Sec. 701. Revisions to TRICARE cost sharing requirements
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Section 1097 of title 10, United States Code, is amended— in subsection (e)— by striking
(1)before The Secretary ; and by striking paragraph (2); and by adding at the end the following new subsection: Beginning January 1, 2014, the enrollment fee described in subsection
(e)for a covered beneficiary shall be an amount (rounded to the nearest dollar) equal to the applicable percentage (specified in paragraph (2)) of the retired pay of the member or former member upon whom the covered beneficiary’s eligibility is based, except that the amount of such enrollment fee shall not be in excess of the applicable maximum enrollment fee nor less than the applicable minimum enrollment fee specified in paragraph (3). The applicable percentage of retired pay shall be determined in accordance with the following table: For: The applicable percentage for a family group of two or more persons is: The applicable percentage for an individual is: 2014 2.95% 1.475% 2015 3.30% 1.650% 2016 3.65% 1.825% 2017 and after 4.00% 2.000%. For the years 2014 through 2017, the applicable maximum and minimum enrollment fees for a family group of two or more persons shall be determined in accordance with the following table: For: The applicable minimum enrollment fee is: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–7 or above is: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–6 or below is: 2014 $548 $900 $750 2015 $558 $1,200 $900 2016 $569 $1,500 $1,050 2017 $581 $1,800 $1,200. The applicable maximum and minimum enrollment fees for an individual shall be one-half the corresponding maximum and minimum enrollment fees for a family group of two or more persons (as specified in clause (i)). For any year after 2017, the applicable maximum and minimum enrollment fees shall be equal to the maximum and minimum enrollment fees for the previous year increased by the percentage by which retired pay is increased under section 1401a of this title for such calendar year. Notwithstanding paragraph (1), the enrollment fee described in subsection
(e)for a dependent of a member of the uniformed services who dies while on active duty, a member retired under chapter 61 of this title, or for a dependent of such a member shall not exceed the amount of any such enrollment fee for 2013. . Section 1086(b) of such title is amended to read as follows: For a person covered by this section, any plan contracted for under section 1079(a) of this title shall contain the following provisions for payment by the patient: An annual enrollment fee. The amount of such annual enrollment fee for a year is— for 2014, $70 for an individual or $140 for a family group of two or more persons; for 2015, $85 for an individual or $170 for a family group of two or more persons; for 2016, $100 for an individual or $200 for a family group of two or more persons; for 2017, $115 for an individual or $230 for a family group of two or more persons; for 2018, $125 for an individual or $250 for a family group of two or more persons; and for any year after 2018, the amount of the applicable enrollment fee for the previous year increased by the percentage by which retired pay is increased under section 1401a of this title for such year. An annual deductible of the charges in a year for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a year. The amount of such annual deductible for a year is— for 2014, $160 for an individual or $320 for a family group of two or more persons; for 2015, $200 for an individual or $400 for a family group of two or more persons; for 2016, $230 for an individual or $460 for a family group of two or more persons; for 2017, $260 for an individual or $520 for a family group for a family group of two or more persons; for 2018, $290 for an individual or $580 for a family group of two or more persons; and for any year after 2018, the amount of the applicable deductible for the previous year increased by the percentage by which retired pay is increased under section 1401a of this title for such year. 25 percent of the charges for inpatient care. The Secretary of Defense may exempt a patient from paying such charges if the hospital to which the patient is admitted does not impose a legal obligation on any of its patients to pay for inpatient care. A person covered by this section may not be required to pay a total in excess of a catastrophic cap, excluding the amount of any annual enrollment fee under paragraph (1), for health care received during any year under a plan contracted for under section 1079(a) of this title. The amount of such catastrophic cap for a year is— for 2013, $3,000; and for any year after 2013, the amount of the catastrophic cap for the previous year increased by the percentage by which retired pay is increased under section 1401a of this title for such year. Notwithstanding paragraphs (1), (2), and (4), for a dependent of a member of the uniformed services who dies while on active duty, a member retired under chapter 61 of this title, or a dependent of such a member— there is no annual enrollment fee; the annual deductible referred to in paragraph
(2)for a year is $150 for an individual or $300 for a family group of two or more persons; and the catastrophic cap for a year is $3,000. . Section 1086(d)(3) of such title is amended by adding at the end the following new subparagraph: Beginning January 1, 2014, a person described in paragraph
(2)(except as provided in clauses
(vi)and (vii)), shall pay an annual enrollment fee as a condition of eligibility for health care benefits under this section. Such enrollment fee shall be an amount (rounded to the nearest dollar) equal to the applicable percentage (specified in clause (ii)) of the retired pay of the member or former member upon whom the covered beneficiary’s eligibility is based, except that the amount of such enrollment fee shall not be in excess of the applicable maximum enrollment fee (specified in clause (iii)). The applicable percentage of retired pay shall be determined in accordance with the following table: For: The applicable percentage for a family group of two or more persons is: The applicable percentage for an individual is: 2014 0.50% 0.25% 2015 1.00% 0.50% 2016 1.50% 0.75% 2017 and after 2.00% 1.00%. For any year 2014 through 2017, the applicable maximum enrollment fees for a family group of two or more persons shall be determined in accordance with the following table: For: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–7 or above is: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–6 or below is: 2014 $200 $150 2015 $400 $300 2016 $600 $450 2017 $800 $600. For any year after 2017, the applicable maximum enrollment fee shall be equal to the maximum enrollment fee for the previous year increased by the percentage by which retired pay is increased under section 1401a of this title for such year. The applicable maximum enrollment fee for an individual shall be one-half the corresponding maximum fee for a family group of two or more persons (as determined under clauses
(iii)and (iv)). Clause
(i)shall not apply to a dependent of a member of the uniformed services who dies while on active duty, a member retired under chapter 61 of this title, or a dependent of such a member. Clause
(i)also shall not apply to a person who, prior to the date of the enactment of this subparagraph, met the conditions described in paragraph (2)(A) and (B). . Section 1074g(a)(5) of such title is amended— by striking at least one of the means described in paragraph (2)(E) and inserting the national mail-order pharmacy program ; and by striking may include and all that follows through the end of the paragraph and inserting shall include cost sharing by the eligible covered beneficiary as specified in paragraph (6). . Section 1074g(a)(6) of such title is amended to read as follows: In the case of any of the years 2014 through 2023, the cost sharing amounts referred to in paragraph
(5)shall be determined in accordance with the following table: For: The cost sharing amount for 30-day supply of a retail generic is: The cost sharing amount for 30-day supply of a retail formulary is: The cost sharing amount for a 90-day supply of a mail order generic is: The cost sharing amount for a 90-day supply of a mail order formulary is: The cost amount for a 90-day supply of a mail order non-formulary is: 2014 $5 $26 $0 $26 $51 2015 $6 $28 $0 $28 $54 2016 $7 $30 $0 $30 $58 2017 $8 $32 $0 $32 $62 2018 $9 $34 $9 $34 $66 2019 $10 $36 $10 $36 $70 2020 $11 $38 $11 $38 $75 2021 $12 $40 $12 $40 $80 2022 $13 $43 $13 $43 $85 2023 $14 $45 $14 $45 $90. For any year after 2023, the cost sharing amounts referred to in paragraph
(5)shall be equal to the cost sharing amounts for the previous year, adjusted by an amount, if any, as determined by the Secretary to reflect changes in the costs of pharmaceutical agents and prescription dispensing, rounded to the nearest dollar. Notwithstanding subparagraphs
(A)and (B), the cost-sharing amounts referred to in paragraph
(5)for any year for a dependent of a member of the uniformed services who dies while on active duty, a member retired under chapter 61 of this title, or a dependent of such a member shall be equal to the cost sharing amounts, if any, for fiscal year 2013. . Such section 1074g is further amended by adding at the end the following new subsection: The pharmacy benefits program shall require eligible covered beneficiaries to refill non-generic prescription maintenance medications through military treatment facility pharmacies or the national mail-order pharmacy program. The Secretary shall determine the maintenance medications subject to the requirement under paragraph (1). In carrying out the requirement under paragraph (1), the Secretary shall ensure that the medications subject to the requirement under paragraph
(1)are— generally available to eligible covered beneficiaries through retail pharmacies only for an initial filing of a 30-day or less supply; and any refills of such medications are obtained through a military treatment facility pharmacy or the national mail-order pharmacy program. The Secretary may exempt the following prescription maintenance medications from the requirements in subparagraph (B): Medications that are for acute care needs. Such other medications as the Secretary determines appropriate. . Section 716 of the National Defense Authorization Act for Fiscal Year 2013 ( Public Law 112–239 ; 125 Stat. 1804) is repealed. Section 1079(b) of such title 10 is amended by striking fiscal each place it appears. The Secretary of Defense shall prescribe regulations to transition TRICARE health plan benefit years from a fiscal-year basis to a calendar-year basis pursuant to the amendments made by this subsection. Section 724 of the National Defense Authorization Act for Fiscal Year 1997 ( Public Law 104–201 ; 10 U.S.C. 1073 note) is amended— in subsection (b)— by striking For each fiscal year beginning after September 30, 1997, the and inserting The ; by inserting during any year after by designated providers ; and by striking fiscal year. and inserting year. ; and in subsection (d)(2)(B)— by striking For each fiscal year beginning after September 30, 2003, the and inserting The ; by striking during such fiscal year the first place it appears and inserting during any year ; and by striking fiscal year. and inserting year. . Section 1116 of such title is amended by adding at the end the following new subsection: During any fiscal year, if the Secretary of Defense determines that the amount certified under subsection
(c)is no longer accurate because of a significant change in circumstances or law, the Secretary of Defense may, if appropriate, certify a revised amount determined in accordance with subsection (b)(2) to the Secretary of the Treasury. If the Secretary of Defense makes a certification under paragraph (1), each other administering Secretary shall make and advise the Secretary of the Treasury of a revised determination, consistent with section 1111(c) of this title. If a certification and determination are made under paragraphs
(1)and (2), the Secretary of the Treasury shall promptly pay into or recoup from the Fund the difference between the amount paid into the Fund under subsection
(a)and the amount certified or determined by the administering Secretary under paragraph
(1)or (2). .
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- Pub. L. 112-239
- 125 Stat. 1804
- Pub. L. 104-201
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Sec. 701
Revisions to TRICARE cost sharing requirements
Pub. L.Pub. L. 112-239
Stat.125 Stat. 1804
Pub. L.Pub. L. 104-201
Cites 4Cited by 0 across 0 sources