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10 U.S.C. § 1097c — TRICARE program: relationship with employer-sponsored group health plans
Federal law — U.S. Code and appendices · legal_authorities
**(a) Prohibition on Financial Incentives Not to Enroll in a Group Health Plan.—**
(1) Except as provided in this subsection, the provisions of section 1862(b)(3)(C) of the Social Security Act shall apply with respect to financial or other incentives for a TRICARE-eligible employee not to enroll (or to terminate enrollment) under a health plan which would (in the case of such enrollment) be a primary plan under sections 1079(j)(1) 11 See References in Text note below. and 1086(g) of this title in the same manner as such section 1862(b)(3)(C) applies to financial or other incentives for an individual entitled to benefits under title XVIII of the Social Security Act not to enroll (or to terminate enrollment) under a group health plan or a large group health plan which would (in the case of enrollment) be a primary plan (as defined in section 1862(b)(2)(A) of such Act).
(2)
(A) The Secretary of Defense may by regulation adopt such additional exceptions to the prohibition referenced and applied under paragraph (1) as the Secretary deems appropriate and such paragraph (1) shall be implemented taking into account the adoption of such exceptions.
(B) The Secretary of Defense and the Secretary of Health and Human Services are authorized to enter into agreements for carrying out this subsection. Any such agreement shall provide that any expenses incurred by the Secretary of Health and Human Services pertaining to carrying out this subsection shall be reimbursed by the Secretary of Defense.
(C) Authorities of the Inspector General of the Department of Defense shall be available for oversight and investigations of responsibilities of employers and other entities under this subsection.
(D) Information obtained under [section 1095(k) of this title](https://uscode.house
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**(a) Prohibition on Financial Incentives Not to Enroll in a Group Health Plan.—**
(1) Except as provided in this subsection, the provisions of section 1862(b)(3)(C) of the Social Security Act shall apply with respect to financial or other incentives for a TRICARE-eligible employee not to enroll (or to terminate enrollment) under a health plan which would (in the case of such enrollment) be a primary plan under sections 1079(j)(1) 11 See References in Text note below. and 1086(g) of this title in the same manner as such section 1862(b)(3)(C) applies to financial or other incentives for an individual entitled to benefits under title XVIII of the Social Security Act not to enroll (or to terminate enrollment) under a group health plan or a large group health plan which would (in the case of enrollment) be a primary plan (as defined in section 1862(b)(2)(A) of such Act).
(2)
(A) The Secretary of Defense may by regulation adopt such additional exceptions to the prohibition referenced and applied under paragraph (1) as the Secretary deems appropriate and such paragraph (1) shall be implemented taking into account the adoption of such exceptions.
(B) The Secretary of Defense and the Secretary of Health and Human Services are authorized to enter into agreements for carrying out this subsection. Any such agreement shall provide that any expenses incurred by the Secretary of Health and Human Services pertaining to carrying out this subsection shall be reimbursed by the Secretary of Defense.
(C) Authorities of the Inspector General of the Department of Defense shall be available for oversight and investigations of responsibilities of employers and other entities under this subsection.
(D) Information obtained under [section 1095(k) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1095/k&num=0&edition=prelim) may be used in carrying out this subsection in the same manner as information obtained under section 1862(b)(5) of the Social Security Act may be used in carrying out section 1862(b) of such Act.
(E) Any amounts collected in carrying out paragraph (1) shall be handled in accordance with [section 1079a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079a&num=0&edition=prelim).
**(b) Election of TRICARE-Eligible Employees to Participate in Group Health Plan.—** A TRICARE-eligible employee shall have the opportunity to elect to participate in the group health plan offered by the employer of the employee and receive primary coverage for health care services under the plan in the same manner and to the same extent as similarly situated employees of such employer who are not TRICARE-eligible employees.
**(c) Inapplicability to Certain Employers.—** The provisions of this section do not apply to any employer who has fewer than 20 employees.
**(d) Retention of Eligibility for Coverage Under TRICARE.—** Nothing in this section, including an election made by a TRICARE-eligible employee under subsection (b), shall be construed to affect, modify, or terminate the eligibility of a TRICARE-eligible employee or spouse of such employee for health care or dental services under this chapter in accordance with the other provisions of this chapter.
**(e) Outreach.—** The Secretary of Defense shall, in coordination with the other administering Secretaries, conduct outreach to inform covered beneficiaries who are entitled to health care benefits under the TRICARE program of the rights and responsibilities of such beneficiaries and employers under this section.
**(f) Definitions.—** In this section:
(1) The term “employer” includes a State or unit of local government.
(2) The term “group health plan” means a group health plan (as that term is defined in section 5000(b)(1) of the Internal Revenue Code of 1986 without regard to section 5000(d) of the Internal Revenue Code of 1986).
(3) The term “TRICARE-eligible employee” means a covered beneficiary under [section 1086 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1086&num=0&edition=prelim) entitled to health care benefits under the TRICARE program.
**(g) Effective Date.—** This section shall take effect on January 1, 2008.
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim). However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).
**(b)** For persons covered by this section the plans contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim) shall contain the following provisions for payment by the patient:
(1) Except as provided in paragraph (2), the first $150 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a calendar year.
(2) A family group of two or more persons covered by this section shall not be required to pay collectively more than the first $300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year.
(3) 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535 per day during the period beginning on April 1, 2006, and ending on September 30, 2011. The Secretary of Defense may
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1086
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Federal law — U.S. Code and appendices · legal_authorities
All refunds and other amounts collected in the administration of the TRICARE program shall be credited to the appropriation available for that program for the fiscal year in which the refund or amount is collected.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Imposition of tax** There is hereby imposed on any employer (including a self-employed person) or employee organization that contributes to a nonconforming group health plan a tax equal to 25 percent of the employer’s or employee organization’s expenses incurred during the calendar year for each group health plan to which the employer or employee organization contributes.
**(b) Group health plan and large group health plan** For purposes of this section—
(1) **Group health plan** — The term “group health plan” means a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families.
(2) **Large group health plan** — The term “large group health plan” means a plan of, or contributed to by, an employer or employee organization (including a self-insured plan) to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families, that covers employees of at least one employer that normally employed at least 100 employees on a typical business day during the previous calendar year. For purposes of the preceding sentence—
(A) all employers treated as a single employer under subsection (a) or (b) of section 52 shall be treated as a single employer,
(B) all employees of the members of an affiliated service group (as defined in section 414(m)) shall be treated as employed by a single employer, and
(C) leased employees (as defined in section 414(n)(2)) shall be trea
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
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Federal law — U.S. Code and appendices · legal_authorities
With respect to covered part D drugs that would be applicable drugs (as defined in [section 1395w–114c(g)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–114c/g/2&num=0&edition=prelim)) but for the application of subparagraph (B) of such section, the Secretary shall provide a process whereby, in the case of an applicable beneficiary (as defined in [section 1395w–114c(g)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–114c/g/1&num=0&edition=prelim)) who, with respect to a year, is enrolled in a prescription drug plan or is enrolled in an MA–PD plan, has not incurred costs that are equal to or exceed the annual out-of-pocket threshold specified in [section 1395w–102(b)(4)(B)(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–102/b/4/B/i&num=0&edition=prelim), and is dispensed such a drug, the Secretary (periodically and on a timely basis) provides the PDP sponsor or the MA organization offering the plan, a subsidy with respect to such drug that is equal to 10 percent of the negotiated price (as defined in [section 1395w–114c(g)(6) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–114c/g/6&num=0&edition=prelim)) of such drug.
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Federal law — U.S. Code and appendices · legal_authorities
Page 1155
TITLE 10—ARMED FORCES
§ 1097c
1 See References in Text note below.
(2) The Secretary of Defense shall prescribe
regulations for the administration of this sub-
section. The regulations shall set forth the
method to be used for the computation of the
reasonable charges for inpatient, outpatient,
and other health care services. The method of
computation may be—
(A) a method that is based on—
(i) per diem rates;
(ii) all-inclusive rates for each visit;
(iii) diagnosis-related groups; or
(iv) rates prescribed under the regulations
implementing sections 1079 and 1086 of this
title; or
(B) any other method considered appro-
priate.
(c) CONSULTATION
REQUIREMENT.—The Sec-
retary of Defense shall carry out the responsibil-
ities under this section after consultation with
the other administering Secretaries.
(Added Pub. L. 106–65, div. A, title VII, § 716(a)(1),
Oct. 5, 1999, 113 Stat. 690; amended Pub. L. 112–81,
div. A, title VII, § 715, Dec. 31, 2011, 125 Stat.
1477.)
Editorial Notes
AMENDMENTS
2011—Subsec. (a)(3). Pub. L. 112–81 added par. (3).
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE
Pub. L. 106–65, div. A, title VII, § 716(d), Oct. 5, 1999,
113 Stat. 692, provided that: ‘‘The amendments made by
subsection (a) [enacting this section] shall take effect
one year after the date of the enactment of this Act
[Oct. 5, 1999].’’
REPORT ON IMPLEMENTATION
Pub. L. 106–65, div. A, title VII, § 716(b), Oct. 5, 1999,
113 Stat. 691, directed the Secretary of Defense to sub-
mit to Congress a report assessing the effects of the im-
plementation of the requirements and authorities set
forth in this section not later than 6 months after Oct.
5, 1999.
§ 1097c. TRICARE program: relationship with
employer-sponsored group health plans
(a) P
Source: Supplied 2024 U.S. Code historical extraction · 10 U.S.C. § 1097c
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