1.0 CONTINUED HEALTH CARE BENEFIT
PROGRAM (CHCBP)
1.1 The CHCBP is a health care program
that allows certain groups of former Military Health System (MHS) beneficiaries
to continue receiving health care coverage when they lose eligibility
for military health care under the TRICARE programs. This temporary
health program is supported by premium revenue collected from the
program participants
in
the program.
1.1.1 The Managed Care Support Contractor
(MCSC) for the East geographic area of responsibility (herein referred
to as the ‘CHCBP contractor’ unless otherwise specified) shall provide
all services necessary to support the CHCBP as outlined in
32
CFR 199.20.
Other references describing
the CHCBP that are to be used by In addition
to this Section, the CHCBP contractor
in
fulfilling its responsibilities are shall
also use the applicable sections of
this manual
and the TRICARE Policy Manual (TPM), TRICARE Reimbursement
Manual (TRM), TRICARE Systems Manual (TSM), and the
Federal
Register dated September 30, 1994 (pg. 49817ff), February
11, 1997 (pg. 6225ff), February 24, 1997 (pg. 8312), and September
16, 2011 (pg. 57637ff)
to fulfill its responsibilities.
1.1.2 The CHCBP
contractor shall perform these functions for CHCBP beneficiaries
on a worldwide basis, irrespective of the geographic area in which
the beneficiary resides or the area in which health care services
are received.
1.1.3 The CHCBP contractor shall
adhere to the following requirements for those areas in which the
CHCBP instructions and processing requirements are different than
TRICARE.
1.1.4 CHCBP is not part of the TRICARE
Program.
1.2 The legislative basis for the
program is Section 4408 of the National Defense Authorization Act
(NDAA) of 1993 (Public Law 102-484) which added Section 1078a to
Chapter 55 of 10 United States Code (USC).
1.2.1 Beneficiaries, who
may be eligible to purchase the continued health program after eligibility
for coverage ends under a health benefits plan under 10 USC Chapter
55 or 10 USC § 1145(a) are described in 10 USC § 1078a.
1.2.2 For
thoseBeneficiaries covered
under premium-based TRICARE health benefits plans (e.g., TRICARE Reserve
Select (TRS), TRICARE Retired Reserve (TRR), and TRICARE Young Adult
(TYA), etc.), such must
purchase coverage must have been purchased and have
it in place the day before the loss of eligibility.
2.0 VALIDATE
ELIGIBILITY FOR CHCBP
2.1 The CHCBP contractor shall
validate eligibility on the Defense Enrollment and Eligibility Reporting System
(DEERS) upon receipt DD Form 2837, CHCBP Application, from a prospective
beneficiary.
2.2 The CHCBP contractor shall
contact the applicant if additional documentation is required to
validate CHCBP eligibility.
2.3 The CHCBP
contractor shall request supporting documentation from the applicant
depending based on the
category of individual who is applying for enrollment:
2.3.1 Individual
Uniformed Service sponsor (herein referred to as “sponsor”) and his
or her their family:.
The contractor shall obtain a copy of the DD Form 214,
Certificate of Release or Discharge from Active Duty, or a copy
of the sponsor’s active duty orders from the applicant.
2.3.2 Unremarried
Former Spouse (URFS) and stepchildren of the sponsor:.
The contractor shall obtain a copy of the final divorce
decree from the applicant.
2.3.3 Child who
loses TRICARE coverage due to marriage:.
The contractor shall obtain a copy of marriage certificate from
the applicant.
2.3.4 Child who
loses TRICARE coverage on his or her their 21st
birthday (age 23 if enrolled in a full-time course of study at an
approved institution of higher learning and dependent on the uniformed
service Uniformed Service sponsor
for more than half of his or her their financial
support). The contractor shall obtain a copy
of the front and back of the Uniformed Services identification (ID)
card from the applicant.
2.3.5 Child who
loses TRICARE coverage due to college graduation:.
The contractor shall obtain a copy of college transcript from
the applicant.
2.3.6 Child over
the age of 21 and before the age of 23 who loses TRICARE coverage
when no longer enrolled in a full-time course of study at an approved
institution of higher learning or no longer dependent on the uniformed
service Uniformed Service sponsor
for more than half of his or her their financial
support:. The contractor
shall obtain a letter from the institution of higher
learning stating the student’s status or a written statement from
the dependent family member that he
or she is they are no longer
dependent on the uniformed services Uniformed
Service sponsor for more than half of his
or her their financial support from
the applicant.
2.3.7 Child
that was previously placed in sponsor’s legal custody and then loses
TRICARE coverage. The contractor shall obtain a
copy of the court order from the applicant.
Note: Children who lose TRICARE coverage
under
paragraphs 2.3.4 through
2.3.7 may
qualify to purchase TYA coverage until reaching the age of 26 (see
Chapter
25). If qualified to purchase TYA coverage, the
contractor
shall not allow the child
cannot to purchase
CHCBP as an individual. If the child does not qualify to purchase
TYA because he or she qualifies for employer sponsored coverage,
he
or she is ineligible to purchase the contractor
shall not enroll the child in CHCBP.
2.3.8 If TYA coverage
was terminated due to eligibility for employer-sponsored health
care coverage based on
his or her their own
employment or failure to pay TYA premiums, then the
contractor
shall not enroll the child
is not eligible
to purchase in CHCBP
coverage (see
Chapter
25).
2.3.9 The CHCBP contractor shall request
information needed it needs to
verify eligibility for any other situations in which an individual
loses TRICARE coverage and may potentially be eligible for CHCBP.
2.4 Family
Members Not Identified On DEERS
2.4.1 The CHCBP contractor shall
take the following action upon receipt of a CHCBP claim which includes
a family member not identified on DEERS as enrolled, but the sponsor
indicates CHCBP family coverage:
• If the claim includes a copy
of an appropriately marked CHCBP coverage card for the beneficiary,
the contractor shall process the claim is
to be processed.
• If the claim is for a beneficiary
who is less than 60 calendar days old, the contractor
shall process the claim is to be processed, even
if no copy of a CHCBP coverage card is attached as long as at least
one member of the sponsor’s family is currently enrolled in CHCBP.
In all other cases, the contractor shall deny the claim is
to be denied.
2.4.2 In
order to beWhen a beneficiary is enrolled
in the CHCBP, the contractor shall disenroll the beneficiary will
be disenrolled from any all
other TRICARE programs in which enrolled. This
will require no action on the beneficiary’s part. The
contractor shall not require the beneficiary to take any action.
2.5 Disputes
Regarding Enrollment
2.5.1 The CHCBP contractor shall confirm
a person’s eligibility as a for CHCBP beneficiary.
2.5.2 DisputedThe
contractor shall not consider disputed questions of
fact concerning a beneficiary’s eligibility will not
be considered an appealable issue, but
must be and the contractor shall resolved the
issue with the appropriate Uniformed Service.
2.5.3 The CHCBP
contractor shall deny applications in writing within 10 business
days of the reason for the denial under the following circumstance:
if the contractor determines the applicant does not appear eligible
due to an ineligible response from DEERS (i.e., no history segments
or record of previous Department of Defense (DoD) entitlement) or
failure of the applicant to provide the documentation requested
to verify eligibility.
3.0 APPLICATION
PERIOD AND PREMIUMS
3.1 CHCBP Application Period
3.1.1 The CHCBP
contractor shall deny any applications received after a 60 calendar
day period, beginning the day following the end date of the beneficiary’s
eligibility for TRICARE coverage.
3.1.2 The CHCBP
contractor shall apply the following business rules when determining
the start of the 60-calendar day application period.
3.1.3 Members
and Former Members, Their Families, and Other Individuals Losing
TRICARE Coverage
3.1.3.1 The Government routinely notifies
beneficiaries prior to their loss of TRICARE coverage;.
The Government (Uniformed Service) informs Active Duty Service
Members (ADSMs) are notified (AD) members of
the CHCBP during out processing.;
other beneficiaries who lose TRICARE coverage are notified by the The
Defense Manpower Data Center (DMDC) notifies
other beneficiaries in writing of the CHCBP availability of
the CHCBP.
3.1.3.2 The CHCBP contractor shall forward
documentation to the Government Designated Authority (GDA) if an
eligible beneficiary advises the contractor that he
or she was they were not notified
of this program and submits documentation to support their position.
3.1.3.3 The GDA will provide direction
on the start date of the 60 calendar day application period.
3.1.4 URFSs
The CHCBP contractor shall
process all applications from URFS upon receipt as no formal mechanism
is established to promptly identify URFS that may qualify for this
program.
3.2 Coverage Categories
3.2.1 CHCBP
offers two coverage categories:
• Individual coverage is available
to the member or former member, an URFS, an adult child, a surviving
spouse, or other qualified individuals, and
• Family coverage is only available
to the member or former member and his or her dependents their
family members.
3.2.2 DependentsFamily
members cannot be covered under family coverage unless
the member or former member is also covered by family coverage.
3.3 CHCBP
Application
3.3.1 The CHCBP contractor
shall accept the DD Form 2837, CHCBP application,
as the application form for CHCBP coverage.
3.3.2 The CHCBP
contractor shall use the latest version should DD Form 2837 be revised
or renumbered in the future.
3.4 Dates
of Coverage & Premiums
3.4.1 Coverage will begin the day
following the beneficiary’s loss of TRICARE coverage and will end
the last day of premium coverage.
3.4.2 Due to
the documentation requirements for purchasing coverage, most coverage
will be retroactive; however, there may be some coverage that will
be prospective.
3.4.2.1 ProspectiveThe
contractor shall ensure prospective coverage must
be is accompanied by a premium payment
for one quarter.
3.4.2.2 RetroactiveThe
contractor shall ensure retroactive coverage must
be is accompanied by full
premium payment retroactive to the effective date of coverage through
the end coverage date in the quarter in which the individual is
applying.
3.4.3 Premiums
are as stated in paragraph 3.5 of
these instructions.
3.4.3 Examples of the premiums the
contractor shall required for
retroactive and prospective coverage:
|
|
MILITARY Benefits End
|
APPLICATION RECEIVED
|
QUARTERS OF PREMIUM DUE
|
CHCBP COVERAGE
|
|
Example 1:
|
10/01/2020
|
11/15/2020
|
1 quarter
|
10/02/2020
|
|
Example 2:
|
09/15/2020
|
02/10/2021
|
2 quarters
|
09/16/2020
|
|
Example 3:
|
11/05/2020
|
10/01/2020
|
1 quarter
|
11/06/2020
|
|
Example 4:
|
03/01/2021
|
11/01/2020
|
1 quarter
|
03/02/2021
|
3.5 Premium
Rates
3.5.1 The
amount of the Government
establishes CHCBP premium
s will be established
by amounts and the Government
and may
be adjust
ed them each
fiscal
year Fiscal Year (FY).
The
Government will establish premium amounts and may adjust them on
a Calendar Year (CY) basis beginning January 1.Note: The typical CHCBP FY
is a twelve month period from October 1 to September 30; however,
CHCBP FY 2022 includes the three month period from October 1, 2022
to December 31, 2022.
3.5.2 The CHCBP
contractor shall
begin charging charge the
adjusted quarterly premiums on the date specified in
Addendum A.
The
CHCBP will transition to CY operation on January 1, 2023, to allow
premium collection to align with the CY collection of CHCBP out-of-pocket
expenses. The one-time transition period from FY to CY will be in
effect for the quarterly premium collection period from October
1, 2022 through December 31, 2022.
3.5.3 The CHCBP
contractor shall
issue a written notice to the beneficiary
of the changes in premium amounts, to include the effective date
of the change upon receipt of adjusted rates from the Government. during the
one-time transition period:
• Continue to charge FY
2022 quarterly premiums.
• Upon receipt of adjusted
rates from the Government, issue a written notice to the beneficiary
to notify them of the premium amount changes, the effective date
of the change and the transition to CY premium collection. The contractor
shall provide this notification at least 30 days prior to the effective
date directed by the Contracting Officer (CO).
3.5.4 This
notification should be done at least 30 calendar days prior to the
effective date directed by the Contracting Officer (CO).Starting
January 1, 2023, the contractor shall:
• Collect quarterly CHCBP
premiums on a CY basis.
• Upon receipt of adjusted
rates from the Government, issue a written notice to the beneficiary
to notify them of the premium amount changes, and the effective
date of the change. The contractor shall provide this notification
at least 30 days prior to the effective date directed by the CO.
3.5.5 The
CHCBP contractor shall issue a written notice to the beneficiary
of changes in the coverage category and premium amount, including
the effective date of the changes, within 10 business days of receiving such
information.The CHCBP contractor shall
change coverage and premiums effective with the date of the qualifying
event when qualifying events occur that change the sponsor from
individual to family coverage or vice versa. The contractor shall,
within 10 business days of receiving such information, notify the
beneficiary in writing of the changes in coverage category and premium
amount, including the effective date of the changes.
3.5.6 When qualifying
events occur that change the sponsor from individual to family coverage
or vice-versa, coverage and premiums shall be changed effective
with the date of the qualifying event.
3.6 Forms
of Payment
3.6.1 The CHCBP contractor
may propose additional payment mechanisms to include electronic
processes for premium payments. ChecksThe
contractor shall accept checks, money orders, or credit
cards are allowable as forms
of premium payment for CHCBP
beneficiaries to use in paying their premiums. The
contractor may propose additional payment mechanisms to include
electronic processes for premium payments.
3.6.2 The contractor shall
ensure proposed electronic processes shall maintain the integrity
and security of the application processes which includes documentation
required to validate eligibility for CHCBP.
3.6.3 Proposed electronic
processes shall maintain the integrity and security of the application
processes which includes important documentation required to validate
eligibility for CHCBP. The contractor
shall accept VISA and MasterCard® for credit card payments at a
minimum, but is not required to, accept additional nationally recognized
major credit cards for premium payment.
3.6.3 The CHCPB contractor
shall accept VISA and MasterCard® for credit card payments, but
is not required to accept additional nationally recognized major
credit cards as a form of premium payment.
3.6.4 The CHCBP contractor shall not
accept premiums submitted by, or on behalf, of a health care provider for
any beneficiary other than: (1) the provider
him or
herself, and (2) a member of the provider’s immediate
family.
3.6.4.1 The CHCBP contractor shall
return a provider submitted payment to the provider with a written notice
advising the provider that submission of premium payments by health
care providers is prohibited.
3.6.4.2 The CHCBP contractor shall also send
a copy of the letter to the beneficiary.
3.6.4.3 The CHCBP contractor shall
submit documentation of this action to the Defense Health Agency
(DHA) Program Integrity (PI) Office to include the following:
• A copy of contractor’s notification
to the provider.
• Copy of front and back of premium
(money order or check).
• Originals of all documentation
submitted by the provider (to include mailing envelope).
• Documentation of all conversations
and communications the CHCBP contractor had with the provider on
the subject of paying premiums.
• Other information that the
CHCBP contractor has in its files or records concerning the provider
that might be of assistance in Government follow-up action on this
issue.
3.7 Insufficient
Funds
3.7.1 The CHCBP contractor shall, in
the case of insufficient funds, issue a written notice to the applicant
(for initial applications) or beneficiary (in the case of renewal
premiums) within three business days, advising the applicant or
beneficiary of the insufficient funds, the amount of the premium
due, and the date
by which the contractor
will receive a valid premium
must be received
by the CHCBP contractor payment.
3.7.1.1 For initial application requests,
the notice contractor shall also advise
the beneficiary that if the contractor does not receive
the premium payment is not received in
full by the due date (the last day of the 60-calendar day application
period), the applicant will not be covered in CHCBP.
3.7.1.2 For renewals, the notice contractor shall
advise the beneficiary in writing that if
the CHCBP contractor does not receive valid payment in full within
30 calendar days of the date of the contractor’s letter, the coverage
will be terminated contractor will terminate
the CHCBP. That notice shall also The
contractor shall provide the effective date of termination
if payment is not received.
3.7.2 The CHCBP
contractor shall terminate the CHCBP coverage and issue a written
Termination Notice (TN) to the beneficiary confirming the termination
of coverage if the premium payment has not been received by the CHCBP
contractor within the specified time frame.
3.7.3 The CHCBP
contractor may assess the CHCBP applicant or purchaser and
retain a fee of up to $20 US dollars ($20.00), which
is retained by the CHCBP contractor, in the event that there are
insufficient funds to process a premium payment from
the CHCBP applicant/purchaser.
3.8 Refunds
3.8.1 The CHCBP
contractor shall refund premiums if the applicant is no longer eligible
for CHCBP coverage, i.e., beneficiary regains TRICARE eligibility;
ex-spouse remarries; death of beneficiary; prospective member who
has prepaid premium but fails to provide required eligibility documentation;
and sponsor change in coverage from family to individual.
3.8.2 Voluntary
termination because the beneficiaryThe
contractor shall not refund unused premiums if the beneficiary voluntary
terminated CHCBP coverage because they obtained Other
Health Insurance (OHI) does not constitute grounds
for a refund of unused premiums.
3.8.3 The CHCBP
contractor shall prorate refunds from the date of loss of eligibility
for program benefits through the last coverage date for which the
premium was paid when refunds are appropriate.
3.9 Limits
of CHCBP Coverage
The length
of a beneficiary’s CHCBP coverage varies according to the category
of individual. Coverage lengths and categories are listed in the
TPM,
Chapter 10, Section 4.1, Figure 10.4.1-1.
3.10 Processing
Applications
3.10.1 The CHCBP contractor shall
enter CHCBP enrollment into DEERS through the applicable on-line interface
once the CHCBP contractor has verified eligibility and approved
the application request.
3.10.1.1 As DEERS does not allow individuals
to be added to a sponsor’s record after the sponsor’s TRICARE coverage
ends, there will be a small number of CHCBP beneficiaries that the
contractor cannot complete the CHCBP enrollment in DEERS.
3.10.1.2 The majority will be newborns
whose birth occurred after the sponsor’s TRICARE coverage ends,
but there will occasionally be other beneficiaries as well.
3.10.1.3 TheBecause
of this, the contractor
should shall not
rely on DEERS as
being the sole determinant
of whether or not an individual is eligible for CHCBP coverage
as
these individuals would not be reflected on DEERS (refer
to
paragraph 2.0).
3.10.2 The CHCBP contractor shall
ensure that its systems can accurately accommodate
these unique cases in which the beneficiary is covered under CHCBP
but not reflected on DEERS to ensure these beneficiaries are provided
with all required CHCBP benefits and accurate processes (e.g., claims
processing, issuing authorizations, accessing services).
3.10.3 DEERS will not allow
the
contractor to enter a CHCBP enrollment
to
be entered if the sponsor or
dependents family
member are still showing as eligible for TRICARE coverage.
In these cases:
3.10.3.1 The CHCBP contractor shall
pend the application and advise the applicant in writing for the
sponsor to contact the nearest Uniformed Services ID card issuing
office (Real-Time Automated Personnel Identification System (RAPIDS))
to rectify the situation.
3.10.3.2 The CHCBP contractor shall complete
the processing of the application when DEERS has been updated to
reflect that the sponsor or dependents family
members are no longer eligible for services under TRICARE.
3.10.4 The CHCBP contractor shall issue
the beneficiaries a CHCBP coverage ID card within 10 business days once
the application has been fully processed. The card provides the
beneficiaries with (1) confirmation that the individual is covered
and the effective dates; and (2) documentation
that
the beneficiary on how to access health care services.
3.10.4.1 The contractor shall
ensure the card shall contains sufficient
information to facilitate access to health care. Coverage The
contractor shall limit coverage dates on the card shall
be limited to those dates for which the contractor
has received a valid quarterly premium has
been received by the contractor.
3.10.4.2 The CHCBP contractor shall
issue cards each quarter for all subsequent quarterly payments received by
the contractor.
3.10.4.3 The contractor shall
ensure the card shall reflects that coverage is for
the CHCBP and including but not limited to the contractor’s name,
address, toll-free telephone number, and claims center mailing address at
a minimum.
3.10.5 The CHCBP contractor shall
issue a letter to the applicant confirming CHCBP coverage (including
the dates of coverage) within 10 business days once an application
has been fully processed.
The contractor shall ensure
the letter:
• Includes requirements
for continued coverage;
• Includes information
regarding future bills and premium payments;
• Includes CHCBP coverage
policy, or such other sufficient written information regarding the
CHCBP for beneficiaries to reference for benefits and program requirements
questions.
3.10.6 The letter shall
advise the beneficiary of the requirements that must be met for
continued coverage in the program, including information regarding
future contractor billings and premium payments that the beneficiary
will be required to make.
3.10.7 The CHCBP contractor
shall issue either a CHCBP coverage policy or such other sufficient
written information regarding the CHCBP for beneficiaries’ reference
should they have any questions regarding benefits and program requirements.
3.11 Coverage
And Renewals
3.11.1 The CHCBP contractor shall
mail initial premium renewal notices to beneficiaries no later than
30 calendar days before the expiration of the coverage.
3.11.2 The CHCBP contractor shall
not routinely query DEERS for renewal coverages and quarterly billings
as the beneficiary’s coverage in CHCBP is based on the documentation
that the applicant submits to verify eligibility.
3.11.3 The CHCBP contractor shall
assume that the individual continues to meet the requirements for
CHCBP absent information or evidence to the contrary.
3.11.3.1 The CHCBP contractor’s shall
ensure renewal notices shall clearly
specify the premium amount due, the date by which the premium must
be received, and the mailing address to which send the
premium payment must be sent.
3.11.3.2 The CHCBP contractor’s shall
ensure renewal notices shall specify
that failure to submit the premium due will result in denial of
continued coverage and termination from the program.
3.11.4 The CHCBP contractor shall provide
a 30 calendar day grace period following
the premium due date in which the beneficiary may submit his
or her their premium and continue
benefits with no break in coverage.
3.11.5 The CHCBP contractor shall
issue a second renewal notice to the beneficiary within 10 business
days of the start of the grace period if the premium is not received
following the initial renewal notice to the beneficiary requesting
premium
payment for the next quarter.
3.11.5.1 The CHCBP contractor’s shall
ensure the second renewal notice shall indicates that
this it is the second and
final billing notice and that if the contractor does
not receive payment is not received by
the due date specified in the notice, that CHCBP coverage will be
terminated as of that date.
3.11.5.2 The CHCBP contractor’s shall
ensure the notice shall advises the
beneficiary that if coverage is terminated due to nonpayment of
premium, he or she the beneficiary will
be permanently locked-out of CHCBP.
3.11.6 The CHCBP contractor shall
terminate the beneficiary’s coverage in CHCBP and send a TN to the beneficiary
confirming the termination within 10 business days, to include the
effective date and basis for the termination if the premium is not
received by the end of the grace period.
3.11.7 The CHCBP contractor shall
enter all CHCBP terminations into DEERS.
3.11.8 Beneficiaries who desire to voluntarily
withdraw from the CHCBP prior to the end of their paid up period
shall will send
a written request to the contractor.
Beneficiaries The
contractor shall not permit beneficiaries who voluntarily
disenroll from the CHCBP
are not permitted to
re-enroll until they gain and then once again lose TRICARE coverage.
Refund
of The contractor shall refund unused
premiums
is only allowed for items
covered in
paragraph 3.8.
3.11.9 The CHCBP contractor shall
issue a TN to the beneficiary following his or her termination from
the CHCBP within 10 business days from the termination date and
upon request up to 24 months after the termination date, unless
the beneficiary has re-established TRICARE coverage.
3.11.10 The CHCBP contractor shall
use the most current address on file or available when preparing
and mailing all written notices and correspondence to applicants
and beneficiaries.
3.12 CHCBP Coverage Data and Reports
3.12.1 The CHCBP contractor shall
maintain systems and databases to collect, track, and process applications.
3.12.2 The CHCBP contractor shall
have the capability to retroactively retrieve pertinent coverage
information on any individual who has been accepted or denied coverage
in the program, to include the basis for such denials.
6.0 FIDUCIARY
RESPONSIBILITIES AND REPORTING
6.1 The CHCBP contractor shall
act as a fiduciary for all funds acquired from CHCBP premium collections.
All funds acquired from CHCBP collections are retained by the Government.
6.1.1 The CHCBP
contractor shall develop strict funds control processes for its
collection, retention and transfer of CHCBP premiums to the Government.
6.1.2 The CHCBP
contractor shall follow the requirements in
Chapter
3.
6.2 The CHCBP contractor shall
maintain a system for tracking and reporting premiums and beneficiaries
and policy holders. The system is subject to Government review and
audit.
6.3 The CHCBP contractor shall
submit the following reports:
• Adjusted Premiums Report;
• Enrollment Premium Report;
• Enrollment Report;
• Premiums Summary Report;
• Workload Report; and
• Ad Hoc Reports.
For reporting requirements,
see DD Form 1423, Contract Data Requirements List (CDRL), located
in Section J of the applicable contract.
8.0 REPORTING
RESPONSIBILITIES
8.1 The CHCBP contractor shall
maintain the capability to produce CHCBP ad hoc reports on request
by the Government.
8.2 The Government will
limit data elements or information for such reports would
be limited to that information that the CHCBP contractor
has collected or should reasonably have collected in the performance
of CHCBP work.
8.3 Some manipulation and formatting
of the data and information may be required to meet the requirements
of the ad hoc reports.
8.4 The Government estimates that the
CHCBP contractor would not receive more than five it
will require up to three such requests ad
hoc reports per contract year. and
that the The Government does not expect
the contractor level of effort for the CHCBP
contractor to produce the ad hoc reports is
not expected to be significant.
9.0 PATIENT
PROTECTION AND AFFORDABLE CARE ACT (ACA) OF 2010 INFORMATION REPORTING
9.1 When purchased,
CHCBP coverage is considered Minimum Essential Coverage (MEC) and
meets the individual coverage requirement of the ACA.
9.2 The CHCBP
contractor shall perform all Section 6055 information reporting
to the Internal Revenue Service (IRS) and provide statements to
individuals with CHCBP coverage during the reporting tax period
in the manner, time frames, and forms specified in Section 6055
of the Internal Revenue Code (IRC) and associated IRS regulations.
9.3 The CHCBP
contractor shall notify the Contracting Officer’s Representative
(COR) by email when completed each year.
9.4 The CHCBP
contractor shall use coverage data from the contractor’s enrollment
system to generate the required information reports and statements
because not all CHCBP enrollments are recorded in DEERS.
9.5 OnlyThe CHCBP contractor
shall report CHCBP coverage information shall
be reported to the IRS by the CHCBP
contractor.