TITLE and PURPOSE:“The National Guard and Reserve
Comprehensive Health Benefit Act of 2003", to provide comprehensive health
care benefits to National Guardsmen, Reservists, and their family members in
furtherance of their military readiness and well-being.
OBJECTIVE:1) Offer Reserve and National Guard members of the Selected Reserve the
opportunity to participate for themselves and their family members in the
TRICARE program available to active duty service members and their families; 2)
Offer a partial DOD subsidy of private health insurance premiums for family
members of activated Reservists and Guardsmen who wish to retain their private
health insurance, rather than converting to TRICARE coverage; and 3) Improve
transition coverage upon deactivation.
Eligibility for the Program
Members
of the Selected Reserve of the Ready Reserve and members of the Individual
Ready Reserve described in 10 USC 10144(b) and their dependents.
TRICARE Coverage
The
Secretary of Defense shall establish a program whereby eligible members of
the Ready Reserve may enroll for health care coverage under TRICARE.Eligible members may elect individual or
family coverage.
The
benefit available, in terms of covered services and member copayments and deductibles, will be the same as
currently available to active duty service members and their dependents
under chapter 55 of title 10, U.S. Code.
Eligible
members may enroll in either TRICARE Standard or TRICARE Prime and, if
enrolled in Prime, would be eligible for coverage under the TRICARE Prime
Remote program.
This
program will be offered on a cost-shared basis between DOD and the
eligible member.To participate in
this program, eligible members must pay a premium determined by the
Secretary of Defense.The cost
sharing split of premium costs between the Department of Defense and the
member should be analogous to the current cost sharing split between the
Government and Federal employees under the Federal Employees’ Health
Benefits Program (FEHBP) prescribed in title 5, U.S. Code; the overall
members’ share of premium costs may not exceed the employees’ share under
FEHBP.The Secretary shall
prescribe premiums for individual and family coverage.
The
Secretary of Defense shall offer an open period during which eligible
members may enroll, disenroll, or change their
coverage option (single/family) at least once per year.
The
member’s share of the premium for the plan established under this section
may be paid by deductions from the basic pay of the member and from
compensation paid under section 206 of title 37, as the case may be.The regulations prescribed shall specify
the procedures for payment of the premiums by enrollees who do not receive
such pay.
Coverage
under this program is terminated if the individual is no longer an
eligible member of the Ready Reserve.
Allowance for Continuation of Family Member Private Health Insurance
Coverage
Dependents
of eligible members of the Ready Reserve may, upon activation of the
eligible member, decline participation in TRICARE and receive in lieu
thereof an allowance for the premium costs of continuing their current
private health insurance coverage.The Secretary of Defense shall establish by regulation the procedure
by which dependents may verify the payment of their insurance premium
costs and thereby obtain reimbursement.
The
amount of the allowance may not exceed DOD’s total per capita cost of
providing the TRICARE benefit to dependents.
Transition Coverage Upon Release from Active Duty
Upon release
from active duty, eligible members of the Ready Reserve may elect to
enroll for single or family coverage in the cost-shared Reserve TRICARE
program established by this section.The member and dependents may enroll, with coverage effective upon
the expiration of transitional health care benefits authorized by 10 USC
1145, regardless of whether the member and dependents were enrolled in the
Reserve TRICARE program prior to activation.
During
the first year of coverage, the member may terminate program participation
without regard to the open enrollment/disenrollment
period prescribed by the Secretary of Defense.Thereafter, any disenrollment
must occur during the open period prescribed by the Secretary.
Coverage under this program is terminated
if the individual is no longer an eligible member of the Ready Reserve.
