View all text of Chapter 55 [§ 1071 - § 1110b]

§ 1097a. TRICARE Prime: automatic enrollments
(a)Automatic Enrollment of Certain Dependents.—
(1) In the case of a dependent of a member of the uniformed services who is entitled to medical and dental care under section 1076(a)(2)(A) of this title and resides in a catchment area in which TRICARE Prime is offered, the Secretary—
(A) shall automatically enroll the dependent in TRICARE Prime if the member is in pay grade E–4 or below; and
(B) may automatically enroll the dependent in TRICARE Prime if the member is in pay grade E–5 or higher.
(2) Whenever a dependent of a member is enrolled in TRICARE Prime under paragraph (1), the Secretary concerned shall provide written notice of the enrollment to the member.
(3) The enrollment of a dependent of the member may be terminated by the member or the dependent at any time.
(b)Automatic Renewal of Enrollments of Covered Beneficiaries.—An enrollment of a covered beneficiary in TRICARE Prime shall be automatically renewed upon the expiration of the enrollment unless the renewal is declined.
(c)Regulations and Exceptions.—The Secretary of Defense shall prescribe regulations, including procedures, to carry out this section. Regulations prescribed to carry out the automatic enrollment requirements under this section may include such exceptions to the automatic enrollment procedures as the Secretary determines appropriate for the effective operation of TRICARE Prime.
(d)No Copayment for Immediate Family.—No copayment shall be charged a member for care provided under TRICARE Prime to a dependent of a member of the uniformed services described in subparagraph (A), (D), or (I) of section 1072(2) of this title.
(e)Authority for Multiple Networks in the Same Geographic Area.—
(1) The Secretary may establish a system of multiple networks of providers under TRICARE Prime in the same geographic area or areas.
(2) Under a system established under paragraph (1), the Secretary may require a covered beneficiary enrolling in TRICARE Prime to enroll in a specific provider network established pursuant to such system, in which case any provider not in that specific provider network shall be deemed an out-of-network provider with respect to the covered beneficiary (regardless of whether the provider is in a different TRICARE Prime provider network) for purposes of this section or any other provision of law limiting the coverage or provision of health care services to those provided by network providers under the TRICARE program.
(f)Definitions.—In this section:
(1) The term “TRICARE Prime” means the managed care option of the TRICARE program.
(2) The term “catchment area”, with respect to a facility of a uniformed service, means the service area of the facility, as designated under regulations prescribed by the administering Secretaries.
(Added Pub. L. 105–261, div. A, title VII, § 712(a)(1), Oct. 17, 1998, 112 Stat. 2058; amended Pub. L. 106–398, § 1 [[div. A], title VII, § 752(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–195; Pub. L. 107–107, div. A, title X, § 1048(a)(11), Dec. 28, 2001, 115 Stat. 1223; Pub. L. 112–239, div. A, title VII, § 711, Jan. 2, 2013, 126 Stat. 1801; Pub. L. 114–328, div. A, title VII, § 723, Dec. 23, 2016, 130 Stat. 2229; Pub. L. 116–92, div. A, title VII, § 702(b)(1), (2)(A), Dec. 20, 2019, 133 Stat. 1436; Pub. L. 117–81, div. A, title VII, § 703(b), Dec. 27, 2021, 135 Stat. 1779.)