an eligible dependent of—
(1) a member of a reserve component on active duty pursuant to a call or order to active duty for a period of more than 30 days; or
(2) a member of the National Guard on full-time National Guard duty pursuant to a call or order to full-time National Guard duty for a period of more than 30 days.
(b) Eligible Dependent.—
As used in this section, the term “eligible dependent” means a dependent described in subparagraph (A), (D), or (I) of section 1072(2) of this title.
(Added Pub. L. 106–65, div. A, title VII, § 714(a), Oct. 5, 1999, 113 Stat. 689; amended Pub. L. 106–398, § 1 [[div. A], title X, § 1087(a)(7)], Oct. 30, 2000, 114 Stat. 1654, 1654A–290; Pub. L. 108–375, div. A, title VII, § 704, Oct. 28, 2004, 118 Stat. 1983.)
heading: Amendments
text: 2004—Subsec. (a). Pub. L. 108–375 substituted “more than 30 days” for “less than one year” in pars. (1) and (2).
2000—Subsec. (b). Pub. L. 106–398 substituted “subparagraph” for “subparagraphs”.
10 U.S.C. § 1095e (ARMED FORCES)
§ 1095e. TRICARE program: beneficiary counseling and assistance coordinators
(a) Establishment of Positions.—
The Secretary of Defense shall require in regulations that—
(1) each lead agent under the TRICARE program—
(A) designate a person to serve full-time as a beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program;
(B) designate for each of the TRICARE program regions at least one person (other than a person designated under subparagraph (A)) to serve full-time as a beneficiary counseling and assistance coordinator solely for members of the reserve components and their dependents who are beneficiaries under the TRICARE program; and
(C) provide for toll-free telephone communication between such beneficiaries and the beneficiary counseling and assistance coordinator; and
(2) the commander of each military medical treatment facility under this chapter designate a person to serve, as a primary or collateral duty, as beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program served at that facility.
(b) Duties.—
The Secretary shall prescribe the duties of the position of beneficiary counseling and assistance coordinator in the regulations required by subsection (a).
(Added Pub. L. 106–65, div. A, title VII, § 715(a)(1), Oct. 5, 1999, 113 Stat. 690; amended Pub. L. 108–136, div. A, title VII, § 707, Nov. 24, 2003, 117 Stat. 1529.)
heading: Amendments
text: 2003—Subsec. (a)(1). Pub. L. 108–136 added subpar. (B) and redesignated former subpar. (B) as (C).
heading: Deadline for Initial Designations
text: Pub. L. 106–65, div. A, title VII, § 715(b), Oct. 5, 1999, 113 Stat. 690, directed that each beneficiary counseling and assistance coordinator required under the regulations described in subsec. (a) of this section be designated not later than Jan. 15, 2000.
10 U.S.C. § 1095f (ARMED FORCES)
§ 1095f. TRICARE program: referrals for specialty health care
The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.
(Added Pub. L. 106–398, § 1 [[div. A], title VII, § 728(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189.)
heading: Effective Date
text: Pub. L. 106–398, § 1 [[div. A], title VII, § 728(c)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189, provided that: “Section 1095f of title 10, United States Code, as added by subsection (a), shall apply with respect to a TRICARE managed care support contract entered into by the Department of Defense after the date of the enactment of this Act [Oct. 30, 2000].”
10 U.S.C. § 1096 (ARMED FORCES)
§ 1096. Military-civilian health services partnership program
(a) Resources Sharing Agreements.—
The Secretary of Defense may enter into an agreement providing for the sharing of resources between facilities of the uniformed services and facilities of a civilian health care provider or providers that the Secretary contracts with under section 1079, 1086, or 1097 of this title if the Secretary determines that such an agreement would result in the delivery of health care to which covered beneficiaries are entitled under this chapter in a more effective, efficient, or economical manner.
(b) Eligible Resources.—
An agreement entered into under subsection (a) may provide for the sharing of—
(1) personnel (including support personnel);
(2) equipment;
(3) supplies; and
(4) any other items or facilities necessary for the provision of health care services.
(c) Computation of Charges.—
A covered beneficiary who is a dependent, with respect to care provided to such beneficiary in facilities of the uniformed services under a sharing agreement entered into under subsection (a), shall pay the charges prescribed by section 1078 of this title.
(d) Reimbursement for License Fees.—
In any case in which it is necessary for a member of the uniformed services to pay a professional license fee imposed by a government in order to provide health care services at a facility of a civilian health care provider pursuant to an agreement entered into under subsection (a), the Secretary of Defense may reimburse the member for up to $500 of the amount of the license fee paid by the member.
(Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3894; amended Pub. L. 103–337, div. A, title VII, § 712, Oct. 5, 1994, 108 Stat. 2801; Pub. L. 108–375, div. A, title VI, § 607(b), Oct. 28, 2004, 118 Stat. 1946.)
heading: Amendments
text: 2004—Subsec. (c). Pub. L. 108–375 inserted “who is a dependent” after “covered beneficiary” and substituted “shall pay the charges prescribed by section 1078 of this title.” for “shall pay—
“(1) in the case of a dependent, the charges prescribed by section 1078 of this title; and
“(2) in the case of a member or former member entitled to retired or retainer pay, the charges prescribed by section 1075 of this title.”
1994—Subsec. (d). Pub. L. 103–337 added subsec. (d).
10 U.S.C. § 1098 (ARMED FORCES)
§ 1098. Incentives for participation in cost-effective health care plans
(a) Waiver of Limitations and Copayments.—
Subject to subsection (b), the Secretary of Defense, with respect to any plan contracted for under the authority of section 1079 or 1086 of this title, may waive, in whole or in part—
(1) any limitation set out in the second sentence of section 1079(a) of this title; or
(2) any requirement for payment by the patient under section 1079(b) or 1086(b) of this title.
(b) Determination and Report.—
(1) Subject to paragraph (3), the Secretary may waive a limitation or requirement as authorized by subsection (a) if the Secretary determines that during the period of the waiver such a plan will—
(A) be less costly to the Government than a plan subject to such limitations or payment requirements; or
(B) provide better services than those provided by a plan subject to such limitations or payment requirements at no additional cost to the Government.
(2) The Secretary shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report with respect to a waiver under paragraph (1), including a comparison of costs of and benefits available under—
(A) a plan with respect to which the limitations and payment requirements are waived; and
(B) a plan with respect to which there is no such waiver.
(3) A waiver under paragraph (1) may not take effect until the end of the 180-day period beginning on the date on which the Secretary submits the report required by paragraph (2) with respect to such waiver.
(Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3895; amended Pub. L. 101–510, div. A, title XIV, § 1484(h)(1), Nov. 5, 1990, 104 Stat. 1717; Pub. L. 104–106, div. A, title XV, § 1502(a)(1), Feb. 10, 1996, 110 Stat. 502; Pub. L. 106–65, div. A, title X, § 1067(1), Oct. 5, 1999, 113 Stat. 774.)
heading: Amendments
text: 1999—Subsec. (b)(2). Pub. L. 106–65 substituted “and the Committee on Armed Services” for “and the Committee on National Security”.
1996—Subsec. (b)(2). Pub. L. 104–106 substituted “Committee on Armed Services of the Senate and the Committee on National Security of the House of Representatives” for “Committees on Armed Services of the Senate and House of Representatives”.
1990—Subsec. (a). Pub. L. 101–510 substituted “subsection (b)” for “subsections (b) and (c)” in introductory provisions.
10 U.S.C. § 1099 (ARMED FORCES)
§ 1099. Health care enrollment system
(a) Establishment of System.—
The Secretary of Defense, after consultation with the other administering Secretaries, shall establish a system of health care enrollment for covered beneficiaries who reside in the United States.
(b) Description of System.—
Such system shall—
(1) allow covered beneficiaries to elect a health care plan from eligible health care plans designated by the Secretary of Defense; or
(2) if necessary in order to ensure full use of facilities of the uniformed services in a geographical area, assign covered beneficiaries who reside in such area to such facilities.
(c) Health Care Plans Available Under System.—
A health care plan designated by the Secretary of Defense under the system described in subsection (a) shall provide all health care to which a covered beneficiary is entitled under this chapter. Such a plan may consist of any of the following:
(1) Use of facilities of the uniformed services.
(2) The Civilian Health and Medical Program of the Uniformed Services.
(3) Any other health care plan contracted for by the Secretary of Defense.
(4) Any combination of the plans described in paragraphs (1), (2), and (3).
(d) Regulations.—
The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe regulations to carry out this section.
(Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3896.)
heading: Regulations
text: Pub. L. 99–661, div. A, title VII, § 701(d)(1), (2), Nov. 14, 1986, 100 Stat. 3898, provided that:
“(1) Except as provided in paragraph (2), the Secretary of Defense shall prescribe regulations as required by section 1099(d) of title 10, United States Code (as added by subsection (a)(1)) to implement the system of health care enrollment for covered beneficiaries—
“(A) on October 1, 1987, with respect to—
“(i) covered beneficiaries included in the demonstration project required under section 702 [10 U.S.C. 1073 note]; and
“(ii) facilities of the uniformed services located in the geographical area covered by the demonstration project; and
“(B) not later than September 30, 1990, for all other covered beneficiaries and facilities of the uniformed services.
“(2) The Secretary may not assign covered beneficiaries to facilities of the uniformed services, as authorized by section 1099(b)(2) of such title (as added by subsection (a)(1)), before October 1, 1990.”
heading: Reports to Congress
text: Pub. L. 99–661, div. A, title VII, § 701(c)(1), Nov. 14, 1986, 100 Stat. 3898, required Secretary of Defense, not later than July 1, 1987, to submit to Congress a report detailing any plans to establish or implement a system of health care enrollment (other than as required under section 702(a)(2)(C)) under section 1099(a) of this title and the plan of the Secretary for completing implementation of such system.
10 U.S.C. § 1104 (ARMED FORCES)
§ 1104. Sharing of health-care resources with the Department of Veterans Affairs
(a) Sharing of Health-Care Resources.—
Health-care resources of the Department of Defense shall be shared with health-care resources of the Department of Veterans Affairs in accordance with section 8111 of title 38 or under section 1535 of title 31.
(b) Reimbursement From CHAMPUS Funds.—
Pursuant to an agreement entered into under section 8111 of title 38 or section 1535 of title 31, the Secretary of a military department may reimburse the Secretary of Veterans Affairs from funds available for that military department for the payment of medical care provided under section 1079 or 1086 of this title.
(c) Charges.—
The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided to covered beneficiaries under this chapter pursuant to an agreement entered into by the Secretary of a military department under section 8111 of title 38 or section 1535 of title 31.
(d) Provision of Services During War or National Emergency.—
Members of the armed forces on active duty during and immediately following a period of war, or during and immediately following a national emergency involving the use of the armed forces in armed conflict, may be provided health-care services by the Department of Veterans Affairs in accordance with section 8111A of title 38.
(Added Pub. L. 101–189, div. A, title VII, § 722(a), Nov. 29, 1989, 103 Stat. 1477; amended Pub. L. 102–484, div. A, title X, § 1052(14), Oct. 23, 1992, 106 Stat. 2499; Pub. L. 103–35, title II, § 201(c)(1), May 31, 1993, 107 Stat. 98; Pub. L. 107–314, div. A, title VII, § 721(b), Dec. 2, 2002, 116 Stat. 2595.)
heading: Amendments
text: 2002—Subsec. (a). Pub. L. 107–314 substituted “shall” for “may”.
1993—Subsecs. (a) to (c). Pub. L. 103–35, § 201(c)(1)(A), substituted “section 8111 of title 38” for “section 8011 of title 38”.
Subsec. (d). Pub. L. 103–35, § 201(c)(1)(B), substituted “section 8111A of title 38” for “section 8011A of title 38”.
1992—Subsecs. (a) to (c). Pub. L. 102–484, § 1052(14)(A), substituted “section 8011 of title 38” for “section 5011 of title 38”.
Subsec. (d). Pub. L. 102–484, § 1052(14)(B), substituted “section 8011A of title 38” for “section 5011A of title 38”.
heading: Effective Date of 2002 Amendment
text: Amendment by Pub. L. 107–314 effective Oct. 1, 2003, see section 721(c) of Pub. L. 107–314, set out as a note under section 8111 of Title 38, Veterans’ Benefits.
10 U.S.C. § 1110a (ARMED FORCES)
§ 1110a. Notification of certain individuals regarding options for enrollment under Medicare part B
(a) In General.—
(1) As soon as practicable, the Secretary of Defense shall notify each individual described in subsection (b)—
(A) that the individual is no longer eligible for health care benefits under the TRICARE program under this chapter; and
(B) of options available for enrollment of the individual in the supplementary medical insurance program under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.).
(2) In carrying out this subsection, the Secretary of Defense shall—
(A) establish procedures for identifying individuals described in subsection (b); and
(B) consult with the Secretary of Health and Human Services to accurately identify and notify such individuals.
(b) Individuals Described.—
An individual described in this subsection is an individual who is—
(1) a covered beneficiary;
(2) entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c) under section 226(b) or section 226A of such Act (42 U.S.C. 426(b) and 426–1); and
(3) eligible to enroll in the supplementary medical insurance program under part B of such title (42 U.S.C. 1395j et seq.).
(Added Pub. L. 111–84, div. A, title VII, § 707(a), Oct. 28, 2009, 123 Stat. 2376.)
heading: References in Text
text: The Social Security Act, referred to in subsecs. (a)(1)(B) and (b)(2), (3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Parts A and B of title XVIII of the Act are classified generally to parts A (§ 1395c et seq.) and B (§ 1395j et seq.), respectively, of subchapter XVIII of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
10 U.S.C. § 1110b (ARMED FORCES)
§ 1110b. TRICARE program: extension of dependent coverage
(a) In General.—
In accordance with subsection (c), an individual described in subsection (b) shall be deemed to be a dependent (as described in section 1072(2)(D) of this title) for purposes of coverage under the TRICARE program.
(b) Individual Described.—
An individual described in this subsection is an individual who—
(1) would be a dependent under section 1072(2) of this title but for exceeding an age limit under such section;
(2) has not attained the age of 26;
(3) is not eligible to enroll in an eligible employer-sponsored plan (as defined in section 5000A(f)(2) of the Internal Revenue Code of 1986);
(4) is not otherwise a dependent of a member or a former member under any subparagraph of section 1072(2) of this title; and
(5) meets other criteria specified in regulations prescribed by the Secretary, similar to regulations prescribed by the Secretary of Health and Human Services under section 2714(b) of the Public Health Service Act.
(c) Premium.—
(1) The Secretary shall prescribe by regulation a premium (or premiums) for coverage under the TRICARE program provided pursuant to this section to an individual described in subsection (b).
(2) The monthly amount of the premium in effect for a month for coverage under the TRICARE program pursuant to this section shall be the amount equal to the cost of such coverage that the Secretary determines on an appropriate actuarial basis.
(3) The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums under this subsection.
(4) Amounts collected as premiums under this subsection shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title, shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section for such fiscal year.
(Added Pub. L. 111–383, div. A, title VII, § 702(a)(1), Jan. 7, 2011, 124 Stat. 4244.)
heading: References in Text
text: Section 5000A of the Internal Revenue Code of 1986, referred to in subsec. (b)(3), is classified to section 5000A of Title 26, Internal Revenue Code.
Section 2714 of the Public Health Service Act, referred to in subsec. (b)(5), is classified to section 300gg–14 of Title 42, The Public Health and Welfare.
heading: Effective Date and Regulations
text: Pub. L. 111–383, div. A, title VII, § 702(b), Jan. 7, 2011, 124 Stat. 4245, provided that: “The amendments made by this section [enacting this section] shall take effect on January 1, 2011. The Secretary of Defense shall prescribe an interim final rule with respect to such amendments, effective not later than January 1, 2011.”
10 U.S.C. § 1112 (ARMED FORCES)
§ 1112. Assets of Fund
There shall be deposited into the Fund the following, which shall constitute the assets of the Fund:
(1) Amounts paid into the Fund under section 1116 of this title.
(2) Any amount appropriated to the Fund.
(3) Any return on investment of the assets of the Fund.
(4) Amounts paid into the Fund pursuant to section 1111(c) of this title.
(Added Pub. L. 106–398, § 1 [[div. A], title VII, § 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–180; amended Pub. L. 107–107, div. A, title VII, § 711(b)(2), Dec. 28, 2001, 115 Stat. 1165.)
heading: Amendments
text: 2001—Par. (4). Pub. L. 107–107 added par. (4).
heading: Effective Date of 2001 Amendment
text: Amendment by Pub. L. 107–107 effective as if included in the enactment of this chapter by Pub. L. 106–398, see section 711(f) of Pub. L. 107–107, set out as a note under section 1111 of this title.