R 282030Z NOV 05
FM CMC WASHINGTON DC(UC)
TO AL MARADMIN(UC)
UNCLASSIFIED
MARADMIN 566/05
MSGID/GENADMIN/CMC WASHINGTON DC MR//
SUBJ/ACTIVE DUTY SERVICE MEMBER (ADSM) ENROLLMENT TO TRICARE PRIME//
REF/A/MSGID:UNDER SEC OF DEF/MEMORANDUM/YMD:20051012//
REF/B/MSGID:OSD HA/MEMORANDUM/YMD:20050819//
REF/C/MSGID:CMC(RAP)/MARADMIN 02405/YMD:20050119//
POC/J. M. BRADLEY MAJ/(703) 784-9522/DSN 278-9522 MRH/-
/EMAIL:JESSICA.BRADLEY@USMC.MIL//
GENTEXT/REMARKS/1. PURPOSE. TO ENSURE MARINE CORPS COMPLIANCE WITH
THE POLICY SET FORTH IN REFERENCES A AND B. REFERENCE A IS POLICY
MEMORANDUM FROM THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND
READINESS ON TRICARE ENROLLMENT COMPLIANCE FOR ACTIVE DUTY SERVICE
MEMBERS. REFERENCE B IS POLICY MEMORANDUM FROM THE ASSISTANT
SECRETARY OF DEFENSE FOR HEALTH AFFAIRS ON COMPLIANCE OF MANDATORY
ENROLLMENT OF ACTIVE DUTY SERVICE MEMBERS IN TRICARE PRIME.
2. BACKGROUND. ACTIVE DUTY MARINES MUST ENROLL IN TRICARE PRIME OR
TRICARE PRIME REMOTE IN ORDER TO ENSURE PROPER MEDICAL COVERAGE.
THIS ENROLLMENT IS NOT AUTOMATIC AND MUST BE POSITIVELY
ACCOMPLISHED. RECENT REPORTING FROM OSD REFLECT THAT OVER 15,000 OF
OUR ACTIVE DUTY MARINES ARE NOT ENROLLED IN TRICARE PRIME.
COMMANDERS MUST ENSURE THAT TRICARE ENROLLMENT IS AN ACTIVE PART OF
ADMINISTRATIVE CHECK IN AND CHECK OUT PROCEDURES. FAILURE OF MARINES
TO ENROLL IN TRICARE PRIME CAN RESULT IN SIGNIFICANT PROBLEMS IN
PERSONAL READINESS, PARTICULARLY IN RECEIVING CIVILIAN SPECIALTY
CARE AND RESOLVING BILLING ISSUES.
THE CODE OF FEDERAL REGULATION GOVERNING THE TRICARE PROGRAM,
32 CFR 199.17(b)(2), MANDATES THAT ACTIVE DUTY SERVICE MEMBERS
(ADSM), TO INCLUDE RESERVE COMPONENT (RC) MEMBERS ACTIVATED IN
SUPPORT OF A CONTINGENCY OPERATION FOR MORE THAN 30 DAYS, MUST BE
ENROLLED IN TRICARE PRIME OR TRICARE PRIME REMOTE. THE TWO
POPULATION GROUPS NOTED BELOW ARE THE ONLY EXCEPTIONS TO THE
MANDATORY ENROLLMENT REQUIREMENT:
A. INITIAL ENTRY TRAINING. ADSMS ATTENDING TRAINING COURSES FOR
PERIODS OF 179 DAYS OR LESS MAY REMAIN IN A NON-ENROLLED STATUS
UNTIL THEY ARRIVE AT THEIR PERMANENT DUTY STATION OR COMMENCE
TRAINING AT AN INSTALLATION/SCHOOL REQUIRING ASSIGNMENT OF 180 DAYS
OR MORE. ALL ADSMS MUST BE ENROLLED NO LATER THAN 180 DAYS
FOLLOWING THEIR ACTIVE DUTY SERVICE DATE.
B. ACTIVATED RESERVE COMPONENT (RC) SERVICE MEMBERS CAN BE
ENROLLED IN TRICARE PRIME IN ACCORDANCE WITH THE GUIDANCE PROVIDED
IN REFERENCE C.
3. ADSM(S) MUST BE ENROLLED INTO THE TRICARE PRIME PROGRAM
AVAILABLE IN THEIR AREA AS SPECIFIED BY THE FOLLOWING:
A. ADSM(S) REPORTING FOR A PERMANENT CHANGE OF STATION ASSIGMENT
OR TEMPORTARY ASSIGNED DUTY/TEMPORARY DUTY (TAD/TDY) ORDERS FOR A
PERIOD OF 180 DAYS OR MORE MUST ENROLL TO A TRICARE PRIME PROVIDER
AT THEIR INSTALLATIONS MILITARY TREATMENT FACILITY WHERE THEY ARE
ASSIGNED.
B. ADSM(S) MAY ONLY ENROLL WITH A CIVILIAN PROVIDER AND PRIMARY
CARE MANAGER (PCM) UNDER THE RULES APPLICABLE TO TRICARE PRIME
REMOTE (TPR). GENERALLY, ELIGIBLE TPR BENEFICIARIES MUST BE
STATIONED OUTSIDE A 50-MILE RADIUS OR APPROXIMATELY ONE HOUR'S
TRAVEL TIME FROM AN MTF TO BE ELIGIBLE FOR TRICARE PRIME ENROLLMENT
WITH A CIVILIAN PCM. IF THERE IS NO TRICARE PRIME NETWORK PROVIDER
AVAILABLE, ADSM(S) CAN SEEK PRIMARY CARE FROM A NON-NETWORK
TRICARE-CERTIFIED PROVIDER THROUGH THEIR REGION'S TRICARE
CONTRACTOR. ADDITIONAL INFORMATION ON TPR CAN BE OBTAINED AT
WWW.TRICARE.OSD.MIL/TPR/.
4. HOW TO ENROLL IN TRICARE PRIME. ENROLLMENT CAN BE DONE AT THE
MEMBERS LOCAL TRICARE SERVICE CENTER, OR BY DOWNLOADING ENROLLMENT
FORMS ONLINE AT WWW.TRICARE.OSD.MIL/ENROLLMENT/.
A. TRANSFER OF ENROLLMENT. ONCE ENROLLED IN TRICARE PRIME ADSM'S
WILL NOT DISENROLL WHEN TRANSFERRING DUTY STATIONS OR EXECUTING TAD
ORDERS IN EXCESSIVE OF 180 DAYS. ADSM(S)RELOCATING WITH TAD/TDY
ORDERS FOR PERIODS OF 179 DAYS OR LESS WILL MAINTAIN ENROLLMENT AT
THEIR PERMANENT DUTY STATION. MARINES WILL BE REQUIRED TO TRANSFER
THEIR TRICARE PRIME ENROLLMENT TO THEIR NEW TRICARE REGION UPON
CHECKING INTO THEIR NEW COMMAND. TRANSFER OF ENROLLMENT CAN BE DONE
AT THE MEMBERS LOCAL TRICARE SERVICE CENTER OR THROUGH THEIR NEW
REGIONS TRICARE CONTRACTOR; FOR THE WEST REGION, TRIWEST AT
1-888-TRIWEST, FOR THE SOUTH REGION,HUMANA AT 1-800-444-5445, FOR
THE NORTH REGION, HEALTHNET THE CONTACT INFORMATION FOR THESE
CONTRACTORS CAN ALSO BE FOUND ON LINEAT WWW.TRICARE.OSD.MIL
B. RE-ENROLLMENT. ANY BREAK IN SERVICE, AS REFLECTED IN DEERS,
AUTOMATICALLY DISENROLLS AN ADSM AND HIS/HER ELIGIBLE FAMILY MEMBERS
FROM TRICARE PRIME. ADSM(S) WHO INCUR A BREAK IN SERVICE WILL NEED
TO RE-ENROLL IN TRICARE PRIME TO CONTINUE COVERAGE.
5. IN ACCORDANCE WITH TRICARE POLICY, ACCESS STANDARDS FOR
TRICARE PRIME AND TRICARE PRIME REMOTE BENEFICIARIES DICTATE THAT
MEMBERS MUST BE SEEN WITHIN 7 DAYS FOR ROUTINE APPOINTMENTS, AND 28
DAYS FOR SPECIALTY CARE REFERALS. ADDITIONALLY, APPOINTMENTS FOR
CIVILIAN SPECIALITY CARE SHOULD NOT EXCEED 50 MILES, OR ONE HOURS
DRIVING TIME FROM MEMBERS DUTY STATION.
6. ADDITIONAL TRICARE INFORMATION. THE FOLLOWING IS A LIST OF
RESOURCES FOR ADDITIONAL INFORMATION ON TRICARE ACCESS AND BENEFITS.
A. VISIT THE TRICARE WEBSITE AT WWW.TRICARE.OSD.MIL
B. LOCAL TRICARE SERVICE CENTER.
C. FOR TRICARE ENTITLEMENT PROBLEMS OR CLAIMS AND BILLING ISSUES
CONTACT YOUR NEAREST REGIONS TRICARE BENEFICIARY COUNSELING AND
ASSISTANCE COORDINATOR (BCAC). A LISTING OF BCAC NAMES, E-MAIL AND
TELEPHONE NUMBERS CAN ACCESSED AT WWW.TRICARE.OSD.MIL/BCAC/
D. BENEFICIARIES MAY ALSO E-MAIL TRICARE QUESTIONS TO
QUESTIONS@TMA.OSD.MIL//