Guard/Reserve TRICARE Continuum of Coverage
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Guard/Reserve TRICARE Continuum of Coverage Speaker: Mr. Sanders TRICARE Regional Office - South. TRICARE Eligibility. Coverage Life Cycle. Pre-Activation. Traditional Status. Activation. Post-Activation. TRICARE Eligibility. Coverage Life Cycle. Pre-Activation: Early Eligibility

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Guard/Reserve TRICARE Continuum of Coverage Speaker: Mr. Sanders

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Guard reserve tricare continuum of coverage speaker mr sanders

Guard/Reserve TRICARE Continuum of Coverage

Speaker: Mr. Sanders

TRICARE Regional Office - South


Coverage life cycle

TRICARE Eligibility

Coverage Life Cycle

Pre-Activation

Traditional Status

Activation

Post-Activation


Coverage life cycle1

TRICARE Eligibility

Coverage Life Cycle

Pre-Activation:

Early Eligibility

Service Member – Direct Care

Family Members – Prime/Prime Remote

Standard/Extra

Traditional Status:

TRICARE Reserve Select

Activation:

Prime/Prime Remote

Family – Prime/Prime Remote

Standard/Extra

Post-Activation:

Transitional Assistance

Management Program

(if eligible)

Continued Health Care

Benefit Program


Healthcare benefits during pre activation and while on active duty

Healthcare BenefitsDuring Pre-Activation andWhile on Active Duty


Eligibility

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


Care during pre activation

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


Reserve component member health care options

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


Family member health care options when sponsor is activated

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)


Tricare prime remote for active duty family members tpradfm

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.


Tpradfm enrollment

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


Routine medical care

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


Specialty care

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


Catastrophic cap benefi t

Catastrophic Cap Benefit

  • 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


T ricare and other health insurance

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


Tricare dental program when sponsor is activated

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


Guard reserve tricare continuum of coverage speaker mr sanders

TAMP & TRS Programs


Transitional assistance management program tamp

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


Guard reserve tricare continuum of coverage speaker mr sanders

TRICARE Reserve Select (TRS)


Qualifying for and purchasing trs

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


Tricare reserve select trs

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

    • Noteligible for or enrolled in the Federal Employees Health Benefits (FEHB) program

      ** More to come on this.


Continuous open enrollment

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.


Continuous coverage

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.


Trs premiums

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 RequestForm

    • Member-only: $49.62

    • Member-and-family: $197.65


In conclusion

In Conclusion…

Questions?

Comments or feedback?


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