Overview of Reserve Health Care Benefits

Overview of Reserve Health Care Benefits Benefits Discussion • • • • • • • Pre-deployment Screening E-ID Active Duty TAMP TRS NDAA 06 Please ask questions at any time… Benefits Timeline Early Identification (E-ID) Notification (TRICARE) Activation Deactivation < 90 days before activation Mob/ADSW-CO orders >30 days NO-COST MED/DENT SCREENING * *Screening only available at Military Treatment Facilities Active Duty (TRICARE) Deactivation TRICARE RESERVE SELECT (TRICARE Eligibility)* 180 days *TRS eligibility = 1yr coverage per 90 days activation. Dependent on continuous service in the SelRes TAMP Period (TRICARE) Pre-deployment Screening • Authorized by § 1074a of title 10 U. S. C. • Medical & Dental care & screening to ensure member meets applicable medical & dental standards for deployment. • Requires notification • Period of duty > 30 days ISO contingency • Must be in a duty status (e.g., IDT) Early Identification (E-ID) • • • • • Authorized by § 1074 of title 10 U. S. C. Active duty TRICARE benefits Requires notification Period of duty > 30 days ISO contingency Benefits begin up to 90 days before activation E-ID (cont) • Notification = delayed-effective-date active-duty order • Diary action required - TTC 897 000 EARLY NOTICE DT___PROJ ACDU DT___CONTINGENCY CD___ - TTC 897 001 EARLY NOTICE TERMINATION DATE___ - DEL/ADD and Delete as erroneous Active Duty & TAMP • TRICARE benefits same as Active Duty • TAMP authorized by § 1145 of title 10 U. S. C. - 180 days - Begins immediately after end of contingency operation orders - Requires update in DEERS and issue of new ID Cards TriCare Reserve Select A premium-based health care plan for certain members of the Reserve Component and their families What Is TRS? • Reservists, and their family members, are normally eligible for Tricare coverage only when they are on active duty. • Law passed by Congress in Oct 2004 that authorizes Tricare coverage for reservists, and their family members, when they are in a drilling status if they meet certain criteria. Type of Coverage • TRS member-only • TRS member and family coverage • Cannot change type of coverage unless there is a qualifying life event - Birth of child - Marriage or divorce - Loss of eligibility TRICARE Reserve Select Costs Monthly Premiums Annual Deductibles (per fiscal year) TRS Member-only: $81 TRS Member and family: $253 Rank E-4 & below: $50/individual or $100/family Rank E-5 & above: $150/individual or $300/family Network Provider: 15% Non-network Provider: 20% $1000 per enrollment Cost-Shares (after annual deductible is met) Catastrophic Cap (per fiscal year) Eligibility for TRICARE Reserve Select • Reserve members who were called or ordered after 9/11 in support of a contingency operation for more than 30 consecutive days. Reserve members who served continuously on active duty for 90 days or more under that call or order. Reserve members must enter a Service Agreement to serve in the Selected Reserve within 90 days of transitioning from active duty. • • Purchasing TRICARE Reserve Select: A Three-Step Process Step 1 Enter into the Service Agreement • Within 90 days after leaving active duty • Agreement form is on line at https://www.dmdc.osd.mil/appj/tsa/index.jsp Step 2 Execute the Service Agreement • Unit TRS VO must verify the agreement • You must be in the Selected Reserve before TRICARE Reserve Select coverage begins. • Submit a completed enrollment form with a one-month premium payment to your regional contractor. • http://www.tricare.osd.mil/reserve/reserveselect/TRSpurchasing.cfm Step 3 Purchase TRICARE Reserve Select Enrollment and Customer Service Health Net Federal Services, Inc. 1-800-555-2605 www.healthnetfederalservices.com TriWest Healthcare Alliance 1-888-TRIWEST (1-888-874-9378) www.triwest.com Humana Military Healthcare Services, Inc. 1-800-444-5445 www.humana-military.com Period of Coverage Days Served on Active Duty 1-89 days 90-179 days 180-269 days 270-359 days 360 days Maximum Period of Coverage None* 1 year 2 years 3 years 4 years *If you are otherwise eligible, but did not serve continuously on active duty for 90 days due to an injury, illness, or disease incurred or aggravated on active duty, you may be eligible for one whole year of TRS coverage. Service Agreement (DD Form 2895) • Should not be confused with reenlistment. • Does not obligate Marine to serve in SelRes. • Does not modify a Marine’s Mandatory Drill Participation Stop Date. • Marines are responsible for joining an SMCR unit or IMA det. • Marines still must request reenlistment via the RELMS (if necessary). Marines Who Decline TRS. • Must indicate their desire to decline TRS by logging on to the DoD web site. • Cannot later change their minds. When Coverage Begins • Coverage begins the first day after the transitional TRICARE coverage ends under the Transitional Assistance Management Program (TAMP). • IRR can defer coverage for up to 1-yr after completion of TAMP. TAMP Period Begins Day 1 Period of Activation TAMP Period Last Day of TAMP Day 180 TRS TRS Begins Day 181 Last Day of Active Duty Disenrollment/Loss of Eligibility • Needs of the Service apply. • Service limitation law and policy take precedence over TRS eligibility. • Transfer to the IRR results in permanent loss of TRS coverage. Additional mobilization • Benefits & premiums suspended during active duty benefits (EID, AD, TAMP) • Eligibility extended by period of mobilization. • Members may elect to extend eligibility for benefits based on additional qualifying period. For More Information • *The TRICARE Reserve Select Handbook is available on the TRICARE Reserve Select Web page and can be downloaded from http://www.tricare.osd.mil/ • For assistance with determining your eligibility for TRICARE Reserve Select and executing your Service Agreement, contact your Service/Reserve Component personnel offices. - Reserve Affairs Web site www.defenselink.mil/ra/ - Guard-Reserve Portal https://www.dmdc.osd.mil/Guard-ReservePortal For More Information (cont’d) • For assistance with DEERS enrollment and customer service, contact your regional contractor at: http://www.tricare.osd.mil/reserve/reserv eselect/TRS-purchasing.cfm TriCare Standard Coverage for the Selected Reserves TriCare Standard for Reserves • New Law introduced in NDAA 06 • Requires SelRes affiliation • Enrollment - Annual (July) - Life Changing Event • Benefits to begin October 1st Premiums • Tier 1 • Tier 2 - TriCare Reserve Select - 28% cost share - Self-employed, unemployed, no employee sponsored plan - 50% cost share - Not eligible for Tier 1 or 2 - 85% cost share • Tier 3 Questions???? ?