Reserve Health Benefits Jody W. Donehoo, Ph.D. TRICARE Management Activity Office of Assistant Secretary of Defense for Health Affairs

Slide 2 RC TRICARE Beneficiaries 530,920Activated RC members 714,079RC Family members 1,244,999RC TRICARE beneficiaries 9/11/2001 – 5/31/2006 Source: 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 portal 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 servicesSpace available TRICARE PrimeMust re-enroll to continue coverage TRICARE ExtraActive duty family member cost-shares TRICARE StandardActive duty family member cost-shares TRICARE Prime RemoteNot available Includes pharmacy coverage

Slide 7 Pre-activationActive Duty Service TAMPTRICARE 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 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 Operations Reserve Health Coverage Continuum 2 new premium sharing tiers for TRS, non-contingency related

Slide TRS Premiums Total Annual Premium $ 3,487TRS Member only $10,834TRS Member & Family Tier 1 – 28% monthly $ 81.00TRS Member only $253.00TRS Member & Family Tier 2 – 50% monthly $145.29TRS Member only $451.42TRS Member & Family Tier 3 – 85% monthly $247.00TRS Member only $767.41TRS Member & Family

Slide 9 Getting TRS Coverage Two 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 1 Step 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 qualify Only opportunity to purchase TRS (Tier 1) unless you re-qualify through another period of active duty service.

Slide 11 Tier 2 Step 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 3 Step 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 1Tiers 2 & 3 One year of coverage for each 90 days you served on active duty Active DutyCoverage 1 – 89 daysNone* 90 – 179 days1 year 180 – 269 days2 years 270 – 359 days3 years 360 – 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 & 3 Special Open Season - coverage starts 01 Oct 2006 – if Service Agreement starts 01 Oct 2006 and form/payment is postmarked on or before 25 Sep 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 accession Qualifying Life Event - 60 days after event

Slide 15 TRICARE Regional Contractors North Region Health Net South Region Humana Military www-humana-military.com West Region TriWest TRICARE 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 1Tiers 2 & 3 May 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 TierSurvivor Coverage Tier 1Coverage continues for 6 months following member’s death. If member-only coverage in effect at death, survivors may purchase coverage Monthly 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 & 3Coverage 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 Affairswww.defenselink.mil/ra Guard-Reserve Portalwww.dmdc.osd.mil/Guard-ReservePortal TRICARE Reserve Selectwww.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.