10 U.S.C. § 1078a — Continued health benefits coverage

Page 1097 TITLE 10—ARMED FORCES § 1078a 1 See References in Text note below. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1980 AMENDMENT Amendment by Pub. L. 96–513 effective Dec. 12, 1980, see section 701(b)(3) of Pub. L. 96–513, set out as a note under section 101 of this title. EFFECTIVE DATE OF 1966 AMENDMENT For effective date of amendment by Pub. L. 89–614, see section 3 of Pub. L. 89–614, set out as a note under section 1071 of this title. § 1078a. Continued health benefits coverage (a) PROVISION OF CONTINUED HEALTH COV- ERAGE.—The Secretary of Defense shall imple- ment and carry out a program of continued health benefits coverage in accordance with this section to provide persons described in sub- section (b) with temporary health benefits com- parable to the health benefits provided for former civilian employees of the Federal Gov- ernment and other persons under section 8905a of title 5. (b) ELIGIBLE PERSONS.—The persons referred to in subsection (a) are the following: (1) A member of the uniformed services who— (A) is discharged or released from active duty (or full-time National Guard duty), whether voluntarily or involuntarily, under other than adverse conditions, as character- ized by the Secretary concerned; (B) immediately preceding that discharge or release, is entitled to medical and dental care under section 1074(a) of this title (ex- cept in the case of a member discharged or released from full-time National Guard duty); and (C) after that discharge or release and any period of transitional health care provided under section 1145(a) of this title, would not otherwise be eligible for any benefits under this chapter. (2) A member of the Selected Reserve of the Ready Reserve of a reserve component of the armed forces who— (A) is discharged or released from service in the Selected Reserve, whether voluntarily or involuntarily, under other than adverse conditions, as characterized by the Sec- retary concerned; (B) immediately preceding that discharge or release, is enrolled in TRICARE Reserve Select; and (C) after that discharge or release, would not otherwise be eligible for any benefits under this chapter. (3) A person who— (A) ceases to meet the requirements for being considered an unmarried dependent child of a member or former member of the uniformed services under section 1072(2)(D) of this title or ceases to meet the require- ments for being considered an unmarried de- pendent under section 1072(2)(I) of this title; (B) on the day before ceasing to meet those requirements, was covered under a health benefits plan under this chapter or transitional health care under section 1145(a) of this title as a dependent of the member or former member; and (C) would not otherwise be eligible for any benefits under this chapter. (4) A person who— (A) is an unremarried former spouse of a member or former member of the uniformed services; and (B) on the day before the date of the final decree of divorce, dissolution, or annulment was covered under a health benefits plan under this chapter or transitional health care under section 1145(a) of this title as a dependent of the member or former member; and (C) is not a dependent of the member or former member under subparagraph (F) or (G) of section 1072(2) of this title or ends a one-year period of dependency under sub- paragraph (H) of such section. (5) Any other person specified in regulations prescribed by the Secretary of Defense for pur- poses of this paragraph who loses entitlement to health care services under this chapter or section 1145 of this title, subject to such terms and conditions as the Secretary shall prescribe in the regulations. (c) NOTIFICATION OF ELIGIBILITY.—(1) The Sec- retary of Defense shall prescribe regulations to provide for persons described in subsection (b) to be notified of eligibility to receive health bene- fits under this section. (2) In the case of a member who becomes (or will become) eligible for continued coverage under subsection (b)(1) or subsection (b)(2), the regulations shall provide for the Secretary con- cerned to notify the member of the member’s rights under this section as part of preseparation counseling conducted under sec- tion 1142 of this title or any other provision of other law. (3) In the case of a dependent of a member or former member who becomes eligible for contin- ued coverage under subsection (b)(3), the regula- tions shall provide that— (A) the member or former member may sub- mit to the Secretary concerned a written no- tice of the dependent’s change in status (in- cluding the dependent’s name, address, and such other information as the Secretary of De- fense may require); and (B) the Secretary concerned shall, within 14 days after receiving that notice, inform the dependent of the dependent’s rights under this section. (4) In the case of a former spouse of a member or former member who becomes eligible for con- tinued coverage under subsection (b)(4), the reg- ulations shall provide appropriate notification provisions and a 60-day election period under subsection (d)(3).1 (d) ELECTION OF COVERAGE.—In order to obtain continued coverage under this section, an appro- priate written election (submitted in such man- ner as the Secretary of Defense may prescribe) shall be made as follows: (1) In the case of a member described in sub- section (b)(1), the written election shall be submitted to the Secretary concerned before Page 1098 TITLE 10—ARMED FORCES § 1078a the end of the 60-day period beginning on the later of— (A) the date of the discharge or release of the member from active duty or full-time National Guard duty; (B) the date on which the period of transi- tional health care applicable to the member under section 1145(a) of this title ends; or (C) the date the member receives the noti- fication required pursuant to subsection (c). (2) In the case of a member described in sub- section (b)(2), the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the later of— (A) the date of the discharge or release of the member from service in the Selected Re- serve; and (B) the date the member receives the noti- fication required pursuant to subsection (c). (3)(A) In the case of a dependent of a member or former member who becomes eligible for continued coverage under subsection (b)(3), the written election shall be submitted to the Secretary concerned before the end of the 60- day period beginning on the later of— (i) the date on which the dependent first ceases to meet the requirements for being considered a dependent under subparagraph (D) or (I) of section 1072(2) of this title; or (ii) the date the dependent receives the no- tification pursuant to subsection (c). (B) Notwithstanding subparagraph (A), if the Secretary concerned determines that the de- pendent’s parent has failed to provide the no- tice referred to in subsection (c)(3)(A) with re- spect to the dependent in a timely fashion, the 60-day period under this paragraph shall be based only on the date under subparagraph (A)(i). (4) In the case of a former spouse of a mem- ber or a former member who becomes eligible for continued coverage under subsection (b)(4), the written election shall be submitted to the Secretary concerned before the end of the 60- day period beginning on the later of— (A) the date as of which the former spouse first ceases to meet the requirements for being considered a dependent under section 1072(2) of this title; or (B) such other date as the Secretary of De- fense may prescribe. (5) In the case of a person described in sub- section (b)(5), by such date as the Secretary shall prescribe in the regulations required for purposes of that subsection. (e) COVERAGE OF DEPENDENTS.—A person eligi- ble under subsection (b)(1) or subsection (b)(2) to elect to receive coverage may elect coverage ei- ther as an individual or, if appropriate, for self and dependents. A person eligible under sub- section (b)(3) or subsection (b)(4) may elect only individual coverage. (f) CHARGES.—(1) Under arrangements satisfac- tory to the Secretary of Defense, a person re- ceiving continued coverage under this section shall be required to pay into the Military Health Care Account or other appropriate account an amount equal to the sum of— (A) the employee and agency contributions which would be required in the case of a simi- larly situated employee enrolled in a com- parable health benefits plan under section 8905a(d)(1)(A)(i) of title 5; and (B) an amount, not to exceed 10 percent of the amount determined under subparagraph (A), determined under regulations prescribed by the Secretary of Defense to be necessary for administrative expenses; and (2) If a person elects to continue coverage under this section before the end of the applica- ble period under subsection (d), but after the person’s coverage under this chapter (and any transitional extension of coverage under section 1145(a) of this title) expires, coverage shall be re- stored retroactively, with appropriate contribu- tions (determined in accordance with paragraph (1)) and claims (if any), to the same extent and effect as though no break in coverage had oc- curred. (g) PERIOD OF CONTINUED COVERAGE.—(1) Con- tinued coverage under this section may not ex- tend beyond— (A) in the case of a member described in sub- section (b)(1), the date which is 18 months after the date the member ceases to be enti- tled to care under section 1074(a) of this title and any transitional care under section 1145 of this title, as the case may be; (B) in the case of a member described in sub- section (b)(2), the date which is 18 months after the date the member ceases to be eligible to enroll in TRICARE Reserve Select; (C) in the case of a person described in sub- section (b)(3), the date which is 36 months after the date on which the person first ceases to meet the requirements for being considered a dependent under subparagraph (D) or (I) of section 1072(2) of this title; (D) in the case of a person described in sub- section (b)(4), except as provided in paragraph (4), the date which is 36 months after the later of— (i) the date on which the final decree of di- vorce, dissolution, or annulment occurs; and (ii) if applicable, the date the one-year ex- tension of dependency under section 1072(2)(H) of this title expires; and (E) in the case of a person described in sub- section (b)(5), the date that is 36 months after the date on which the person loses entitlement to health care services as described in that subsection. (2) Notwithstanding paragraph (1)(C), if a de- pendent of a member becomes eligible for con- tinued coverage under subsection (b)(3) during a period of continued coverage of the member for self and dependents under this section, extended coverage of the dependent under this section may not extend beyond the date which is 36 months after the date the member became ineli- gible for medical and dental care under section 1074(a) of this title and any transitional health care under section 1145(a) of this title. (3) Notwithstanding paragraph (1)(D), if a per- son becomes eligible for continued coverage under subsection (b)(4) as the former spouse of a member during a period of continued coverage of the member for self and dependents under this Page 1099 TITLE 10—ARMED FORCES § 1078a section, extended coverage of the former spouse under this section may not extend beyond the date which is 36 months after the date the mem- ber became ineligible for medical and dental care under section 1074(a) of this title and any transitional health care under section 1145(a) of this title. (4)(A) Notwithstanding paragraph (1), in the case of a former spouse described in subpara- graph (B), continued coverage under this section shall continue for such period as the former spouse may request. (B) A former spouse referred to in subpara- graph (A) is a former spouse of a member or former member (other than a former spouse whose marriage was dissolved after the separa- tion of the member from the service unless such separation was by retirement)— (i) who has not remarried before age 55 after the marriage to the employee, former em- ployee, or annuitant was dissolved; (ii) who was enrolled in an approved health benefits plan under this chapter as a family member at any time during the 18-month pe- riod before the date of the divorce, dissolution, or annulment; and (iii)(I) who is receiving any portion of the re- tired or retainer pay of the member or former member or an annuity based on the retired or retainer pay of the member; or (II) for whom a court order (as defined in section 1408(a)(2) of this title) has been issued for payment of any portion of the retired or retainer pay or for whom a court order (as de- fined in section 1447(13) of this title) or a writ- ten agreement (whether voluntary or pursuant to a court order) provides for an election by the member or former member to provide an annuity to the former spouse. (h) TRICARE RESERVE SELECT DEFINED.—In this section, the term ‘‘TRICARE Reserve Se- lect’’ means TRICARE Standard coverage pro- vided under section 1076d of this title. (Added Pub. L. 102–484, div. D, title XLIV, § 4408(a)(1), Oct. 23, 1992, 106 Stat. 2708; amended Pub. L. 103–35, title II, § 201(g)(1), May 31, 1993, 107 Stat. 99; Pub. L. 103–337, div. A, title VII, § 702(c), Oct. 5, 1994, 108 Stat. 2798; Pub. L. 104–201, div. A, title X, § 1074(a)(4), Sept. 23, 1996, 110 Stat. 2658; Pub. L. 105–85, div. A, title X, § 1073(a)(17), Nov. 18, 1997, 111 Stat. 1901; Pub. L. 108–136, div. A, title VII, § 713(a), Nov. 24, 2003, 117 Stat. 1530; Pub. L. 110–181, div. A, title VII, § 705, Jan. 28, 2008, 122 Stat. 189; Pub. L. 114–92, div. A, title VII, § 703, Nov. 25, 2015, 129 Stat. 861.) Editorial Notes REFERENCES IN TEXT Subsection (d)(3), referred to in subsec. (c)(4), was re- designated subsec. (d)(4) by Pub. L. 114–92, div. A, title VII, § 703(c)(1), Nov. 25, 2015, 129 Stat. 861. AMENDMENTS 2015—Subsec. (b)(2) to (5). Pub. L. 114–92, § 703(a), added par. (2) and redesignated former pars. (2) to (4) as (3) to (5), respectively. Subsec. (c)(2). Pub. L. 114–92, § 703(b), inserted ‘‘or sub- section (b)(2)’’ after ‘‘subsection (b)(1)’’. Subsec. (c)(3). Pub. L. 114–92, § 703(g)(1)(A), substituted ‘‘subsection (b)(3)’’ for ‘‘subsection (b)(2)’’ in introduc- tory provisions. Subsec. (c)(4). Pub. L. 114–92, § 703(g)(1)(B), substituted ‘‘subsection (b)(4)’’ for ‘‘subsection (b)(3)’’. Subsec. (d)(2). Pub. L. 114–92, § 703(c)(2), added par. (2). Former par. (2) redesignated (3). Subsec. (d)(3). Pub. L. 114–92, § 703(c)(1), redesignated par. (2) as (3). Former par. (3) redesignated (4). Subsec. (d)(3)(A). Pub. L. 114–92, § 703(g)(2)(A), sub- stituted ‘‘subsection (b)(3)’’ for ‘‘subsection (b)(2)’’ in introductory provisions. Subsec. (d)(4). Pub. L. 114–92, § 703(c)(1), (g)(2)(B), re- designated par. (3) as (4) and substituted ‘‘subsection (b)(4)’’ for ‘‘subsection (b)(3)’’ in introductory provi- sions. Former par. (4) redesignated (5). Subsec. (d)(5). Pub. L. 114–92, § 703(c)(1), (g)(2)(C), re- designated par. (4) as (5) and substituted ‘‘subsection (b)(5)’’ for ‘‘subsection (b)(4)’’. Subsec. (e). Pub. L. 114–92, § 703(d), (g)(3), inserted ‘‘or subsection (b)(2)’’ after ‘‘subsection (b)(1)’’ and sub- stituted ‘‘subsection (b)(3) or subsection (b)(4)’’ for ‘‘subsection (b)(2) or subsection (b)(3)’’. Subsec. (g)(1)(B). Pub. L. 114–92, § 703(e)(2), added sub- par. (B). Former subpar. (B) redesignated (C). Subsec. (g)(1)(C). Pub. L. 114–92, § 703(e)(1), (g)(4)(A)(i), redesignated subpar. (B) as (C) and substituted ‘‘sub- section (b)(3)’’ for ‘‘subsection (b)(2)’’. Former subpar. (C) redesignated (D). Subsec. (g)(1)(D). Pub. L. 114–92, § 703(e)(1), (g)(4)(A)(ii), redesignated subpar. (C) as (D) and sub- stituted ‘‘subsection (b)(4)’’ for ‘‘subsection (b)(3)’’ in introductory provisions. Former subpar. (D) redesig- nated (E). Subsec. (g)(1)(E). Pub. L. 114–92, § 703(e)(1), (g)(4)(A)(iii), redesignated subpar. (D) as (E) and sub- stituted ‘‘subsection (b)(5)’’ for ‘‘subsection (b)(4)’’. Subsec. (g)(2). Pub. L. 114–92, § 703(g)(4)(B), substituted ‘‘paragraph (1)(C)’’ for ‘‘paragraph (1)(B)’’ and ‘‘sub- section (b)(3)’’ for ‘‘subsection (b)(2)’’. Subsec. (g)(3). Pub. L. 114–92, § 703(g)(4)(C), substituted ‘‘paragraph (1)(D)’’ for ‘‘paragraph (1)(C)’’ and ‘‘sub- section (b)(4)’’ for ‘‘subsection (b)(3)’’. Subsec. (h). Pub. L. 114–92, § 703(f), added subsec. (h). 2008—Subsec. (b)(4). Pub. L. 110–181, § 705(a), added par. (4). Subsec. (d)(4). Pub. L. 110–181, § 705(b), added par. (4). Subsec. (g)(1)(D). Pub. L. 110–181, § 705(c), added sub- par. (D). 2003—Subsec. (b)(1), (2)(A), (3)(A). Pub. L. 108–136 sub- stituted ‘‘uniformed services’’ for ‘‘armed forces’’. 1997—Subsec. (g)(4)(B)(iii)(II). Pub. L. 105–85 sub- stituted ‘‘section 1447(13)’’ for ‘‘section 1447(8)’’. 1996—Subsec. (a). Pub. L. 104–201 substituted ‘‘The Secretary’’ for ‘‘Beginning on October 1, 1994, the Sec- retary’’. 1994—Subsec. (b)(2)(A). Pub. L. 103–337, § 702(c)(1), in- serted before semicolon ‘‘or ceases to meet the require- ments for being considered an unmarried dependent under section 1072(2)(I) of this title’’. Subsec. (c)(3). Pub. L. 103–337, § 702(c)(2), substituted ‘‘dependent’’ for ‘‘child’’ in two places and ‘‘depend- ent’s’’ for ‘‘child’s’’ wherever appearing. Subsec. (d)(2)(A). Pub. L. 103–337, § 702(c)(3), sub- stituted ‘‘a dependent’’ for ‘‘a child’’ in introductory provisions, ‘‘the dependent’’ for ‘‘the child’’ in cls. (i) and (ii), and ‘‘a dependent under subparagraph (D) or (I) of section 1072(2) of this title;’’ for ‘‘an unmarried de- pendent child under section 1072(2)(D) of this title,’’ in cl. (i). Subsec. (d)(2)(B). Pub. L. 103–337, § 702(c)(4), sub- stituted ‘‘dependent’s’’ for ‘‘child’s’’ and ‘‘dependent’’ for ‘‘child’’. Subsec. (g)(1)(B). Pub. L. 103–337, § 702(c)(5), sub- stituted ‘‘a dependent under subparagraph (D) or (I) of section 1072(2) of this title’’ for ‘‘an unmarried depend- ent child under section 1072(2)(D) of this title’’. Subsec. (g)(2). Pub. L. 103–337, § 702(c)(6), substituted ‘‘dependent’’ for ‘‘child’’ in two places. 1993—Subsec. (b)(3)(C). Pub. L. 103–35, § 201(g)(1)(A), substituted ‘‘subparagraph’’ for ‘‘subparagraphs’’ after ‘‘member under’’. Subsec. (d)(2)(A). Pub. L. 103–35, § 201(g)(1)(B), inserted ‘‘under’’ after ‘‘coverage’’. Page 1100 TITLE 10—ARMED FORCES § 1078b Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2003 AMENDMENT Pub. L. 108–136, div. A, title VII, § 713(b), Nov. 24, 2003, 117 Stat. 1531, provided that: ‘‘The amendments made by subsection (a) [amending this section] shall apply to members of the uniformed services who are not other- wise covered by section 1078a of title 10, United States Code, before the date of the enactment of this Act [Nov. 24, 2003] and who, on or after such date, first meet the eligibility criteria specified in subsection (b) of that section.’’ § 1078b. Provision of food to certain members and dependents not receiving inpatient care in military medical treatment facilities (a) IN GENERAL.—(1) Under regulations pre- scribed by the Secretary of Defense, the Sec- retary may provide food and beverages to an in- dividual described in paragraph (2) at no cost to the individual. (2) An individual described in this paragraph is the following: (A) A member or former member of the uni- formed services or dependent— (i) who is receiving outpatient medical care at a military medical treatment facil- ity; and (ii) whom the Secretary determines is un- able to purchase food and beverages while at such facility by virtue of receiving such care. (B) A member or former member of the uni- formed services or dependent— (i) who is a family member of an infant re- ceiving inpatient medical care at a military medical treatment facility; (ii) who provides care to the infant while the infant receives such inpatient medical care; and (iii) whom the Secretary determines is un- able to purchase food and beverages while at such facility by virtue of providing such care to the infant. (C) A member or former member of the uni- formed services or dependent whom the Sec- retary determines is under similar cir- cumstances as a member, former member, or dependent described in subparagraph (A) or (B). (b) REGULATIONS.—The Secretary shall ensure that regulations prescribed under this section are consistent with generally accepted practices in private medical treatment facilities. (Added Pub. L. 112–81, div. A, title VII, § 704(a), Dec. 31, 2011, 125 Stat. 1472; amended Pub. L. 113–291, div. A, title VII, § 705, Dec. 19, 2014, 128 Stat. 3413.) Editorial Notes AMENDMENTS 2014—Subsec. (a)(2). Pub. L. 113–291, § 705(1), sub- stituted ‘‘A member or former member’’ for ‘‘A mem- ber’’ wherever appearing. Subsec. (a)(2)(C). Pub. L. 113–291, § 705(2), substituted ‘‘member, former member, or dependent’’ for ‘‘member or dependent’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 112–81, div. A, title VII, § 704(c), Dec. 31, 2011, 125 Stat. 1473, provided that: ‘‘The amendments made by this section [enacting this section] shall take effect on the date that is 90 days after the date of the enact- ment of this Act [Dec. 31, 2011].’’ § 1079. Contracts for medical care for spouses and children: plans (a) To assure that medical care is available for dependents, as described in subparagraphs (A), (D), and (I) of section 1072(2) of this title, of members of the uniformed services who are on active duty for a period of more than 30 days, the Secretary of Defense, after consulting with the other administering Secretaries, shall con- tract, under the authority of this section, for medical care for those persons under such insur- ance, medical service, or health plans as he con- siders appropriate. The types of health care au- thorized under this section shall be the same as those provided under section 1076 of this title, except as follows: (1) With respect to dental care— (A) except as provided in subparagraph (B), only that care required as a necessary ad- junct to medical or surgical treatment may be provided; and (B) in connection with dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under, only institutional and anes- thesia services may be provided. (2) Consistent with such regulations as the Secretary of Defense may prescribe regarding the content of health promotion and disease prevention visits, the schedule and method of cervical cancer screenings and breast cancer screenings, the schedule and method of colon and prostate cancer screenings, and the types and schedule of immunizations— (A) for dependents under six years of age, both health promotion and disease preven- tion visits and immunizations may be pro- vided; and (B) for dependents six years of age or older, health promotion and disease preven- tion visits may be provided in connection with immunizations or with diagnostic or preventive cervical and breast cancer screenings or colon and prostate cancer screenings. (3) Not more than one eye examination may be provided to a patient in any calendar year. (4) Under joint regulations to be prescribed by the administering Secretaries, the services of Christian Science practitioners and nurses and services obtained in Christian Science sanatoriums may be provided. (5) Durable equipment provided under this section may be provided on a rental basis. (6) Services in connection with non- emergency inpatient hospital care may not be provided if such services are available at a fa- cility of the uniformed services located within a 40-mile radius of the residence of the pa- tient, except that those services may be pro- vided in any case in which another insurance