Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care
(a)
In General .—
The Secretary of Defense, after consulting with the other administering Secretaries, may contract for the delivery of health care to which covered beneficiaries are entitled under this chapter. The Secretary may enter into a contract under this section with any of the following:
(1)
Health maintenance organizations.
(2)
Preferred provider organizations.
(3)
Individual providers, individual medical facilities, or insurers.
(4)
Consortiums of such providers, facilities, or insurers.
(b)
Scope of Coverage Under Health Care Plans .—
A contract entered into under this section may provide for the delivery of—
(1)
selected health care services;
(2)
total health care services for selected covered beneficiaries; or
(3)
total health care services for all covered beneficiaries who reside in a geographical area designated by the Secretary.
(c)
Coordination With Facilities of the Uniformed Services .—
The Secretary of Defense may provide for the coordination of health care services provided pursuant to any contract or agreement under this section with those services provided in medical treatment facilities of the uniformed services. Subject to the availability of space and facilities and the capabilities of the medical or dental staff, the Secretary may not deny access to facilities of the uniformed services to a covered beneficiary on the basis of whether the beneficiary enrolled or declined enrollment in any program established under, or operating in connection with, any contract under this section. Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall, as an incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiaries enrolled in any program established under, or operating in connection with, any contract under this section.
(d)
Coordination With Other Health Care Programs .—
In the case of a covered beneficiary who is enrolled in a managed health care program not operated under the authority of this chapter, the Secretary may contract under this section with such other managed health care program for the purpose of coordinating the beneficiary’s dual entitlements under such program and this chapter. A managed health care program with which arrangements may be made under this subsection includes any health maintenance organization, competitive medical plan, health care prepayment plan, or other managed care program recognized pursuant to regulations issued by the Secretary.
(e)
Charges for Health Care .—
(1)
section 1099 of this titlesection 1086 of this titlesection 1086(b) of this titlesection 1086(d)(1) of this titlesection 1099 of this title The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided under this section. In the case of contracts for health care services under this section or health care plans offered under for which the Secretary permits covered beneficiaries who are covered by and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in , the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in who also participate in such contracts or plans. Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under , the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation. Except as provided by paragraph (2), a premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on , and ending on .
(2)
section 1401a of this title Beginning , the Secretary of Defense may only increase in any year the annual enrollment fees described in paragraph (1) by an amount equal to the percentage by which retired pay is increased under .
Pub. L. 112–812011—Subsec. (e). designated existing provisions as par. (1), substituted “Except as provided by paragraph (2), a premium,” for “A premium,”, and added par. (2).
Pub. L. 109–3642006—Subsec. (e). inserted at end “A premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on , and ending on .”
Pub. L. 104–106, § 7121996—Subsec. (c). , substituted “Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall” for “However, the Secretary may”.
Pub. L. 104–106, § 713section 1099 of this titleSubsec. (e). , inserted at end “Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under , the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation.”
Pub. L. 103–337, § 713section 1099 of this titlesection 1086 of this titlesection 1086(b) of this titlesection 1086(d)(1) of this title, inserted at end “In the case of contracts for health care services under this section or health care plans offered under for which the Secretary permits covered beneficiaries who are covered by and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in , the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in who also participate in such contracts or plans.”
Pub. L. 103–337, § 714(a)Subsecs. (d), (e). , added subsec. (d) and redesignated former subsec. (c) as (e).
section 1097(e)(2) of title 10“The Secretary of Defense shall determine the maximum enrollment fees for TRICARE Prime under , United States Code, as added by subsection (a), for fiscal year 2013 and thereafter as if the enrollment fee for each enrollee during fiscal year 2012 was the amount charged to an enrollee who enrolled for the first time during such fiscal year.”