§1097c TRICARE program: relationship with employer-sponsored group health plans

Summary

Makes the same rule that Medicare uses about paying or offering perks to keep people from joining employer health plans apply to TRICARE-eligible employees. In short, employers may not give money or other incentives to stop a TRICARE-eligible worker from enrolling in, or to make them leave, an employer group health plan that would be the main payer. The Secretary of Defense can write rules to allow some exceptions. The Defense and Health and Human Services departments can make agreements to run this rule, with Defense paying HHS for any costs. The Defense Inspector General can check and investigate compliance. Any information or money handled under related parts of law must be used the same way as under the comparable Medicare rules. A TRICARE-eligible employee must be allowed to join their employer’s group health plan and get primary coverage just like other employees. The rule does not apply to employers with fewer than 20 employees. Choosing to join the employer plan does not change the person’s TRICARE or dental benefits. The Defense Department must tell beneficiaries and employers about these rights. Definitions: “employer” includes state or local government; “group health plan” uses the Internal Revenue Code section 5000(b)(1) meaning; “TRICARE-eligible employee” means the beneficiary described in section 1086. The rule took effect on January 1, 2008.