Sec. 712. CONTINUITY OF HEALTH CARE COVERAGE FOR RESERVE COMPONENTS
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## SEC. 712 CONTINUITY OF HEALTH CARE COVERAGE FOR RESERVE COMPONENTS ###
(a)Study ####
(1)In general The Secretary of Defense shall conduct a study of options for providing health care coverage that improves the continuity of health care provided to current and former members of the Selected Reserve of the Ready Reserve who are not— #####
(A)serving on active duty; #####
(B)eligible for the Transitional Assistance Management Program under section 1145 of title 10, United States Code; or #####
(C)eligible for the Federal Employees Health Benefit Program. ####
(2)Elements The study under paragraph
(1)shall address the following: #####
(A)Whether to allow current and former members of the Selected Reserve to participate in the Federal Employees Health Benefit Program. #####
(B)Whether to pay a stipend to current and former members to continue coverage in a health plan obtained by the member. #####
(C)Whether to allow current and former members to participate in the TRICARE program under section 1076d of title 10, United States Code. #####
(D)Whether to amend section 1076f of title 10, United States Code, as added by section 711, to require the extension of TRICARE program coverage for members of the National Guard assigned to Homeland Response Force Units mobilized for a State emergency pursuant to chapter 9 of title 32, United States Code. #####
(E)The findings and recommendations under section 748. #####
(F)Any other options for providing health care coverage to current and former members of the Selected Reserve the Secretary considers appropriate. ####
(3)Consultation In carrying out the study under paragraph (1), the Secretary shall consult with, and obtain the opinions of, current and former members of the Selected Reserve, including the leadership of the Selected Reserve. ####
(4)Submission #####
(A)Report Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the congressional defense committees a report on the study under paragraph (1). #####
(B)Matters included The report under subparagraph
(A)shall include the following: ######
(i)A description of the health care coverage options addressed by the Secretary under paragraph (2). ######
(ii)Identification of such health care coverage option that the Secretary recommends as the best option. ######
(iii)The justifications for such recommended best option. ######
(iv)The number and proportion of the current and former members of the Selected Reserve projected to participate in such recommended best option. ######
(v)A determination of the appropriate cost sharing for such recommended best option with respect to the percentage contribution as a monthly premium for current members of the Selected Reserve. ######
(vi)An estimate of the cost of implementing such recommended best option. ######
(vii)Any legislative language required to implement such recommended best option. ###
(b)Pilot Program **[**[10 U.S.C. 1076d note](/us/usc/t10/s1076d)**]** ####
(1)Authorization 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. ####
(2)Elements The pilot program shall— #####
(A)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; #####
(B)include a variety of national and regional health benefits plans that— ######
(i)meet the requirements of this subsection; ######
(ii)are broadly representative of the health benefits plans available in the commercial market; and ######
(iii)do not contain unnecessary restrictions, as determined by the Director; and #####
(C)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. ####
(3)Duration 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. ####
(4)Health benefits plans #####
(A)In general In providing health insurance coverage under the pilot program, the Director shall contract with qualified carriers for a variety of health benefits plans. #####
(B)Description of plans Health benefits plans contracted for under this subsection— ######
(i)may vary by type of plan design, covered benefits, geography, and price; ######
(ii)shall include maximum limitations on out-of-pocket expenses paid by an eligible reserve component beneficiary for the health care provided; and ######
(iii)may not exclude an eligible reserve component member who chooses to enroll. #####
(C)Quality of plans The Director shall ensure that each health benefits plan offered under this subsection offers a high degree of quality, as determined by criteria that include— ######
(i)access to an ample number of medical providers, as determined by the Director; ######
(ii)adherence to industry-accepted quality measurements, as determined by the Director; ######
(iii)access to benefits described in paragraph (5), including ease of referral for health care services; and ######
(iv)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. ####
(5)Benefits A health benefits plan offered by the Director under this subsection shall include, at a minimum, the following benefits: #####
(A)The health care benefits provided under chapter 55 of title 10, United States Code, excluding pharmaceutical, dental, and extended health care option benefits. #####
(B)Such other benefits as the Director determines appropriate. ####
(6)Care at facilities of uniformed services #####
(A)In general 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. #####
(B)Military medical treatment facilities The Secretary, in consultation with the Director— ######
(i)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 ######
(ii)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. ####
(7)Special rule relating to active duty period #####
(A)In general 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. #####
(B)Treatment of dependents Subparagraph
(A)does not affect the coverage under a health benefits plan of any dependent of an eligible reserve component member. ####
(8)Eligibility for federal employees health benefits program 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. ####
(9)Cost sharing #####
(A)Responsibility for payment ######
(i)In general 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. ######
(ii)Active duty period ######
(I)In general 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). ######
(II)Coverage of dependents 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. #####
(B)Premium amount ######
(i)In general 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. ######
(ii)Types of coverage The premium amounts calculated under this subparagraph shall include separate calculations for— ######
(I)coverage as an individual; ######
(II)self plus one coverage; and ######
(III)self and family coverage. #####
(C)Additional amounts 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. ####
(10)Contracting #####
(A)In general In contracting for health benefits plans under paragraph (4), the Director may contract with qualified carriers in a manner similar to the manner in which the Director contracts with carriers under section 8902 of title 5, United States Code, including that— ######
(i)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; ######
(ii)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); ######
(iii)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 ######
(iv)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. #####
(B)Evaluation of financial solvency 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). ####
(11)Recommendations and data #####
(A)In general The Secretary of Defense, in consultation with the Secretary of Homeland Security, shall provide recommendations and data to the Director with respect to— ######
(i)matters involving military medical treatment facilities; ######
(ii)matters unique to eligible reserve component members and dependents of such members; and ######
(iii)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. #####
(B)Limitation on implementation 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. ####
(12)Transmission of information On an annual basis during each year in which the pilot program is carried out, the Director shall provide the Secretary with information on the use of health care benefits under the pilot program, including— #####
(A)the number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered; #####
(B)the number of health benefits plans offered under the pilot program and a description of each such plan; and #####
(C)the costs of the health care provided under the plans. ####
(13)Funding #####
(A)In general The Secretary of Defense and the Director shall jointly establish an appropriate mechanism to fund the pilot program. #####
(B)Availability of amounts Amounts shall be made available to the Director pursuant to the mechanism established under subparagraph (A), without fiscal year limitation— ######
(i)for payments to health benefits plans under this subsection; and ######
(ii)to pay the costs of administering this subsection. ####
(14)Reports #####
(A)Initial reports 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. #####
(B)Matters included The report under subparagraph
(A)shall include, with respect to the year covered by the report, the following: ######
(i)The number of eligible reserve component beneficiaries participating in the pilot program, listed by the health benefits plan under which the beneficiary is covered. ######
(ii)The number of health benefits plans offered under the pilot program. ######
(iii)The cost of the pilot program to the Department of Defense. ######
(iv)The estimated cost savings, if any, to the Department of Defense. ######
(v)The average cost to the eligible reserve component beneficiary. ######
(vi)The effect of the pilot program on the medical readiness of the members of the reserve components. ######
(vii)The effect of the pilot program on access to health care for members of the reserve components. #####
(C)Final report Not later than 180 days before the date on which the pilot program will terminate pursuant to paragraph (3), the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the pilot program that includes— ######
(i)the matters specified under subparagraph (B); and ######
(ii)the recommendation of the Secretary regarding whether to make the pilot program permanent or to terminate the pilot program. ###
(c)Definitions In this section: ####
(1)The term “Director” means the Director of the Office of Personnel Management. ####
(2)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). ####
(3)The term “eligible reserve component member” means a member of the Selected Reserve of the Ready Reserve of an Armed Force. ####
(4)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. ####
(5)The term “Federal Employees Health Benefits Program” means the health insurance program under chapter 89 of title 5, United States Code. ####
(6)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.
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Sec. 712
CONTINUITY OF HEALTH CARE COVERAGE FOR RESERVE COMPONENTS
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