Enhanced Health Care Benefits for Reserve Component Members and Their Dependents

Language on TRICARE Benefits for "Delayed-Effective-Date Active Duty Orders" for Reserve Component members. *

The information below is provided for use in preparing orders to active duty for reserve component members serving for a period of more than 30 days in support of a contingency operation as defined in 10 U.S.C. 101(a)(13)(B). This information provides additional guidance concerning the enhanced TRICARE benefits for Reserves, enacted in sections 703 and 704 of the National Defense Authorization Act for Fiscal Year 2004 and implemented in the Under Secretary of Defense for Personnel and readiness policy memorandum of January 7, 2004, entitled "Health Care Benefits for Reserve Component Members and Their Dependents: second Addendum to Mobilization/Demobilization Personnel and Pay Policy for Reserve Component Members Ordered to Active Duty in Response to the World Trade Center and Pentagon Attacks."

The language below is provided as a template or guide for use as appropriate to inform reserve component members about more specific details of their benefit entitlement under the new authorities, and where to seek additional information in the attachment should be referred to the Reserve Affairs point of contact, Colonel Kate Woody at (703) 693-2296.

1. Reserve component members who are issued a delayed-effective-date active duty order are eligible for TRICARE Benefits along with their Family members, upon the date of issuance of such order, or up to 60 days before the date on which the 30-day period of active duty for screening is to commence, whichever is later. This eligibility must be shown on the Defense Enrollment Eligibility Reporting System (DEERS) for civilian TRICARE health care claims processing. Once DEERS has been updated, Reserve components members can verify their eligibility on the Guard and Reserve Web Portal at https://www.dmdc.osd.mil/appj/esgr/index.jsp. For questions or problems concerning eligibility for TRICARE benefits on the DEERS, contact "EACH RESERVE COMPONENT WILL ADD ITS OWN SPECIFIC POC CONTACT INFORMATION FOR MEMBER"

2. Reserve component members who are issued a delayed-effective-date active duty order and whose orders are subsequently rescinded prior to the member being required to report for active duty, and their Family members are not covered by the Uniformed Services Employment Reemployment Rights Act (USERRA) protections pertaining to reinstatement in an employer-sponsored health plan. Members are strongly encouraged to consider retaining their employer health plan coverage until they actually report for active duty, at which time they are fully covered by USERRA.

3. Reserve component members who are issued a delayed-effective-date active duty order shall be provided heath care by military hospitals and clinics or by TRICARE-authorized providers reimbursed through supplemental care rules. RC members will not be enrolled into TRICARE Prime unless, and until, they reach their final duty station location.

4. Family members will become eligible for TRICARE Standard/Extra upon establishment of TRICARE eligibility for their Reserve component sponsor. They will be covered under the TRICARE Reserve Family Member Demonstration through October 31, 2004 (unless further extended by law), which waives their TRICARE Standard/Extra deductible and enables higher payments to nonparticipating TRICARE authorized providers. Family members may choose to enroll in TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members (TPRADFM) if they reside in a TPR zip code. To be eligible for TPRADFM, eligible Family members had to reside with the RC member before activation or receipt of a delayed-effective-date activation order and continue to reside at that address; transfers of TPRADFM enrollment to another TPR site are not authorized. Family members who reside outside the fifty United States will follow the appropriate enrollment procedures for the overseas programs in accordance with Service guidance.
   
   Note: The TRICARE Reserve Family Member Demonstration program has been extended through November 1, 2005.

5. Reserve component members who are issued a delayed-effective-date active duty order and are enrolled in the TRICARE Dental Program (TDP), will be disenrolled automatically and will become eligible for care at Dental Treatment Facilities (DTF) or through the Tri-Service Remote Dental Program. Their Family members, who are enrolled in the TDP, will continue to be enrolled in the TDP, but at the lower active duty Family member shared premium rate.

6. Reserve component members who are issued a delayed-effective-date active duty order that is subsequently rescinded or who are released after serving on active duty under such an order, and were previously enrolled in the TDP, will automatically be reenrolled back to the previous TDP plan

7. Family members of Reserve component members issued a delayed-effective-date active duty order who are not enrolled in the TDP, may enroll in the active duty premium share plan. The standard 12-month TDP enrollment requirement is waived for those Family members who enroll during the period prior to the Reserve component member entering on active duty or during the first 30 days of the member's active duty. Those Family members who elected to enroll in the TDP after issuance of the delayed-effective-date order or within 30 days of the member's active duty will automatically be disenrolled upon release from orders. Eligible Family members must take action to reenroll if they wish to continue in the TDP, which will be at the RC full premium rate. Family members who enroll in the TDP after the first 30 days of the sponsor's active duty period will be obligated to stay in the TDP for at least 12 months, after which they may continue on a month-to-month basis. If the sponsor deactivates from active duty before the end of the 12-month enrollment period, Family members will be automatically reenrolled in the RC full premium rate plan.

8. Reserve component members who have served on active duty for more than 30 days in support of a contingency operation and who are released from that active duty after November 6, 2003 are authorized Transitional Assistance Management Program (TAMP) healthcare benefits for 180 days, beginning on the date the member is released from active duty. This 180-day period of TAMP eligibility is valid through December 31, 2004. As of January 1, 2005 (unless further extended by law) this temporary extended TAMP period will revert to the normal duration of 60 days for members with less than six years of cumulative active service and 120 days for members with six or more years of cumulative active service. During the TAMP period the deactivated Reserve component member and their Family members receive TRICARE active duty Family member cost sharing. Reserve component members not previously enrolled in the TDP and who have a 12-month service commitment remaining may be eligible to enroll in the TDP. TPR and TPRADFM are not available for the RC member and their Families under TAMP.
   
   Note: Under the National Defense Authorization Act for Fiscal Year 2005, effective Oct. 28, 2004, TRICARE eligibility under the TAMP has been permanently extended from 60 or 120 days to 180 days." (Source: "Transitional Assistance Management Program: A Transitional Health Care Benefit For Service Members and Their Families", TRICARE web site)

9. For more information on these benefits, Reserve component members or their Family should call 888-DOD-CARE (888-363-2273) or access the TRICARE website at www.tricare.osd.mil/reserve. Beneficiary Counseling and Assistance Coordinators (BCAC) are available at each military treatment facility or TRICARE Lead Agent/Regional Office.

Source: DOD - Assistant Secretary of Defense - Memorandum: Enhanced Health Care Benefits for Reserve Component Members and Their Dependents; 16 June 2004.