SUPPLEMENTARY INFORMATION:

I. Background

Section 709 of the NDAA for FY 2025 requires the Department to conduct a demonstration project to reimburse covered members specifically for the cryopreservation of gametes. This demonstration project will allow the Department to evaluate covered member participation, cost trends, administrative feasibility, and potential long-term readiness impacts.

II. Description of Demonstration

(i) Covered Services and Eligibility

The demonstration authorizes reimbursement of the following services (“covered services”): gamete retrieval procedures (including associated medications, laboratory evaluation, and imaging); medical testing required for retrieval and cryopreservation; cryopreservation of gametes; shipping of gametes; and storage of gametes in an appropriate private storage facility during the demonstration period.

Participation is voluntary. As DHA does not have the ability to authenticate operational orders issued to covered members by their Military Department or Military Service, Commanders will validate eligibility under Section 709 and this notice. To receive reimbursement under this demonstration, covered members will need to obtain written Command attestation via DHA Form 459 (detailed below) indicating that they met one of the statutory eligibility conditions at the time covered services were rendered. Covered members must consult their unit's specific policies and procedures regarding participation in this program and to request any leave or permissive temporary duty, as necessary. Eligibility conditions are as follows:

(1) Has received orders (including deployment orders) for duty for which the covered member may receive hazardous duty pay under section 351 of title 37, United States Code;

(2) Whom the Secretary determines is likely to receive such orders in the next 120 days; or

(3) Who will, under orders, be geographically separated from a spouse, domestic partner, or dating partner for a period of not less than 180 days, including sea duty.

(ii) Service Delivery

Covered members meeting at least one of the eligibility criteria may obtain gamete cryopreservation service(s) from a provider of their selection. Covered services may be rendered either through military medical treatment facilities (MTFs) that have reproductive endocrinology and infertility (REI) programs, or through a civilian fertility clinic of the covered member's choosing. The use of MTFs is encouraged, and a list of participating MTFs are listed here: tricare.mil/​CoveredServices/​IsItCovered/​AssistedReproductiveServices. Civilian providers are not required to be TRICARE authorized. Information regarding civilian providers will be made available on the program website.

Note, REI covered services provided at these MTFs are generally first-come, first-serve, and individual locations may not be able to accommodate covered services in a timeline that aligns with the covered member's pertinent orders. There is no requirement for MTFs to provide preference for covered members participating in this program. There is also variability as to the scope of Assisted Reproductive Technology (ART) performed within each MTF as well as the cost to the beneficiary for components of care that are not provided by the MTF or DoD health care providers based upon the specific private-sector collaboration. Reimbursement is available only for covered services paid for by the covered member.

(iii) Reimbursement Process

Except for recurring storage fees or subsequent shipping costs, for covered members meeting the first two eligibility criteria (orders (including deployment orders) for duty for which the covered member may receive hazardous duty pay; or likely to receive such orders), all cryopreservation service(s) (testing, gamete retrieval procedures, cryopreservation of gametes), must be obtained prior to the start date of the pertinent orders ( e.g., prior to deployment) to be eligible for reimbursement. For covered members meeting the third eligibility criteria (those who will, under orders, be geographically separated from a spouse, domestic partner, or dating partner for a period of not less than 180 days, including sea duty), cryopreservation service(s) may be obtained either prior to the geographic separation start date or during the period of geographic separation should such covered services be available at the location where the covered member has been sent on orders. Reimbursement for recurring storage fees or shipping during the course of the demonstration may be processed separately.

There is no requirement to meet eligibility criteria again for reimbursement of subsequent shipping or storage costs not incurred at time of initial cryopreservation ( i.e., annual storage fees, transport of gametes at time of intended fertilization), covered members must have previously received reimbursement under this program. For those determined to be eligible and previously reimbursed under this program, storage and shipment costs will be reimbursed for the entirety of the program duration, up to statutory limitations.

At the time of request for reimbursement, the covered member's Commander (or designee) must attest, via DHA Form 459, that on the date the medical covered services for which the covered member is seeking reimbursement were rendered (except for recurring storage or shipping as outlined), that the covered member met eligibility criteria. Reimbursement must be sought within 120 days from the date which covered services were rendered ( e.g., 120 days from the date gamete retrieval, 120 days from the date of laboratory procedure, 120 days from receipt of prescription, etc.) and may be submitted as separate requests throughout the process or as a single consolidated request for reimbursement within 120 days of the completion of gamete retrieval and cryopreservation. To receive reimbursement, the covered member must complete DHA Form 459, sign, and submit proof of payment to dha.ncr.medical-affairs.mbx.dha-cryopreservation-demo@health.mil.

• This form is available on the program website.
• Covered members must provide complete, itemized invoices reflecting ( printed page 52297) the dates of the covered services provided for all covered services submitted for reimbursement.
• DHA Form 459 must be completed and signed by the covered member and their Commander (or designee).
• Incomplete forms or forms submitted more than 120 days after the covered services were rendered to the member will be denied. Participating covered members will receive reimbursement upon review and processing of required invoices and documentation.

(iv) Reimbursement Limitations

Reimbursement is limited to $500 per year for sperm cryopreservation services and $10,000 per year for oocyte cryopreservation services, as established in statute. For purposes of the per year cap on reimbursement, a one-year period will be individualized for each covered member and measured from the first date on which reimbursable covered services are rendered. The one-year period will include any additional requests for reimbursement of costs incurred by the covered member within the 365-day window. Any claims for reimbursement for covered services provided in subsequent years will be processed in a similar manner. As this is a reimbursement demonstration, clear rules are required so that covered members have a precise understanding of what will be reimbursable and how the annual caps will be applied to their claims.

A covered member may participate more than once during the three year program duration, so long as they meet the eligibility criteria ( i.e., have, or anticipate having, new orders (including deployment orders) for duty for which the covered member may receive hazardous duty pay; or who will, under orders, be geographically separated from a spouse, domestic partner, or dating partner for a period of not less than 180 days, including sea duty) and remain under annual coverage limitations.

Services dated prior to program initiation or after program termination are not eligible for reimbursement. This includes new costs for storage or shipment incurred after termination of the program.

(v) Program Considerations

Participants are required to attest to having an advanced medical directive specifying disposition of gametes upon death. Covered members should consult their local legal assistance office for assistance in completing an advanced medical directive.

(vi) Program Evaluation

The demonstration will be evaluated using the following measures: participation rates, including by covered Armed Force and deployment status; total cost and cost per participant; administrative burden and claims processing outcomes; covered member experience and satisfaction; and impact on perceived readiness and retention indicators.

III. Demonstration Limitations

• The program covers only the categories of services listed, also known as “covered services”. A list of possible services covered is provided on the cryopreservation demonstration website, available atdha.mil/​CryopreservationDemo; anything not included on this list will be reviewed on a case-by-case basis. No other services—such as embryo creation, in-vitro fertilization, or other elective procedures—are eligible for reimbursement.
• The Department is not a party to any agreement between a covered member and a private medical or storage provider and assumes no liability related to gamete handling or storage conditions. Decisions regarding continued storage, disposition, or later use of gametes are solely the responsibility of the covered member and outside the scope of the program.
• All covered services must be rendered prior to or on the final date of the demonstration program; requests for reimbursement will be accepted up to 30 days thereafter. Any costs, including storage, incurred after the end of this program are not eligible for reimbursement.
• Reimbursement is limited to services provided to eligible covered members.
• Participating covered members must be on active duty in one of the covered Armed Forces (i.e., Army, Navy, Marine Corps, Air Force, or Space Force), during the provision of covered services and at the point of reimbursement.
• Decisions regarding continued storage following the end of the demonstration program, as well as later use and disposition of gametes, are solely a responsibility of the covered member, and outside the scope of this program.

IV. Demonstration Duration

This demonstration project will operate for three years, beginning on the effective date specified above. The Department may extend or modify the demonstration based on evaluation results or statutory requirements.

91 FR 52295