UNCLAS 222149Z AUG 07
CMC WASHINGTON DC(UC)
MARADMIN 503/07
MSGID/GENADMIN/CMC WASHINGTON DC MRA RA//
SUBJ/ANNOUNCEMENT OF ENHANCEMENTS TO TRICARE RESERVE SELECT (TRS)//
REF/A/DOC/PUB.L.NO.109-364, 120STAT.2083/16OCT2006//
REF/B/DOC/DOD/26JUL2007//
REF/C/DOC/CMC (RAP)/28JUL2006//
REF/D/DOC/CMC (RAP)/28JUL2006//
NARR/REF A IS SEC 706 OF THE NATIONAL DEFENSE AUTHORIZATION ACT
(NDAA) FOR FY 2007. REF B IS USD P&R MEMO POLICY GUIDANCE FOR TRICARE RESERVE SELECT (TRS). REF C IS MARADMIN 354/06 CHANGES TO TRICARE RESERVE SELECT (TRS), PART 1 OF 2 (TIER 1). REF D IS MARADMIN 355/06 CHANGES TO TRICARE RESERVE SELECT (TRS), PART 2 OF 2 (INTRODUCTION OF TIERS 2 AND 3)//
POC/A. J. LOCKETT/MAJ/CMC (RAP)/-/EMAIL:ANDREW.LOCKETT@USMC.MIL/ TEL:COMM (703) 784-9138/TEL:DSN 278-9138//
GENTEXT/REMARKS/1. PURPOSE. TO IMPLEMENT RECENT ENHANCEMENTS AND PROMULGATE UPDATED GUIDANCE, BASED ON REF A AND B, TO THE TRS PROGRAM. MARINE FORCES RESERVE (MARFORRES) COMMANDERS MUST ENSURE THAT UNIT TRS REPRESENTATIVES THOROUGHLY FAMILIARIZE THEMSELVES
WITH THE NEW ENHANCEMENTS TO THE TRS PROGRAM.
2. BACKGROUND.
A. ORIGINALLY ESTABLISHED UNDER NDAA FY05, TRS IS A PREMIUM-BASED HEALTH CARE PLAN THAT IS AVAILABLE TO CERTAIN MEMBERS OF THE SELECTED RESERVE AT 28 PERCENT OF THE PREMIUM COST. TRS OFFERS RESERVE MEMBERS TRICARE STANDARD COVERAGE WITH THE SAME DEDUCTIBLES AND COST SHARES THAT APPLY TO ACTIVE DUTY MEMBERS.
B. EFFECTIVE 30 SEP 2007, THE THREE-TIERED BENEFIT PLAN WITH DIFFERENT QUALIFICATION REQUIREMENTS AND PREMIUM RATES FOR EACH TIER INTRODUCED BY REFERENCES C AND D WILL BE TERMINATED.
EFFECTIVE 1 OCT 2007, THE ENHANCED TRS PROGRAM WILL COMMENCE AS DETAILED BELOW.
3. PROGRAM SUMMARY.
A. COSTS/FEES.
(1) PREMIUMS (ADJUSTED EACH CALENDAR YEAR BASED ON 28 PERCENT OF THE AVERAGE PREMIUMS FOR PRIVATE EQUIVALENT INSURANCE): CURRENTLY,
$81 PER MONTH FOR MEMBER ONLY, $253 PER MONTH FOR MEMBER AND FAMILY
COVERAGE.
(2) ANNUAL (FY) DEDUCTIBLES: $50 PER INDIVIDUAL, $150 PER FAMILY FOR
CORPORALS AND BELOW. $150 PER INDIVIDUAL, $300 PER FAMILY FOR SERGEANTS AND ABOVE.
(3) COST SHARES (OUTPATIENT): 15 PERCENT ON-NETWORK, 20 PERCENT OFF-NETWORK.
(4) CATASTROPHIC CAP: $1000 PER FY.
B. QUALIFYING CRITERIA.
(1) EFFECTIVE 1 OCTOBER 2007, CERTAIN MEMBERS OF THE SELECTED MARINE CORPS RESERVE (SMCR) (RESERVISTS DRILLING WITH SMCR UNITS AND INDIVIDUAL MOBILIZATION AUGMENTEES) WILL BE ELIGIBLE TO PURCHASE TRS. THE ORIGINAL REQUIREMENT TO BE ACTIVATED ISO GWOT IOT BE ELIGIBLE FOR TRS (AND SUBSEQUENTLY TIER 1) IS HEREBY RESCINDED.
(2) IN ACCORDANCE WITH REF A, SMCR MEMBERS WHO ARE ENROLLED, OR ARE ELIGIBLE TO ENROLL, IN THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP) ARE NOT ELIGIBLE TO PURCHASE TRS.
C. REQUIREMENTS TO PURCHASE COVERAGE.
(1) RESERVE MARINES MUST BE JOINED TO AN SMCR UNIT OR IMA BILLET ON THE FIRST DAY OF COVERAGE, AND MUST REMAIN JOINED FOR COVERAGE TO CONTINUE.
(2) TRS ENROLLMENT FORM. TO PURCHASE COVERAGE, A QUALIFIED SMCR MEMBER MUST COMPLETE AND SUBMIT THE TRS REQUEST FORM (DD2896-1) ACCOMPANIED BY THE FIRST MONTHS PREMIUM PAYMENT TO THE APPLICABLE TRICARE MANAGED CARE SUPPORT CONTRACTOR. THE DD2896-1 WILL BE AVAILABLE BEGINNING 11 AUG 2007 ON THE DMDC
TRS APPLICATION (HTTPS://
WWW.DMDC.OSD.MIL/APPJ/TRS/INDEX.JSP).
(3) THE QUALIFIED SMCR MEMBER SHALL SIGN THE TRS REQUEST FORM AND CERTIFY THAT HE OR SHE IS NOT ELIGIBLE FOR OR ENROLLED IN FEHBP.
THE SIGNED DD2896-1 SHALL DOCUMENT THE MEMBERS UNDERSTANDING AND
RESPONSIBILITY TO TERMINATE TRS COVERAGE UPON ENTERING ELIGIBILITY FOR OR ENROLLING IN FEHBP.
(4) ELIGIBILITY IS DETERMINED BY TRICARE VIA RCCPDS/DEERS INFORMATION AS CONTAINED IN MCTFS, THEREFORE UNIT REPS ARE NO LONGER REQUIRED TO VERIFY MEMBER ELIGIBILITY AND/OR EXECUTE AGREEMENT FORMS.
D. PURCHASING COVERAGE.
(1) CONTINUOUS OPEN ENROLLMENT. OPEN ENROLLMENT FOR THE ENHANCED TRS PROGRAM WILL BEGIN ON OR ABOUT 11 AUG 2007 FOR COVERAGE BEGINNING 1 OCT 2007. QUALIFIED RESERVE MEMBERS MAY PURCHASE TRS COVERAGE THROUGHOUT THE YEAR.
(2) CONTINUATION OF COVERAGE. FOLLOWING A PERIOD OF ACTIVE DUTY OF GREATER THAN 30 DAYS, A PERIOD OF EARLY TRICARE COVERAGE BASED ON
DELAYED-EFFECTIVE-DATE ACTIVE DUTY ORDERS (EID), OR A PERIOD OF TRANSITIONAL ASSISTANCE MANAGEMENT PROGRAM (TAMP), QUALIFIED SMCR MEMBERS MAY PURCHASE TRS COVERAGE WITH A BEGIN DATE OF COVERAGE THE DAY AFTER THE TERMINATION OF COVERAGE UNDER ANOTHER NON-PREMIUM BASED TRICARE PROGRAM LISTED ABOVE. THE DD2896-1 AND CORRECT PREMIUM PAYMENT MUST BE RECEIVED BY THE TRICARE MANAGED CARE SUPPORT CONTRACTOR NLT 60 DAYS AFTER THE TERMINATION OF THE NON-
PREMIUM BASED TRICARE COVERAGE.
(3) QUALIFYING LIFE EVENT (QLE). FOR CONTINUOUS COVERAGE FOR A NEW FAMILY MEMBER OR DURING A CHANGE OF FAMILY COMPOSITION, A QUALIFIED MEMBER MAY PURCHASE OR CHANGE TRS COVERAGE TYPE IN CONNECTION WITH A QLE THAT RESULTS IN A CHANGE OF FAMILY COMPOSITION. THE QUALIFIED MEMBER SHALL SUBMIT THE DD2896-1 AND APPROPRIATE PREMIUM AMOUNT TO THE TRICARE MANAGED CARE SUPPORT
CONTRACTOR. THE DD2896-1 AND CORRECT PREMIUM PAYMENT MUST BE RECEIVED BY THE TRICARE MANAGED CARE SUPPORT CONTRACTOR NO LATER THAN 60 DAYS AFTER THE DATE OF THE QLE.
(4) SURVIVOR COVERAGE. IF A MEMBER DIES WHILE COVERED UNDER TRS, THE
ELIGIBLE FAMILY MEMBER(S) MAY ELECT TO RETAIN OR PURCHASE TRS COVERAGE FOR UP TO SIX MONTHS BEYOND THE DATE OF THE MEMBERS DEATH.
IF THE COVERAGE WAS FOR MEMBER AND SPOUSE WITHOUT ADDITIONAL DEPENDENTS, MEMBER AND FAMILY COVERAGE WILL BE CONVERTED TO SELF- ONLY COVERAGE. THE SURVIVING SPOUSE (OR LEGAL GUARDIAN TO THE MEMBERS CHILD OR CHILDREN IF THERE IS NO SURVIVING SPOUSE) SHALL BE RESPONSIBLE FOR PAYMENT OF THE MONTHLY TRS PREMIUMS.
E. COVERAGE START DATE.
(1) CURRENTLY ENROLLED IN A TRS TIERED PLAN. CURRENT TRS TIERED PLANS WILL BE TERMINATED ON 30 SEP 2007. MEMBERS DESIRING TO CONTINUE TRS COVERAGE EFFECTIVE 1 OCT 2007 UNDER THE ENHANCED PLAN MUST MEET THE REQUIREMENTS IN PARA 4 BELOW.
(2) CONTINUOUS OPEN ENROLLMENT. IF THE DD2896-1 AND PREMIUM PAYMENT ARE RECEIVED BY THE TRICARE MANAGED CARE SUPPORT CONTRACTOR BY THE LAST DAY OF THE MONTH, TRS COVERAGE WILL BEGIN EITHER THE FIRST DAY OF THE NEXT MONTH, OR THE FIRST DAY OF THE SECOND FOLLOWING MONTH AS INDICATED BY THE MEMBER ON THE DD2896-1.
(3) CONTINUATION OF COVERAGE. TRS COVERAGE SHALL BEGIN THE DAY IMMEDIATELY FOLLOWING THE TERMINATION OF THE MEMBERS NON-PREMIUM BASED TRICARE PROGRAM (SEE PARA 3D(2)). THE MEMBER MUST SUBMIT A COMPLETED DD2896-1 AND CORRECT PREMIUM PAYMENT WITHIN 60 DAYS OF THE TERMINATION OF THE NON-PREMIUM BASED TRICARE PROGRAM TO AVOID A BREAK IN TRICARE COVERAGE.
(4) QUALIFYING LIFE EVENT. TRS COVERAGE SHALL BEGIN THE DATE OF THE
QUALIFYING LIFE EVENT.
(5) SURVIVOR COVERAGE. TRS COVERAGE SHALL BEGIN ON THE DATE AFTER THE
SPONSORS DATE OF DEATH.
F. TERMINATION OF COVERAGE.
(1) TRS COVERAGE SHALL TERMINATE EFFECTIVE THE DATE OF LOSS OF SELECTED RESERVE STATUS, INCLUDING TRANSFER TO THE IRR, ASL, OR ISL FOR A SINGLE DAY. MEMBERS MAY REENROLL IF THEY REGAIN SELECTED RESERVE STATUS AND ARE OTHERWISE ELIGIBLE FOR TRS.
(2) ELIGIBILITY OR ENROLLMENT IN FEHBP. THE MEMBER SHALL SUBMIT A
DD2896-1 INDICATING HIS OR HER ELIGIBILITY FOR OR ENROLLMENT IN FEHBP.
(3) FAILURE TO MAKE PREMIUM PAYMENTS. NOTE: THE MEMBER WILL STILL BE
RESPONSIBLE FOR PREMIUM PAYMENTS UNTIL FORMALLY DISENROLLED FROM COVERAGE (NORMALLY TWO MONTHS). THE SERVICE MEMBER AND ENROLLED FAMILY MEMBERS SHALL BE LOCKED OUT OF TRS COVERAGE FOR THE LONGER PERIOD OF ONE YEAR FROM THE EFFECTIVE DATE OF TERMINATION OR UNTIL OVERDUE PREMIUMS ARE PAID IN FULL.
(4) COVERAGE UNDER ANOTHER TRICARE BENEFIT. TRS COVERAGE SHALL TERMINATE THE DAY OF THE MEMBERS ELIGIBILITY FOR ANY NON-PREMIUM BASED TRICARE BENEFIT.
(5) VOLUNTARY TERMINATION. THE EFFECTIVE DATE OF TERMINATION WILL BE THE LAST DAY OF THE MONTH IN WHICH THE MEMBER NOTIFIES THE TRICARE MANAGED CARE SUPPORT CONTRACTOR BY LETTER OF THEIR DESIRE TO TERMINATE TRS COVERAGE. MEMBERS WHO VOLUNTARILY TERMINATE TRS COVERAGE WILL NOT BE ABLE TO REENROLL
FOR ONE YEAR FOLLOWING THE EFFECTIVE DATE OF TERMINATION.
(6) DEATH OF A COVERED MEMBER. TRS COVERAGE FOR THE SPONSOR SHALL END THE DATE OF THE SPONSORS DEATH.
4. TRANSITION FROM TRS TIERED PROGRAM TO ENHANCED TRS PROGRAM.
(1) THE THREE-TIER TRS PROGRAM AND ASSOCIATED DMDC WEB APPLICATION WILL REMAIN IN EFFECT THROUGH 30 SEP 2007. QUALIFIED MEMBERS MAY STILL ENROLL IN A TIERED TRS PLAN IN ACCORDANCE WITH REFERENCES C AND D THROUGH 30 SEP 2007.
(2) QUALIFIED MEMBERS WHO ARE CURRENTLY ENROLLED IN TRS AND DESIRE TO
CONTINUE COVERAGE EFFECTIVE 1 OCT 2007 UNDER THE ENHANCED TRS PROGRAM MUST SUBMIT A DD2896-1 TO THE TRICARE MANAGED CARE SUPPORT CONTRACTOR BY 30 SEP 2007 (SEE PARA 3C(2)).
(A) MEMBERS CURRENTLY ENROLLED IN A TIERED TRS PLAN MAY CONTINUE TO MAKE PREMIUM PAYMENTS BY THE SAME MEANS (ELECTRONIC FUNDS TRANSFER, AUTOMATIC CREDIT/DEBIT CARD PAYMENTS, CHECK, MONEY ORDER, OR ONE TIME CREDIT/DEBIT CARD PAYMENT).
(B) THE TRICARE MANAGEMENT ACTIVITY WILL ADJUST TIER 2 AND TIER 3 PREMIUMS TO THE 28 PERCENT RATE EFFECTIVE 1 OCT 2007.
(3) MEMBERS CURRENTLY ENROLLED IN A TIERED TRS PLAN WHO DO NOT SUBMIT A DD2896-1 BY 30 SEP 2007 WILL HAVE THEIR TRS COVERAGE TERMINATED ON 30 SEP 2007. THOSE MEMBERS MAY REENROLL IN THE ENHANCED TRS PROGRAM AFTER 1 OCT 2007 IF OTHERWISE QUALIFIED.
5. UNIT RESPONSIBILITIES. THE CONVENTIONAL ROLE OF THE UNIT TRS VERIFYING OFFICIAL HAS BEEN ELIMINATED DUE TO THE EXPANDED AND SIMPLIFIED ELIGIBILITY CRITERIA AND ENROLLMENT PROCEDURES. HOWEVER, UNITS MUST CONTINUE TO DISSEMINATE HEALTH CARE ELIGIBILITY AND ENROLLMENT INFORMATION TO MEMBERS.
A. COMMANDERS MUST ENSURE SELRES MARINES ARE PROPERLY JOINED.
B. COMMANDERS MUST ENSURE ALL DEACTIVATING MARINES RECEIVE A BRIEF ON TRS HEALTH CARE BENEFITS AND ENROLLMENT PROCEDURES PRIOR TO THEIR EAS.
C. NEW JOINS SHALL RECEIVE A BRIEF ON TRS HEALTH CARE BENEFITS, ELIGIBILITY CRITERIA, AND ENROLLMENT PROCEDURES WITHIN 5 WORKING DAYS OF UNIT AFFILIATION.
6. ADDITIONAL TRICARE INFORMATION CAN BE FOUND ON THE TRICARE WEBSITE AT WWW.TRICARE.OSD.MIL OR BY CALLING 888.DOD.CARE (363.2273).//