10 U.S.C. § 1097c — TRICARE program: relationship with

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) 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 in- centives for a TRICARE-eligible employee not to enroll (or to terminate enrollment) under a health plan which would (in the case of such en- rollment) be a primary plan under sections 1079(j)(1) 1 and 1086(g) of this title in the same manner as such section 1862(b)(3)(C) applies to fi- nancial or other incentives for an individual en- titled to benefits under title XVIII of the Social Security Act not to enroll (or to terminate en- rollment) 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 sec- tion 1862(b)(2)(A) of such Act). (2)(A) The Secretary of Defense may by regula- tion adopt such additional exceptions to the pro- hibition 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 Sec- retary of Health and Human Services are au- thorized to enter into agreements for carrying out this subsection. Any such agreement shall provide that any expenses incurred by the Sec- retary of Health and Human Services pertaining to carrying out this subsection shall be reim- bursed 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 sub- section. (D) Information obtained under section 1095(k) of this title 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 sec- tion 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. (b) ELECTION OF TRICARE-ELIGIBLE EMPLOY- EES TO PARTICIPATE IN GROUP HEALTH PLAN.—A TRICARE-eligible employee shall have the op- portunity to elect to participate in the group health plan offered by the employer of the em- ployee and receive primary coverage for health care services under the plan in the same manner and to the same extent as similarly situated em- ployees 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, in- cluding an election made by a TRICARE-eligible employee under subsection (b), shall be con- strued to affect, modify, or terminate the eligi- bility of a TRICARE-eligible employee or spouse of such employee for health care or dental serv- ices 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 entitled to health care benefits under the TRICARE program. (g) EFFECTIVE DATE.—This section shall take effect on January 1, 2008. (Added Pub. L. 109–364, div. A, title VII, § 707(a), Oct. 17, 2006, 120 Stat. 2283.) Page 1156 TITLE 10—ARMED FORCES § 1097d Editorial Notes REFERENCES IN TEXT Section 1079(j) of this title, referred to in subsec. (a)(1), was redesignated section 1079(i) of this title by Pub. L. 113–291, div. A, title VII, § 703(a)(3), Dec. 19, 2014, 128 Stat. 3411. The Social Security Act, referred to in subsec. (a)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. Section 1862 of the Act is classified to section 1395y of Title 42. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. Section 5000 of the Internal Revenue Code of 1986, re- ferred to in subsec. (f)(2), is classified to section 5000 of Title 26, Internal Revenue Code. § 1097d. TRICARE program: notice of change to benefits (a) PROVISION OF NOTICE.—(1) If the Secretary makes a significant change to any benefits pro- vided by the TRICARE program to covered bene- ficiaries, the Secretary shall provide individuals described in paragraph (2) with notice explaining such changes. (2) The individuals described by this paragraph are covered beneficiaries participating in the TRICARE program who may be affected by a significant change covered by a notification under paragraph (1). (3) The Secretary shall provide notice under paragraph (1) through electronic means. (b) TIMING OF NOTICE.—The Secretary shall provide notice under paragraph (1) of subsection (a) by the earlier of the following dates: (1) The date that the Secretary determines would afford individuals described in para- graph (2) of such subsection adequate time to understand the change covered by the notifi- cation. (2) The date that is 90 days before the date on which the change covered by the notifica- tion becomes effective. (3) The effective date of a significant change that is required by law. (c) SIGNIFICANT CHANGE DEFINED.—In this sec- tion, the term ‘‘significant change’’ means a systemwide change— (1) in the structure of the TRICARE program or the benefits provided under the TRICARE program (not including the addition of new services or benefits); or (2) in beneficiary cost-share rates of more than 20 percent. (Added Pub. L. 113–291, div. A, title VII, § 711(a), Dec. 19, 2014, 128 Stat. 3413.) § 1098. Incentives for participation in cost-effec- tive health care plans (a) WAIVER OF LIMITATIONS AND COPAYMENTS.— Subject to subsection (b), the Secretary of De- fense, 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 sen- tence of section 1079(a) of this title; or (2) any requirement for payment by the pa- tient under section 1079(b) or 1086(b) of this title. (b) DETERMINATION AND REPORT.—(1) Subject to paragraph (3), the Secretary may waive a lim- itation or requirement as authorized by sub- section (a) if the Secretary determines that dur- ing 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 pro- vided by a plan subject to such limitations or payment requirements at no additional cost to the Government. (2) The Secretary shall submit to the Com- mittee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report with respect to a waiv- er under paragraph (1), including a comparison of costs of and benefits available under— (A) a plan with respect to which the limita- tions 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 begin- ning 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.) Editorial Notes AMENDMENTS 1999—Subsec. (b)(2). Pub. L. 106–65 substituted ‘‘and the Committee on Armed Services’’ for ‘‘and the Com- mittee on National Security’’. 1996—Subsec. (b)(2). Pub. L. 104–106 substituted ‘‘Com- mittee on Armed Services of the Senate and the Com- mittee on National Security of the House of Represent- atives’’ for ‘‘Committees on Armed Services of the Sen- ate and House of Representatives’’. 1990—Subsec. (a). Pub. L. 101–510 substituted ‘‘sub- section (b)’’ for ‘‘subsections (b) and (c)’’ in introduc- tory provisions. § 1099. Health care enrollment system and pay- ment options (a) ESTABLISHMENT OF SYSTEM.—The Secretary of Defense, after consultation with the other ad- ministering Secretaries, shall establish a system of health care enrollment for covered bene- ficiaries who reside in the United States. (b) DESCRIPTION OF SYSTEM.—Such system shall— (1) allow covered beneficiaries to elect to en- roll in a health care plan, or modify a previous election, from eligible health care plans des- ignated by the Secretary of Defense during— (A) an annual open enrollment period; and (B) any period based on a qualifying event experienced by the beneficiary, as deter- mined appropriate by the Secretary; or (2) if necessary in order to ensure full use of facilities of the uniformed services in a geo-