Presentation on theme: "As of 8/17/2015 1 Guard/Reserve TRICARE Continuum of Coverage Speaker: Mr. Sanders TRICARE Regional Office - South."— Presentation transcript:
As of 8/17/2015 1 Guard/Reserve TRICARE Continuum of Coverage Speaker: Mr. Sanders TRICARE Regional Office - South
As of 8/17/2015 2 Coverage Life Cycle TRICARE Eligibility Post-Activation Traditional Status Activation Pre-Activation
As of 8/17/2015 3 Coverage Life Cycle TRICARE Eligibility Pre-Activation: Early Eligibility Service Member – Direct Care Family Members – Prime/Prime Remote Standard/Extra Post-Activation: Transitional Assistance Management Program (if eligible) Continued Health Care Benefit Program Traditional Status: TRICARE Reserve Select Activation: Prime/Prime Remote Family – Prime/Prime Remote Standard/Extra
As of 8/17/2015 4 Healthcare Benefits During Pre-Activation and While on Active Duty
As of 8/17/2015 5 Eligibility Determined by Service/Reserve Component –Recorded in Defense Enrollment Eligibility Reporting System (DEERS) –DEERS is the key to unlock all TRICARE benefits Register or update information in DEERS –Reserve Component member –Family members Verify eligibility through Guard-Reserve Portal https://www.dmdc.osd.mil/Guard-ReservePortal
As of 8/17/2015 6 Care During Pre-Activation Early eligibility for TRICARE—up to 90 days before active duty begins Eligibility: Reserve component member must –Be called or ordered to active duty for more than 30 consecutive days in support of a contingency operation –Receive delayed-effective-date orders –Verify eligibility through the Guard/Reserve Portal Coverage –Full TRICARE coverage including pharmacy –Active duty dental benefits Family members also eligible during pre-activation period Only Family Members can enroll
As of 8/17/2015 7 Reserve Component Member Health Care Options Access to care –Military treatment facility (MTF), when available –TRICARE network or TRICARE authorized provider if MTF is not available –Follow protocol of assigned duty station to obtain care Enroll into one of the TRICARE Prime programs at your final duty station –TRICARE Prime –TRICARE Prime Remote –TRICARE Overseas Prime –TRICARE Global Remote Overseas
As of 8/17/2015 8 Family Member Health Care Options When Sponsor is Activated Access to care –Military treatment facility (MTF), when available –TRICARE network or TRICARE authorized provider if MTF is not available Covered by one of the TRICARE options –TRICARE Standard and TRICARE Extra –TRICARE Prime –TRICARE Prime Remote for Active Duty Family Members (TPRADFM)
As of 8/17/2015 9 TRICARE Prime Remote for Active Duty Family Members (TPRADFM) For eligible family members residing with their TRICARE Prime Remote-eligible sponsoring service member who is enrolled in the program –If enrolled sponsor is reassigned to a location where the family cannot accompany him or her, the family remains eligible so long as they continue to live in the remote area.
As of 8/17/2015 10 TPRADFM Enrollment Enrollment for family members is voluntary Eligible family members may enroll in TPRADFM or elect to use TRICARE Extra or TRICARE Standard Remember the “20th-of-the-month rule” to avoid a gap in your TRICARE Prime Remote
As of 8/17/2015 11 Routine Medical Care Most care provided by contracted network PCM or non- network primary care provider, if no network Call your provider directly No pre-approval is required for routine care Preauthorization –For service members - required for routine pregnancy care, physical therapy, behavioral health, family counseling and programs to help stop smoking –For family members - unauthorized care may result in Point-of-Service (POS) fees
As of 8/17/2015 12 Specialty Care PCM determines your need to see a specialist Before obtaining specialty care, PCM must obtain a prior authorization from your regional contractor –Make sure a referral/authorization is processed before going to the appointment –If no PCM, you are responsible for helping ensure that your primary care provider obtains authorization by calling a health care coordinator –If you do not have a PCM, you or your provider must contact the regional contractor for prior authorization
As of 8/17/2015 13 Catastrophic Cap Benefi t ADFMs using TRICARE Standard—$1,000 per fiscal year All other beneficiaries using TRICARE Standard (retirees, family members of retirees, survivors, former spouses) —$3,000 per fiscal year ADFMs using TRICARE Prime—$1,000 per fiscal year All other beneficiaries using TRICARE Prime (retirees, family members of retirees, survivors, former spouses)— $3,000 per fiscal year
As of 8/17/2015 14 TRICARE and Other Health Insurance TRICARE pays after all other health insurance plans except for: –Medicaid –Medi-Cal in California –Arizona Health Care Cost Containment System (AHCCCS) in Yuma, Arizona –TRICARE supplements –The Indian Health Service –Other programs/plans as identified by TMA
As of 8/17/2015 15 TRICARE Dental Program When Sponsor is Activated If enrolled before activation: –Coverage continues –Premiums reduced to active duty family member rates if sponsor is activated for more than 30 days If not enrolled, may enroll now –Reduced monthly premium rates If activation is in support of a contingency –12-month “lock-in” period waived if you enroll within 30 days of activation Contact United Concordia for information: www.TRICAREdentalprogram.com or 1-800-866-8499
As of 8/17/2015 17 Transitional Assistance Management Program (TAMP) Offers transitional TRICARE coverage for 180 days with the same costs as active duty family members –eligible for continued TRICARE medical benefits including enrollment/re-enrollment in TRICARE Prime, Services and supplies provided under the Extended Care Health Option (ECHO) MTF care Coverage is based on DEERS
As of 8/17/2015 18 TRICARE Reserve Select (TRS)
As of 8/17/2015 19 Qualifying for and Purchasing TRS Step 1 – Qualify –Log on to the Guard and Reserve Web Portal at www.dmdc.osd.mil/Guard-ReservePortal –Complete the TRICARE Reserve Select (TRS) Request Form (DD Form 2896-1) –Print and sign the form Step 2 – Purchase –Submit completed form with premium payment to regional contractor
As of 8/17/2015 20 TRICARE Reserve Select (TRS) Premium-based health plan that qualified National Guard and Reserve members may purchase May qualify to purchase TRS if you meet the following conditions: –Member of the Selected Reserve of the Ready Reserve –Not eligible for or enrolled in the Federal Employees Health Benefits (FEHB) program ** More to come on this.
As of 8/17/2015 21 Continuous Open Enrollment If you qualify, you may purchase TRS coverage to begin in any month throughout the year. Coverage begins on the first day of the first or second month after the postmark date of your TRS Request Form. The member can choose which month he or she wishes to begin coverage.
As of 8/17/2015 22 Continuous Coverage You must qualify for and purchase TRS no later than 60 days after loss of other TRICARE coverage to ensure no break in health care coverage. TRS is effective immediately following the termination of other TRICARE coverage. Member’s qualification for TRS must be reflected in DEERS; member must not be eligible for or enrolled in the FEHB program.
As of 8/17/2015 23 TRS Premiums Total annual premium (DoD pays 72%) –$3,487 Member-only coverage –$10,834 Member-and-family coverage First month’s premium due with TRS Request Form –Member-only: $47.51 –Member-and-family: $180.17
As of 8/17/2015 24 In Conclusion… Questions? Comments or feedback?