Officials Working to Get Reserve, Guard Temporary Health Benefits in Place
By Sgt. 1st Class Doug Sample, USA
American Forces Press Service
WASHINGTON, Mar. 24, 2004 The Defense Department is working as quickly as possible to implement enhanced Tricare healthcare benefits for reserve component sponsors and their family members, according to defense officials.
The Emergency Supplemental Appropriations Act and the National Defense Authorization Act for fiscal 2004 authorized the new healthcare benefits, some permanent and some temporary.
Eligibility for some of the new temporary Tricare enhancements began Nov. 6, 2003, and ends for all on Dec. 31, 2004. Implementation of the new temporary provisions began in January and will continue over the next few months under the department's 2004 Temporary Reserve Health Benefit Program. Total expenditures for the new provisions may not exceed the $400 million limit established by Congress for fiscal 2004.
"These temporary benefits were designed to enhance access to care for our reserve component service members and their families and ultimately improve our readiness as a fighting force," Richard A. Mayo, deputy director Tricare Management Activity explained in a recent interview. "We are establishing a totally new benefit that currently doesn't exist today. To implement this temporary program, we had to make modifications to the Defense Enrollment Eligibility Reporting System, which is the system utilized in the military to determine eligibility for any healthcare plan, and modifications to our managed-care support contracts before claims can be paid."
The first temporary program, implemented mid-February by TMA, temporarily extends Tricare eligibility under the Transitional Assistance Management Program from 60 or 120 days to 180 days for active duty and reserve component TAMP-eligible sponsors who separate from active federal service on or after Nov.6, 2003. That was the effective date for benefits under this program for sponsors and family members. On Jan. 1, 2005, Tricare eligibility under the transitional program returns to 60 or 120 days, even for those who separated in 2004 and whose orders may indicate eligibility for 180 days.
TAMP-eligible sponsors and family members who were saving their receipts may apply for Tricare reimbursement by submitting a Tricare claim form, a copy of their itemized bill, an explanation of benefits, and proof of payment if the bill was already paid to their Tricare regional claims processor.
The second temporary program is scheduled to be implemented by TMA in the next few weeks. It will authorize medical and dental benefits for reserve component sponsors activated in support of a contingency operation for more than 30 days. Family members enrolled in DEERS are also eligible for this benefit.
Under this program, Tricare eligibility for reserve component sponsors and their family members begins the day the sponsor receives delayed-effective-date active duty orders or 90 days before the active duty period begins, whichever is later. The effective date for benefits under this program was also Nov. 6, 2003.
Until TMA announces that the program has begun and members can begin submitting their claims to apply for reimbursement from Tricare, sponsors and family members should pay all medical and dental bills incurred and save their receipts.
The third, final temporary program, scheduled for implementation at a later date, is limited to reserve component sponsors who are either unemployed or employed but not eligible for employer-sponsored health coverage and their family members. Tricare coverage under this program is limited to medical care only. Eligibility for sponsors and family members will start the day that TMA implements the program. Officials point out that Tricare claims under this program are not paid retroactive to Nov. 6, 2003, but will be paid only from the date the program is implemented through the Dec. 31, 2004, expiration date for all benefits under the temporary program.
Mayo said the biggest challenge will be modifying the existing Tricare enrollment system to accept each reservist and his or her family member for each of these programs. He noted that's the part that takes an awful lot of time and work. There are also new regulations to be written and implementation guidance to be staffed with the services.
"There is a lot of detail work that needs to be done in modifying our systems to accept each and every one of these changes," he said. "On the surface it appears simple to say we have this new benefit and there it is. This is not a simple process, but we are committed to making these changes as quickly as possible to ensure eligible reserve component sponsors and family members have access to Tricare health benefits.
Congress placed the overall $400 million limit on expenditures under fiscal 2004 provisions to implement the temporary healthcare program slated to end Dec. 31. Mayo said Congress is reviewing the program, but that he would not speculate on whether it would extend past that date.
In addition to the temporary program, Congress also authorized three permanent health benefit provisions for reservists and guardsmen.
Those benefits include benefit counselors for the reserve component in each Tricare region, authorization for medical and dental screening and care for members alerted for mobilization, and Tricare eligibility for reserve officers pending orders to active duty following commissioning who do not have other health care insurance coverage.
More information for reserve component families who have questions regarding the Tricare benefits or need assistance processing Tricare claims is available on the Tricare and Reserve Affairs Web sites.
(The Tricare Management Activity staff contributed to this article.)