Medical Coverage for Reserve Component Soldiers
Reserve Component drilling members are covered for any injury, illness or disease incurred or aggra-vated in the line of duty, including traveling to and from military duty; under line-of-duty procedures. Medical coverage for the member and the family is available though Tricare Prime/Prime Remote or at a Medical Treatment Facility when the member is activated.
TRICARE
Eligibility
Reserve Component members have comprehensive health care coverage under TRICARE. Reserve Component members are eligible for "Early" and “Transitional Assistance Management Program (TAMP)” (demobilization) benefits when ordered to active duty for more than 30 days in support of a contingency operation.
Early: Some members of the National Guard and Reserve (collectively known as the Reserve Component, or RC), who are issued delayed-effective-date active duty orders for more than 30 days in support of a contingency operation, are eligible for “early” TRICARE medical and dental benefits beginning on the later of either: (a) the date their orders were issued or (b) 90 days before they report to active duty.
To be eligible for this early TRICARE benefit, RC members and family members must be registered and TRICARE eligible in the Defense Enrollment Eligibility Reporting System (DEERS). The member’s Service personnel office is responsible for determining the member’s eligibility for the early TRICARE benefit. The Services will notify and advise eligible RC members of their TRICARE medical and dental benefits when their delayed-effective-date active duty orders are issued.
RC members may verify their eligibility for TRICARE through the secure Guard and Reserve Web Portal Web site at https://www.dmdc.osd.mil/appj/esgr/index.jsp (if the employer input page appears, click the “BACK” button located on the bottom of the “employer input page”). For assistance with an eligibility problem, members should contact their Service Point of Contact listed on the TRICARE Web site at www.tricare.mil/reserve/reservepoc.cfm.
Transitional Assistance Management Program (TAMP)
The Transitional Assistance Management Program (TAMP) offers transitional TRICARE coverage to certain separating active duty members and their eligible family members. Care is available for a limited time. These certain members will be issued a TA-180 card, the so called TAMP Card. This card gives them and their dependents180 days of Tricare Coverage.
Tricare Reserve Select
When TAMP Coverage ends, the member can elect to purchase Tricare Reserve Select. Member monthly premiums currently are $81. Member and Family monthly premiums are $253. TRICARE Reserve Select (TRS) is the premium-based health plan available for purchase by qualified members of the Reserve Component. TRS offers comprehensive health coverage similar to TRICARE Standard and TRICARE Extra. Purchasing TRS is a two-step process. Members must qualify with their Reserve Component before they can purchase TRS coverage. Once qualified, members may purchase member-only or member and family coverage. Covered members and family members may access care from any TRICARE-authorized provider, hospital or pharmacy—TRICARE network or non-network. TRS covered members may access care from a military treatment facility on a space-available basis only. TRS members and their covered family members pay the same TRICARE cost-share and deductibles as active duty family members.
*****See the Restructured Tricare Reserve Select section because of major changes to the program which become effective 1 October 2007.*******
Options
TRICARE Prime/Prime Remote - are only available to Active Duty soldiers
- Enrollment fees apply—$230 for individuals, $460 for families
- Outpatient care—$12 per visit
- Inpatient care—$11 per day, $25 minimum
- Inpatient mental health—$40 per day
- Emergency care—$30 per visit
TRICARE Extra
- Annual outpatient deductible—$150 for individuals, $300 for families
- Inpatient care—$250 per day** or 25% of hospital’s negotiated charges, whichever is less, plus 20% of - negotiable professional fees
- Outpatient care—20% of the negotiated fee
- Inpatient mental health—20% of the negotiable fees
TRICARE Standard
- Annual outpatient deductible—$150 for individuals, $300 for families
- Inpatient care—$512 per day** or 25% of hospital’s billed charges, whichever is less, plus 25% of allowed professional charges
- Outpatient care—25% of allowed charges
- Inpatient mental health—lesser of $169 per day** or 25% of allowable fees
Dental
TRICARE Dental Program is available to Active Duty Dependents, Reserve/National Guard Service Members (Select Reserve) and their Dependents. TDP is premium based program that allows you the Sponsor to select coverage for yourself and or your eligible dependents (i.e.. spouse and children up to age 21 or 23 if enrolled in school as a full-time student)
Current TDP Enrollment and monthly Premium information can be found at their web site: www.tricaredentalprogram.com or by calling toll-free (888)622-2256
Restructured TRICARE Reserve Select:
Actions to Take for Current TRS Members:
Summary of Changes:
New Program at a Glance:
Here's a snapshot of the new program, effective October 1, 2007. Although, this program is effective 1 Oct 07, some members may be eligible to purchase the plan on or after 11 August 2007, go to the website and check.
Many aspects of the program are not changing.
In this section, we're focusing on things that are different than the current plan.
Qualifying and Purchasing to qualify for TRS: You must be a member of the Selected Reserve of the Ready Reserve, and you cannot be eligible for or enrolled in the Federal Employee Health Benefit (FEHB) Program.
Once you qualify: You may purchase the plan at any time throughout the year, there are no tiers or open seasons.
Qualifying for and purchasing TRS is a 2-step process:
Step 1: Qualify: Log on to the Guard and Reserve Web Portal. Click on the "TRICARE Reserve Select" box. Select the type of coverage that you want to purchase: TRS Member-Only or TRS Member-and-Family Certify that you are not eligible for or enrolled in the FEHB program Select when you want your coverage to begin Print and sign the TRS Request Form (DD Form 2896-1)
Step 2: Purchase by Mail or Fax your completed TRS Request Form along with the first month's premium payment to your regional contractor by the applicable deadline. Your coverage begins on the first day of the first or second month (whichever you select on the TRS Request Form) following the postmark of your TRS Request Form. For example, if your form is postmarked in July, you may choose for your coverage to begin on the first day of the next month, August, or on the first day of the second month, September.
Monthly Premiums and Other Costs: Your monthly premium rate is determined by the type of coverage you purchase: TRS Member-Only or TRS Member-and-Family. TRS premiums are adjusted annually effective January 1. TRS Member-Only coverage is currently $81 per month. TRS Member-and-Family coverage is currently $253 per month. Premiums can be paid by check, money order or cashier's check (payable to your regional contractor), or by Visa®/MasterCard®. After the initial premium payment, your regional contractor will bill you by the 10th of each month. Payments are due no later than the 30th of each month, and payments are applied to the following month of coverage. Do not miss payment; failure to pay overdue amounts by the deadline will result in termination of coverage and debt collection. Note: Other fees such as annual deductibles and cost shares are not changing.
Covered Services: TRS covered services will not be changing, and continues to be comparable to TRICARE Standard and Extra. You'll still be able to access a wide variety of services from any TRICARE-authorized provider network or non-network. Additionally, you'll be eligible for TRICARE prescription drug coverage.
Changes in Family Composition: You may change the type of TRS coverage; TRS Member-Only or TRS Member-and-Family, with a qualifying life event:
Marriage
Birth or adoption
Placement of child in the legal custody of the member by order of the court
Divorce or annulment
Death of a spouse or family member
Family member loses eligibility (e.g. child turns 21 or 23 if enrolled in college)
Sponsors must report all qualifying life events to a military personnel office and record the information in the Defense Enrollment Eligibility Reporting System (DEERS).
To change the TRS coverage:, download a new TRS Request Form from the Guard and Reserve Web Portal, complete the form, and submit it to your regional contractor (postmarked) within 60 days of the qualifying life event. The change in coverage is effective the date the qualifying life event occurred. Changes to your TRS coverage that don't involve a change in family composition, (e.g., eligibility for other health coverage) can be made at anytime during your enrollment in TRS.
Voluntary Disenrollment: You may choose to disenroll from TRS coverage at any time. If you want to disenroll, do not just stop making payments. You must take the following action to end your coverage: Log on to the Guard and Reserve Web Portal. Complete the TRS Request Form. Print and mail your completed TRS Request Form to your regional contractor.
A one-year TRS purchase lockout will apply if you voluntarily disenroll from TRS, which means you will not be able to purchase TRS coverage for up to one year.
If you do not take action to disenroll and you simply stop making premium payments, your coverage terminates. However, you are still responsible for any premium amounts that are due prior to the date you were officially terminated from TRS.
Disenrollment Due to Change in Status: When you're activated you and your family become eligible for TRICARE (without premiums) and your TRS coverage is automatically terminated. When you deactivate and lose eligibility for TRICARE (without premiums), you may purchase TRS with no break in coverage as long as you re-qualify. Submit your completed TRS Request Form with a premium payment postmarked no later than 60 days after the loss of the TRICARE coverage. Your TRS coverage begins on the day after the loss of other TRICARE coverage.
Your TRS coverage will also be automatically terminated if you leave the Selected Reserve. You may purchase TRS coverage again if you re-qualify.
Termination Due to Non-Payment: Your payment is due no later than the 30th day of each month. Your payment will apply to the following month of coverage. Failure to pay monthly premiums on time will result in termination of coverage, but you must still pay any overdue amounts. (This may result in up to two months of overdue premium payments.) The government pursues collection action for overdue and delinquent premiums and may notify your commander and collect overdue and delinquent amounts from your National Guard or Reserve pay. Termination of coverage due to non-payment will result in a TRS purchase lockout for one year or until overdue premiums are paid, whichever is longer.
Survivor Coverage: If a National Guard and Reserve member is covered by TRS on the day of his or her death, surviving family members may purchase or continue TRS coverage for an additional six months from the date of the member's death.If TRS Member-and-Family coverage is in effect at the time of death, DEERS will automatically convert the TRS Member-and-Family coverage to TRS survivor coverage.If TRS Member-Only coverage is in effect at the time of death, the coverage will terminate and survivors may purchase TRS survivor coverage within 60 days.Survivors are responsible for paying appropriate monthly premiums.
Did you know? When TRS coverage is terminated, your regional contractor will initiate refunds for premium payments paid in excess of amount due within 10 days of receiving the termination request.
www.tricare.mil
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