
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 10USC1095]

 
                         TITLE 10--ARMED FORCES
 
                    Subtitle A--General Military Law
 
                           PART II--PERSONNEL
 
                   CHAPTER 55--MEDICAL AND DENTAL CARE
 
Sec. 1095. Health care services incurred on behalf of covered 
        beneficiaries: collection from third-party payers
        
    (a)(1) In the case of a person who is a covered beneficiary, the 
United States shall have the right to collect from a third-party payer 
reasonable charges for health care services incurred by the United 
States on behalf of such person through a facility of the uniformed 
services to the extent that the person would be eligible to receive 
reimbursement or indemnification from the third-party payer if the 
person were to incur such charges on the person's own behalf. If the 
insurance, medical service, or health plan of that payer includes a 
requirement for a deductible or copayment by the beneficiary of the 
plan, then the amount that the United States may collect from the third-
party payer is a reasonable charge for the care provided less the 
appropriate deductible or copayment amount.
    (2) A covered beneficiary may not be required to pay an additional 
amount to the United States for health care services by reason of this 
section.
    (b) No provision of any insurance, medical service, or health plan 
contract or agreement having the effect of excluding from coverage or 
limiting payment of charges for certain care shall operate to prevent 
collection by the United States under subsection (a) if that care is 
provided--
        (1) through a facility of the uniformed services;
        (2) directly or indirectly by a governmental entity;
        (3) to an individual who has no obligation to pay for that care 
    or for whom no other person has a legal obligation to pay; or
        (4) by a provider with which the third party payer has no 
    participation agreement.

    (c) Under regulations prescribed under subsection (f), records of 
the facility of the uniformed services that provided health care 
services to a beneficiary of an insurance, medical service, or health 
plan of a third-party payer shall be made available for inspection and 
review by representatives of the payer from which collection by the 
United States is sought.
    (d) Notwithstanding subsections (a) and (b), and except as provided 
in subsection (j), collection may not be made under this section in the 
case of a plan administered under title XVIII or XIX of the Social 
Security Act (42 U.S.C. 1395 et seq.).
    (e)(1) The United States may institute and prosecute legal 
proceedings against a third-party payer to enforce a right of the United 
States under this section.
    (2) The administering Secretary may compromise, settle, or waive a 
claim of the United States under this section.
    (f) The Secretary of Defense, in consultation with the other 
administering Secretaries, shall prescribe regulations for the 
administration of this section. Such regulations shall provide for 
computation of the reasonable cost of health care services. Computation 
of such reasonable cost may be based on--
        (1) per diem rates;
        (2) all-inclusive per visit rates;
        (3) diagnosis-related groups; or
        (4) such other method as may be appropriate.

    (g)(1) Amounts collected under this section from a third-party payer 
or under any other provision of law from any other payer for health care 
services provided at or through a facility of the uniformed services 
shall be credited to the appropriation supporting the maintenance and 
operation of the facility and shall not be taken into consideration in 
establishing the operating budget of the facility.
    (2) Not later than February 15 of each year, the Secretary of 
Defense shall submit to Congress a report specifying for each facility 
of the uniformed services the amount credited to the facility under this 
subsection during the preceding fiscal year.
    (h) In this section:
        (1) The term ``third-party payer'' means an entity that provides 
    an insurance, medical service, or health plan by contract or 
    agreement, including an automobile liability insurance or no fault 
    insurance carrier, and any other plan or program that is designed to 
    provide compensation or coverage for expenses incurred by a 
    beneficiary for health care services or products. Such term also 
    includes entities described in subsection (j) under the terms and to 
    the extent provided in such subsection.
        (2) The term ``insurance, medical service, or health plan'' 
    includes a preferred provider organization, an insurance plan 
    described as Medicare supplemental insurance, and a personal injury 
    protection plan or medical payments benefit plan for personal 
    injuries resulting from the operation of a motor vehicle.
        (3) The term ``health care services'' includes products provided 
    or purchased through a facility of the uniformed services.

    (i)(1) In the case of a third-party payer that is an automobile 
liability insurance or no fault insurance carrier, the right of the 
United States to collect under this section shall extend to health care 
services provided to a person entitled to health care under section 
1074(a) of this title.
    (2) In cases in which a tort liability is created upon some third 
person, collection from a third-party payer that is an automobile 
liability insurance carrier shall be governed by the provisions of 
Public Law 87-693 (42 U.S.C. 2651 et seq.).
    (j) The Secretary of Defense may enter into an agreement with any 
health maintenance organization, competitive medical plan, health care 
prepayment plan, or other similar plan (pursuant to regulations issued 
by the Secretary) providing for collection under this section from such 
organization or plan for services provided to a covered beneficiary who 
is an enrollee in such organization or plan.
    (k)(1) To improve the administration of this section and sections 
1079(j)(1) and 1086(d) of this title, the Secretary of Defense, in 
consultation with the other administering Secretaries, may prescribe 
regulations providing for the collection of information regarding 
insurance, medical service, or health plans of third-party payers held 
by covered beneficiaries.
    (2) The collection of information under regulations prescribed under 
paragraph (1) shall be conducted in the same manner as is provided in 
section 1862(b)(5) of the Social Security Act (42 U.S.C. 1395y(b)(5)). 
The Secretary may provide for obtaining from the Commissioner of Social 
Security employment information comparable to the information provided 
to the Administrator of the Health Care Financing Administration 
pursuant to such section. Such regulations may require the mandatory 
disclosure of Social Security account numbers for all covered 
beneficiaries.
    (3) The Secretary may disclose relevant employment information 
collected under this subsection to fiscal intermediaries or other 
designated contractors.
    (4) The Secretary may provide for contacting employers of covered 
beneficiaries to obtain group health plan information comparable to the 
information authorized to be obtained under section 1862(b)(5)(C) of the 
Social Security Act (42 U.S.C. 1395y(b)(5)(C)). Notwithstanding clause 
(iii) of such section, clause (ii) of such section regarding the 
imposition of civil money penalties shall apply to the collection of 
information under this paragraph.
    (5) Information obtained under this subsection may not be disclosed 
for any purpose other than to carry out the purpose of this section and 
sections 1079(j)(1) and 1086(d) of this title.

(Added Pub. L. 99-272, title II, Sec. 2001(a)(1), Apr. 7, 1986, 100 
Stat. 100; amended Pub. L. 101-189, div. A, title VII, Sec. 727(a), 
title XVI, Sec. 1622(e)(5), Nov. 29, 1989, 103 Stat. 1480, 1605; Pub. L. 
101-510, div. A, title VII, Sec. 713(a)-(d)(2), Nov. 5, 1990, 104 Stat. 
1583, 1584; Pub. L. 102-25, title VII, Sec. 701(j)(8), Apr. 6, 1991, 105 
Stat. 116; Pub. L. 102-190, div. A, title VII, Sec. 714, Dec. 5, 1991, 
105 Stat. 1403; Pub. L. 103-160, div. A, title VII, Sec. 713, Nov. 30, 
1993, 107 Stat. 1689; Pub. L. 103-337, div. A, title VII, Sec. 714(b), 
title X, Sec. 1070(b)(6), Oct. 5, 1994, 108 Stat. 2802, 2857; Pub. L. 
104-106, div. A, title VII, Sec. 734, Feb. 10, 1996, 110 Stat. 381; Pub. 
L. 104-201, div. A, title VII, Sec. 735(a), (b), Sept. 23, 1996, 110 
Stat. 2598; Pub. L. 106-65, div. A, title VII, Sec. 716(c)(1), Oct. 5, 
1999, 113 Stat. 691.)

                       References in Text

    The Social Security Act, referred to in subsec. (d), is act Aug. 14, 
1935, ch. 531, 49 Stat. 620, as amended. Titles XVIII and XIX of the 
Social Security Act are classified generally to subchapters XVIII 
(Sec. 1395 et seq.) and XIX (Sec. 1396 et seq.) of chapter 7 of Title 
42, The Public Health and Welfare. For complete classification of this 
Act to the Code, see section 1305 of Title 42 and Tables.
    Public Law 87-693, referred to in subsec. (i)(2), is Pub. L. 87-693, 
Sept. 25, 1962, 76 Stat. 593, which is classified generally to chapter 
32 (Sec. 2651 et seq.) of Title 42. For complete classification of this 
Act to the Code, see Tables.

                          Codification

    Another section 1095 was renumbered section 1095a of this title.


                               Amendments

    1999--Subsec. (a)(1). Pub. L. 106-65, Sec. 716(c)(1)(A), substituted 
``reasonable charges for'' for ``the reasonable costs of'', ``such 
charges'' for ``such costs'', and ``a reasonable charge for'' for ``the 
reasonable cost of''.
    Subsec. (g)(1). Pub. L. 106-65, Sec. 716(c)(1)(B), struck out ``the 
costs of'' after ``any other payer for''.
    Subsec. (h)(1). Pub. L. 106-65, Sec. 716(c)(1)(C), substituted ``The 
term `third-party payer' means an entity that provides an insurance, 
medical service, or health plan by contract or agreement, including an 
automobile liability insurance or no fault insurance carrier, and any 
other plan or program that is designed to provide compensation or 
coverage for expenses incurred by a beneficiary for health care services 
or products.'' for ``The term `third-party payer' means an entity that 
provides an insurance, medical service, or health plan by contract or 
agreement, including an automobile liability insurance or no fault 
insurance carrier and a workers' compensation program or plan.''
    1996--Subsec. (g)(1). Pub. L. 104-201, Sec. 735(a), inserted ``or 
through'' after ``provided at''.
    Subsec. (h)(1). Pub. L. 104-201, Sec. 735(b)(1), inserted ``and a 
workers' compensation program or plan'' after ``insurance carrier''.
    Subsec. (h)(2). Pub. L. 104-201, Sec. 735(b)(2), substituted 
``organization,'' for ``organization and'' and inserted before period at 
end ``, and a personal injury protection plan or medical payments 
benefit plan for personal injuries resulting from the operation of a 
motor vehicle''.
    Subsec. (k). Pub. L. 104-106 added subsec. (k).
    1994--Subsec. (b). Pub. L. 103-337, Sec. 714(b)(1), substituted 
``shall operate to prevent collection by the United States under 
subsection (a) if that care is provided--'' and pars. (1) to (4) for 
``if that care is provided through a facility of the uniformed services 
shall operate to prevent collection by the United States under 
subsection (a).''
    Subsec. (d). Pub. L. 103-337, Sec. 714(b)(2), inserted ``and except 
as provided in subsection (j),'' after ``(b),''.
    Subsec. (g). Pub. L. 103-337, Sec. 1070(b)(6), made technical 
correction to directory language of Pub. L. 103-160, Sec. 713(a)(1). See 
1993 Amendment note below.
    Subsec. (h)(1). Pub. L. 103-337, Sec. 714(b)(3), inserted at end 
``Such term also includes entities described in subsection (j) under the 
terms and to the extent provided in such subsection.''
    Subsec. (j). Pub. L. 103-337, Sec. 714(b)(4), added subsec. (j).
    1993--Subsec. (g). Pub. L. 103-160, Sec. 713(c), designated existing 
provisions as par. (1) and added par. (2).
    Pub. L. 103-160, Sec. 713(a)(2), inserted before period ``and shall 
not be taken into consideration in establishing the operating budget of 
the facility''.
    Pub. L. 103-160, Sec. 713(a)(1), as amended by Pub. L. 103-337, 
Sec. 1070(b)(6), inserted ``or under any other provision of law from any 
other payer'' after ``third-party payer''.
    Subsec. (h). Pub. L. 103-160, Sec. 713(b), inserted ``a preferred 
provider organization and'' after ``includes'' in par. (2) and added 
par. (3).
    1991--Subsec. (a)(1). Pub. L. 102-25 inserted ``a'' before ``covered 
beneficiary''.
    Subsec. (i)(2). Pub. L. 102-190 struck out ``or no fault insurance'' 
before ``carrier''.
    1990--Pub. L. 101-510, Sec. 713(d)(2), substituted ``Health care 
services incurred on behalf of covered beneficiaries: collection from 
third-party payers'' for ``Collection from third-party payers of 
reasonable inpatient hospital care costs incurred on behalf of retirees 
and dependents'' in section catchline.
    Subsec. (a)(1). Pub. L. 101-510, Sec. 713(d)(1)(A), substituted 
``covered beneficiary'' for ``covered by section 1074(b), 1076(a), or 
1076(b) of this title''.
    Pub. L. 101-510, Sec. 713(a)(1), substituted ``health care 
services'' for ``inpatient hospital care''.
    Subsec. (a)(2). Pub. L. 101-510, Sec. 713(d)(1)(B), substituted 
``covered beneficiary'' for ``person covered by section 1074(b), 
1076(a), or 1076(b) of this title''.
    Pub. L. 101-510, Sec. 713(a)(1), substituted ``health care 
services'' for ``inpatient hospital care''.
    Subsec. (c). Pub. L. 101-510, Sec. 713(a)(1), substituted ``health 
care services'' for ``inpatient hospital care''.
    Subsec. (f). Pub. L. 101-510, Sec. 713(a)(1), substituted ``health 
care services'' for ``inpatient hospital care'' in introductory 
provisions.
    Subsec. (f)(2) to (4). Pub. L. 101-510, Sec. 713(b), added pars. (2) 
and (3) and redesignated former par. (2) as (4).
    Subsec. (g). Pub. L. 101-510, Sec. 713(a)(1), substituted ``health 
care services'' for ``inpatient hospital care''.
    Subsecs. (h), (i). Pub. L. 101-510, Sec. 713(c), added subsecs. (h) 
and (i) and struck out former subsec. (h) which read as follows: ``In 
this section, the term `third-party payer' means an entity that provides 
an insurance, medical service, or health plan by contract or 
agreement.''
    1989--Subsec. (g). Pub. L. 101-189, Sec. 727(a)(2), added subsec. 
(g). Former subsec. (g) redesignated (h).
    Subsec. (h). Pub. L. 101-189, Sec. 1622(e)(5), which directed 
amendment of subsec. (g) by insertion of ``the term'' after ``In this 
section,'' was executed by making the insertion in subsec. (h) to 
reflect the probable intent of Congress and the intervening 
redesignation of subsec. (g) as (h) by Pub. L. 101-189, Sec. 727(a)(1), 
see below.
    Pub. L. 101-189, Sec. 727(a)(1), redesignated subsec. (g) as (h).


                    Effective Date of 1994 Amendment

    Section 1070(b) of Pub. L. 103-337 provided that the amendment made 
by that section is effective as of Nov. 30, 1993, and as if included in 
the National Defense Authorization Act for Fiscal Year 1994, Pub. L. 
103-160, as enacted.


                    Effective Date of 1990 Amendment

    Section 713(e) of Pub. L. 101-510 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to health care services provided in a medical facility of the uniformed 
services after the date of the enactment of this Act [Nov. 5, 1990], but 
not with respect to collection under any insurance, medical service, or 
health plan agreement entered into before the date of the enactment of 
this Act that the Secretary of Defense determines clearly excludes 
payment for such services. Such an exception shall apply until the 
amendment or renewal of such agreement after that date.''


                    Effective Date of 1989 Amendment

    Section 727(b) of Pub. L. 101-189 provided that: ``The amendment 
made by this section [amending this section] shall take effect on 
October 1, 1989, and shall apply to amounts collected under section 1095 
of title 10, United States Code, on or after that date.''


                             Effective Date

    Section 2001(b) of Pub. L. 99-272 provided that: ``Section 1095 of 
title 10, United States Code, as added by subsection (a), shall apply 
with respect to inpatient hospital care provided after September 30, 
1986, but only with respect to an insurance, medical service, or health 
plan agreement entered into, amended, or renewed on or after the date of 
the enactment of this Act [Apr. 7, 1986].''

                  Section Referred to in Other Sections

    This section is referred to in sections 1079, 1086, 1095b, 1097b of 
this title.
