(a) Purpose.
The
CHCBP is a premium-based temporary health care coverage program,
authorized by 10 U.S.C. 1078a, and available to individuals who
meet the eligibility and enrollment criteria as set forth in paragraph
(d)(1) of this section. The CHCBP is not part of the TRICARE program.
However, as set forth in this section, it functions under similar
rules and procedures to the TRICARE Select program. Because the
purpose of the CHCBP is to provide a continuation health care benefit
for Department of Defense and the other uniformed services beneficiaries
losing eligibility, it will be administered so that it appears,
to the maximum extent practicable, to be part of the TRICARE Select
program. Medical coverage under this program will be the same as
the benefits payable under the TRICARE Select program. There is
a cost for enrollment to the CHCBP and these premium costs must
be paid by CHCBP enrollees before any care may be cost shared.
(b) General provisions.
Except
for any provisions the Director of the TRICARE Management Activity may
exclude, the general provisions of Sec. 199.1 shall apply to the
CHCBP as they do to TRICARE.
(c) Definitions.
Except
as may be specifically provided in this section, to the extent terms
defined in Sec. 199.2 are relevant to the administration of the
CHCBP, the definitions contained in that section shall apply to
the CHCBP as they do to the TRICARE Select program.
(d) Eligibility and
enrollment.
(1) Eligibility.
Enrollment in
the CHCBP is open to any individual, except as noted in this section,
who:
(i) Ceases
to meet the requirements for eligibility under 10 U.S.C. chapter
55 or 10 U.S.C. 1145, and
(ii) Who on the day before they cease to meet the
eligibility requirements for such care they were covered under a
health benefit plan under 10 U.S.C. chapter 55 or transitional healthcare
under 10 U.S.C. 1145, and
(iii) Who would otherwise
not be eligible for any benefits under 10 U.S.C. chapter 55 or 10
U.S.C. 1145 except for CHCBP.
(2) Exceptions.
The following individuals are not eligible
to enroll in CHCBP:
(i) Members of uniformed services, who are discharged
or released from active duty either voluntarily or involuntarily
under conditions that are adverse.
(ii) Individuals who
lost their eligibility or entitlement to care under 10 U.S.C. chapter
55 or 10 U.S.C. 1145 before October 1, 1994.
(iii) Individuals who
are locked out of other TRICARE programs per that program’s requirements.
(3) Effective date.
Eligibility
in the CHCBP is limited to individuals who lost their entitlement
to benefits under the MHS on or after October 1, 1994. The effective
date of their coverage under CHCBP shall begin on the day after
they cease to be eligible for care under 10 U.S.C. chapter 55 or
10 U.S.C. 1145.
(4) Notification of eligibility.
(i) The
Department of Defense and the other uniformed services (National
Oceanic and Atmospheric Administration (NOAA), Public Health Service
(PHS), and Coast Guard) will notify persons in the uniformed services
eligible to receive health benefits under the CHCBP. In the case
of a member who becomes (or will become) eligible for continued
coverage, the Department of Defense shall notify the member of their
rights for coverage as part of pre-separation counseling conducted
under 10 U.S.C. 1142.
(ii) In the case of
a dependent of a member or former member who become eligible for
continued coverage under paragraph (d)(1)(ii) of this section:
(A) The member or former
member may submit to the CHCBP contractor a notice with supporting documentation
of the dependent’s change in status (including the dependent’s name,
address, and such other information needed); and
(B) The
CHCBP contractor, within fourteen (14) days after receiving such
information, will inform the dependent of the dependent’s rights
under 10 U.S.C. 1142.
(iii) In
the case of a former spouse of a member or former member who becomes
eligible for continued coverage, the member, former member or former
spouse may submit to the CHCBP contractor a notice of the former
spouse’s change in status. The CHCBP contractor within fourteen
(14) days after receiving such information will notify the individual
of their potential eligibility for CHCBP.
(5) Election of coverage.
In order to
obtain coverage under the CHCBP, a written election by the eligible
beneficiary must be made within a prescribed time period.
(i) In
the case of a member discharged or released from active duty or
full-time National Guard duty (whether voluntarily or involuntarily),
or a RC member formerly eligible for care under 10 U.S.C. chapter 55,
the written election shall be submitted to the CHCBP contractor
before the end of the 60-day period beginning on the later of:
(A) The date of the
discharge or release of the member; or
(B) The date that the
period of transitional health care applicable to the member under
10 U.S.C. 1145(a) ends; or
(C) The date the member receives the notification
required in paragraph (d)(3) of this section.
(ii) In
the case of a child who ceases to meet the requirements for being
an unremarried dependent child of a member or former member under
10 U.S.C. 1072(2)(D) or an unmarried dependent of a member or former
member of the uniformed services under 10 U.S.C. 1072(2)(I), the
written election shall be submitted to the CHCBP contractor before
the end of the 60-day period beginning on the later of:
(A) The date that the
dependent ceases to meet the definition of a dependent under 10
U.S.C. 1072(2)(D) or 10 U.S.C. 1072(2)(I); or
(B) The date that the
dependent receives the notification required in paragraph (d)(3)
of this section,
(iii) In the case of
former spouse of a member or former member, the written election
shall be submitted to the CHCBP contractor before the end of the
60-day period beginning on the date as of which the former spouse
first ceases to meet the requirements for being considered a dependent under
10 U.S.C. 1072(2).
(iv) In the case of
an unmarried surviving spouse of a member or former member of the
uniformed services who on the day before the death of the member
or former member was covered under 10 U.S.C. chapter 55 or 10 U.S.C.
1145(a), the written election shall be submitted to the CHCBP contractor within
60 days of the date of the member or former member’s death.
(v) A member of the
uniformed services who is eligible for enrollment under paragraph
(d)(1) of this section may elect self-only or family coverage. Family
members who may be included in such family coverage are the spouse
and children of the member.
(vi) All other categories eligible for enrollment
under paragraph (d)(1) of this section must elect self-only coverage.
(6) Enrollment.
To enroll in the CHCBP, an eligible individual
must submit the completed enrollment form designated by the Director,
TRICARE as well as any documentation as requested on the enrollment
form to verify the applicant’s eligibility for enrolling in CHCBP,
and payment to cover the quarter’s premium. The CHCBP contractor
may request additional information and documentation to confirm
the applicant’s eligibility for CHCBP.
(7) Period of coverage.
Except as noted below CHCBP coverage may
not extend beyond 18 months from the date the individual becomes
eligible for CHCBP. Although beneficiaries have sixty (60) days
to elect coverage under the CHCBP, upon enrolling, the period of
coverage must begin the day after entitlement or eligibility to
a military health care plan ends as though no break in coverage
had occurred notwithstanding the date the enrollment form with any
applicable premium is submitted.
(i) Exceptions:
(A) In the case of
a child of a member or former member, the date which is 36 months
after the date on which the person first ceases to meet the requirements
for being considered an unmarried dependent child under 10 U.S.C.
1072(2)(D) or 10 U.S.C. 1072(2)(I).
(B) In the case of
an unremarried former spouse (as this term is defined in 10 U.S.C.
1072(2)(G) or (H)) of a member or former member, the date which
is 36 months after the later of:
(1) The date on which the final decree of
divorce, dissolution, or annulment occurs; or
(2) If applicable,
the date the one-year extension of dependency under 10 U.S.C. 1072(2)(H)
expires.
(C) In the case of an unremarried surviving spouse
(widow or widower) (under 10 U.S.C. 1072(2)(B) or (C)) of a member
or former member of the uniformed services who is not otherwise
eligible for care under 10 U.S.C. chapter 55, the date which is
36 months after the date the surviving spouse becomes ineligible
under 10 U.S.C chapter 55 or 10 U.S.C. 1145(a).
(D)
In
the case of a former spouse of a member or former member (other
than the former spouse whose marriage was dissolved after the separation
of the member from the service unless such separation was by retirement),
the period of coverage under the CHCBP is unlimited, if former spouse:(1) Has
not remarried before age of 55 after the marriage to the member
or former member was dissolved; and
(2) Was
eligible for TRICARE as a dependent or enrolled in CHCBP at any
time during the 18 month period before the date of the divorce,
dissolution, or annulment; and
(3) Is receiving
a portion of the retired or retainer pay of a member or former member
or an annuity based on the retainer pay of the member; or
(4) Has a court
order for payment of any portion of the retired or retainer pay
or has a written agreement (whether voluntary or pursuant to a court
order) which provides for an election by the member or former member
to provide an annuity to the former spouse.
(E) For the beneficiary
who becomes eligible for the CHCBP by ceasing to meet the requirements
for being considered an unmarried dependent child of a member or
former member, health care coverage may not extend beyond the date
which is 36 months after the date the member becomes ineligible
for medical and dental care under 10 U.S.C. 1074(a) and any transitional
health care under 10 U.S.C. 1145(a).
(e) CHCBP benefits.
(1) In general.
Except
as provided in paragraph (e)(2) of this section, the provisions
of Sec. 199.4 shall apply to the CHCBP as they do to TRICARE Select
under Sec. 199.17.
(2) Exceptions.
The following provisions of Sec. 199.4
are not applicable to the CHCBP:
(i) Section 199.4(a)(2)
concerning eligibility.
(ii) All provisions regarding requirements to use
facilities of the uniformed services because CHCBP enrollees are
not eligible to use those facilities.
(3) Beneficiary liability.
For
purposes of CHCBP coverage, the beneficiary deductible, catastrophic cap
and cost share provisions of the TRICARE Select plan applicable
to Group B beneficiaries under Sec. 199.17(l)(2)(ii) shall apply
based on the category of beneficiary (e.g., Active Duty Family Member
or Retiree Family) to which the CHCBP enrollee last belonged, except
that for separating active duty members, amounts applicable to TRICARE
Select Active Duty Family Members shall apply. The premium under
paragraph (q) of this section applies instead of any TRICARE Select
plan enrollment fee under Sec. 199.17.
(f) Authorized providers.
The
provisions of Sec. 199.6 shall apply to the CHCBP as they do to TRICARE
Select program.
(g) Claims submission,
review, and payment.
The provisions of
Sec. 199.7 shall apply to the CHCBP as they do to TRICARE Select
program except no provisions regarding nonavailability statements
shall apply.
(h) Double coverage.
The
provisions of Sec. 199.8 shall apply to the CHCBP as they do to
TRICARE Select program.
(i) Administrative
remedies for fraud, abuse, and conflict of interest.
The
provisions of Sec. 199.9 shall apply to the CHCBP as they do to
TRICARE Select program.
(j) Appeal and hearing
procedures.
The
provisions of Sec. 199.10 shall apply to the CHCBP as they do to
TRICARE Select program.
(k) Overpayments recovery.
The
provisions of Sec. 199.11 shall apply to the CHCBP as they do to TRICARE
Select program.
(l) Third party recoveries.
The
provisions of Sec. 199.12 shall apply to the CHCBP as they do to TRICARE
Select program.
(m) Provider reimbursement
methods.
The
provisions of Sec. 199.14 shall apply to the CHCBP as they do to
TRICARE Select program.
(n) Quality and Utilization
Review Peer Review Organization Program.
The provisions of
Sec. 199.15 shall apply to the CHCBP as they do to TRICARE Select
program.
(o) [Reserved]
(p) Special programs not applicable.
(1) In general.
Special programs established
under this part that are not part of the TRICARE Select program
are not, unless specifically provided in this section, available
to participants in the CHCBP.
(2) Examples.
The
special programs referred to in paragraph (p)(1) of this section
include but are not limited to:
(i) The Extended Care
Health Option under Sec. 199.5;
(ii) The TRICARE Dental
Program or Retiree Dental Program under Sec. 199.13 and 199.22 respectively;
(iii) The
Supplemental Health Care Program under Sec. 199.16; and
(iv) The
TRICARE Prime Program under Sec. 199.17.
(q) Premiums.
(1) Rates.
Premium
rates will be established by the Assistant Secretary of Defense (Health
Affairs) for two rate groups--individual and family. Eligible beneficiaries
will select the level of coverage they require at the time of initial
enrollment (either individual or family) and pay the appropriate
premium payment. The rates are based on Federal Employees Health
Benefits Program employee and agency contributions required for
a comparable health benefits plan, plus an administrative fee. The
administrative fee, not to exceed ten percent of the basic premium
amount, shall be determined based on actual expected administrative
costs for administration of the program. Premiums may be revised
annually and shall be published when the premium amount is changed. Premiums
will be paid by enrollees quarterly.
(2) Effects of failure
to make premium payments.
Failure by enrollees to submit timely
and proper premium payments will result in denial of continued enrollment
and denial of payment of medical claims. Premium payments that are
late thirty (30) days or more past the start of the quarter for
which payment is due will result in the termination of beneficiary
enrollment. Beneficiaries denied continued enrollment due to lack
of premium payments will not be allowed to reenroll. In such a case,
benefit coverage will cease at the end of the ninety (90) day period
for which a premium payment was received. Enrollees will be held
liable for medical costs incurred after losing eligibility.
(r) Procedures.
The
Director, TRICARE Management Activity, may establish other rules
and procedures for the administration of the CHCBP.
[59
FR 49818, Sep 30, 1994, as amended at 62 FR 35097, Jun 30, 1997;
64 FR 46141, Aug 24, 1999; 69 FR 44952, Jul 28, 2004; 69 FR 51569,
Aug 20, 2004; 76 FR 57639, Sep 16, 2011; 82 FR 45457,
Sep 29, 2017]