(a)
(1) There are no cost-sharing requirements for beneficiaries who are covered by section 1074(a) of this title.
(2) With respect to beneficiaries in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title) by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018, or by reason of being a dependent of such a member, the cost-sharing requirements shall be calculated pursuant to subsection (b)(1).
(3)
(A) With respect to beneficiaries described in subparagraph (B) in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title), the cost-sharing requirements shall be calculated in accordance with the other provisions of this chapter without regard to subsection (b).
(B) Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018, or by reason of being a dependent of such a member.
(b)
| TRICARE Prime | Active-Duty Family Member
(Individual/Family) |
Retired
(Individual/Family) |
|---|---|---|
| Annual Enrollment | $0 | $350 / $700 |
| Annual deductible | No | No |
| Annual catastrophic cap | $1,000 | $3,500 |
| Outpatient visit civilian network | $0 | $20 primary care |
| $30 specialty care | ||
| ER visit civilian network | $0 | $60 network |
| Urgent care civilian network | $0 | $30 network |
| Ambulatory surgery civilian network | $0 | $60 network |
| Ground ambulance civilian network | $0 | $40 |
| Durable medical equipment civilian network | $0 | 20% of negotiated fee, network |
| Inpatient visit civilian network | $0 | $150 per admission |
| Inpatient skilled nursing/rehab civilian | $0 | $30 per day network |
(2) Each dollar amount expressed as a fixed dollar amount in the table set forth in paragraph (1) shall be annually indexed to the amount by which retired pay is increased under section 1401a of this title, rounded to the next lower multiple of $1. The remaining amount above such multiple of $1 shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and made when the aggregate amount of increases carried over under this clause for a year is $1 or more.
(3) Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis.
(4) The cost-sharing requirements applicable to services not specifically addressed in the table set forth in paragraph (1) shall be established by the Secretary.
(c)
Amendments
2017—Subsec. (b)(1). Pub. L. 115–91, §739(b)(2)(B), which directed amendment of "Paragraph (1) of such section" by substituting "Ground ambulance civilian network" for "Ambulance civilian network" in first column of table, was executed by making the substitution in par. (1) of subsec. (b) of this section, to reflect the probable intent of Congress.
Subsec. (b)(4). Pub. L. 115–91, §739(b)(2)(A), added par. (4).
Subsec. (c). Pub. L. 115–91, §739(e)(2), substituted "section 1095f(a)" for "section 1075f(a)".
Effective Date
Section applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see section 701(k) of Pub. L. 114–328, set out as an Effective Date of 2016 Amendment note under section 1072 of this title.
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