Temporary Reserve Health Care Program
>
>
> KEY POINTS:
> The provisions of the Temporary Reserve Health Care Program enhance access
> to care for our Reserve Component (RC) Service members and their families
> and ultimately, improve our readiness as a fighting force.
>
> By law, Section 702 will be effective upon implementation of an enrollment
> process and other administrative actions. Members will be eligible to
> enroll themselves and their family members at that time. This benefit will
> be available for persons not eligible for employer-provided coverage, or
> who are eligible unemployment compensation recipients. We are in the
> process of recording and collecting health care data to determine the
> appropriate premium rate for coverage for those RC members and their
> families eligible for premium-based TRICARE coverage. We will build on
> existing mechanisms for determining eligibility, enrolling members in
> TRICARE and delivering health care services.
> Under Sections 703 and 704, some RC sponsors and family members may be
> eligible for reimbursement of health care costs incurred before the
> temporary program is implemented. For this reason, the Department of
> Defense encourages families whose sponsors are deployed in support of a
> contingency operation to save their health care receipts, claims and the
> explanation of benefits forms for dates of service from Nov. 6, 2003.
>
> By law, the total cost of expenditures for implementing sections 702, 703
> and 704 is limited to $400 million. We are establishing mechanisms to
> accurately track and account for all expenditures to ensure that the
> Department is in compliance with the law.
>
> Personnel and Readiness will ask the Services to identify by mid-January
> 2004, individuals who will serve as full-time RC Beneficiary Counseling
and
> Assistance Coordinators (BCACs) in each of the 11 TRICARE regional
offices.
> The RC BCACs will attend the TRICARE Fundamentals Course to gain an
> understanding of the unique challenges faced by RC families and will serve
> as advocates and problem solvers for RC sponsors and family members
needing
> assistance understanding their health care options or using the TRICARE
> benefit.
>
> BACKGROUND:
>
> The recently enacted Emergency Supplemental Appropriations Act and the
> National Defense Authorization Act for Fiscal Year 2004 authorized
> temporary health care benefits and TRICARE eligibility for RC sponsors and
> family members. Several of the new benefits are effective Nov. 6, 2003
> through Dec. 31, 2004, whereas others require implementing procedures and
> systems before they become available. Total expenditures during Fiscal
Year
> 2004 may not exceed the $400 million specified by Congress for these
programs.
>
>
> KEY PROVISIONS UNDER THE NEW LEGISLATION INCLUDE:
>
>
> Section 701: Medical and Dental Screening and Care for Members of Ready
> Reserve Alerted for Mobilization
> Authorizes medical and dental screening and care in advance of
mobilization.
> Guidance will be issued from OSD to Service Secretaries, alerting them to
> new provisions and providing implementing instructions.
> Members of Ready Reserve will be notified of eligibility for
medical/dental
> screening coincident with notification of impending activation.
> There will be no charge to the member for any screening or care provided.
>
> Section 702: Coverage for Ready Reserve Members under TRICARE
> This section introduces premium-based TRICARE coverage for persons not
> eligible for employer-provided coverage, or who are eligible unemployment
> compensation recipients.
> To speed implementation, we plan to build on existing TRICARE mechanisms:
> Using the TRICARE regional contractors to determine eligibility and
collect
> premiums.
> Defense Enrollment Eligibility Reporting System (DEERS) to record
eligibility.
> TRICARE regional contractors to educate and enroll beneficiaries in
TRICARE
> options.
> Military facilities and civilian network providers to deliver health care
> services.
> TRICARE regional contractors to process health care claims.
> Coverage would be effective when the member enrolls and pays premium.
> Implementation timeline will be determined based on time needed to modify
> contracts and systems and establish implementing rules and procedures.
>
> Section 703: Earlier Eligibility Date for TRICARE Benefits for Members of
> Reserve Components
> This section makes TRICARE coverage effective on the date a reservist
> received a delayed-effective-date order for activation.
> Guidance will be issued from OSD to Service Secretaries, alerting them to
> new provisions and providing implementing instructions.
> Upon issuance of a delayed-effective-date order, Service will transmit
> eligibility records to DEERS, and Regional TRICARE contractor will
initiate
> education and enrollment activities for affected individuals - Service
> member and family.
> We will rely on established practice and procedure to extent practicable -
> but will need to modify DEERS to record eligibility and track expenditures
> for this benefit. Coverage is effective with issuance of qualifying orders
> after November 6. Changes to DEERS will need to be implemented.
>
> Section 704: Temporary Extension of Transitional Health Care Benefits
> This section changes the period for receipt of transitional health care
> benefits from 60 or 120 days to 180 days for eligible beneficiaries.
> Guidance will be issued from OSD to Service Secretaries, alerting them to
> new provisions and providing implementing instructions.
> DEERS will be modified to reflect extended transitional health care
benefit.
> The extension to 180 days is applicable to all persons eligible for the
> transitional benefit - this includes reservists being deactivated after
> contingency call-up, other involuntary separations, and separations
> following retention in support of contingency mission.
> Extensions are effective for persons deactivated/separated on or after
> November 6, and are to be implemented as soon as DEERS can be modified.
> While DEERS modifications are being made, members and their dependents
will
> already be receiving these benefits under their previous 60 or 120 day
> benefit.
>
> Section 705: Assessment of Health Care Needs of Reserves
>
> This section requires GAO to conduct a comprehensive assessment of the
> health care needs of reservists, incorporating information about the
> benefits included in the FY 2004 National Defense Authorization Act, and
to
> report to Congress by May 1, 2004.
>
> Section 706: Limitation on FY 2004 Outlays for Temporary Reserve Health
> Care Programs
> This section prescribes a limitation of $400 million on FY 2004 outlays
for
> the benefits authorized in sections 702, 703, and 704.
> Adherence to this limitation will entail careful tracking of outlays as
> they occur.
> DoD will adhere to the $400 million limitation in FY 2004 to avoid an
> Anti-Deficiency Act violation
>
> Section 707: TRICARE Beneficiary Counseling and Assistance Coordinators
for
> Reserve Component Beneficiaries
> Reserve components will appoint beneficiary counseling and assistance
> coordinators to support reserve component members. Policy guidance to
> Services will be issued shortly.
> This support will be part of an information campaign to inform affected
> members and families about the new provisions and how to use their
benefits.
> The transition to new TRICARE regions will enhance support for reserve
> component members.
>
> Section 708: Eligibility of Reserve Officers for Health Care Pending
Orders
> to Active Duty Following Commissioning
> This section makes newly commissioned officers eligible for health care,
> pending orders to active duty, if the officer lacks other health coverage.
> Guidance will be issued to Services to implement this new provision.
> Individuals needing this coverage can be handled on a case-by-case basis.
>
> STRATEGY:
> Phase I: Provide awareness of the Temporary Reserve Health Care Program
and
> plans for implementation.
> Phase II: Provide guidance on policy, benefit, and eligibility.
> Phase III: Provide implementation date and guidance for both claims
> processing and BCAC assistance.
> Phase IV: Measure success of communications outreach through media,
> beneficiary and congressional inquires.
>
> FOR MORE INFORMATION:
>
> Start dates for each portion of the pilot program will be available online
> via the TRICARE Management Activity (TMA) Web site at www.tricare.osd.mil
> and the Reserve Affairs Web site at www.defenselink.mil/ra. TMA will also
> post news releases, frequently asked questions (FAQs) and updated fact
> sheets online and distribute public affairs guidance to provide timely
> information on the pilot program to all Reserve Component members and
their
> families.
>
>
>
>
>
>
> --------------------------------------------------------------------------
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> The TRICARE/Military Health System Web site www.tricare.osd.mil is the
> official Web presence of the
> Office of the Assistant Secretary of Defense (Health Affairs) and the
> TRICARE Management Activity
> Skyline 5, Suite 810, 5111 Leesburg Pike, Falls Church, VA 22041-3206
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> The content of this page was updated on 31 December 2003.