(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]