TRICARE Reserve Family Demonstration Project

The TRICARE Reserve Family Demonstration Project is effective for health care services received on or after Sept. 14, 2001, and it is nationwide. The demonstration project tests approaches for the Military Health System to ensure timely access to health care during a national crisis for Family members of activated reservists and members of the National Guard, and to maintain clinically appropriate continuity of health care for their Family members. Demonstration participants are limited to Families of Reserve and National Guard members called to active duty for periods of more than 30 days in support of operations that result from the terrorist attacks of Sept. 11, 2001, under Executive Order 13223, 10 U.S.C. 12302, 10 U.S.C. 12301(d), or 32 U.S.C. 502(f). Such operations include, for example, Operation ENDURING FREEDOM and NOBLE EAGLE.

TRICARE for Reserve/National Guard Military Sponsor

Members of the Reserves and the National Guard who are called to active duty become eligible for TRICARE* as active duty service members. All care is provided at military treatment facilities or from TRICARE network providers. When the sponsor is no longer on active duty orders, and after TAMP eligibility ends, TRICARE eligibility ends; however, care may be received in a military treatment facility for injuries or illnesses incurred while the sponsor was on active duty.

TRICARE for Families of Activated Reservists or Members of the National Guard

Family members of eligible reservists and guardsmen may qualify for the TRICARE Reserve Family Demonstration Project. The demonstration project has three major components that remove potential barriers to health care access and limit out-of-pocket expenses.

Demonstration Project Components

• Waiver of TRICARE Standard and Extra Annual Deductible. Participants who do not or cannot enroll in TRICARE Prime are not required to pay the annual outpatient deductible under Standard or Extra (up to $300). These beneficiaries are only responsible for their cost share (20 percent for TRICARE Standard and 15 percent for TRICARE Extra). This component covers all outpatient health care received by an eligible participant through Oct. 31, 2007.
• Waiver of the TRICARE Maximum Allowable Charge under TRICARE Standard. The Department of Defense will pay up to 115 percent of the TRICARE maximum allowable charge, less the applicable cost share, for demonstration participants who are covered by TRICARE Standard and receive care from nonparticipating providers who bill in excess of the TRICARE maximum allowable charge. This component covers all health care received by an eligible participant through Oct. 31, 2007.
• Waiver of Nonavailability Statement (NAS) Requirement for Nonemergency Inpatient Care. The requirement to obtain a NAS before nonemergency inpatient care can be paid under TRICARE Standard is waived for all eligible demonstration participants. This component covers all nonemergency inpatient care received by an eligible participant through Oct. 31, 2007.

To ensure Family members are eligible for the TRICARE Reserve Family Demonstration Project upon activation, activated Reserve and Guard members should update their information in the Defense Enrollment Eligibility Reporting System (DEERS) database by visiting their local military ID card issuing facility. They should bring proper documentation to update their Family file, such as a marriage certificate, birth certificate or divorce decree. Incorrect information can result in delayed claims processing, problems with the use of retail pharmacies and the TRICARE Mail Order Pharmacy benefit, and other difficulties. Beneficiaries may go online to find the three closest personnel offices or ID card facilities at www.dmdc.osd.mil/rsl/. For more information about DEERS enrollment*, beneficiaries may contact the Defense Manpower Data Center Support Office (DSO) Telephone Center at 1-800-538-9552.

For more information about medical care, dental care and other benefits for reservists, members of the National Guard and their eligible Family members, please visit the TRICARE Web site at www.tricare.osd.mil/reserve/. For details about TRICARE Prime, Extra or Standard*, please visit the TRICARE Web site at www.tricare.osd.mil. For more information about the TRICARE Dental Program, visit the TRICARE Dental Program Web site at www.ucci.com/tdp/tdp.html.

Source: TRICARE Reserve Family Demonstration Project