10 U.S.C. § 1076d (ARMED FORCES)
§ 1076d. TRICARE program: TRICARE Standard coverage for members of the Selected Reserve
(a) Eligibility.—
(1) Except as provided in paragraph (2), a member of the Selected Reserve of the Ready Reserve of a reserve component of the armed forces is eligible for health benefits under TRICARE Standard as provided in this section.
(2) Paragraph (1) does not apply to a member who is enrolled, or is eligible to enroll, in a health benefits plan under chapter 89 of title 5.
(b) Termination of Eligibility Upon Termination of Service.—
(1) Except as provided in paragraph (2), eligibility for TRICARE Standard coverage of a member under this section shall terminate upon the termination of the member’s service in the Selected Reserve.
(2) During the period beginning on the date of the enactment of this paragraph and ending December 31, 2018, eligibility for a member under this section who is involuntarily separated from the Selected Reserve under other than adverse conditions, as characterized by the Secretary concerned, shall terminate 180 days after the date on which the member is separated.
(c) Family Members.—
While a member of a reserve component is covered by TRICARE Standard under the section, the members of the immediate family of such member are eligible for TRICARE Standard coverage as dependents of the member. If a member of a reserve component dies while in a period of coverage under this section, the eligibility of the members of the immediate family of such member for TRICARE Standard coverage shall continue for six months beyond the date of death of the member.
(d) Premiums.—
(1) A member of a reserve component covered by TRICARE Standard under this section shall pay a premium for that coverage.
(2) The Secretary of Defense shall prescribe for the purposes of this section one premium for TRICARE Standard coverage of members without dependents and one premium for TRICARE Standard coverage of members with dependents referred to in subsection (f)(1). The premium prescribed for a coverage shall apply uniformly to all covered members of the reserve components.
(3)
(A) The monthly amount of the premium in effect for a month for TRICARE Standard coverage under this section shall be the amount equal to 28 percent of the total monthly amount determined on an appropriate actuarial basis as being reasonable for that coverage.
(B) The appropriate actuarial basis for purposes of subparagraph (A) shall be determined, for each calendar year after calendar year 2009, by utilizing the actual cost of providing benefits under this section to members and their dependents during the calendar years preceding such calendar year.
(4) The premiums payable by a member of a reserve component under this subsection may be deducted and withheld from basic pay payable to the member under section 204 of title 37 or from compensation payable to the member under section 206 of such title. The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums.
(5) 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.
(e) Regulations.—
The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section.
(f) Definitions.—
In this section:
(1) The term “immediate family”, with respect to a member of a reserve component, means all of the member’s dependents described in subparagraphs (A), (D), and (I) of section 1072(2) of this title.
(2) The term “TRICARE Standard” means—
(A) medical care to which a dependent described in section 1076(a)(2) of this title is entitled; and
(B) health benefits contracted for under the authority of section 1079(a) of this title and subject to the same rates and conditions as apply to persons covered under that section.
(Added Pub. L. 108–375, div. A, title VII, § 701(a)(1), Oct. 28, 2004, 118 Stat. 1980; amended Pub. L. 109–163, div. A, title VII, § 701(a)–(f)(1), Jan. 6, 2006, 119 Stat. 3339, 3340; Pub. L. 109–364, div. A, title VII, §§ 704(c), 706(a)–(c), Oct. 17, 2006, 120 Stat. 2280, 2282; Pub. L. 110–181, div. A, title VII, § 701(c), Jan. 28, 2008, 122 Stat. 188; Pub. L. 110–417, [div. A], title VII, § 704(a), Oct. 14, 2008, 122 Stat. 4498; Pub. L. 111–84, div. A, title X, § 1073(a)(11), Oct. 28, 2009, 123 Stat. 2473; Pub. L. 112–239, div. A, title VII, § 701(a), Jan. 2, 2013, 126 Stat. 1798; Pub. L. 114–328, div. A, title VII, § 701(j)(1)(B), Dec. 23, 2016, 130 Stat. 2192.)
heading: Amendment of Section
text: Pub. L. 114–328, div. A, title VII, § 701(j)(1)(B), (k), Dec. 23, 2016, 130 Stat. 2192, 2193, provided that, applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, this section is amended:
(1) in subsection (d)(1), by inserting after “coverage.” the following: “Such premium shall apply instead of any enrollment fees required under section 1075 of this section.”;
(2) in subsection (f), by striking paragraph (2) and inserting the following new paragraph:
“(2) The term ‘TRICARE Reserve Select’ means the TRICARE Select self-managed, preferred-provider network option under section 1075 made available to beneficiaries by reason of this section and in accordance with subsection (d)(1).”; and
(3) by striking “TRICARE Standard” each place it appears (including in the heading) and inserting “TRICARE Reserve Select”.
See 2016 Amendment notes below.
heading: References in Text
text: The date of the enactment of this paragraph, referred to in subsec. (b)(2), probably means the date of enactment of Pub. L. 112–239, which was approved Jan. 2, 2013.
heading: Amendments
text: 2016—Pub. L. 114–328, § 701(j)(1)(B)(iii), substituted “TRICARE Reserve Select” for “TRICARE Standard” in section catchline and wherever appearing in text.
Subsec. (d)(1). Pub. L. 114–328, § 701(j)(1)(B)(i), inserted at end “Such premium shall apply instead of any enrollment fees required under section 1075 of this section.”
Subsec. (f)(2). Pub. L. 114–328, § 701(j)(1)(B)(ii), added par. (2) and struck out former par. (2) which defined the term “TRICARE Standard”.
2013—Subsec. (b). Pub. L. 112–239 designated existing provisions as par. (1), substituted “Except as provided in paragraph (2), eligibility” for “Eligibility”, and added par. (2).
2009—Pub. L. 111–84 substituted “Standard” for “standard” in section catchline.
2008—Subsec. (d)(3). Pub. L. 110–417 designated existing provisions as subpar. (A), substituted “determined” for “that the Secretary determines”, struck out at end “During the period beginning on April 1, 2006, and ending on September 30, 2008, the monthly amount of the premium may not be increased above the amount in effect for the month of March 2006.”, and added subpar. (B).
Pub. L. 110–181 substituted “September 30, 2008” for “September 30, 2007”.
2006—Pub. L. 109–364, § 706(c)(2), substituted “TRICARE standard coverage for members of the Selected Reserve” for “coverage for members of reserve components who commit to continued service in the Selected Reserve after release from active duty in support of a contingency operation” in section catchline.
Pub. L. 109–163, § 701(f)(1), substituted “active duty in support of a contingency operation” for “active duty” in section catchline.
Subsec. (a). Pub. L. 109–364, § 706(a), designated introductory provisions as par. (1), substituted “Except as provided in paragraph (2), a member” for “A member”, substituted period at end for “after the member completes service on active duty to which the member was called or ordered for a period of more than 30 days on or after September 11, 2001, under a provision of law referred to in section 101(a)(13)(B), if the member—”, added par. (2), and struck out former pars. (1) and (2) which read as follows:
“(1) served continuously on active duty for 90 or more days pursuant to such call or order; and
“(2) not later than 90 days after release from such active-duty service, entered into an agreement with the Secretary concerned to serve continuously in the Selected Reserve for a period of one or more whole years following such date.”
Subsec. (a)(2). Pub. L. 109–163, § 701(d), substituted “not later than 90 days after release” for “on or before the date of the release”.
Subsec. (b). Pub. L. 109–364, § 706(b), substituted “Termination of Eligibility Upon Termination of Service” for “Period of Coverage” in heading, struck out “(4)” before “Eligibility”, and struck out pars. (1) to (3) and (5), which related to beginning of period of coverage, length of coverage period, period of coverage in the case of a member recalled to active duty, and coverage for a member of the Individual Ready Reserve.
Subsec. (b)(2). Pub. L. 109–163, § 701(a)(2), substituted “Subject to paragraph (3) and unless earlier terminated under paragraph (4)” for “Unless earlier terminated under paragraph (3)”.
Subsec. (b)(3), (4). Pub. L. 109–163, § 701(a)(1), added par. (3) and redesignated former par. (3) as (4).
Subsec. (b)(5). Pub. L. 109–163, § 701(b), added par. (5).
Subsec. (c). Pub. L. 109–163, § 701(c), inserted at end “If a member of a reserve component dies while in a period of coverage under this section, the eligibility of the members of the immediate family of such member for TRICARE Standard coverage shall continue for six months beyond the date of death of the member.”
Subsec. (d)(3). Pub. L. 109–364, § 704(c), inserted at end “During the period beginning on April 1, 2006, and ending on September 30, 2007, the monthly amount of the premium may not be increased above the amount in effect for the month of March 2006.”
Subsec. (e). Pub. L. 109–364, § 706(c)(1)(A), (B), redesignated subsec. (g) as (e) and struck out heading and text of former subsec. (e). Text read as follows: “The service agreement required of a member of a reserve component under subsection (a)(2) is separate from any other form of commitment of the member to a period of obligated service in that reserve component and may cover any part or all of the same period that is covered by another commitment of the member to a period of obligated service in that reserve component.”.
Subsec. (f)(2). Pub. L. 109–163, § 701(e), amended par. (2) generally. Prior to amendment, par. (2) read as follows: “The term ‘TRICARE Standard’ means the Civilian Health and Medical Program of the Uniformed Services option under the TRICARE program.”
Subsec. (f)(3). Pub. L. 109–364, § 706(c)(1)(C), struck out par. (3) which read as follows: “The term ‘member recalled to active duty’ means, with respect to a member who is eligible for coverage under this section based on a period of active duty service, a member who is called or ordered to active duty for an additional period of active duty subsequent to the period of active duty on which that eligibility is based.”
Pub. L. 109–163, § 701(a)(3), added par. (3).
Subsec. (g). Pub. L. 109–364, § 706(c)(1)(B), redesignated subsec. (g) as (e).
heading: Effective Date of 2016 Amendment
text: Amendment by Pub. L. 114–328 applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see section 701(k) of Pub. L. 114–328, set out as a note under section 1072 of this title.
heading: Effective Date of 2008 Amendment
text: Pub. L. 110–417, [div. A], title VII, § 704(c), Oct. 14, 2008, 122 Stat. 4499, provided that: “The amendments made by this section [amending this section] shall take effect as of October 1, 2008.”
heading: Effective Date of 2006 Amendment
text: Pub. L. 109–364, div. A, title VII, § 706(g), Oct. 17, 2006, 120 Stat. 2282, provided that: “The Secretary of Defense shall ensure that health care under TRICARE Standard is provided under section 1076d of title 10, United States Code, as amended by this section, beginning not later than October 1, 2007.”
heading: Savings Provision
text: Pub. L. 109–364, div. A, title VII, § 706(f), Oct. 17, 2006, 120 Stat. 2282, as amended by Pub. L. 110–181, div. A, title VII, § 706(a), Jan. 28, 2008, 122 Stat. 189, provided that:
“(1) Except as provided in paragraph (2), enrollments in TRICARE Standard that are in effect on the day before the date of the enactment of this Act [Oct. 17, 2006] under section 1076d of title 10, United States Code, as in effect on such day, shall be continued until terminated after such day under such section 1076d as amended by this section.
“(2) The enrollment of a member in TRICARE Standard that is in effect on the day before health care under TRICARE Standard is provided pursuant to the effective date in subsection (g) [set out as an Effective Date of 2006 Amendment note above] shall not be terminated by operation of the exclusion of eligibility under subsection (a)(2) of such section 1076d, as so amended, for the duration of the eligibility of the member under TRICARE Standard as in effect on October 16, 2006.”
[Pub. L. 110–181, div. A, title VII, § 706(b), Jan. 28, 2008, 122 Stat. 189, provided that: “The amendments made by subsection (a) [amending section 706(f) of Pub. L. 109–364, set out above] shall take effect on October 1, 2007.”
]
heading: Commercial Health Insurance Coverage Pilot Program for Eligible Reserve Component Members
text: Pub. L. 114–328, div. A, title VII, § 712(b), (c), Dec. 23, 2016, 130 Stat. 2215, 2219, provided that:
“(b) Pilot Program.—
“(1) Authorization.—
The Secretary of Defense and the Director may jointly carry out a pilot program, at the election of the Secretary, under which the Director provides commercial health insurance coverage to eligible reserve component members who enroll in a health benefits plan under paragraph (4) as an individual, for self plus one coverage, or for self and family coverage.
“(2) Elements.—
The pilot program shall—
“(A) provide for enrollment by eligible reserve component members, at the election of the member, in a health benefits plan under paragraph (4) during an open enrollment period established by the Director for purposes of this subsection;
“(B) include a variety of national and regional health benefits plans that—
“(i) meet the requirements of this subsection;
“(ii) are broadly representative of the health benefits plans available in the commercial market; and
“(iii) do not contain unnecessary restrictions, as determined by the Director; and
“(C) offer a sufficient number of health benefits plans in order to provide eligible reserve component beneficiaries with an ample choice of health benefits plans, as determined by the Director.
“(3) Duration.—
If the Secretary elects to carry out the pilot program, the Secretary and the Director shall carry out the pilot program for not less than five years.
“(4) Health benefits plans.—
“(A) In general.—
In providing health insurance coverage under the pilot program, the Director shall contract with qualified carriers for a variety of health benefits plans.
“(B) Description of plans.—
Health benefits plans contracted for under this subsection—
“(i) may vary by type of plan design, covered benefits, geography, and price;
“(ii) shall include maximum limitations on out-of-pocket expenses paid by an eligible reserve component beneficiary for the health care provided; and
“(iii) may not exclude an eligible reserve component member who chooses to enroll.
“(C) Quality of plans.—
The Director shall ensure that each health benefits plan offered under this subsection offers a high degree of quality, as determined by criteria that include—
“(i) access to an ample number of medical providers, as determined by the Director;
“(ii) adherence to industry-accepted quality measurements, as determined by the Director;
“(iii) access to benefits described in paragraph (5), including ease of referral for health care services; and
“(iv) inclusion in the services covered by the plan of advancements in medical treatments and technology as soon as practicable in accordance with generally accepted standards of medicine.
“(5) Benefits.—
A health benefits plan offered by the Director under this subsection shall include, at a minimum, the following benefits:
“(A) The health care benefits provided under chapter 55 of title 10, United States Code, excluding pharmaceutical, dental, and extended health care option benefits.
“(B) Such other benefits as the Director determines appropriate.
“(6) Care at facilities of uniformed services.—
“(A) In general.—
If an eligible reserve component beneficiary receives benefits described in paragraph (5) at a facility of the uniformed services, the health benefits plan under which the beneficiary is covered shall be treated as a third-party payer under section 1095 of title 10, United States Code, and shall pay charges for such benefits as determined by the Secretary.
“(B) Military medical treatment facilities.—
The Secretary, in consultation with the Director—
“(i) may contract with qualified carriers with which the Director has contracted under paragraph (4) to provide health insurance coverage for health care services provided at military treatment facilities under this subsection; and
“(ii) may receive payments under section 1095 of title 10, United States Code, from qualified carriers for health care services provided at military medical treatment facilities under this subsection.
“(7) Special rule relating to active duty period.—
“(A) In general.—
An eligible reserve component member may not receive benefits under a health benefits plan under this subsection during any period in which the member is serving on active duty for more than 30 days.
“(B) Treatment of dependents.—
Subparagraph (A) does not affect the coverage under a health benefits plan of any dependent of an eligible reserve component member.
“(8) Eligibility for federal employees health benefits program.—
An individual is not eligible to enroll in or be covered under a health benefits plan under this subsection if the individual is eligible to enroll in a health benefits plan under the Federal Employees Health Benefits Program.
“(9) Cost sharing.—
“(A) Responsibility for payment.—
“(i) In general.—
Except as provided in clause (ii), an eligible reserve component member shall pay an annual premium amount calculated under subparagraph (B) for coverage under a health benefits plan under this subsection and additional amounts described in subparagraph (C) for health care services in connection with such coverage.
“(ii) Active duty period.—
“(I) In general.—
During any period in which an eligible reserve component member is serving on active duty for more than 30 days, the eligible reserve component member is not responsible for paying any premium amount under subparagraph (B) or additional amounts under subparagraph (C).
“(II) Coverage of dependents.—
With respect to a dependent of an eligible reserve component member that is covered under a health benefits plan under this subsection, during any period described in subclause (I) with respect to the member, the Secretary shall, on behalf of the dependent, pay 100 percent of the total annual amount of a premium for coverage of the dependent under the plan and such cost-sharing amounts as may be applicable under the plan.
“(B) Premium amount.—
“(i) In general.—
The annual premium calculated under this subparagraph is an amount equal to 28 percent of the total annual amount of a premium under the health benefits plan selected.
“(ii) Types of coverage.—
The premium amounts calculated under this subparagraph shall include separate calculations for—
“(I) coverage as an individual;
“(II) self plus one coverage; and
“(III) self and family coverage.
“(C) Additional amounts.—
The additional amounts described in this subparagraph with respect to an eligible reserve component member are such cost-sharing amounts as may be applicable under the health benefits plan under which the member is covered.
“(10) Contracting.—
“(A) In general.—
In contracting for health benefits plans under paragraph (4), the Director may contract with qualified carriers in a manner similar to the manner in which the Director contracts with carriers under section 8902 of title 5, United States Code, including that—
“(i) a contract under this subsection shall be for a uniform term of not less than one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party;
“(ii) a contract under this subsection shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits determined by the Director in accordance with paragraph (5);
“(iii) a contract under this subsection shall ensure that an eligible reserve component member who is eligible to enroll in a health benefits plan pursuant to such contract is able to enroll in such plan; and
“(iv) the terms of a contract under this subsection relating to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any conflicting State or local law.
“(B) Evaluation of financial solvency.—
The Director shall perform a thorough evaluation of the financial solvency of an insurance carrier before entering into a contract with the insurance carrier under subparagraph (A).
“(11) Recommendations and data.—
“(A) In general.—
The Secretary of Defense, in consultation with the Secretary of Homeland Security, shall provide recommendations and data to the Director with respect to—
“(i) matters involving military medical treatment facilities;
“(ii) matters unique to eligible reserve component members and dependents of such members; and
“(iii) such other strategic guidance necessary for the Director to administer this subsection as the Secretary of Defense, in consultation with the Secretary of Homeland Security, considers appropriate.
“(B) Limitation on implementation.—
The Director shall not implement any recommendation provided by the Secretary of Defense under subparagraph (A) if the Director determines that the implementation of the recommendation would result in eligible reserve components beneficiaries receiving less generous health benefits under this subsection than the health benefits commonly available to individuals under the Federal Employees Health Benefits Program during the same period.
“(12) Transmission of information.—
On an annual basis during each year in which the pilot program is carried out, the Director shall provide the Secretary with information on the use of health care benefits under the pilot program, including—
“(A) the number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered;
“(B) the number of health benefits plans offered under the pilot program and a description of each such plan; and
“(C) the costs of the health care provided under the plans.
“(13) Funding.—
“(A) In general.—
The Secretary of Defense and the Director shall jointly establish an appropriate mechanism to fund the pilot program.
“(B) Availability of amounts.—
Amounts shall be made available to the Director pursuant to the mechanism established under subparagraph (A), without fiscal year limitation—
“(i) for payments to health benefits plans under this subsection; and
“(ii) to pay the costs of administering this subsection.
“(14) Reports.—
“(A) Initial reports.—
Not later than one year after the date on which the Secretary establishes the pilot program, and annually thereafter for the following three years, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the pilot program.
“(B) Matters included.—
The report under subparagraph (A) shall include, with respect to the year covered by the report, the following:
“(i) The number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered.
“(ii) The number of health benefits plans offered under the pilot program.
“(iii) The cost of the pilot program to the Department of Defense.
“(iv) The estimated cost savings, if any, to the Department of Defense.
“(v) The average cost to the eligible reserve component beneficiary.
“(vi) The effect of the pilot program on the medical readiness of the members of the reserve components.
“(vii) The effect of the pilot program on access to health care for members of the reserve components.
“(C) Final report.—
Not later than 180 days before the date on which the pilot program will terminate pursuant to paragraph (3), the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the pilot program that includes—
“(i) the matters specified under subparagraph (B); and
“(ii) the recommendation of the Secretary regarding whether to make the pilot program permanent or to terminate the pilot program.
“(c) Definitions.—
In this section:
“(1) The term ‘Director’ means the Director of the Office of Personnel Management.
“(2) The term ‘eligible reserve component beneficiary’ means an eligible reserve component member enrolled in, or a dependent of such a member described in subparagraph (A), (D), or (I) of section 1072(2) of title 10, United States Code, covered under, a health benefits plan under subsection (b).
“(3) The term ‘eligible reserve component member’ means a member of the Selected Reserve of the Ready Reserve of an Armed Force.
“(4) The term ‘extended health care option’ means the program of extended benefits under subsections (d) and (e) of section 1079 of title 10, United States Code.
“(5) The term ‘Federal Employees Health Benefits Program’ means the health insurance program under chapter 89 of title 5, United States Code.
“(6) The term ‘qualified carrier’ means an insurance carrier that is licensed to issue group health insurance in any State, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, Guam, and any territory or possession of the United States.”
heading: Calculation of Monthly Premiums for 2009
text: Pub. L. 110–417, [div. A], title VII, § 704(b), Oct. 14, 2008, 122 Stat. 4499, provided that: “For purposes of section 1076d(d)(3) of title 10, United States Code, the appropriate actuarial basis for purposes of subparagraph (A) of that section shall be determined for calendar year 2009 by utilizing the reported cost of providing benefits under that section to members and their dependents during calendar years 2006 and 2007, except that the monthly amount of the premium determined pursuant to this subsection may not exceed the amount in effect for the month of March 2007.”
heading: Implementation
text: Pub. L. 108–375, div. A, title VII, § 701(b), Oct. 28, 2004, 118 Stat. 1981, provided that:
“(1) The Secretary of Defense shall implement section 1076d of title 10, United States Code, not later than 180 days after the date of the enactment of this Act [Oct. 28, 2004].
“(2)
(A) A member of a reserve component of the Armed Forces who performed active-duty service described in subsection (a) of section 1076d of title 10, United States Code, for a period beginning on or after September 11, 2001, and was released from that active-duty service before the date of the enactment of this Act, or is released from that active-duty service on or within 180 days after the date of the enactment of this Act, may, for the purpose of paragraph (2) of such subsection, enter into an agreement described in such paragraph not later than one year after the date of the enactment of this Act. TRICARE Standard coverage (under such section 1076d) of a member who enters into such an agreement under this paragraph shall begin on the later of—
“(i) the date applicable to the member under subsection (b) of such section; or
“(ii) the date of the agreement.
“(B) The Secretary of Defense shall take such action as is necessary to ensure, to the maximum extent practicable, that members of the reserve components eligible to enter into an agreement as provided in subparagraph (A) actually receive information on the opportunity and procedures for entering into such an agreement together with a clear explanation of the benefits that the members are eligible to receive as a result of entering into such an agreement under section 1076d of title 10, United States Code.”