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TRICARE Covers Most Activated Reservists' Families

By Sgt. 1st Class Kathleen T. Rhem, USA
American Forces Press Service

WASHINGTON, Sept. 21, 2001 – Family members of Guard and Reserve members called to active duty for more than 30 days are eligible for TRICARE benefits the day their military sponsor mobilizes.

President Bush authorized the Defense Department to mobilize up to 50,000 National Guard and Reserve members to deal with the aftermath of the Sept. 11 terrorist attacks at the Pentagon and in New York City. DoD officials have indicated they intend initially to call up about 35,000.

The type of TRICARE coverage reserve component family members receive depends on the length of the sponsors' activation orders, Air Force Col. Kathleen Woody said. Woody, a full-time reservist, is director of medical readiness and programs in the Office of the Assistant Secretary of Defense for Reserve Affairs.

Woody said Guard and Reserve members who are activated receive the same individual healthcare as their active duty counterparts. Coverage for their families, though, can take many different forms.

Guard and Reserve families are ineligible for DoD medical benefits if their military sponsors have orders that call them to duty for 30 days or less.

If sponsors have orders to active duty for more than 30 days, their families are covered under the TRICARE Extra or Standard programs from the day the member is activated, Woody said. While these family members would be eligible for space-available care in any military medical treatment facility, Woody, who is a nurse, cautioned that available space is limited and suggested using it only for an emergency.

"You want to have them in a program with some continuity with the providers," she said.

Eligible family members pay deductibles and cost-shares under both TRICARE Extra and Standard, Woody explained. Using a TRICARE Extra network provider can minimize those costs. Beneficiaries can get information on finding network providers in their area on the TRICARE Web site at www.tricare.osd.mil, or at their local TRICARE service center.

In addition, family members of reservists and guardsmen activated under orders for 179 days or more have the option to enroll in TRICARE Prime, the military's version of a health maintenance organization. They will receive care in a military medical treatment facility or be assigned to a network provider in their area with no cost-shares or deductibles.

"TRICARE Prime is the only one of the TRICARE options that requires pre-enrollment on the part of the family members," Woody said. Enrollment information can also be found on the TRICARE Web site or by contacting a local TRICARE benefits counselor. "Enrollment has to occur by the 20th of the month in order to be eligible for care on the 1st of the following month."

For instance, reserve component members who might be mobilized in coming weeks must have their enrollment forms in to TRICARE by Oct. 20 in order for their families to start receiving care on Nov. 1 under the Prime option, she explained. The family would be covered under TRICARE Standard or Extra until enrolled in Prime.

She said the most important thing for all reserve component members to do is make sure all the information in the Defense Enrollment Eligibility Reporting System is accurate, Woody said. Since DEERS is the system used to determine eligibility for military health care, family members could be denied care if DEERS information is incorrect or incomplete.

Activated reservists are given a chance to review and make changes to their families' DEERS enrollments during the mobilization process, Woody said.

In cases where service members are activated for contingency operations, they and their family members are eligible to retain their military medical benefits for up to 30 days after they're released from active duty, unless sooner covered by an employer sponsored health care plan.

"This gives them a cushion to get civilian healthcare coverage in place," Woody said.

Dental care for both reservists and their family members fall under somewhat different rules. Since earlier this year, reserve component members and their families have been eligible to enroll in the TRICARE Dental Program.

Woody explained that reserve members who had previously enrolled in the program are automatically removed when mobilized because they receive dental care from military providers while on active duty.

Reserve members in the Dental Program pay monthly premiums of $19.08 for one family member or $47.69 for a family enrollment. If the reserve sponsor is called to active duty, the premiums fall to the active-duty rates of $7.63 per month for one family member or $19.08 for multiple family members, Woody said.

Families who had previously declined TRICARE dental coverage but who wish to enroll after their sponsors are mobilized will be able to join at active-duty rates during the first 30 days. Enrollment forms and information are available online at http://www.ucci.com/tdp/tdp.html.

Woody noted that once the sponsor leaves active duty the rates revert to the higher premiums.

For more information on TRICARE benefits, visit the program's Web site at www.tricare.osd.mil.

Information on the TRICARE Dental Program can be found at www.ucci.com/tdp/tdp.html.

Reserve Affairs has set up a family readiness Web site at www.defenselink.mil/ra/family/toolkit/.

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