§1097c — Title 10 Armed Forces | U.S. Code

Summary

Treats the rule in Social Security Act section 1862(b)(3)(C) as applying when employers or others offer money or other incentives to a TRICARE-eligible employee to keep them from joining, or to get them to drop, an employer health plan. A TRICARE-eligible employee may choose to join their employer’s group health plan and have that plan be their main coverage just like other employees. Employers with fewer than 20 employees are not covered. Choosing the employer plan does not end the employee’s or their spouse’s TRICARE benefits. The rule took effect on January 1, 2008. The Secretary of Defense can make extra exceptions and must be able to work with the Secretary of Health and Human Services; HHS costs for this work are paid back by Defense. The Defense Inspector General can investigate employer duties. Information from section 1095(k) may be used here, and any money collected must be handled under section 1079a. The Secretary of Defense must tell beneficiaries about these rights. Definitions: employer = includes state and local government; group health plan = as defined in Internal Revenue Code section 5000(b)(1); TRICARE-eligible employee = a covered beneficiary under section 1086.

Title 10, §1097c

Armed Forces — Source: USLM XML via OLRC

(a)(1)Except as provided in this subsection, the provisions of section 1862(b)(3)(C) of the Social Security Act shall apply with respect to financial or other incentives for a TRICARE-eligible employee not to enroll (or to terminate enrollment) under a health plan which would (in the case of such enrollment) be a primary plan under section 1079(j)(1) 11 See References in Text note below. and 1086(g) of this title in the same manner as such section 1862(b)(3)(C) applies to financial or other incentives for an individual entitled to benefits under title XVIII of the Social Security Act not to enroll (or to terminate enrollment) under a group health plan or a large group health plan which would (in the case of enrollment) be a primary plan (as defined in section 1862(b)(2)(A) of such Act).

(2)(A)The Secretary of Defense may by regulation adopt such additional exceptions to the prohibition referenced and applied under paragraph (1) as the Secretary deems appropriate and such paragraph (1) shall be implemented taking into account the adoption of such exceptions.

(B)The Secretary of Defense and the Secretary of Health and Human Services are authorized to enter into agreements for carrying out this subsection. Any such agreement shall provide that any expenses incurred by the Secretary of Health and Human Services pertaining to carrying out this subsection shall be reimbursed by the Secretary of Defense.

(C)Authorities of the Inspector General of the Department of Defense shall be available for oversight and investigations of responsibilities of employers and other entities under this subsection.

(D)Information obtained under section 1095(k) of this title may be used in carrying out this subsection in the same manner as information obtained under section 1862(b)(5) of the Social Security Act may be used in carrying out section 1862(b) of such Act.

(E)Any amounts collected in carrying out paragraph (1) shall be handled in accordance with section 1079a of this title.

(b)A TRICARE-eligible employee shall have the opportunity to elect to participate in the group health plan offered by the employer of the employee and receive primary coverage for health care services under the plan in the same manner and to the same extent as similarly situated employees of such employer who are not TRICARE-eligible employees.

(c)The provisions of this section do not apply to any employer who has fewer than 20 employees.

(d)Nothing in this section, including an election made by a TRICARE-eligible employee under subsection (b), shall be construed to affect, modify, or terminate the eligibility of a TRICARE-eligible employee or spouse of such employee for health care or dental services under this chapter in accordance with the other provisions of this chapter.

(e)The Secretary of Defense shall, in coordination with the other administering Secretaries, conduct outreach to inform covered beneficiaries who are entitled to health care benefits under the TRICARE program of the rights and responsibilities of such beneficiaries and employers under this section.

(f)In this section:

(1)The term “employer” includes a State or unit of local government.

(2)The term “group health plan” means a group health plan (as that term is defined in section 5000(b)(1) of the Internal Revenue Code of 1986 without regard to section 5000(d) of the Internal Revenue Code of 1986).

(3)The term “TRICARE-eligible employee” means a covered beneficiary under section 1086 of this title entitled to health care benefits under the TRICARE program.

(g)This section shall take effect on January 1, 2008.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 1079(j) of this title, referred to in subsec. (a)(1), was redesignated section 1079(i) of this title by Pub. L. 113–291, div. A, title VII, § 703(a)(3), Dec. 19, 2014, 128 Stat. 3411. The Social Security Act, referred to in subsec. (a)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to subchapter XVIII (§ 1395 et seq.) of chapter 7 of Title 42, The Public Health and Welfare. section 1862 of the Act is classified to section 1395y of Title 42. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. section 5000 of the Internal Revenue Code of 1986, referred to in subsec. (f)(2), is classified to section 5000 of Title 26, Internal Revenue Code.

§1097c Tricare Program: Relationship with Employer-sponsored Group Health Plans

Summary

Title 10, §1097c

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata