10 U.S.C. § 1075

Current through P.L. 118-106 (published on www.congress.gov on 10/04/2024)

Section 1075 - TRICARE Select

(a) ESTABLISHMENT.-

(1) Not later than January 1, 2018, the Secretary of Defense shall establish a self-managed, preferred-provider network option under the TRICARE program. Such option shall be known as "TRICARE Select".

(2) The Secretary shall establish TRICARE Select in all areas. Under TRICARE Select, eligible beneficiaries will not have restrictions on the freedom of choice of the beneficiary with respect to health care providers.

(b) ENROLLMENT ELIGIBILITY.-

(1) The beneficiary categories for purposes of eligibility to enroll in TRICARE Select and cost-sharing requirements applicable to such category are as follows:

(A) An "active-duty family member" category that consists of beneficiaries who are covered by section 1079 of this title (as dependents of active duty members).

(B) A "retired" category that consists of beneficiaries covered by subsection (c) of section 1086 of this title, other than Medicare-eligible beneficiaries described in subsection (d)(2) of such section.

(C) A "reserve and young adult" category that consists of beneficiaries who are covered by-

(i) section 1076d of this title;

(ii) section 1076e; or

(iii) section 1110b.

(2) A covered beneficiary who elects to participate in TRICARE Select shall enroll in such option under section 1099 of this title.

(c) COST-SHARING REQUIREMENTS.-The cost-sharing requirements under TRICARE Select are as follows:

(1) With respect to beneficiaries in the active-duty family member category or the retired category by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018, or by reason of being a dependent of such a member, the cost-sharing requirements shall be calculated pursuant to subsection (d)(1).

(2)

(A) Except as provided by subsection (e), with respect to beneficiaries described in subparagraph (B) in the active-duty family member category or the retired category, the cost-sharing requirements shall be calculated as if the beneficiary were enrolled in TRICARE Extra or TRICARE Standard as if TRICARE Extra or TRICARE Standard, as the case may be, were still being carried out by the Secretary.

(B) Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018, or by reason of being a dependent of such a member.

(3) With respect to beneficiaries in the reserve and young adult category, the cost-sharing requirements shall be calculated pursuant to subsection (d)(1) as if the beneficiary were in the active-duty family member category or the retired category, as applicable, except that the premiums calculated pursuant to section 1076d, 1076e, or 1110b of this title, as the case may be, shall apply instead of any enrollment fee required under this section.

(4)

(A) Consistent with other provisions of this chapter and subject to requirements to be prescribed by the Secretary, the Secretary may waive cost-sharing requirements for the first three outpatient mental health visits each year of any of the following beneficiaries:

(i) Beneficiaries in the active-duty family member category.

(ii) Beneficiaries covered by section 1110b of this title.

(B) This paragraph shall terminate on the date that is five years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2024.

(d) COST-SHARING AMOUNTS FOR CERTAIN BENEFICIARIES.-

(1) Beneficiaries described in subsection (c)(1) enrolled in TRICARE Select shall be subject to cost-sharing requirements in accordance with the amounts and percentages under the following table during calendar year 2018 and as such amounts are adjusted under paragraph (2) for subsequent years:

TRICARE Select	Active-Duty Family Member (Individual/Family)	Retired (Individual/Family)
Annual Enrollment	$0	$450 / $900
Annual deductible	E4 & below: $50 / $100	$150 / $300 Network
	E5 & above: $150 / $300	$300 / $600 out of network
Annual catastrophic cap	$1,000	$3,500
Outpatient visit civilian network	$15 primary care	$25 primary care
	$25 specialty care	$40 specialty care
	Out of network: 20%	25% out of network
ER visit civilian network	$40 network	$80 network
	20% out of network	25% out of network
Urgent care civilian network	$20 network	$40 network
	20% out of network	25% out of network
Ambulatory surgery civilian network	$25 network	$95 network
	20% out of network	25% out of network
Ground ambulance civilian network	$15	$60
Durable medical equipment civilian network	10% of negotiated fee	20% network
Inpatient visit civilian network	$60 per network admission	$175 per admission network
	20% out of network	25% out of network
Inpatient skilled nursing/rehab civilian	$25 per day network	$50 per day network
	$50 per day out of network	Lesser of $300 per day or 20% of billed charges out of network

(2) Each dollar amount expressed as a fixed dollar amount in the table set forth in paragraph (1), and the amounts specified under paragraphs (1) and (2) of subsection (e), shall be annually indexed to the amount by which retired pay is increased under section 1401a of this title, rounded to the next lower multiple of $1. The remaining amount above such multiple of $1 shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and made when the aggregate amount of increases carried over under this clause for a year is $1 or more.

(3) Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis.

(4) The cost-sharing requirements applicable to services not specifically addressed in the table set forth in paragraph (1) shall be established by the Secretary.

(e) EXCEPTIONS TO CERTAIN COST-SHARING AMOUNTS FOR CERTAIN BENEFICIARIES ELIGIBLE PRIOR TO 2018.-

(1) Subject to paragraph (4), and in accordance with subsection (d)(2), the Secretary shall establish an annual enrollment fee for beneficiaries described in subsection (c)(2)(B) in the retired category who enroll in TRICARE Select (other than such beneficiaries covered by paragraph (3)). Such enrollment fee shall be $150 for an individual and $300 for a family.

(2) For the calendar year for which the Secretary first establishes the annual enrollment fee under paragraph (1), the Secretary shall adjust the catastrophic cap amount to be $3,500 for beneficiaries described in subsection (c)(2)(B) in the retired category who are enrolled in TRICARE Select (other than such beneficiaries covered by paragraph (3)).

(3) The enrollment fee established pursuant to paragraph (1) and the catastrophic cap adjusted under paragraph (2) for beneficiaries described in subsection (c)(2)(B) in the retired category shall not apply with respect to the following beneficiaries:

(A) Retired members and the family members of such members covered by paragraph (1) of section 1086(c) of this title by reason of being retired under chapter 61 of this title or being a dependent of such a member.

(B) Survivors covered by paragraph (2) of such section 1086(c).

(4) The Secretary may not establish an annual enrollment fee under paragraph (1) until 90 days has elapsed following the date on which the Comptroller General of the United States is required to submit the review under paragraph (5).

(5) Not later than February 1, 2020, the Comptroller General of the United States shall submit to the Committees on Armed Services of the House of Representatives and the Senate a review of the following:

(A) Whether health care coverage for covered beneficiaries has changed since the enactment of this section.

(B) Whether covered beneficiaries are able to obtain appointments for health care according to the access standards established by the Secretary of Defense.

(C) The percent of network providers that accept new patients under the TRICARE program.

(D) The satisfaction of beneficiaries under TRICARE Select.

(f) EXCEPTION TO COST-SHARING REQUIREMENTS FOR TRICARE FOR LIFE BENEFICIARIES.-A beneficiary enrolled in TRICARE for Life is subject to cost-sharing requirements pursuant to section 1086(d)(3) of this title and calculated as if the beneficiary were enrolled in TRICARE Standard as if TRICARE Standard were still being carried out by the Secretary.

(g) CONSTRUCTION.-Nothing in this section may be construed as affecting the availability of TRICARE Prime and TRICARE for Life or the cost-sharing requirements for TRICARE for Life under section 1086(d)(3) of this title.

(h) AUTHORITY FOR MULTIPLE NETWORKS IN THE SAME GEOGRAPHIC AREA.-

(1) The Secretary may establish a system of multiple networks of providers under TRICARE Select in the same geographic area or areas.

(2) Under a system established under paragraph (1), the Secretary may-

(A) require a covered beneficiary enrolling in TRICARE Select to enroll in a specific provider network established pursuant to such system, in which case any provider not in that specific provider network shall be deemed an out-of-network provider with respect to the covered beneficiary (regardless of whether the provider is in a different TRICARE Select provider network) for purposes of this section or any other provision of law limiting the coverage or provision of health care services to those provided by network providers under the TRICARE program; and

(B) include beneficiaries covered by subsection (c)(2).

(i) DEFINITIONS.-In this section:

(1) The terms "active-duty family member category", "retired category", and "reserve and young adult category" mean the respective categories of TRICARE Select enrollment described in subsection (b).

(2) The term "network" means-

(A) with respect to health care services, such services provided to beneficiaries by TRICARE-authorized civilian health care providers who have entered into a contract under this chapter with a contractor under the TRICARE program; and

(B) with respect to providers, civilian health care providers who have agreed to accept a pre-negotiated rate as the total charge for services provided by the provider and to file claims for beneficiaries.

(3) The term "out-of-network" means, with respect to health care services, such services provided by TRICARE-authorized civilian providers who have not entered into a contract under this chapter with a contractor under the TRICARE program.

10 U.S.C. § 1075

Added Pub. L. 114-328, div. A, title VII, §701(a)(1), Dec. 23, 2016, 130 Stat. 2180; amended Pub. L. 115-91, div. A, title VII, §739(b)(1), Dec. 12, 2017, 131 Stat. 1446; Pub. L. 116-92, div. A, title XVII, §1731(a)(23), Dec. 20, 2019, 133 Stat. 1813; Pub. L. 117-81, div. A, title VII, §703(a), Dec. 27, 2021, 135 Stat. 1779; Pub. L. 118-31, div. A, title VII, §701(a), Dec. 22, 2023, 137 Stat. 299.

EDITORIAL NOTES

REFERENCES IN TEXTThe date of the enactment of the National Defense Authorization Act for Fiscal Year 2024, referred to in subsec. (c)(4)(B), is the date of enactment of Pub. L. 118-31, which was approved Dec. 22, 2023.

PRIOR PROVISIONSA prior section 1075, added Pub. L. 85-861, §1(25)(B), Sept. 2, 1958, 72 Stat. 1447; amended Pub. L. 97-22, §10(b)(2), July 10, 1981, 95 Stat. 137; Pub. L. 108-87, §8146(a), Sept. 30, 2003, 117 Stat. 1109; Pub. L. 108-106, §1112(a), Nov. 6, 2003, 117 Stat. 1215, related to subsistence charges for officers and certain enlisted members, prior to repeal by Pub. L. 108-375, div. A, title VI, §607(a)(1), Oct. 28, 2004, 118 Stat. 1946. Another prior section 1075, act Aug. 10, 1956, ch. 1041, 70A Stat. 82, related to post card requests for absentee ballots, and for printing and transmission thereof, prior to repeal by Pub. L. 85-861, §36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which is classified to subchapter I-D (§1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare.

AMENDMENTS2023-Subsec. (c)(4). Pub. L. 118-31 added par. (4).2021-Subsecs. (h), (i). Pub. L. 117-81 added subsec. (h) and redesignated former subsec. (h) as (i). 2019-Subsec. (d)(1). Pub. L. 116-92 substituted "25% out of network" for "25% of out of network" in third column of table row relating to Outpatient visit civilian network. 2017-Subsec. (d)(1). Pub. L. 115-91, §739(b)(1)(B), substituted "Ground ambulance civilian network" for "Ambulance civilian network" in first column of table.Subsec. (d)(4). Pub. L. 115-91, §739(b)(1)(A), added par. (4).

STATUTORY NOTES AND RELATED SUBSIDIARIES

EFFECTIVE DATESection applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see section 701(k) of Pub. L. 114-328, set out as an Effective Date of 2016 Amendment note under section 1072 of this title.

PILOT PROGRAM ON HEALTH CARE ASSISTANCE SYSTEM Pub. L. 115-91, div. A, title VII, §731, Dec. 12, 2017, 131 Stat. 1441, as amended by Pub. L. 117-81, div. A, title VII, §705, Dec. 27, 2021, 135 Stat. 1781, provided that:"(a) PILOT PROGRAM.-The Secretary of Defense shall carry out a pilot program to provide a health care assistance service to certain covered beneficiaries enrolled in TRICARE Select using purchased care to improve the health outcomes and patient experience for covered beneficiaries with complex medical conditions."(b) ELEMENTS.-The pilot program under subsection (a) may include the following elements:"(1) Assisting beneficiaries with complex medical conditions to understand and use the health benefits under the TRICARE program."(2) Supporting such beneficiaries in accessing and navigating the purchased care health care delivery system."(3) Providing such beneficiaries with information to allow the beneficiaries to make informed decisions regarding the quality, safety, and cost of available health care services. "(4) Improving the health outcomes for such beneficiaries. "(c) DURATION.-The Secretary shall carry out the pilot program for an amount of time determined appropriate by the Secretary during the five-year period beginning 180 days after the date of the enactment of this Act [Dec. 12, 2017]."(d) REPORT.-Not later than November 1, 2022, the Secretary shall submit to the Committees on Armed Services of the House of Representatives and the Senate a report containing an evaluation of the success of the pilot program under subsection (a), including-"(1) an analysis of the implementation of the elements under subsection (b); "(2) the feasibility of incorporating such elements into TRICARE support contracts; and"(3) input from covered beneficiaries who have participated in the pilot program regarding their satisfaction with, and any benefits attained from, such participation."(e) DEFINITIONS.-In this section, the terms 'covered beneficiary', 'TRICARE program', and 'TRICARE Select' have the meaning given those terms in section 1072 of title 10, United States Code."

TRICARE Extra

The term "TRICARE Extra" means the preferred-provider option of the TRICARE program made available prior to January 1, 2018, under which TRICARE Standard beneficiaries may obtain discounts on cost sharing as a result of using TRICARE network providers.

TRICARE Prime

The term "TRICARE Prime" means the managed care option of the TRICARE program.

TRICARE Select

The term "TRICARE Select" means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of this title.

TRICARE Standard

The term "TRICARE Standard" means the TRICARE program made available prior to January 1, 2018, covering health benefits contracted for under the authority of section 1079(a) or 1086(a) of this title and subject to the same rates and conditions as apply to persons covered under those sections.

TRICARE for Life

The term "TRICARE for Life" means the Medicare wraparound coverage option of the TRICARE program made available to the beneficiary by reason of section 1086(d) of this title.

TRICARE program

The term "TRICARE program" means the various programs carried out by the Secretary of Defense under this chapter and any other provision of law providing for the furnishing of medical and dental care and health benefits to members and former members of the uniformed services and their dependents, including the following health plan options:(A) TRICARE Prime.(B) TRICARE Select.(C) TRICARE for Life.

active duty

The term "active duty" means full-time duty in the active military service of the United States, including sustained duty in the Space Force. Such term includes full-time training duty, annual training duty, and attendance, while in the active military service, at a school designated as a service school by law or by the Secretary of the military department concerned. Such term does not include full-time National Guard duty.

covered beneficiary

The term "covered beneficiary" means a beneficiary under this chapter other than a beneficiary under section 1074(a) of this title.

health care

The term "health care" includes mental health care.

pay

The term "pay" includes basic pay, special pay, retainer pay, incentive pay, retired pay, and equivalent pay, but does not include allowances.

uniformed services

The term "uniformed services" means-(A) the armed forces;(B) the commissioned corps of the National Oceanic and Atmospheric Administration; and(C) the commissioned corps of the Public Health Service.