[Federal Register Volume 80, Number 178 (Tuesday, September 15, 2015)]
[Rules and Regulations]
[Pages 55250-55256]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-22815]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2006-HA-0207]
RIN 0720-AB15


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early 
Eligibility for TRICARE for Certain Reserve Component Members

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: TRICARE Reserve Select (TRS) is a premium-based TRICARE health 
plan available for purchase worldwide by qualified members of the Ready 
Reserve and by qualified survivors of TRS members. TRICARE Dental 
Program (TDP) is a premium-based TRICARE dental plan available for 
purchase worldwide by qualified Service members. This final rule 
revises requirements and procedures for the TRS program to specify the 
appropriate actuarial basis for calculating premiums in addition to 
making other minor clarifying administrative changes. For a member who 
is involuntarily separated from the Selected Reserve under other than 
adverse conditions this final rule provides a time-limited exception 
that allows TRS coverage in effect to continue for up to 180 days after 
the date on which the member is separated from the Selected Reserve and 
TDP coverage in effect to continue for no less than 180 days after the 
separation date. It also expands early TRICARE eligibility for certain 
Reserve Component members from a maximum of 90 days to a maximum of 180 
days prior to activation in support of a contingency operation for more 
than 30 days.

DATES: This rule is effective October 15, 2015.

FOR FURTHER INFORMATION CONTACT: Brian Smith, Defense Health Agency, 
TRICARE Health Plan Division, telephone (703) 681-0039.
    Questions regarding payment of specific claims under the TRICARE 
allowable charge method should be addressed to the appropriate TRICARE 
contractor.

SUPPLEMENTARY INFORMATION:

I. Introduction and Background

A. Overview

    An interim final rule was published in the Federal Register on 
August 20, 2007 (72 FR 46380). That interim final rule addressed 
provisions of the National Defense Authorization Act for Fiscal Year 
2007 (NDAA-07) (Pub. L. 109-364),which expanded eligibility for the 
TRICARE Reserve Select program to include all Selected Reservists 
except those individuals either enrolled or

[[Page 55251]]

eligible to enroll in the Federal Employees Health Benefits program.
    Before finalizing the interim final rule, a proposed rule was 
published in the Federal Register on August 27, 2014 (79 FR 51127). The 
proposed rule addressed provisions of the National Defense 
Authorization Act for Fiscal Year 2009 (NDAA-09) (Pub. L. 110-417), the 
National Defense Authorization Act for Fiscal Year 2010 (NDAA-10) (Pub. 
L. 111-84), and the National Defense Authorization Act for Fiscal Year 
2013 (NDAA-13) (Pub. L. 112-239). First, section 704 of NDAA-09 
specifies that the appropriate actuarial basis for calculating premiums 
for TRS shall utilize the actual cost of providing benefits to members 
and their dependents during preceding calendar years. Second, section 
702 of NDAA-10 expands early eligibility for Reserve Component members 
issued delayed-effective-date active duty orders from a maximum of 90 
days to a maximum of 180 days prior to activation in support of a 
contingency for more than 30 days. Third, for a member who is 
involuntarily separated from the Selected Reserve under other than 
adverse conditions as characterized by the Secretary concerned, section 
701 of NDAA-13 provides a time-limited exception that allows TRS 
coverage already in effect at time of separation to continue for up to 
180 days after the date on which the member is separated from the 
Selected Reserve and TDP coverage already in effect at time of 
separation to continue for no less than 180 days after the separation 
date. This exception expires December 31, 2018. Finally, the proposed 
rule addressed additional administrative clarifications to 32 CFR 
199.24, which implements TRS.
    This final rule addresses and finalizes the provisions in both the 
interim final rule and the proposed rule.

B. Public Comments

    An interim final rule was published in the Federal Register on 
August 20, 2007 and we received 4 comments (one comment was a duplicate 
submission). A proposed rule was published in the Federal Register on 
August 27, 2014 and we received 1 comment. We thank those who provided 
comments. Specific matters raised by those who submitted comments are 
summarized below.

II. Provisions of the Rule Regarding Early TRICARE Eligibility

    1. Provisions of Proposed Rule. Section 199.3(b)(5) implements 
section 702 of NDAA-10, which specifies that Reserve Component members 
issued delayed-effective-date orders for service in support of a 
contingency operation, and their family members, are eligible for 
TRICARE on the date the orders are issued, up to a maximum of 180 days 
prior to the date on which the period of active duty of more than 30 
consecutive days is to begin. Previously, members and their family 
members could become eligible for TRICARE up to a maximum of 90 days 
prior to the date on which the period of active duty in support of a 
contingency operation of more than 30 consecutive days is to begin.
    2. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    3. Provisions of the Final Rule. The final rule is consistent with 
the proposed rule.

III. Provisions of the Rule Regarding the TRICARE Dental Program

    A summary of the relevant proposed rule provision is presented, 
followed by an analysis of major public comments, and by a summary of 
the final rule provisions.
    1. Provisions of Proposed Final Rule. So that the existing 
provisions of Sec.  199.13(c)(3)(ii)(E)(2) would not be confused with 
the new paragraph described below, we proposed to clarify that the 
continued coverage described in this paragraph is actually survivor 
coverage. We also proposed to reinsert the provision that the 
government will pay both the government and the beneficiary's portion 
of the premium share during the three-year period of continued survivor 
enrollment, which was inadvertently deleted by a previous amendment to 
the regulation.
    We proposed to add new Sec.  199.13(c)(3)(ii)(E)(5) that implements 
the provisions in section 701 of NDAA- 13 concerning TDP. A time-
limited exception is added to the general rule that TDP coverage shall 
terminate for members who no longer qualify for TDP. This exception 
specifies that if a member is involuntarily separated from the Selected 
Reserve under other than adverse conditions, as characterized by the 
Secretary concerned, and TDP coverage was in effect for the member and/
or the family on the last day of his or her membership in the Selected 
Reserve, the TDP coverage that was in effect, whether member coverage 
and/or family coverage, may terminate no earlier than 180 days after 
the date on which the member is separated from the Selected Reserve. 
This exception expires December 31, 2018.
    2. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    3. Provisions of the Final Rule. The final rule is consistent with 
the proposed rule.

IV. Provisions of the Rule Regarding the TRICARE Reserve Select Program

    Many of our proposed clarifications update the rules for TRS (Sec.  
199.24) and, as appropriate, bring the rules in closer alignment and 
sequencing with the very similar TRICARE Retired Reserve program (Sec.  
199.25).

A. Establishment of the TRICARE Reserve Select Program (Sec.  
199.24(a))

    1. Provisions of Interim Final Rule. This paragraph describes the 
nature, purpose, statutory basis, scope, and major features of TRICARE 
Reserve Select, a premium-based medical coverage program that was made 
available worldwide to certain members of the Selected Reserve and 
their family members. TRICARE Reserve Select is authorized by 10 U.S.C. 
1076d.
    2. Provisions of the Proposed Rule. We proposed to remove the 
existing terminology at Sec.  199.24(a)(4) and to redesignate Sec.  
199.24(a)(5) as Sec.  199.24(a)(4). We proposed to clarify that certain 
special programs established in 32 CFR part 199 are not available to 
members covered under TRS (Sec.  199.24(a)(4)(i)(B)).
    We proposed to clarify the wording for submitting an initial 
payment of the appropriate premium along with the request to purchase 
coverage (Sec.  199.24(a)(4)(iii)) and to make it consistent throughout 
this section. We proposed to clarify that both the member and the 
member's covered family members are provided access priority for care 
in military treatment facilities on the same basis as active duty 
service members' dependents who are not enrolled in TRICARE Prime 
(Sec.  199.24(a)(4)(iv)).
    3. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    4. Provisions of the Final Rule. The final rule is consistent with 
the interim final rule and the proposed rule.

B. Qualifications for TRICARE Reserve Select Coverage (Sec.  199.24(b))

    1. Provisions of Interim Final Rule. In the interim final rule, 
paragraph (b) addressed TRICARE Reserve Select premiums (Sec.  
199.24(b)). It continued that members are charged premiums for coverage 
under TRICARE Reserve Select that represent 28 percent of the total 
annual premium amount that the Assistant Secretary of Defense, Health 
Affairs (ASD(HA)) determines on an appropriate actuarial basis as being

[[Page 55252]]

appropriate for coverage under the TRICARE Standard (and Extra) benefit 
for the TRICARE Reserve Select eligible population. Premiums are to be 
paid monthly, except as otherwise established as part of the 
administrative implementation of TRICARE Reserve Select.
    Annual rates for the first year TRICARE Reserve Select was offered 
(2005) were based on the calendar year annual premiums for the Blue 
Cross and Blue Shield Standard Service Benefit Plan under the Federal 
Employees Health Benefits Program, a nationwide plan closely resembling 
TRICARE Standard (and Extra) coverage, with an adjustment based on 
estimated differences in covered populations, as determined by the 
ASD(HA).
    Based on an analysis of demographic differences between Blue Cross 
and Blue Shield members and beneficiaries eligible for TRICARE Reserve 
Select, the adjustment amount in calendar year 2005 represented a 32 
percent reduction from the Blue Cross and Blue Shield annual premium 
for member-only coverage and represented an 8 percent reduction from 
the Blue Cross and Blue Shield annual premium for member and family 
coverage. (The difference in the percentage reductions between member 
only and member and family premiums is due to the disproportionately 
high number of high cost, single, elderly retiree federal employees 
covered by Blue Cross and Blue Shield member-only coverage).
    TRICARE Reserve Select monthly premium rates are established and 
updated annually, on a calendar year basis, to maintain an appropriate 
relationship with the annual changes in Blue Cross and Blue Shield 
premiums, or by other adjustment methodology determined to be 
appropriate by the ASD(HA) for each of the two types of coverage, 
member-only coverage and member and family coverage, on a calendar year 
basis. The monthly rate for each month of a calendar year is one 
twelfth of the annual rate for that calendar year.
    In addition to these annual premium changes, premium adjustments 
may also be made prospectively for any calendar year to reflect any 
significant program changes or any actual experience in the costs of 
administering the TRICARE Reserve Select Program.
    A surviving family member of a Reserve Component service member who 
qualified for TRICARE Reserve Select coverage as described in paragraph 
(c)(3) of this section will pay premium rates as follows. The premium 
amount shall be at the member-only rate if there is only one surviving 
family member to be covered by TRICARE Reserve Select and at the member 
and family rate if there are two or more survivors to be covered.
    2. Provisions of the Proposed Rule. We proposed to redesignate 
Sec.  199.24(c) as Sec.  199.24(b) so that it precedes the section on 
TRICARE Reserve Select premiums for clarity and maintains parallel 
sequencing with Sec.  199.25.
    Section 10144(b) of title 10, U.S.C. provides that the Secretary 
concerned may designate a category of members within the Individual 
Ready Reserve (IRR) of each Reserve Component who are subject to being 
ordered to active duty involuntarily in accordance with section 12304 
of title 10, U.S.C. We proposed to clarify that since a member of the 
IRR who has volunteered to serve in such mobilization category is 
eligible for benefits (other than pay and training) as are normally 
available to members of the Selected Reserve, these members may also 
qualify for TRS (Sec.  199.24(b)(1)(i)).
    We proposed to clarify the exclusion involving the Federal 
Employees Health Benefits (FEHB) program. Section 199.24(b)(1)(ii) 
specifies that an otherwise qualified member of the Ready Reserve 
qualifies to purchase TRS coverage if the member is not enrolled in, or 
eligible to enroll in, a health benefits plan under chapter 89 of title 
5, U.S.C. That statute has been implemented under part 890 of title 5, 
CFR as the ``Federal Employees Health Benefits'' program. For purposes 
of the FEHB program, the terms ``enrolled,'' ``enroll'' and 
``enrollee'' are defined in Sec.  890.101 of title 5, CFR. We proposed 
to clarify that the member (or certain involuntarily separated former 
member) no longer qualifies for TRS coverage when the member has been 
eligible for active coverage in a health benefits plan under the FEHB 
program for more than 60 days (Sec.  199.24(b)(1)(ii)). This affords 
the member sufficient time to make arrangements for health coverage 
other than TRS and avoid any days without having health coverage being 
in force.
    We proposed to clarify that qualification for TRS survivor coverage 
applies regardless of type of coverage in effect on the day of the TRS 
member's death (Sec.  199.24(b)(2)).
    3. Analysis of Major Public Comments. One commenter suggested that 
we eliminate the exclusion regarding the FEHB program rather than 
clarify it.
    Response. The exclusion is statutory; the Department of Defense has 
no authority to eliminate it.
    4. Provisions of the Final Rule. Note in the proposed rule that we 
proposed to redesignate paragraph (c) as paragraph (b) so that the 
section on Qualifications for TRICARE Reserve Select coverage would 
precede the section on TRICARE Reserve Select premiums for clarity 
purposes and to maintain consistent sequencing with Sec.  199.25. Then 
we proposed to replace the content in the section on Eligibility for 
(qualifying to purchase) TRICARE Reserve Select coverage that appeared 
in the interim final rule in its entirety with the newly revised 
section on Qualifications for TRICARE Reserve Select coverage. 
Therefore, the final rule is consistent with the proposed rule.

C. TRICARE Reserve Select Premiums (Sec.  199.24(c))

    1. Provisions of Interim Final Rule. In the interim final rule, 
Sec.  199.24(c) addressed Eligibility for (qualifying to purchase) 
TRICARE Reserve Select coverage. It reflected the statutory conditions 
under which members of a Reserve component may qualify to purchase 
TRICARE Reserve Select coverage.
    2. Provisions of the Proposed Rule. We proposed to redesignate 
Sec.  199.24(b) as Sec.  199.24(c) so that it follows the section on 
Qualifications for TRICARE Reserve Select coverage for clarity purposes 
and maintains consistent sequencing with Sec.  199.25. We also proposed 
to clarify that the Director, Healthcare Operations in the Defense 
Health Agency may establish procedures for administrative 
implementation related to premiums (Sec.  199.24(c)).
    Section 199.24(c)(1) implements section 704 of NDAA-09, which 
requires that monthly premiums be determined by utilizing the actual 
reported cost of providing benefits to TRS members and their dependents 
during preceding calendar years. Section 704 of NDAA-09 specified that 
actual TRS cost data from calendar years 2006 and 2007 be utilized in 
the determination of premium rates for calendar year 2009. This 
established pattern has been followed to determine premium rates for 
all calendar years starting with 2009 (Sec.  199.24(c)(1)). Further, we 
proposed to amend Sec.  199.24(c) by deleting all former provisions 
involving the relationship between premium rates for TRS and premium 
rates for the Blue Cross and Blue Shield Standard Service Benefit Plan 
under the Federal Employees Health Benefits program.
    3. Analysis of Major Public Comments. Three military service 
organizations commented on the methodology described in the interim 
final rule to be used for annual TRS premium updates that was based on

[[Page 55253]]

annual changes in premiums in the Blue Cross/Blue Shield plan offered 
nationwide by the Federal Employees Health Benefits program. Rather 
than applying the same percentage increases to TRS premiums that were 
observed in the federal Blue Cross/Blue Shield nationwide plan, each 
commenting organization requested that the annual TRS premium increases 
not exceed the percentage increase in military basic pay.
    Response. Section 704 of NDAA-09 added 10 U.S.C. 1076 d(d)(3)(B) to 
specify that the appropriate actuarial basis for calculating premiums 
for TRS shall utilize the actual cost of providing benefits to members 
and their dependents during preceding calendar years. The final rule is 
consistent with this statutory requirement.
    4. Provisions of the Final Rule. Note in the proposed rule that we 
proposed to redesignate paragraph (b) as paragraph (c) so that the 
section on TRICARE Reserve Select premiums would follow the section on 
Qualifications for TRICARE Reserve Select coverage for clarity purposes 
and to maintain consistent sequencing with Sec.  199.25). Then we 
proposed to replace the content on TRICARE Reserve Select premiums that 
appeared in the interim final rule in its entirety with the newly 
revised section on TRICARE Reserve Select premiums in order to 
implement section 704 of NDAA-09. That had the effect of removing all 
of the former provisions involving the relationship between premium 
rates for TRS and premium rates for the Blue Cross and Blue Shield 
Standard Service Benefit Plan under the Federal Employees Health 
Benefits program will appear in the amended Sec.  199.24(c). The final 
rule is consistent with the proposed rule.

D. Procedures (Sec.  199.24(d))

1. Provisions of Interim Final Rule
    The interim final rule addressed procedures for TRS coverage.
    2. Provisions of the Proposed Rule. We proposed to clarify that the 
Director, Healthcare Operations in the Defense Health Agency may 
establish procedures for TRS (Sec.  199.24(d)).
    We proposed to clarify that either reserve members or survivors 
qualified under Sec.  199.24(b) may follow applicable procedures 
throughout this section regarding TRS coverage. We proposed to clarify 
the rule about immediate family members who may be included in family 
coverage under TRS (Sec.  199.24(d)(1)), which is further supported by 
the proposed definition for immediate family member included in Sec.  
199.24(g).
    We proposed to clarify continuation coverage by removing the 
previous requirement that the member had to be the sponsor of the other 
TRICARE coverage in order to qualify for continuation coverage (Sec.  
199.24(d)(1)(i)). In circumstances when the spouse of the Reserve 
Component member is the sponsor for purposes of the other TRICARE 
coverage, it would be clear that the qualified member would be able to 
purchase TRS coverage with an effective date immediately following the 
date of termination of coverage under another TRICARE program 
regardless whether it was the Reserve Component member or the spouse 
who was the sponsor of the other TRICARE coverage.
    We proposed rules to implement the provisions in section 701 of 
NDAA-13 concerning TRS coverage (Sec.  199.24(d)(3)(i)). Similar to the 
TDP, this provision would apply to members involuntarily separated from 
the Selected Reserve if, and only if, the member was covered by TRS on 
the last day of his or her membership in the Selected Reserve. However, 
the termination date of TRS is characterized slightly differently from 
the TDP provision because TRS may terminate up to 180 days after the 
date on which the member is separated from the Selected Reserve. This 
delayed termination exception applies regardless of type of TRS 
coverage actually in effect at the time. This exception expires 
December 31, 2018.
    We proposed to clarify the rule that procedures may be established 
for TRS coverage to be suspended for up to one year followed by final 
termination for members or qualified survivors if they fail to make 
premium payments in accordance with established procedures or otherwise 
if they request suspension/termination of coverage (Sec.  
199.24(d)(3)). Suspension/termination of coverage for the TRS member/
survivor will result in suspension/termination of coverage for the 
member's/survivor's family members in TRS, except as described in Sec.  
199.24 (d)(1)(iv). We also proposed to clarify that procedures may be 
established for the suspension to be lifted upon request before final 
termination is applied.
    3. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    4. Provisions of the Final Rule. The final rule is consistent with 
the interim final rule and the proposed rule.

E. Preemption of State Laws (Sec.  199.24(e))

    1. Provisions of Interim Final Rule. In the interim final rule, 
paragraph (e) addressed Relationship to Continued Health Care Benefits 
Program (CHCBP) (Sec.  199.24(e)). Based on a statutory amendment 
concerning CHCBP, the Final Rule published September 16, 2011 (76 FR 
57637-57641) removed paragraph (e) in its entirety and replaced it with 
the placeholder (e) Reserved to maintain numerical sequencing.
    3. Provisions of the Proposed Rule. We proposed to remove the 
previous Sec.  199.24(e) Reserved and redesignate Sec.  199.24(f) as 
Sec.  199.24(e). No other changes are proposed this section.
    4. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    5. Provisions of the Final Rule. The final rule is consistent with 
the proposed rule.

F. Administration (Sec.  199.25(f))

    1. Provisions of Interim Final Rule. In the interim final rule, 
paragraph (f) addressed Preemption of State laws (Sec.  199.25(f)).
    2. Provisions of the Proposed Rule. We proposed to redesignate 
Sec.  199.24(g) as Sec.  199.24(f). We proposed to clarify this 
provision by removing the phrase, ``based on extraordinary 
circumstances'' as a limitation on authority to grant exceptions to 
requirements of the section and to clarify that the Director, 
Healthcare Operations in the Defense Health Agency has authority to 
grant such exceptions and establish administrative rules and procedures 
for TRS.
    3. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    4. Provisions of the Final Rule. The final rule is consistent with 
the proposed rule.

G. Terminology (Sec.  199.25(g))

    1. Provisions of Interim Final Rule. In the interim final rule, 
paragraph (g) addressed Administration (Sec.  199.25(g)).
    2. Provisions of the Proposed Rule. We proposed to redesignate 
paragraph (g) as paragraph (f) and to add a new paragraph (g) regarding 
terminology. This would also remove the terminology under Sec.  
199.25(a)(4).
    3. Analysis of Major Public Comments. No public comments were 
received relating to this section of the rule.
    4. Provisions of the Final Rule. The final rule is consistent with 
the proposed rule.

V. Costs

    Fiscal year 2014 through 2019 costs are anticipated to be 
$7,735,728.00:

[[Page 55254]]



------------------------------------------------------------------------
                                                            Government
                       Fiscal year                             cost
------------------------------------------------------------------------
2014....................................................      $1,296,884
2015....................................................       1,373,929
2016....................................................       1,455,633
2017....................................................       1,542,277
2018....................................................       1,634,096
2019....................................................         432,909
                                                         ---------------
  Total FY14-FY19.......................................       7,735,728
------------------------------------------------------------------------

VI. Regulatory Procedures

    Executive Orders 12866 and 13563 require certain regulatory 
assessments for any significant regulatory action that would result in 
an annual effect on the economy of $100 million or more, or have other 
substantial impacts. The Congressional Review Act establishes certain 
procedures for major rules, defined as those with similar major 
impacts. The Regulatory Flexibility Act (RFA) requires that each 
Federal agency prepare, and make available for public comment, a 
regulatory flexibility analysis when the agency issues a regulation 
that would have significant impact on a substantial number of small 
entities. This final rule is not subject to any of these requirements 
because it will not have any of these substantial impacts. However, 
this rule has been designated a ``significant regulatory action,'' 
although not economically significant, under section 3(f) of Executive 
Order 12866. Accordingly, the rule has been reviewed by the Office of 
Management and Budget (OMB).
    This rule will not impose additional information collection 
requirements on the public under the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501-3511).
    We have examined the impact(s) of the final rule under Executive 
Order 13132 and it does not have policies that have federalism 
implications that will have substantial direct effects on the States, 
on the relationship between the national government and the States, or 
on the distribution of power and responsibilities among the various 
levels of government. The preemption provisions in the rule conform to 
law and long-established TRICARE policy. Therefore, consultation with 
State and local officials is not required.

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, Military personnel.

    Accordingly, the interim final rule published at 72 FR 46380 on 
August 20, 2007, amending 32 CFR part 199 is adopted as a final rule 
with the following changes:

PART 199--[AMENDED]

0
1. The authority citation for part 199 continues to read as follows:


    Authority:  5 U.S.C. 301; 10 U.S.C. chapter 55.

0
2. Amend Sec.  199.3 by revising paragraph (b)(5)(iii)(B) to read as 
follows:


Sec.  199.3  Eligibility.

* * * * *
    (b) * * *
    (5) * * *
    (iii) * * *
    (B) 180 days before the date on which the period of active duty is 
to begin.
* * * * *

0
3. Amend Sec.  199.13 by revising paragraph (c)(3)(ii)(E)(2) 
introductory text and adding paragraph (c)(3)(ii)(E)(5) to read as 
follows:


Sec.  199.13  TRICARE Dental Program.

* * * * *
    (c) * * *
    (3) * * *
    (ii) * * *
    (E) * * *
    (2) Survivor eligibility. Eligible dependents of active duty 
members who die while on active duty for a period of more than 30 days 
and eligible dependents of members of the Ready Reserve (i.e., Selected 
Reserve or Individual Ready Reserve, as specified in 10 U.S.C. 10143 
and 10144(b) respectively) who die, shall be eligible for survivor 
enrollment in the TDP. During the period of survivor enrollment, the 
government will pay both the government and the eligible dependent's 
portion of the premium share. This survivor enrollment shall be up to 
(3) three years from the date of the member's death, except that, in 
the case of a dependent of the deceased who is described in 10 U.S.C. 
1072(2)(D) or (I), the period of survivor enrollment shall be the 
longer of the following periods beginning on the date of the member's 
death:
* * * * *
    (5) TRICARE Dental Program coverage shall terminate for members who 
no longer qualify for the TRICARE Dental Program as specified in 
paragraph (c)(2) of this section, with one exception. If a member is 
involuntarily separated from the Selected Reserve under other than 
adverse conditions, as characterized by the Secretary concerned, and 
TRICARE Dental Program coverage is in effect for the member and/or the 
family on the last day of his or her membership in the Selected 
Reserve; then the TRICARE Dental Program coverage that was actually in 
effect may terminate no earlier than 180 days after the date on which 
the member is separated from the Selected Reserve. This exception 
expires December 31, 2018.
* * * * *

0
4. Amend Sec.  199.24 as follows.
0
a. Remove paragraph (a)(4).
0
b. Redesignate paragraph (a)(5) as paragraph (a)(4).
0
c. Revise newly redesignated paragraphs (a)(4)(i)(B), (a)(4)(iii), and 
(a)(4)(iv).
0
d. Redesignate paragraphs (b) and (c) as paragraphs (c) and (b), 
respectively.
0
e. Revise newly redesignated paragraphs (b) and (c).
0
f. Revise paragraph (d).
0
g. Redesignate paragraphs (f) and (g) as paragraphs (e) and (f), 
respectively.
0
h. Revise newly redesignated paragraph (f).
0
i. Add new paragraph (g).
    The revisions and additions read as follows:


Sec.  199.24  TRICARE Reserve Select.

    (a) * * *
    (4) * * *
    (i) * * *
    (B) Certain special programs established in 32 CFR part 199 are not 
available to members covered under TRICARE Reserve Select. These 
include the Extended Care Health Option (Sec.  199.5), the Special 
Supplemental Food Program (see Sec.  199.23), and the Supplemental 
Health Care Program (Sec.  199.16), except when referred by a Military 
Treatment Facility (MTF) provider for incidental consults and the MTF 
provider maintains clinical control over the episode of care. The 
TRICARE Dental Program (Sec.  199.13) is independent of this program 
and is otherwise available to all members of the Selected Reserve and 
their eligible family members whether or not they purchase TRICARE 
Reserve Select coverage. The Continued Health Care Benefits Program 
(Sec.  199.20) is also independent of this program and is otherwise 
available to all members who qualify.
* * * * *
    (iii) Procedures. Under TRICARE Reserve Select, Reserve Component 
members who fulfilled all of the statutory qualifications may purchase 
either the member-only type of coverage or the member-and-family type 
of coverage by submitting a completed request in the appropriate format 
along with an initial payment of the applicable premium. Rules and 
procedures for purchasing coverage and paying applicable premiums are 
prescribed in this section.
    (iv) Benefits. When their coverage becomes effective, TRICARE 
Reserve

[[Page 55255]]

Select beneficiaries receive the TRICARE Standard (and Extra) benefit 
including access to military treatment facility services and 
pharmacies, as described in Sec. Sec.  199.17 and 199.21. TRICARE 
Reserve Select coverage features the deductible and cost share 
provisions of the TRICARE Standard (and Extra) plan applicable to 
active duty family members for both the member and the member's covered 
family members (paragraph (a)(4)(iv) of this section). Both the member 
and the member's covered family members are provided access priority 
for care in military treatment facilities on the same basis as active 
duty service members' dependents who are not enrolled in TRICARE Prime 
as described in Sec.  199.17(d)(1)(i)(D).
    (b) Qualifications for TRICARE Reserve Select coverage--(1) Ready 
Reserve member. A Ready Reserve member qualifies to purchase TRICARE 
Reserve Select coverage if the Service member meets both the following 
criteria:
    (i) Is a member of the Selected Reserve of the Ready Reserve of the 
Armed Forces, or a member of the Individual Ready Reserve of the Armed 
Forces who has volunteered to be ordered to active duty pursuant to the 
provisions of 10 U.S.C. 12304 in accordance with section 10 U.S.C. 
10144(b); and
    (ii) Is not enrolled in, or eligible to enroll in, a health 
benefits plan under 5 U.S.C. chapter 89. That statute has been 
implemented under 5 CFR part 890 as the Federal Employees Health 
Benefits (FEHB) program. For purposes of the FEHB program, the terms 
``enrolled,'' ``enroll'' and ``enrollee'' are defined in 5 CFR 890.101. 
Further, the member (or certain former member involuntarily separated) 
no longer qualifies for TRICARE Reserve Select when the member (or 
former member) has been eligible for coverage to be effective in a 
health benefits plan under the FEHB program for more than 60 days.
    (2) TRICARE Reserve Select survivor. If a qualified Service member 
dies while in a period of TRICARE Reserve Select coverage, the 
immediate family member(s) of such member is qualified to purchase new 
or continue existing TRICARE Reserve Select coverage for up to six 
months beyond the date of the member's death as long as they meet the 
definition of immediate family members as specified in paragraph (g)(2) 
of this section. This applies regardless of type of coverage in effect 
on the day of the TRICARE Reserve Select member's death.
    (c) TRICARE Reserve Select premiums. Members are charged premiums 
for coverage under TRICARE Reserve Select that represent 28 percent of 
the total annual premium amount that the Director, Defense Health 
Agency determines on an appropriate actuarial basis as being 
appropriate for coverage under the TRICARE Standard (and Extra) benefit 
for the TRICARE Reserve Select eligible population. Premiums are to be 
paid monthly, except as otherwise provided through administrative 
implementation, pursuant to procedures established by the Director, 
Healthcare Operations in the Defense Health Agency. The monthly rate 
for each month of a calendar year is one-twelfth of the annual rate for 
that calendar year.
    (1) Annual establishment of rates. TRICARE Reserve Select monthly 
premium rates shall be established and updated annually on a calendar 
year basis for each of the two types of coverage, member-only and 
member- and-family as described in paragraph (d)(1) of this section. 
Starting with calendar year 2009, the appropriate actuarial basis for 
purposes of this paragraph (c) shall be determined for each calendar 
year by utilizing the actual reported cost of providing benefits under 
this section to members and their dependents during the calendar years 
preceding such calendar year. Reported actual TRS cost data from 
calendar years 2006 and 2007 was used to determine premium rates for 
calendar year 2009. This established pattern will be followed to 
determine premium rates for all calendar years subsequent to 2009.
    (2) Premium adjustments. In addition to the determinations 
described in paragraph (c)(1) of this section, premium adjustments may 
be made prospectively for any calendar year to reflect any significant 
program changes or any actual experience in the costs of administering 
TRICARE Reserve Select.
    (3) Survivor premiums. A surviving family member of a Reserve 
Component service member who qualified for TRICARE Reserve Select 
coverage as described in paragraph (b)(2) of this section will pay 
premium rates as follows. The premium amount shall be at the member-
only rate if there is only one surviving family member to be covered by 
TRICARE Reserve Select and at the member and family rate if there are 
two or more survivors to be covered.
    (d) Procedures. The Director, Healthcare Operations in the Defense 
Health Agency, may establish procedures for the following.
    (1) Purchasing coverage. Procedures may be established for a 
qualified member to purchase one of two types of coverage: Member-only 
coverage or member and family coverage. Immediate family members of a 
qualified member as specified in paragraph (g)(2) of this section may 
be included in such family coverage. To purchase either type of TRICARE 
Reserve Select coverage for effective dates of coverage described 
below, members and survivors qualified under either paragraph (b)(1) or 
(2) of this section must submit a request in the appropriate format, 
along with an initial payment of the applicable premium required by 
paragraph (c) of this section in accordance with established 
procedures.
    (i) Continuation coverage. Procedures may be established for a 
qualified member or qualified survivor to purchase TRICARE Reserve 
Select coverage with an effective date immediately following the date 
of termination of coverage under another TRICARE program.
    (ii) Qualifying life event. Procedures may be established for a 
qualified member or qualified survivor to purchase TRICARE Reserve 
Select coverage on the occasion of a qualifying life event that changes 
the immediate family composition (e.g., birth, adoption, divorce, etc.) 
that is eligible for coverage under TRICARE Reserve Select. The 
effective date for TRICARE Reserve Select coverage will coincide with 
the date of the qualifying life event. It is the responsibility of the 
member to provide personnel officials with the necessary evidence 
required to substantiate the change in immediate family composition. 
Personnel officials will update DEERS in the usual manner. Appropriate 
action will be taken upon receipt of the completed request in the 
appropriate format along with an initial payment of the applicable 
premium in accordance with established procedures.
    (iii) Open enrollment. Procedures may be established for a 
qualified member to purchase TRICARE Reserve Select coverage at any 
time. The effective date of coverage will coincide with the first day 
of a month.
    (iv) Survivor coverage under TRICARE Reserve Select. Procedures may 
be established for a surviving family member of a Reserve Component 
service member who qualified for TRICARE Reserve Select coverage as 
described in paragraph (b)(2) of this section to purchase new TRICARE 
Reserve Select coverage or continue existing TRICARE Reserve Select 
coverage for up to six months beyond the date of the member's death. 
The effective date of coverage will be the day following the date of 
the member's death.

[[Page 55256]]

    (2) Changing type of coverage. Procedures may be established for 
TRICARE Reserve Select members to request to change type of coverage 
during open enrollment as described in paragraph (d)(1)(iii) of this 
section or on the occasion of a qualifying life event that changes 
immediate family composition as described in paragraph (d)(1)(ii) of 
this section by submitting a completed request in the appropriate 
format.
    (3) Suspension and termination. Suspension/termination of coverage 
for the TRS member/survivor will result in suspension/termination of 
coverage for the member's/survivor's family members in TRICARE Reserve 
Select, except as described in paragraph (d)(1)(iv) of this section. 
Procedures may be established for coverage to be suspended or 
terminated as follows.
    (i) Coverage shall terminate when members or survivors no longer 
qualify for TRICARE Reserve Select as specified in paragraph (b) of 
this section, with one exception. If a member is involuntarily 
separated from the Selected Reserve under other than adverse 
conditions, as characterized by the Secretary concerned, and is covered 
by TRICARE Reserve Select on the last day of his or her membership in 
the Selected Reserve, then TRICARE Reserve Select coverage may 
terminate up to 180 days after the date on which the member was 
separated from the Selected Reserve. This applies regardless of type of 
coverage. This exception expires December 31, 2018.
    (ii) Coverage may terminate for members, former members, and 
survivors who gain coverage under another TRICARE program.
    (iii) Coverage may be suspended and finally terminated for members/
survivors who fail to make premium payments in accordance with 
established procedures.
    (iv) Coverage may be suspended and finally terminated for members/
survivors upon request at any time by submitting a completed request in 
the appropriate format in accordance with established procedures.
    (v) Under paragraph (d)(3)(iii) or (iv) of this section, TRICARE 
Reserve Select coverage may first be suspended for a period of up to 
one year followed by final termination. Procedures may be established 
for the suspension to be lifted upon request before final termination 
is applied.
    (4) Processing. Upon receipt of a completed request in the 
appropriate format, enrollment actions will be processed into DEERS in 
accordance with established procedures.
    (5) Periodic revision. Periodically, certain features, rules or 
procedures of TRICARE Reserve Select may be revised. If such revisions 
will have a significant effect on members' or survivors' costs or 
access to care, members or survivors may be given the opportunity to 
change their type of coverage or terminate coverage coincident with the 
revisions.
* * * * *
    (f) Administration. The Director, Healthcare Operations in the 
Defense Health Agency may establish other rules and procedures for the 
effective administration of TRICARE Reserve Select, and may authorize 
exceptions to requirements of this section, if permitted by law.
    (g) Terminology. The following terms are applicable to the TRICARE 
Reserve Select program.
    (1) Coverage. This term means the medical benefits covered under 
the TRICARE Standard or Extra programs as further outlined in other 
sections of 32 CFR part 199 whether delivered in military treatment 
facilities or purchased from civilian sources.
    (2) Immediate family member. This term means spouse (except former 
spouses) as defined in Sec.  199.3(b)(2)(i), or child as defined in 
Sec.  199.3(b)(2)(ii).
    (3) Qualified member. This term means a member who has satisfied 
all the criteria that must be met before the member is authorized for 
TRS coverage.
    (4) Qualified survivor. This term means an immediate family member 
who has satisfied all the criteria that must be met before the survivor 
is authorized for TRS coverage.

    Dated: September 4, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-22815 Filed 9-14-15; 8:45 am]
 BILLING CODE 5001-06-P