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1Presenter Name Month DD, YYYY TRICARE® Your Military Health PlanTRICARE Overview for Retired Reserve Members and Their Eligible Family MembersPresenter TipsReview slides before briefing.Print out briefing with notes prior to presentation.Ensure “slide show” setting.You may add slides from other briefings as appropriate for your audience.Note to Presenter: This briefing is not intended for Retired Reserve members in full-time staff positions.Estimated Briefing Time: 15–20 minutesRecommended Handouts:TRICARE Reserve Select and TRICARE Retired Reserve brochureYour TRICARE Resources fact sheetBriefing Objectives:Increase awareness of TRICARE benefits for qualified Retired Reserve members and their families.Inform beneficiaries of the steps to access their TRICARE benefit.Optional Presenter Comments: Welcome to the TRICARE Overview for Retired Reserve Members and Their Eligible Family Members briefing. The goal of today’s presentation is to give you information about your TRICARE Retired Reserve benefit.Presenter Name Month DD, YYYYUpdated October 2011
2Photo courtesy of the National Guard Today’s AgendaTRICARE OverviewMedical CoverageOther Important InformationFor Information and AssistanceToday, we’ll provide an overview of TRICARE and give you specific TRICARE Retired Reserve, or TRR, plan information. We’ll also provide you with important contact information, so you can get assistance and find answers to any additional questions you may have.Photo courtesy of the National Guard
3What Is TRICARE? TRICARE is… … the health care program serving active duty service members, National Guard and Reserve members, retirees, family members, survivors, and certain former spouses worldwide.… a network of military and civilian health care professionals working together to foster, protect, sustain, and restore health for those entrusted to their care.TRICARE is the uniformed services health care program for active duty service members, National Guard and Reserve members, retired service members, their family members, and others who are eligible.TRICARE brings together the health care resources of the Military Health System—such as military hospitals and clinics—with a network of civilian health care professionals, institutions, pharmacies, and suppliers.TRICARE has no preexisting-condition exclusions, so you cannot be denied TRICARE coverage because of a health condition you had before becoming a TRICARE beneficiary.
4TRICARE Stateside Regions (United States and Washington, DC) What Is TRICARE?TRICARE Stateside Regions (United States and Washington, DC)Health Net Federal Services, LLCTriWest Healthcare AllianceHumana Military Healthcare Services, Inc.TRICARE is available worldwide and managed regionally. There are three TRICARE regions in the United States—TRICARE North, TRICARE South, and TRICARE West. Your benefits are the same regardless of where you live, but you will have different customer service contacts based on your region.If you are in the [North, South, West] region, your contractor is [Health Net Federal Services; Humana Military Healthcare Services; TriWest Healthcare Alliance]. [Health Net; Humana Military; TriWest] partners with the Military Health System to provide you with health, medical, and administrative support including customer service, claims processing, and authorizations for certain health care services.Customer service information for each region will be provided at the end of this presentation.4
5TRICARE Overseas Program (TOP) What Is TRICARE?The TRICARE Overseas Program is managed through three geographic areasInternational SOS Assistance, Inc., or International SOS, administers the TRICARE Overseas Program, or TOP, in the areas shown and operates the TOP Regional Call Centers in each area. The TOP Regional Call Centers assist beneficiaries with health care finder services and help coordinate medical care overseas. Contact information for your area will be provided at the end of the presentation.Latin America and CanadaCentral and South America,the Caribbean Basin, Canada,Puerto Rico, and the U.S. Virgin IslandsEurasia-AfricaEurope, Africa, and the Middle EastPacificAsia, Guam, Australia,New Zealand, and Western Pacific remote countriesInternational SOS Assistance, Inc. administers the TRICARE Overseas Program
6Register Your Family in DEERS TRICARE EligibilityRegister Your Family in DEERSRegistration in DEERS is key to TRICARE eligibilityRegister your family members in the Defense Enrollment Eligibility Reporting System (DEERS)In person at a uniformed services identification (ID) card-issuing facility:By sending changes and required documentation to: Defense Manpower Data Center Support Office400 Gigling Road Seaside, CAYou and your family members must be registered in the Defense Enrollment Eligibility Reporting System, or DEERS, to be eligible for TRICARE benefits.DEERS is a worldwide database of service members and dependents who are entitled to military benefits, including TRICARE.All sponsors are automatically registered in DEERS. However, you must register your family members in DEERS for them to be eligible for TRICARE coverage.To register your family members, visit a uniformed services ID card-issuing facility or mail the information to the Defense Manpower Data Center Support Office.6
7Register Your Family in DEERS TRICARE EligibilityRegister Your Family in DEERSTo register your family in DEERS, proper documentation is required and can include:Marriage certificateDivorce decreeAdoption papersBirth certificateYou can verify eligibility in one of three ways:Go toVisit your local military treatment facility’s (MTF’s) Patient Administration OfficeContact your service’s personnel officeTo register your family in DEERS, proper documentation is required, such as a marriage certificate, divorce decree, birth certificate, and/or adoption papers.In the sponsor’s absence, an individual with a valid power of attorney can add or remove family members.At any time, you can verify eligibility through the Web, through a military treatment facility’s, or MTF’s, Patient Administration Office, or by contacting your service’s personnel office.Providers are legally permitted to copy military and dependent ID cards to verify TRICARE eligibility.Any time your status changes and that change is reflected in DEERS, family members registered in DEERS will also have their eligibility/status changed accordingly.7
8Updating DEERSTRICARE EligibilityRemember to register/update in DEERS whenever there is a change in the family (marriage, birth, adoption, divorce, death, etc.) or when you moveKeep your contact information up to date:Online:By phone:By fax:By visiting an ID card-issuing facility:More information:Once you and your family are registered in DEERS, be sure to keep addresses and other contact information up to date for all family members.Keeping DEERS information current, especially your address, is critical to ensuring uninterrupted TRICARE coverage for you and your family.While only the sponsor can add or remove family members in DEERS, both the sponsor and adult family members can update contact information. Any time there is a change in family status such as marriage, birth, adoption, divorce or death, the sponsor must update DEERS. Promptly update your information when any change occurs, regardless of whether or not you are on active duty at the time.You can contact DEERS online, by phone, or by fax. For more information, go toIf you prefer to update your information in person, you can visit an ID card-issuing facility.Note: Be sure to register newborn or newly adopted children in DEERS within 60 days of birth or adoption. Prompt registration of children in DEERS can minimize delays or problems with coverage and claims processing.8
9TRICARE Retired Reserve (TRR): Qualifying Members Medical CoverageA member may qualify to purchase TRR coverage if he or she is:A member of the Retired Reserve who is qualified for non-regular retirementUnder age 60Not eligible for or enrolled in the Federal Employees Health Benefits (FEHB) programPhoto courtesy of the National GuardTRICARE Retired Reserve, or TRR, is a premium-based health plan available for purchase by qualified members of the Retired Reserve.TRR is a comprehensive health plan that provides TRICARE Standard and TRICARE Extra coverage (in the United States) or TRICARE Overseas Program, or TOP, Standard (overseas).You will not qualify for TRR if you are eligible for the Federal Employees Health Benefits program, or FEHB, based on your civilian employment or if enrolled in FEHB through a family member.You can visit the Defense Manpower Data Center Web site to determine your qualifications.Please note that when you turn 60 and are collecting retirement pay, you will be disenrolled from TRR and will be eligible for TRICARE as a retiree.Beneficiaries can be eligible for TRR and the Continued Health Care Benefit Program, or CHCBP, simultaneously.If a Retired Reserve member is reactivated for more than 30 days, then deactivated, he or she is eligible for CHCBP for 18 months after the activation period.If a Retired Reserve member immediately retires from the National Guard and Reserve following a period of activation, he or she is eligible for CHCBP for 18 months after the activation period.For more information on CHCBP, please visit
10TRR: Qualifying Survivors Medical CoverageTRR: Qualifying SurvivorsSurvivors may qualify to purchase TRR coverage if all of the following apply:The deceased sponsor was covered by TRR on the date of his or her deathSurvivors are immediate family members of the deceased sponsor (spouses cannot have remarried)TRR coverage would begin before the date the deceased sponsor would have reached age 60Survivors of Retired Reserve members may qualify to purchase TRR coverage if all of the following rules apply:Sponsor was covered by TRR on the date of his or her death.Survivors are immediate family members of the deceased sponsor (spouses cannot have remarried).If a qualified member of the Retired Reserve dies while in a period of TRR coverage, his or her immediate family members remain qualified to purchase new or existing TRR family coverage until the date the deceased Retired Reserve member would have reached age 60.Survivors are the only exception to the FEHB rule. Even if a survivor is eligible for FEHB, he or she still qualifies for TRR.
11TRR: Changes in Family Composition Medical CoverageTRR: Changes in Family CompositionAdding a family member: Newborns and newly adopted children must be registered in DEERS and TRR within 60 days for TRICARE to provide coverage retroactive to the date of birth or the date of adoption.Removing a member: Log on to the DMDC Reserve Component Purchase TRICARE Application at https://dmdc.osd.mil/appj/reservetricare and follow instructions to disenroll.Newborns and newly adopted children must be registered in DEERS and TRR within 60 days for TRICARE to provide coverage from the date of birth or the date of adoption. Otherwise, the child is not covered until the first of the following month when the TRR application is received.Overseas beneficiaries have 120 days to register newborns and adopted children in DEERS.To remove a family member, log on to the DMDC Reserve Component Purchase TRICARE Application at https://dmdc.osd.mil/appj/reservetricare and follow instructions to disenroll.
12TRR: PurchasingMedical CoverageLog on to the Defense Manpower Data Center (DMDC) Reserve Component Purchase TRICARE Application at https://www.dmdc.osd.mil/appj/reservetricareTo access the Web site, you will need to use a Department of Defense (DoD) Self Service Logon (DS Logon) premium account or Common Access Card (CAC)Complete, print, and sign the Reserve Component Health Coverage Request form (DD Form )Mail the completed form with the first two months’ premium payment to your regional or overseas contractorWith TRICARE Retired Reserve, you can purchase either member-only or member- and-family coverage.To purchase coverage, visit the Web-based DMDC Reserve Component Purchase TRICARE Application.To access the Web site, you will need a DoD Self Service Logon, or DS Logon, premium account or Common Access Card, or CAC.Note: To obtain a DoD DS Logon premium account, service members and retirees with a CAC or DFAS myPay Login ID, may request a DS Logon for themselves and eligible family members.Via DS Access Center at https://myaccess.dmdc.osd.mil/dsaccessAt a Veterans Affairs Regional Office after completing an in-person proofing processAt a DoD RAPIDS facility when obtaining your military ID cardFollow the instructions to complete, print, and sign the Reserve Component Health Coverage Request form, which is DD FormMail the completed form along with a minimum of two months’ premiums.Note: If you are enrolled in another TRICARE program, once your coverage ends, you must submit your TRR application within 30 days to ensure continuous coverage.
13TRR: Getting Care See any TRICARE-authorized provider for care Medical CoverageSee any TRICARE-authorized provider for careNetwork provider = lower costsNon-network provider = higher costsFind a network provider:No referrals are necessary for care, but certain services require prior authorizationIn the event of an emergency, call 911 or go to the nearest emergency roomCare is available at military treatment facilities (MTFs) on a space-available basis onlyTRICARE Retired Reserve beneficiaries have the flexibility to visit any TRICARE-authorized provider, which is a doctor or other provider who is approved to provide care to TRICARE beneficiaries.However, your out-of-pocket costs will be lower if you see a TRICARE-network provider.A network provider is a TRICARE-authorized provider who has an agreement with your regional contractor to accept TRICARE rates as payment in full and file claims on your behalf.To find a network provider, visit or contact your regional contractor.If you plan to see a non-network provider, ask if he or she is authorized by TRICARE before receiving care. With a non-network provider, you will pay more out of pocket and may have to file your own claims.Although referrals are not required for most health care services, some services require prior authorization to determine medical necessity.Visit your regional contractor’s Web site for information about authorization requirements.In the event of an emergency, call 911 or go to the nearest emergency room.Referral or prior authorization is not required, but, if admitted, contact your regional contractor within 24 hours or the next business day to coordinate ongoing care.TRICARE Retired Reserve beneficiaries may also receive care at military treatment facilities, or MTFs, on a space-available basis, but space is very limited. Your appointment priority is the same as other non-Prime retirees.
14Priority for Access to Military Treatment Facility Care Other Important InformationPriority for Access to Military Treatment Facility Care1Active duty service members, including National Guard and Reserve members on active duty status2Active duty family members enrolled in a TRICARE Prime option3Retired service members, their dependents, and all others enrolled in a TRICARE Prime option4Active duty family members not enrolled in a TRICARE Prime option, and TRICARE Reserve Select beneficiaries5Retired service members and their dependents not enrolled in a TRICARE Prime option, TRICARE Retired Reserve beneficiaries, and all other eligible beneficiaries not enrolled in a TRICARE Prime optionMTFs provide care on a space-available basis.Your priority for care at an MTF is determined by your beneficiary category and TRICARE program option.Active duty service members and National Guard and Reserve members on active duty status (on orders for more than 30 consecutive days) always have first priority for care.After that, the priority is based on beneficiary category and program option.Active duty family members enrolled in TRICARE Prime will have second priority, and space is extremely limited for family members covered by TRICARE Standard and TRICARE Extra.National Guard and Reserve members, the Retired Reserve, and their families not enrolled in TRICARE Prime, TRICARE Reserve Select or TRICARE Retired Reserve are on a space-available basis only and space is very limited.14
15TRICARE Pharmacy Program Other Important InformationYou may use the TRICARE pharmacy benefit unless you are enrolled in the US Family Health Plan.To have a prescription filled, you will need the prescription, a valid uniformed services ID card, and up-to-date information in DEERS. Note: Pharmacies are legally permitted to copy military and dependent ID cards to verify TRICARE eligibility.You will normally receive a generic drug rather than a brand-name drug. Your doctor or other provider must prove medical necessity for you to receive a brand-name medication if a generic version is available. Non-formulary drugs are not available to active duty service members without medical-necessity approval. If the ADSM receives approval, the copayment is $0.Pharmacy costs depend on the pharmacy option you choose, whether the drug is generic or brand name, and whether it’s listed in the TRICARE formulary, which is the list of drugs covered by TRICARE.There is no copayment when you fill a prescription at an MTF pharmacy.If you have recurring prescriptions, such as allergy or blood pressure medicine, you can use TRICARE Pharmacy Home Delivery to order up to a 90-day supply by phone, online, or by mail. TRICARE Pharmacy Home Delivery copayments are $0 for generic formulary drugs, $9 for brand-name formulary drugs, and $25 for non-formulary drugs.If you need a prescription filled immediately, your best option is to find one of TRICARE’s 60,000-plus retail network pharmacies. To find a retail network pharmacy, visit the Express Scripts Web site provided at the bottom of the screen.The most expensive option is a non-network retail pharmacy.Express Scripts, Inc. Web site:Phone number:15
16TRR Member-and-Family: TRR: CostsMedical CoverageTRR Member-Only:TRR Member-and-Family:Monthly Premiums$408.01$1,020.05Annual Deductibles (per fiscal year, Oct. 1-Sept. 30)$150$300Cost-Shares (after annual deductible is met)Network Provider: 20% Non-Network Provider: 25%Catastrophic Cap (per fiscal year)$3,000 per fiscal yearWith TRICARE Retired Reserve, you are responsible for monthly premiums, an annual deductible, cost-shares, and copayments.Premiums are monthly payments due in advance for TRR members. The 2011 premiums are $ for member-only coverage and $1, for member-and-family coverage. These rates will be effective through December 31, 2011.Your deductible is the amount you pay out-of-pocket per year before your TRICARE coverage begins.The deductible is $150 per individual or $300 per family.The cost-share for outpatient services, such as preventive services or doctors’ visits, is 20 percent for TRICARE-network providers and 25 percent for non-network providers, plus any fees that are charged by nonparticipating providers above the TRICARE allowable charge (Please note, within the United States, providers are prohibited from billing more than 15 percent above the TRICARE-allowable charge).Overseas providers and beneficiaries are reimbursed for billed charges, less the applicable deductibles and cost-shares, except in Panama, the Philippines and Puerto Rico. In these places, reimbursement is based on TRICARE-allowable charges.The catastrophic cap is $3,000 and represents the maximum amount you pay for TRICARE-covered services during a fiscal year, which is October 1 through September 30. The cap includes your deductible, cost-shares, and prescription copayments, but it does not include your monthly premiums, amounts paid that exceed the TRICARE-allowable amount for care, or any additional costs you may incur from seeking care without proper authorization.
17TRICARE Retiree Dental Program (TRDP) Other Important InformationTRICARE Retiree Dental Program (TRDP)Voluntary, premium-based programPremiums depend on sponsor’s location and number of family members enrolledEnroll in three ways:Online at TRDP Web site:By toll-free telephone:By mail:Delta Dental of California Federal Government Programs PO Box Sacramento, CAThe TRICARE Retiree Dental Program, or TRDP, is a voluntary, premium-based dental program available to you and your family.Premium rates are subject to change on October 1 of each benefit year.The TRDP is administered by Delta Dental.Federal law requires that monthly premiums for the TRDP be deducted automatically from uniformed services retired pay. If it is determined that uniformed services retired pay is not available or is insufficient to allow the automatic deduction, Delta Dental will notify you of your premium payment options.For more information, or to enroll, visit the TRDP Web site.
18TRICARE and Other Health Insurance Other Important InformationTRICARE and Other Health InsuranceTRICARE serves as the secondary payer, if you have other health insurance (OHI).If you have OHI:Fill out a TRICARE Other Health Insurance Questionnaire (www.tricare.mil/mybenefit/Forms.do)If you have OHI, you must follow your OHI’s rulesTell your provider about your OHI and TRICARE coverageIf you have other health insurance, or OHI, and you choose to purchase TRICARE Retired Reserve, TRICARE is your secondary payer.That means the doctor files a claim with your other health insurance first and TRICARE pays what is left, up to the TRICARE-allowable charge. Note: Does not include certain federal and state programs. In other words, TRICARE pays before any federal or state funded-plans such as Medicaid or the Indian Health Service.If your OHI runs out, or you receive health care for services covered by TRICARE that are not covered by your OHI, TRICARE becomes your primary payer.If you have OHI:Fill out a TRICARE Other Health Insurance Questionnaire and follow the guidelines for submission. You can download the questionnaire from or you can pick one up at your TRICARE Service Center.Because your OHI pays first, you must follow their rules for getting care.Make sure your provider knows you have OHI and TRICARE. Keeping your regional contractor and health care providers informed about your OHI will allow them to better coordinate your benefits.Note: Unlike OHI, supplemental insurance pays after TRICARE pays its portion of the bill, reimbursing you for out-of-pocket medical expenses paid to civilian providers based on the plan’s policies. When considering supplemental insurance, remember that you have a $3,000 catastrophic cap.
19Social Security Number Removal from ID Cards TRICARE Health BenefitSocial Security Number Removal from ID CardsIn an effort to protect the privacy of TRICARE beneficiaries, the Department of Defense (DoD) is removing Social Security numbers (SSNs) from military ID cards, including the Common Access Card.Your new ID card will have one or both of the following:A 10-digit DoD ID NumberA DoD Benefits Number (DBN), if you are eligible for DoD benefitsYou will not need a new ID card until your old card expires.For more information, visitIn an effort to protect the privacy of TRICARE beneficiaries, the Department of Defense (DoD) is removing Social Security numbers (SSNs) from military ID cards, including the Common Access Card.Your new ID card will have one or both of the following:A 10-digit DoD ID Number instead of your SSNA DoD Benefits Number (DBN), if you are eligible for DoD benefitsNot all ID card holders are eligible for DoD benefits.You will not need a new ID card until your old card expires.For more information, visit
20For Information and Assistance Stateside Regional ContractorsTRICARE North Region Health Net Federal Services, LLC1-877-TRICARE ( )TRICARE South RegionHumana Military Healthcare Services, Inc.TRICARE West RegionTriWest Healthcare Alliance1-888-TRIWEST ( )General Contact InformationTRICARE Web site:Contacts:Military Medical Support Office:Overseas Regional ContractorInternational SOS Assistance, Inc.Eurasia-Africa:(overseas)(stateside)Latin America and Canada:(overseas)(stateside)Pacific:Singapore: (overseas)(stateside)Sydney: (overseas)(stateside)Web site:The following contact information provides the stateside and overseas regional contractors, as well as other important information outlets.Remember, your regional contractor is tied to where you reside.Connect with TRICARE Online!PP4372BET09112W2020