As of 04/19/23 1

Guard/Reserve TRICARE Continuum of Coverage

Speaker: Mr. Sanders TRICARE Regional Office - South

As of 04/19/23 2

Coverage Life CycleTRICARE Eligibility

Post-Activation

Traditional Status Activation

Pre-Activation

As of 04/19/23 3

Coverage Life CycleTRICARE Eligibility

Pre-Activation:Early Eligibility

Service Member – Direct CareFamily Members – Prime/Prime Remote

Standard/Extra

Post-Activation:Transitional AssistanceManagement Program

(if eligible)Continued Health Care

Benefit Program

Traditional Status:TRICARE Reserve Select

Activation:Prime/Prime Remote

Family – Prime/Prime RemoteStandard/Extra

As of 04/19/23 4

Healthcare BenefitsDuring Pre-Activation

andWhile on Active Duty

As of 04/19/23 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 04/19/23 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 04/19/23 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 04/19/23 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 04/19/23 9

TRICARE Prime Remote for TRICARE Prime Remote for Active Duty Family MembersActive Duty Family Members

(TPRADFM) (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 04/19/23 10

TPRADFM EnrollmentTPRADFM 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 04/19/23 11

Routine Medical CareRoutine 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 04/19/23 12

Specialty CareSpecialty 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 04/19/23 13

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

As of 04/19/23 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 04/19/23 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 04/19/23 16

TAMP & TRS Programs

As of 04/19/23 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 04/19/23 18

TRICARE Reserve Select (TRS)

As of 04/19/23 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 04/19/23 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 04/19/23 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 04/19/23 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 04/19/23 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 04/19/23 24

In Conclusion…

Questions?

Comments or feedback?