TRICARE Reserve Select Program Information

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TRICARE Reserve Select

This fact sheet is for National Guard and Reserve members. With the great expansion of the TRICARE Reserve Select (TRS) program, as mandated in the National Defense Authorization Act of Fiscal Year 2006, all Guard and Reserve members with billets in the Selected Reserve and their families will have the opportunity to take part in TRS by October 1, 2006. A three tiered system will determine premium rates.

*The Reserve Component includes the Army National Guard, the Army Reserve, the Navy Reserve, the Marine Corps Reserve, the Air National Guard, the Air Force Reserve and the U.S. Coast Guard Reserve.

TRS Eligibility and TIERS

TRS eligibility is established with the member's National Guard or Reserve service personnel offices. National Guard and Reserve members may be eligible to purchase TRS for themselves and their immediate family members; to determine eligibility and which Tier they will fall under they must meet the following conditions:

Tier 1 Tier 2 Tier 3

• Was called or ordered to active duty (AD) for a period of more than 30 days in support of a contingency operation.

• Either
(a) served continuously on AD for 90 days or more, OR

(b) served less than 90 days due, solely, to an injury, illness, or disease incurred or aggravated while on AD.

• Coverage is only forfeited based on this period of active service

• Executed a Service Agreement no later than 90 days after release from AD for continued service in the Selected Reserve from the begin date of TRS coverage through the end date of coverage.

• Is a member of Select Reserve on the start date of TRS coverage. (Individual Ready Reserve (IRR) members have one year after the last day of separating from active duty, or until the last day of TAMP coverage, to occupy a position in the Select Reserve or the opportunity to qualify for TRS is lost.)

• Is one of the following:
(a) an eligible unemployment compensation recipient as determined by state law

(b) an employee whose employer does not offer a health plan to anyone working for the employer

(c) in a category of employees not offered an employer-sponsored health benefits plan

(d) self-employed as reported to the IRS (not including Selected Reserve income)

• Either
(a) qualified during annual Open Season OR

(b) submitted documentation sufficient to verify they experienced a Qualifying Life Event (QLE) (such as change in family composition, change in family employment, or change in family health plan coverage).

• Executed a Service Agreement for service in the Selected Reserves from the begin date of TRS coverage to the end date of coverage.

• Is a member of Select Reserve on the start date of TRS coverage.

• Does not qualify for Tier 1 or Tier 2


• Either
(a) qualified during annual Open Season OR

(b) submitted documentation sufficient to verify they experienced a Qualifying Life Event (QLE) (such as change in family composition, change in family employment, or change in family health plan coverage).

• Executed a Service Agreement for service in Selected Reserves from the begin date of TRS coverage to the end date of coverage.

• Is a member of Select Reserve on the start date of TRS coverage.

Additional qualifying information
  • The Service Agreement (DD Form 2895, Agreement to Serve in the Selected Reserve for TRICARE Reserve Select) must be signed and dated by both you and your Reserve Component to be valid. The Service Verifying Officer must then execute the service agreement (DD Form 2895) through the Guard Portal
  • When the Service Agreement has been fully executed, the RC will record your qualification for TRS in DEERS .
  • The TRICARE regional contractors rely solely on DEERS to identify TRS-qualified members and tiers.
  • The Service Agreement, in itself, does not guarantee Selected Reserve status for the full period of time covered in the Service Agreement.

Tier 1

  • Qualifying for TRS Tier 1 is a one-time opportunity for each period of qualifying active duty.
  • If you do not purchase TRS within the specified deadlines, your opportunity is forfeited based on this period of active service.
  • If you are an IRR member who qualifies for TRS Tier 1 after TAMP coverage ends, within a one-year period of time, your effective start date for TRS coverage is the date of accession into Selected Reserve.

Tiers 2 and 3

  • The National Guard or Reserve will determine what documentation is required to validate your qualifications.
  • Coverage under Tiers 2 and 3 is effective for one year at a time through December 31st each year. (You may be permitted to enter mid-year, for less than a year's coverage, with a Qualifying Life Event .)
  • To renew coverage for another year, you must have the National Guard or Reserve re-validate your qualifications and renew the Service Agreement through December 31st of the enrollment year.
  • When you have re-qualified and your National Guard or Reserve updates DEERS, you will be automatically renewed for another year of TRS, you do not need to do anything further to be renewed.

 

Period of Coverage

Selected Reserve members, who fall under Tier 1 may be eligible for one whole year of TRS coverage for each whole year of service commitment in the executed Service Agreement up to a maximum of one whole year of coverage for each 90 days of continuous active duty service in support of a contingency operation. The following chart illustrates several examples:

Maximum Period of Coverage Maximum Period of Coverage

1 - 89 days

None**

90 - 179 days

1 year

180 - 269 days

2 years

270 - 359 days

3 years

360 - 449 days

4 years

**Selected Reserve members who are otherwise eligible, but did not serve continuously on active duty for 90 days solely because of an injury, illness, or disease incurred or aggravated while activated may be eligible for one whole year of TRS coverage.

Time-limited Opportunity to Decide

Purchasing TRS coverage is a two-step process.

Step 1- Qualifying for TRS

Step 1 may vary by National Guard and Reserve, so prompt contact with the National Guard and Reserve unit or personnel office is recommended for specific qualification procedures. The National Guard and Reserve will validate the National Guard and Reserve member's TRS qualifications and identify the premium tier for which they qualify (reference TRS eligibility above for detailed Tier 1-3 explanation). Step 1 must be completed before they can proceed to Step 2.

Step 2- Purchase Coverage

National Guard and Reserve member must login to Guard-Reserve portal and print their personalized TRS Request Form (application to purchase TRS). This is only available through the on-line portal. The TRS Request From must be competed according to the form's instructions. Once completed, the form must be submitted with the correct one-month premium payment to the TriWest by the applicable deadline. The initial payment may be made by check, money order or cashier's check payable to TriWest Healthcare Alliance. Payment can also be made by Visa or MasterCard.

Follow the instructions on your TRICARE Reserve Select enrollment form, complete the form, and submit it with a one-month premium payment to your TRICARE regional contractor so they receive it no later than 30 days before the end of TAMP. The pre-printed enrollment form is available for download from the Guard Reserve Portal at https://www.dmdc.osd.mil/Guard-ReservePortal when you enter into your Service Agreement.

Don't forget to execute your service agreement.

Be sure to include the first month's premium with the form and mail it to your TRICARE regional contractor at the address below. The check should be made payable to your TRICARE regional contractor.

When Coverage Begins

When Tier 1 Coverage Begins

For National Guard and Reserve members who separated from Tier 1 qualifying active duty service, coverage begins the first day after the National Guard and Reserve member's transitional TRICARE coverage ends under TAMP. TAMP covers the National Guard and Reserve Member and eligible family member for 180 days immediately following release from qualifying active duty. Therefore, TRS Tier 1 begins on the 181st day. After purchasing TRS Tier 1, the member will receive a welcome letter with TRS wallet cards for each covered family member. The wallet card contains phone numbers and information to assist with health care coverage.

When Tier 2 & 3 Coverage Begins

For those qualifying for TRS Tier 2 or 3 National Guard and Reserve members taking part in the one-time open 2006 season whose TRS Request Forms are postmarked August 1through September 25, 2006, coverage begins October 1, 2006. For those members whose forms are postmarked September 26 through November 25, 2006, coverage begins January 1, 2007. For new accessions into the Selected Reserve that wish to participate in TRS Tier 2 or 3, the 20th of the rule applies. If a complete and correct application, including premium payment, is received by the 20th of the month, TRS coverage begins the first day of the next month. If, however, it is received on or after the 20th day of the month, coverage will not begin until the second month following. For example, if payment is received on April 19, coverage begins May 1, but if payment is received April 21, coverage will begin June 1.

Transitioning from TAMP to TRS

Members who qualify for TRS and were enrolled in TRICARE Prime during their TAMP period, their TRICARE Prime benefit ends on the last day of the TAMP period. If the primary care manager (PCM) was a TRICARE network provider, the member may be able to continue seeing that provider. However, cost-shares will apply for outpatient visits. If the member was enrolled in TRICARE Prime at a military treatment facility (MTF) and received care from an MTF PCM, the member will be able to see that provider only on a space-available basis since TRICARE Prime (and assignment to a PCM) is not available under TRS. For RC members who used TRICARE Standard or TRICARE Extra during the TAMP period, they may continue seeing the same provider under TRS. To locate a TRICARE network or non-network TRICARE-authorized provider, members may visit the TRICARE provider directory at www.tricare.mil/providerdirectory or call their TRICARE regional contractor for assistance.

Coverage Provided

TRS offers comprehensive health coverage similar to TRICARE Standard and TRICARE Extra. TRS members will access care from any TRICARE-authorized provider, hospital or pharmacy-TRICARE network or non-network. They may access care from an MTF on a space-available basis only. Pharmacy coverage is available from the TRICARE Mail Order Pharmacy program, TRICARE network and non-network retail pharmacies and MTF pharmacies. For more information, members may visit www.tricare.mil/reserve/reserveselect.

TRS coverage includes:

  • Routine, urgent and emergency care
  • Family health care
  • Maternity services
  • Clinical preventive services, including screenings and immunizations
  • Behavioral/mental health care, including partial hospitalization and residential treatment
  • Annual eye exams
  • Lab work and x-ray services
  • Medical equipment and supplies
  • Prescription drug coverage
Programs Not Available With TRS

The following programs are not available under TRS:

  • TRICARE Prime and TRICARE Overseas Program Prime
  • TRICARE Prime Remote (neither service member nor family member)
  • TRICARE Reserve Demonstration Project (and its successor program that waives deductibles and offers higher payments to providers)
  • Extended Health Care Option Program (ECHO)
  • Continued Health Care Benefits Program (CHCBP) (TRS Tier 1 member may qualify separately for CHCBP coverage)
  • Uniformed Services Family Health Program
  • Supplemental Health Care Program (SHCP) funds (unless an MTF refers you to a civilian care, while the MTF retains clinical control of the case)
  • Special Supplemental Food Program (Women, Infants and Children – Overseas Program)
  • Dental Coverage (the TRICARE Dental Program is available for purchase by all eligible Select Reserve members)
Access to Care Overseas

TRS is available outside the 50 United States. The TRICARE South regional contractor handles TRS overseas enrollment, billing and customer service support for these areas.

Premiums

When a member completes a TRS enrollment form, he/she must select a type of coverage. Monthly premiums for each type of coverage in calendar year 2007 are listed below and may be adjusted annually (see www.tricare.mil/reserve/reserveselect).

  TIER 1* TIER 2* TIER 3*
TRS MEMBER ONLY $81.00 $145.29 $247.00
TRS MEMBER & FAMILY $253.00 $451.42 $767.41

Premium Billing and Payment

After processing the enrollment, the servicing TRICARE regional contractor will send a bill by the 10th day of each month. Payment is due no later than the 30th day of each month*. Failure to pay premiums on time will result in permanent disenrollment, unless the RC member is reactivated for a contingency operation and qualifies again for TRS.

Please be aware, if you stop paying premiums without formally disenrolling, you may be held responsible for up to two months premium coverage.

Tier 1- If you wish to disenroll, please fill out the TRS Update Form and request disenrollment. Disenrollment will take effect the last day of the month in which the form was received.

Tier 2 or 3- Disenrollment can only be requested if you or your family experience a Qualifying Life Event. You must fill out the QLE form and submit to TriWest within 60 days of the QLE. The effective date of disenrollment is the date of the QLE. For more information on QLEs, please visit TRICARE's web site.

* There are no quarterly or annual billing options. Premium will be adjusted January 1 every year. December 2006 premium payment should reflect 2007 monthly premiums.

Annual Deductible, Cost-Shares and Catastrophic Cap

TRS members are required to meet a deductible and to pay cost-shares for outpatient services for each fiscal year (October 1-September 30). If a member's rank is E-4 or below, that member will pay a deductible of $50 per individual or $100 per family. If a member's rank is E-5 or above, that member will pay a deductible of $150 per person or $300 per family.

Upon meeting the annual deductible, the member pays 15 percent for TRICARE network provider care or 20 percent for any non-network TRICARE-authorized provider care. More information about costs for covered services is available online at www.tricare.mil/tricarecost.

The catastrophic cap is the maximum out-of-pocket-expense each federal fiscal year. The TRS catastrophic cap is $1,000 for the TRS member and covered family members. Monthly premium payments do not apply to the catastrophic cap.

Qualifying Life Events

TRS members may request changes to their TRS coverage in connection with Qualifying Life Events (QLE). QLE can include a change in family composition or changes in health coverage status. Under Tier 1 a member may only change their type of coverage and for Tier 2 & 3 they may purchase new coverage, change type of coverage, or terminate existing coverage. The effective date of the type-of-coverage change is the date of the QLE. Beneficiaries have 60 days to notify TriWest Healthcare Alliance of QLE. Beneficiaries are responsible for reporting all changes in family composition to the National Guard or Reserve unit personnel office, so that DEERS records can be updated.

A change in family composition:

  • Marriage
  • Birth or adoption of a child
  • Placement of a child in the legal custody of the member by an order of the court
  • Divorce or annulment
  • Death of a spouse or family member
  • Last family member becomes ineligible (e.g., child ages out)

Changes in employment status that could result in change in family health coverage are:

  • National Guard or Reserve member or eligible family member is reemployed after a break in employment.
  • National Guard or Reserve member or eligible family member returns to pay status after employer-sponsored coverage terminated during leave without pay status.
  • National Guard or Reserve member or eligible family member is employed or reemployed after serving on active duty as a member of the National Guard or Reserve.
  • National Guard or Reserve member or eligible family member changes employment status that changes employer contribution to premiums of employer-sponsored health plan available to the member, such as a change from full-time to part-time status or the reverse.

Changes in health coverage status that could result in a loss of coverage by an National Guard or Reserve member or eligible family member, if the individual becomes eligible to receive care:

  • Under CHAMPVA, TRICARE (CHAMPUS), or TRICARE For Life (TFL).
  • Under another federally-sponsored health benefits program.
  • Under Medicaid or similar state-sponsored program for the needy.
  • When TRS coverage was suspended to participate in one of these government programs.
  • Under a non-federal health plan.

Changes in health coverage status that could result in a loss of coverage by an National Guard or Reserve member or eligible family member:

  • When any of the above events occurs, TriWest will accept your QLE change request.
  • The TRS Request form (QLE request) must be accompanied by any applicable premium for new applications.
  • The QLE request must be received by the TriWest no later than 60 days after the date of the event being claimed as a QLE.
Survivor Benefits

For Tier 2 and 3 family members covered on the day of a National Guard or Reserve member's death, coverage is extended until the last day of the month in which the member's death occurred. Coverage will then be terminated.

For Tier 1 National Guard or Reserve members covered on the day of his or her death, surviving family members may purchase (or continue) TRS Tier 1 coverage for an additional 6 months from the date of the National Guard or Reserve member's death. If there is only one surviving TRS-enrolled member, the survivor will pay for coverage at the member-only rate. If there are two or more surviving TRS-enrolled family members, member-and-family rates will apply. No later than 60 days of the member's death, surviving family members must submit a TRS Request form to request survivor coverage. If the application is not submitted in the proper time frame, it will not be processed and will be returned. If the TRS-covered member was recalled to active duty and dies while on active duty, surviving family members are eligible for active duty survivor benefits. For more information, members may visit: http://www.tricare.mil/survivors/default.cfm

TRS Handbook

The TRS Handbook contains detailed information regarding the rewards of being a TRS member. TRS beneficiaries also receive a copy of the handbook upon enrollment.

Choosing a Health Plan

Choosing a health plan is a personal decision, and RC members should carefully consider their situation. They may have some protections under the Uniformed Services Employment and Reemployment Rights Act of 1994. For more information, RC members may visit www.esgr.org. These protections are of limited duration and may not apply to the RC member's situation by the end of TAMP coverage or TRS coverage, if selected. RC members may be eligible for coverage under the Continued Health Care Benefit Program up to 18 months after TAMP ends (see www.tricare.mil/chcbp).

TRS Renewal

For those National Guard and Reserve members currently enrolled in TRS, their service agreement must be renewed through December 31st of the enrollment year. For those members in Tier 2 & 3, they must have their Selected Reserve unit re-validate their qualifications for Tier 2 or 3, each year. They can renew existing coverage by re-qualifying through their Selected Reserve personnel office. Once their unit has revalidated their qualification and reported the information to DEERS, they will be automatically renewed for another year of TRS—they do not need to do anything further to be renewed. If the Selected Reserve member purchases Tier 2 or 3 coverage during the Qualification/Recertification Period (July 1-October 31) and their Service Agreement is effective through December 31, 2007, they will automatically renewed for calendar year 2007, at 2007 premium costs.

Enrollment and Customer Service

For assistance with TRS enrollment, premium billing and payments, accessing health services or covered benefits, National Guard or Reserve members may contact their TRICARE regional contractor. Members may also subscribe to the TRICARE Management Activity e-mail update service at www.tricare.mil/tricaresubscriptions to have TRS-related information sent to their e-mail address as new information becomes available.

TRICARE North Region Contractor

Health Net Federal Services Inc.
TRICARE Reserve Select Enrollment
P.O. Box 870162
Surfside Beach, SC 29587-9762
1-800-555-2605
https://www.hnfs.net/bene/home

TRICARE South Region Contractor

Humana Military Healthcare Services Inc.
P.O. Box 105389
Atlanta, GA 30348-5389
1-800-444-5445
www.humana-military.com

TRICARE West Region Contractor

TriWest Healthcare Alliance
P.O. Box 42048
Phoenix, AZ 85080-2048
1-888-TRIWEST (1-888-874-9378)
www.triwest.com

Overseas

Humana Military Healthcare Services Inc.
P.O. Box 105838
Atlanta, GA 30348-5838
1-800-444-5445
www.humana-military.com

Overseas provider locator support and other information are available at Overseas TRICARE Area Offices. See chart below.

TRICARE Europe Includes Europe, Africa and the Middle East

TRICARE Area Office Europe
Unit 10310, APO, AE 09136
Commercial Phone 00-49-(0)630-267-6312/6314
DSN 496-6312/6314
www.europe.tricare.osd.mil

TRICARE Pacific Includes Japan, Korea, Guam, the Western Pacific and the Far East

TRICARE Area Office Pacific
PSC 482, Box 2749
FPO AP, 96362
Toll free number: 1-888-777-8343, option 4
http://www.wpsic.com/index.shtml

TRICARE Latin America and Canada Includes all of Latin America, Canada, Puerto Rico and the Virgin Islands

TRICARE Area Office Latin America & Canada
Attn: LATLAC - B38802 (DIR)
Fort Gordon, GA 30905-5650
Commercial Phone 1-706-787-2424
DSN 773-2424
TLAC toll free #: 1-888-777-8343, option #3
tricare15.army.mil/indexReg15.htm