10 U.S.C. § 1076d: TRICARE program: TRICARE Reserve Select coverage for members of the Selected Reserve

Except as provided in paragraph (2), a member of the Selected Reserve of the Ready Reserve of a reserve component of the armed forces is eligible for health benefits under TRICARE Reserve Select as provided in this section. During the period preceding January 1, 2030 , paragraph (1) does not apply to a member who is enrolled, or is eligible to enroll, in a health benefits plan under chapter 89 of title 5. Except as provided in paragraph (2), eligibility for TRICARE Reserve Select coverage of a member under this section shall terminate upon the termination of the member’s service in the Selected Reserve. During the period beginning on the date of the enactment of this paragraph and ending December 31, 2018 , eligibility for a member under this section who is involuntarily separated from the Selected Reserve under other than adverse conditions, as characterized by the Secretary concerned, shall terminate 180 days after the date on which the member is separated. While a member of a reserve component is covered by TRICARE Reserve Select under the section, the members of the immediate family of such member are eligible for TRICARE Reserve Select coverage as dependents of the member. If a member of a reserve component dies while in a period of coverage under this section, the eligibility of the members of the immediate family of such member for TRICARE Reserve Select coverage shall continue for three years beyond the date of death of the member. A member of a reserve component covered by TRICARE Reserve Select under this section shall pay a premium for that coverage. Such premium shall apply instead of any enrollment fees required under section 1075 of this title . The Secretary of Defense shall prescribe for the purposes of this section one premium for TRICARE Reserve Select coverage of members without dependents and one premium for TRICARE Reserve Select coverage of members with dependents referred to in subsection (f)(1). The premium prescribed for a coverage shall apply uniformly to all covered members of the reserve components. The monthly amount of the premium in effect for a month for TRICARE Reserve Select coverage under this section shall be the amount equal to 28 percent of the total monthly amount determined on an appropriate actuarial basis as being reasonable for that coverage. The appropriate actuarial basis for purposes of subparagraph (A) shall be determined, for each calendar year after calendar year 2009, by utilizing the actual cost of providing benefits under this section to members and their dependents during the calendar years preceding such calendar year. The premiums payable by a member of a reserve component under this subsection may be deducted and withheld from basic pay payable to the member under section 204 of title 37 or from compensation payable to the member under section 206 of such title. The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums. Amounts collected as premiums under this subsection shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title , shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section for such fiscal year. The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section. The term “immediate family”, with respect to a member of a reserve component, means all of the member’s dependents described in subparagraphs (A), (D), and (I) of section 1072(2) of this title . medical care at facilities of the uniformed services to which a dependent described in section 1076(a)(2) of this title is entitled; and health benefits under the TRICARE Select self-managed, preferred provider network option under section 1075 of this title made available to beneficiaries by reason of this section and subject to the cost-sharing requirements set forth in such section 1075. Except as provided in paragraph (2), enrollments in TRICARE Standard that are in effect on the day before the date of the enactment of this Act [ Oct. 17, 2006 ] under section 1076d of title 10 , United States Code, as in effect on such day, shall be continued until terminated after such day under such section 1076d as amended by this section. The enrollment of a member in TRICARE Standard that is in effect on the day before health care under TRICARE Standard is provided pursuant to the effective date in subsection (g) [set out as an Effective Date of 2006 Amendment note above] shall not be terminated by operation of the exclusion of eligibility under subsection (a)(2) of such section 1076d, as so amended, for the duration of the eligibility of the member under TRICARE Standard as in effect on October 16, 2006 .” The Secretary of Defense and the Director may jointly carry out a pilot program, at the election of the Secretary, under which the Director provides commercial health insurance coverage to eligible reserve component members who enroll in a health benefits plan under paragraph (4) as an individual, for self plus one coverage, or for self and family coverage. provide for enrollment by eligible reserve component members, at the election of the member, in a health benefits plan under paragraph (4) during an open enrollment period established by the Director for purposes of this subsection; meet the requirements of this subsection; are broadly representative of the health benefits plans available in the commercial market; and do not contain unnecessary restrictions, as determined by the Director; and offer a sufficient number of health benefits plans in order to provide eligible reserve component beneficiaries with an ample choice of health benefits plans, as determined by the Director. If the Secretary elects to carry out the pilot program, the Secretary and the Director shall carry out the pilot program for not less than five years. In providing health insurance coverage under the pilot program, the Director shall contract with qualified carriers for a variety of health benefits plans. may vary by type of plan design, covered benefits, geography, and price; shall include maximum limitations on out-of-pocket expenses paid by an eligible reserve component beneficiary for the health care provided; and may not exclude an eligible reserve component member who chooses to enroll. access to an ample number of medical providers, as determined by the Director; adherence to industry-accepted quality measurements, as determined by the Director; access to benefits described in paragraph (5), including ease of referral for health care services; and inclusion in the services covered by the plan of advancements in medical treatments and technology as soon as practicable in accordance with generally accepted standards of medicine. The health care benefits provided under chapter 55 of title 10, United States Code, excluding pharmaceutical, dental, and extended health care option benefits. Such other benefits as the Director determines appropriate. If an eligible reserve component beneficiary receives benefits described in paragraph (5) at a facility of the uniformed services, the health benefits plan under which the beneficiary is covered shall be treated as a third-party payer under section 1095 of title 10 , United States Code, and shall pay charges for such benefits as determined by the Secretary. may contract with qualified carriers with which the Director has contracted under paragraph (4) to provide health insurance coverage for health care services provided at military treatment facilities under this subsection; and may receive payments under section 1095 of title 10 , United States Code, from qualified carriers for health care services provided at military medical treatment facilities under this subsection. An eligible reserve component member may not receive benefits under a health benefits plan under this subsection during any period in which the member is serving on active duty for more than 30 days. Subparagraph (A) does not affect the coverage under a health benefits plan of any dependent of an eligible reserve component member. An individual is not eligible to enroll in or be covered under a health benefits plan under this subsection if the individual is eligible to enroll in a health benefits plan under the Federal Employees Health Benefits Program. Except as provided in clause (ii), an eligible reserve component member shall pay an annual premium amount calculated under subparagraph (B) for coverage under a health benefits plan under this subsection and additional amounts described in subparagraph (C) for health care services in connection with such coverage. During any period in which an eligible reserve component member is serving on active duty for more than 30 days, the eligible reserve component member is not responsible for paying any premium amount under subparagraph (B) or additional amounts under subparagraph (C). With respect to a dependent of an eligible reserve component member that is covered under a health benefits plan under this subsection, during any period described in subclause (I) with respect to the member, the Secretary shall, on behalf of the dependent, pay 100 percent of the total annual amount of a premium for coverage of the dependent under the plan and such cost-sharing amounts as may be applicable under the plan. The annual premium calculated under this subparagraph is an amount equal to 28 percent of the total annual amount of a premium under the health benefits plan selected. coverage as an individual; self plus one coverage; and self and family coverage. The additional amounts described in this subparagraph with respect to an eligible reserve component member are such cost-sharing amounts as may be applicable under the health benefits plan under which the member is covered. a contract under this subsection shall be for a uniform term of not less than one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party; a contract under this subsection shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits determined by the Director in accordance with paragraph (5); a contract under this subsection shall ensure that an eligible reserve component member who is eligible to enroll in a health benefits plan pursuant to such contract is able to enroll in such plan; and the terms of a contract under this subsection relating to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any conflicting State or local law. The Director shall perform a thorough evaluation of the financial solvency of an insurance carrier before entering into a contract with the insurance carrier under subparagraph (A). matters involving military medical treatment facilities; matters unique to eligible reserve component members and dependents of such members; and such other strategic guidance necessary for the Director to administer this subsection as the Secretary of Defense, in consultation with the Secretary of Homeland Security, considers appropriate. The Director shall not implement any recommendation provided by the Secretary of Defense under subparagraph (A) if the Director determines that the implementation of the recommendation would result in eligible reserve components beneficiaries receiving less generous health benefits under this subsection than the health benefits commonly available to individuals under the Federal Employees Health Benefits Program during the same period. the number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered; the number of health benefits plans offered under the pilot program and a description of each such plan; and the costs of the health care provided under the plans. The Secretary of Defense and the Director shall jointly establish an appropriate mechanism to fund the pilot program. for payments to health benefits plans under this subsection; and to pay the costs of administering this subsection. Not later than one year after the date on which the Secretary establishes the pilot program, and annually thereafter for the following three years, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the pilot program. The number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered. The number of health benefits plans offered under the pilot program. The cost of the pilot program to the Department of Defense. The estimated cost savings, if any, to the Department of Defense. The average cost to the eligible reserve component beneficiary. The effect of the pilot program on the medical readiness of the members of the reserve components. The effect of the pilot program on access to health care for members of the reserve components. the matters specified under subparagraph (B); and the recommendation of the Secretary regarding whether to make the pilot program permanent or to terminate the pilot program. The term ‘Director’ means the Director of the Office of Personnel Management. The term ‘eligible reserve component beneficiary’ means an eligible reserve component member enrolled in, or a dependent of such a member described in subparagraph (A), (D), or (I) of section 1072(2) of title 10 , United States Code, covered under, a health benefits plan under subsection (b). The term ‘eligible reserve component member’ means a member of the Selected Reserve of the Ready Reserve of an Armed Force. The term ‘extended health care option’ means the program of extended benefits under subsections (d) and (e) of section 1079 of title 10 , United States Code. The term ‘Federal Employees Health Benefits Program’ means the health insurance program under chapter 89 of title 5, United States Code. The term ‘qualified carrier’ means an insurance carrier that is licensed to issue group health insurance in any State, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, Guam, and any territory or possession of the United States.” The Secretary of Defense shall implement section 1076d of title 10 , United States Code, not later than 180 days after the date of the enactment of this Act [ Oct. 28, 2004 ]. the date applicable to the member under subsection (b) of such section; or the date of the agreement. The Secretary of Defense shall take such action as is necessary to ensure, to the maximum extent practicable, that members of the reserve components eligible to enter into an agreement as provided in subparagraph (A) actually receive information on the opportunity and procedures for entering into such an agreement together with a clear explanation of the benefits that the members are eligible to receive as a result of entering into such an agreement under section 1076d of title 10 , United States Code.”