Reservists, Guardsmen Need to Know Their Medical Benefits, Colonel Says
By Rudi Williams
American Forces Press Service
WASHINGTON, Jan. 30, 2003 One of the biggest communications problems the reserve components have is ensuring that when their members are called to active duty they know the importance of enrolling in TRICARE at their mobilization or activation stations.
That's what Air Force Reserve Col. Kathleen Woody said Jan. 28 to a roomful of reservists and National Guardsmen from all the services, including the Coast Guard, during the 2003 National TRICARE Conference here.
"TRICARE is a shared responsibility between the Department of Defense, the services and the service members," said Woody, director of medical readiness and programs in the Office of the Assistant Secretary of Defense for Reserve Affairs.
She said reserve component personnel should enroll in TRICARE at their mobilization or activation site because they may be deployed overseas, but their enrollment stays stateside.
"It's very important that we don't get our people overseas trying to enroll in TRICARE Prime because they won't be able to do it," said Woody, a nurse and full-time reservist. "We're trying to push this issue down through the personnel side of the house, reserve components and family support organizations."
The only exception to an enrollment for a reserve member overseas would be Individual Ready Reserve members. They are actually assigned to the overseas unit, the colonel noted.
There are two aspects to reserve health care -- the personnel office that identifies the eligibility, and TRICARE, which manages the medical portion, Woody noted. Communications about both have to take place, she said. The contingency operation should be identified on members' orders because if it isn't coded correctly into the Defense Enrollment Eligibility Reporting System, the reservists won't be reflected as eligible for the Transitional Assistance Management Program when they separate from active duty, she added.
Family members could be denied care if DEERS information is incorrect or incomplete. Guard and Reserve members and their families aren't always aware of their benefits, she said. "When there's a change in the member's status, there's a change in TRICARE benefits."
Woody gave the audience some points to stress when members are released from active duty after supporting a contingency operation: "Members and their families must actively enroll in TRICARE Prime during the transitional health care period," the colonel noted. "If they were enrolled during their active duty period, DEERS will automatically trigger disenrollment and the member would have to re-enroll."
Space-available dental care is limited for reservists and nonexistent for family members, she pointed out. "TRICARE dental care is not part of the transitional healthcare program," Woody emphasized. "Families are eligible for it, but at the full premium rate when the member is released from active duty."
The monthly premium for the dental program is $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 Reserve and National Guard members and their family members need to be educated regularly to ensure they know what their benefits are and how to obtain them. For one thing, she said, 70 percent of reserve members don't live near a military medical facility, where health care would be readily available.
"Education has to be an ongoing process and we're working with the reserve components, the members and family support offices to try to give the member information before they're mobilized, at the mobilization station, and post-mobilization," she said.
"We've developed a brochure that gives a broad brush overview of what Reserve members benefits are when they're activated and what the family members benefits are," Woody noted. "TRICARE has worked aggressively to develop a reserve component TRICARE Web page that addresses issues unique to Reserve members. It also has a link to our Web site, which has a mobilization guide."
Stephen E. Isaacson, a healthcare program specialist in the TRICARE Management Activity in Aurora, Colo., told the audience about changes to make health care more accessible and beneficial to families of reservists and guardsmen participating in Operations Enduring Freedom and Noble Eagle.
"We waived the deductibles for TRICARE Standard and TRICARE Extra, as we'd done under Operation Joint Endeavor in Bosnia, to avoid undue financial hardships for reserve component families," Isaacson said.
"We also waived the requirement for nonavailability statements for inpatient care in civilian hospitals when family members of activated reservists live outside a military treatment facility area," he said. "That was done so reservists' families who were already receiving care in the civilian market could continue to get that care and not be forced into a military treatment facility or network provider."
Isaacson also said, "We allowed payment up to 115 percent of the government rate pay table, which is authorized by law for inpatient care in civilian hospitals when family members live outside the MTF area. That was done to ensure access to care, particularly in areas where there are a limited number of providers. We didn't want providers to say, 'We're not going to take you as a patient because TRICARE doesn't pay enough.'"
"There's another very important aspect to their caring coverage when they're deactivated," Isaacson noted. "That's the Transitional Assistance Management Program and the Continued Health Care Benefit Program."
Taking the podium to outline the two programs, Ann N. Fazzini first called reserve health care a misnomer as it relates to TRICARE. Fazzini, another health care program specialist from the TRICARE Management Activity in Aurora, emphasized that reservists are not entitled to TRICARE benefits unless they're on federal active duty status. Once they're activated, they're considered TRICARE Prime enrollees.
The spouses and eligible children of those on orders for more than 30 days are eligible for TRICARE Extra and Standard coverage on the first day of their sponsor's orders, she said. Family members of reservists and guardsmen with orders for 179 days or more may enroll in TRICARE Prime, which charges no pharmacy co-payments at military hospitals or clinics, she added.
Fazzini said the Transitional Assistance Management Program gives TRICARE benefits to certain eligible members separating from active duty and their families. All eligible members now receive 60 or 120 days of transitional care. Prior this recent change, members on active duty who were retained to support a contingency operation only received 30 days of transitional care.
In the past, transitional health care ended if the member was covered by other health insurance. The 2002 National Defense Authorization Act removed that provision and now, those covered by other insurance plans continue their transitional health care. However, the other insurance plan is the primary payer of benefits.
She noted that the Transitional Assistance Management Program was slated to expire on Oct. 1, 2001, but is now a permanent benefit with an effective date of Dec. 28, 2002.
"There are four categories of those eligible from TAMP including reserve component members who are called to active duty in support of a contingency operation," Fazzini noted. "They, and their families, receive health care under the TAMP program when they're released from active duty."
She said the timeframes for transitional health care are 60 days for members separated with less than six years of total active federal military service and 120 days for those with six or more years of federal service. They receive the same TRICARE benefits they received while on active duty, she said.
"There no fee and no premium associated with transitional care," she emphasized. "However, an extra step separating members must take to stay in TRICARE Prime: They must complete a Prime enrollment form upon separating from active duty. That's because their status is changing from active duty to separating, and the system deletes their Prime enrollment status. The TRICARE Standard and Extra are also available."
Fazzini pointed out that TAMP covers pre-existing conditions. "So if the sponsor is leaving active duty and a family member has an illness, they continue with their health care," she added.
However, she said, the services determine eligibility and provide data to DEERS, which TRICARE contractors check when processing claims.
The second program, the Continued Health Care Benefit Program, kicks in after TAMP expires. CHCBP, created in 1994, covers separating active duty members and their families and also certain former spouses, emancipated children and wards of the court, according to Fazzini.
"Reservists who have used their 60 or 120 days under TAMP can enroll in CHCBP," Fazzini noted. "Unlike TAMP, which doesn't require paying a premium, CHCBP is a premium-based program. The benefits are similar to TRICARE Standard and Extra, but Prime isn't an option.
"Like TRICARE, it requires the use of certified providers, claims submissions and payments and the same reimbursement procedures used in TRICARE Standard," she said. "It's not an inexpensive program. The individual premium is $933 per quarter. For a family, it's $1,996 per quarter. Pre-existing conditions are covered."
The coverage period is either for 18 or 36 months, she said. "You have 60 days from the time you lose your TAMP eligibility to enroll in CHCBP, and care is retroactive to the date TAMP ended."
More TRICARE information is available online at www.tricare.osd.mil, or call 1-888-DoD Care (1-888-363-2273). DMDC Support Office/DEERS information is at www.dmdc.osd.mil, or call, 1-800-538-9552. Continued Health Care Benefit Program questions can be directed to Humana Health Services at www.humana-military.com, or call 1-800-444-5445.