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

Summary

Employers may not pay or give other rewards to get TRICARE-eligible workers to avoid or drop an employer health plan that would be the worker’s main coverage. The rule mostly follows the same limits used to stop similar incentives for people on Medicare. The Secretary of Defense can allow limited extra exceptions by rule. The Defense and Health and Human Services Departments can make agreements to carry out the rule, with HHS costs paid back by Defense. The Defense Department’s Inspector General can check on employers. Certain data may be used to enforce the rule, and any money collected must be handled under existing law. TRICARE-eligible workers can choose to join their employer’s group health plan and get primary coverage just like other employees. Employers with fewer than 20 workers are not covered. Choosing the employer plan does not take away TRICARE or dental benefits. The Secretary of Defense must tell beneficiaries and employers about these rights. Effective date: January 1, 2008. Definitions: employer = includes state or local government; group health plan = as defined in the tax code; TRICARE-eligible employee = a person entitled to TRICARE benefits.