reserve health benefits jody w. donehoo, ph.d. tricare management activity office of assistant...
TRANSCRIPT
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.
Slide 11
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
Slide 12
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.
Slide 14
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
Slide 15
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.
Slide 16
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.