Health Plan

Date of Publication:

3/13/2019

Definition:

Any DOD program that provides or pays the cost of health care, unless exempted under this definition of health plan. The following components of the TRICARE Program are a health plan under this issuance

• The program that provides health care under the authority of the Department of the Army to members of the Uniformed Services. (Administrator: Surgeon General of the Army.)
• The program that provides health care under the authority of the Department of the Navy to members of the Uniformed Services. (Administrator: Surgeon General of the Navy.)
• The program that provides health care under the authority of the Department of the Air Force to members of the Uniformed Services. (Administrator: Surgeon General of the Air Force.)
• The Supplemental Care Program under Section 1074c of Title 10, U.S.C., and Section 199.16 of Title 32, CFR, for members of the Army, Navy, Marine Corps, and Air Force who receive health care services from providers other than providers of the DOD. (Administrators: Surgeon General of the Army for members of the Army; Surgeon General of the Navy for members of the Navy and Marine Corps; Surgeon General of the Air Force for members of the Air Force.) 
• The TRICARE Prime and TRICARE Select (including plans previously known as TRICARE Extra, and TRICARE Standard) health care options offered under Section 199.17 of Title 32, CFR. (Administrator: DHA.) The health care program for the uniformed services under Chapter 55 of Title 10, U.S.C. (Administrator: DHA.)

The following are also included as health plans:

• The TRICARE Dental Program under Section 1076a of Title 10, U.S.C. (Administrator: DHA.)
• The TRICARE Retiree Dental Program under Section 1076c of Title 10, U.S.C. (Administrator: DHA.)
• The Continued Health Care Benefit Program under Section 1078a of Title 10, U.S.C. (Administrator: DHA.)
• The Designated Provider Program under Section 1073 of Title 10, U.S.C. (Administrator: DHA.)

Programs conducted as demonstration projects under Section 1092 of Title 10, U.S.C. to the extent not otherwise included under a health plan.

• The pharmacy benefits program offered under Section 199.21 of Title 32, CFR.
• The TRICARE Reserve Select program offered under Section 199.24 of Title 32, CFR.
• The TRICARE Retired Reserve program offered under Section 199.25 of Title 32, CFR.

Health plan excludes the following DOD programs:

• Although part of the TRICARE Program, the programs that provide health care in medical and dental treatment facilities of the Departments of the Army, Navy, and Air Force to beneficiaries other than members of the Military Services are excluded by the HIPAA Rules from the definition of health plan.
• The Women, Infants, and Children Program.
• Occupational health clinics for civilian employees or contractor personnel.
• Any other policy, plan, or program to the extent that it provides, or pays for the cost of workers’ compensation benefits or insurance coverage such as liability, accident, automobile, disability, or similar coverage.
• Any other program whose principal purpose is other than providing, or paying the cost of, health care.  
• Any other program (other than one identified as specifically being a health plan) whose principal activity is the direct provision of health care to persons.
• Any other program whose principal activity is the making of grants to fund the direct provision of health care to persons.