Reserve Health Benefits

Jody W. Donehoo, Ph.D.TRICARE Management ActivityOffice of Assistant Secretary of

Defense for Health Affairs

Slide 2

RC TRICARE Beneficiaries

530,920 Activated RC members

714,079 RC Family members

1,244,999 RC TRICARE beneficiaries

9/11/2001 – 5/31/2006Source: DEERS

Slide 3

Agenda

• Reserve Health Benefit Continuum

• TRICARE Reserve Select

Slide 4

Activated > 30 Days

• Health benefits• TRICARE Prime/TRICARE Prime Remote• Family members eligible for full TRICARE benefits

• Dental benefits • Military dental treatment facilities (DTF)• Tri-Service Remote Dental Program

• If activated in support of a contingency operation (Title 10), may be eligible for additional benefits• Early eligibility for TRICARE• TAMP coverage upon deactivation

• TAMP (Transitional Assistance Management Program)

Slide 5

Pre-activation Benefits• Early eligibility for TRICARE

• Called or ordered for more than 30 consecutive days

• in support of a contingency operation

• Effective upon issuance of “delayed-effective-date” orders

• up to 90 days before active duty report date

• Verify through the Guard-Reserve portalwww.dmdc.osd.mil/Guard-ReservePortal

• Family members are also eligible for TRICARE

Slide 6

TAMP Health Coverage

• After activation in support of a contingency operation • More than 30 consecutive days• Coverage begins on day after separation date

• TRICARE for 180 days after leaving active duty

• MTF services Space available• TRICARE Prime Must re-enroll to continue

coverage • TRICARE Extra Active duty family member

cost-shares• TRICARE Standard Active duty family member

cost-shares• TRICARE Prime Remote Not available

• Includes pharmacy coverage

Slide 7

Pre-activation Active Duty Service

TAMP TRICARE Reserve Select

Tier 1

Coverage

Full TRICARE and MTF for member & family

- up to 90 days prior to activation if issued “delayed-effective-date” contingency orders

Coverage

Continuous from pre-activation coverage or

beginning on first day of activation with orders > 30 days(if no delayed-effective date orders)

Coverage

Follows active duty coverage- 180 days after demobilization for contingency- Family member cost sharing for member & family

Coverage

TRICARE Standard, TRICARE Extra, MTF “Space A” - One whole year for each 90 days served for contingency ops- begins day after TAMP coverage ends

Contingency OperationsReserve Health Coverage Continuum

2 new premium sharing tiers for TRS, non-contingency related

Slide 8

2006 TRS Premiums

Total Annual Premium$ 3,487 TRS Member only$10,834 TRS Member & Family

Tier 1 – 28% monthly$ 81.00 TRS Member only$253.00 TRS Member & Family

Tier 2 – 50% monthly $145.29 TRS Member only$451.42 TRS Member & Family

Tier 3 – 85% monthly $247.00 TRS Member only$767.41 TRS Member & Family

Slide 9

Getting TRS CoverageTwo Step Procedure

Step 1 – Qualify• Reserve component validates

qualifications and identifies premium tier

Step 2 – Purchase Coverage• Member submits completed TRS request

form and correct payment to TRICARE Regional contractor

Slide 10

Tier 1Step 1 – Qualify

• Meet all the following conditions• Called or ordered to active duty under

Title 10> 30 days in support of a contingency operation

• Served on active duty for 90 days or more

• One year of coverage for each 90 days served

• Execute a Service Agreement to serve in Selected Reserve for entire period of coverage

• within 90 days of deactivation• IRR members have up to one year to secure

a billet in the Selected Reserve and qualifyOnly opportunity to purchase TRS (Tier 1) unless you re-qualify

through another period of active duty service.

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Tier 2Step 1 – Qualify

• Qualify during open season or after a qualifying life event

• Certifies one of the following conditions• An eligible unemployment compensation

recipient as determined by state law• Employer does not offer a health plan to

anyone• In a category of employees not offered a

health plan • Not based on membership in the Selected Reserve

• Self employed as reported to the IRS

Must execute a Service Agreement and be in the

Selected Reserve

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Tier 3Step 1 – Qualify

• Qualify during open season or after a qualifying life event

• Meet qualifying conditions• Member of the Selected Reserve• Not qualified for Tier 1 or Tier 2

Must execute a Service Agreement and be in the

Selected Reserve

Slide 13

Maximum Period of Coverage

Tier 1 Tiers 2 & 3

One year of coverage for each 90 days you served on active dutyActive Duty Coverage 1 – 89 days None* 90 – 179 days 1 year180 – 269 days2 years270 – 359 days3 years360 – 449 days4 years

One year of coverage at a time

May be renewed annually during open season

•Extend Service agreement through personnel

* May qualify for one year of TRS if you would have qualified, but did not serve continuously on active duty for 90 days due to an injury, illness, or disease incurred or aggravated on active duty.

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Step 2 – Deadlines for TRS Request Form & Payment

Tier 1• Received by contractor 30 days before start of

coverage• Unless IRR, then received 60 days after accession into

Selected Reserve

Tier 2 & 3Special Open Season - coverage starts

• 01 Oct 2006 – if Service Agreement starts 01 Oct 2006 and form/payment is postmarked on or before 25 Sep 2006

• 01 Jan 2007 – if Service Agreement starts 01 Jan 2007 and form/payment is postmarked on or before 25 Nov 2006

Annual Open Season - postmarked by Nov 25th (2007)New Selected Reservist - 60 days after accessionQualifying Life Event - 60 days after event

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TRICARE Regional Contractors

North Region

Health Net1-800-555-2605

www.healthnetfederalservices.com

South Region

Humana Military1-800-444-5445

www-humana-military.com

West Region

TriWest1-888-TRICARE

www.triwest.com

If you live overseas, contact Humana

Military for assistance.

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TRS Open Season (Tiers 2 & 3 only)

• Scheduled fall of each year• Renew coverage same tier

• Guard/Reserve personnel office• Extend Service Agreement through Dec. 31 of the next

year• To change type of coverage, renew Service Agreement

and send TRS request form to TRICARE regional contractor

• Terminate existing TRS coverage• Do not renew coverage

• Purchase new TRS coverage or change premium tier• Step 1 – Guard/Reserve personnel office• Step 2 – TRICARE Regional contractor

• Open Season actions are effective Jan. 1 of the next year 2006 Special Open Season: Aug. 1 - Nov.

25• TRS request forms postmarked on or before

Sept. 25: Coverage begins Oct. 1, 2006• TRS request forms postmarked after Sept. 25:

Coverage begins on Jan. 1, 2007

Slide 17

Coverage Provided

• Comprehensive coverage• Emergency and urgent

care• Immunizations and health

screenings• Maternity• Behavioral/mental health• Vision • Prescription drug

coverage• TRICARE-authorized

providers• Military treatment facility,

space-available only

For details about TRS-covered services, refer to your TRICARE Reserve Select

Handbook.

Slide 18

Qualifying Life Events

• Change in family composition • Marriage, newborn, etc.

• Change in employment status • Results in a change in employer-sponsored

health insurance

• Change in health coverage status • New TRICARE eligibility if activated

Tier 1 Tiers 2 & 3May only change type of coverage.

Example: Member-only coverage to Member and Family coverage

May purchase, change or terminate coverage. Without a qualifying life event, must wait until open season.

Slide 19

TRS Survivor Coverage

TRS Tier Survivor CoverageTier 1 Coverage continues for 6 months following

member’s death.If member-only coverage in effect at death, survivors may purchase coverageMonthly premiums must be paid

• One family member: Member-only premium amount applies

• Two or more family members: Member and family premium amount applies

Tiers 2 & 3 Coverage terminates at the end of the month in which the member dies.

Slide 20

Termination of Coverage

• Coverage will be terminated for failure to pay premiums• Must still pay any overdue amounts

• Voluntarily request termination• Tier 1 – at any time• Tiers 2 & 3

• Only during annual Open Season• or with a Qualifying Life Event

• May purchase coverage again if you qualify again• For one of the three premium tiers

Slide 21

Who to Call for Help and Information

Reserve Affairs www.defenselink.mil/raGuard-Reserve Portal www.dmdc.osd.mil/Guard-ReservePortal

TRICARE Reserve Select www.tricare.osd.mil/reserve/reserveselect

Contact your Guard/Reserve personnel office for help with Step 1 – qualifying for TRS or

qualifying life events

Contact your TRICARE regional contractor for help with Step 2- purchasing TRS

coverage and for customer service after your coverage

starts.