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Serving Citizen Warriors Through Advocacy and Education Since 1922
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Information about Enrollment and Coverage for
TRS Coverage for demobilized Selected Reservists, who supported contingency operations.
TRICARE Reserve Select (TRS)
Tier 1 Coverage for Selected Reserve Members
TRICARE Reserve Select (TRS) is the premium-based health plan available for purchase by qualified members of the Reserve Component. TRS offers comprehensive health coverage similar to TRICARE Standard and TRICARE Extra. Purchasing TRS is a two-step process. Members must qualify with their Reserve Component before they can purchase TRS coverage. Once qualified, members may purchase Tier 1 member-only or member and family coverage. Covered members and family members may access care from any TRICARE-authorized provider, hospital or pharmacy—TRICARE network or non-network. TRS covered members may access care from a military treatment facility on a space-available basis only. TRS members and their covered family members pay the same TRICARE cost-share and deductibles as active duty family members.
Step 1―Qualifying for TRS
Since the exact procedures for qualifying under Step 1 may vary by Reserve Component, members should contact their unit or personnel office without delay to obtain specific qualification procedures. The Reserve Component will validate the member’s qualifications for TRS. A member of the Selected Reserve may qualify to purchase TRS coverage at the Tier 1 premium rate if he/she meets the following conditions:
· Is called or ordered to active duty for a period of more than 30 days in support of a contingency operation.
· Serves continuously on active duty:
a. for 90 days or more; or
b. less than 90 days as a result of an injury, illness or disease incurred or aggravated while on active duty.
· Executes a Service Agreement no later than 90 days after release from active duty for service from the begin date of TRS coverage through the end date of coverage.
· Is a member of the Selected Reserve on the start date of TRS coverage. (Members of the Individual Ready Reserve have one year from the day they separate from active duty or from the day coverage under the Transitional Assistance Management Program (TAMP) ends to occupy a position in the Selected Reserve, or the opportunity to qualify for TRS is lost).
For qualified Tier 1 members, purchasing TRS coverage is a time-limited opportunity. Members have 90 days from the day they separate from active duty to execute a Service Agreement (DD Form 2895) with their Reserve Component. Execution of the Service Agreement, however, does not guarantee members a billet in the Selected Reserve. Members of the Individual Ready Reserve who separate from active duty on or after Jan. 6, 2006, and who qualify for Tier 1 coverage, but are unable to locate a position in the Selected Reserve, have one year from their last day on active duty or from their last day of TAMP, whichever is later, to execute a Service Agreement with their Reserve Component to qualify and purchase Tier 1 coverage.
Step 2―Purchasing TRS
To purchase TRS coverage, members of the Selected Reserve may:
1. Login to the Guard-Reserve portal to print a personalized TRS request form (application to purchase TRS), which is available only online.
2. Complete the TRS request form according to instructions on the form.
3. Submit the completed TRS request form with the correct one-month premium payment to their TRICARE regional contractor by the applicable deadline.
The TRICARE regional contractor will not process the member’s request if he/she fails to enclose the correct premium payment or if the form is incomplete or inaccurate. The regional contractor will notify members of any such errors. Any delay in processing the request form may cause members to miss their time-limited opportunity to purchase TRS coverage. After processing of the TRS request form, members will receive a welcome letter, TRS handbook and a TRS wallet card for each family member covered under Tier 1. The wallet card contains telephone numbers and information to assist members with their health care coverage.
Tier 1 Premiums and Payment
Monthly Tier 1 premiums for calendar year 2006 are $81.00 for member-only coverage and $253.00 for member and family coverage. Premiums are adjusted annually on Jan. 1 and rates will be posted on the TRICARE Web page at www.tricare.osd.mil/reserve/reserveselect. The servicing TRICARE regional contractor will bill members for premiums by the 10th day of the month. Premium payments are due in advance to the contractor by the 30th day of the month for the following month. Members who fail to pay premiums on time will be permanently disenrolled from Tier 1 coverage unless they are reactivated for a contingency operation and qualify once again for TRS. Members will still be required to pay any overdue amounts.
For assistance with the TRS request form, premium billing and payments, accessing health services or covered benefits, members may contact their TRICARE regional contractor. Contact information for the regional contractor can be found at
www.tricare.osd.mil by clicking their region on the map.
Period of Coverage
Members may qualify for one whole year of TRS coverage for each continuous 90 day period served in support of a contingency operation. The following chart illustrates several examples:
Days Served on
Active Duty
Maximum
Period of Coverage
1 – 89 days
None**
90 – 179 days
1 year
180 – 269 days
2 years
270 – 359 days
3 years
360 – 449 days
4 years
** Reserve Component members who are otherwise eligible, but did not serve continuously on active duty for 90 days solely because of an injury, illness, or disease incurred or aggravated while activated may be eligible for one whole year of TRS coverage.
When Tier 1 Coverage Begins
For qualified Tier 1 members, coverage begins either on the day following release from qualifying active duty, or on the day after TRICARE benefits under TAMP end, whichever is later. If applicable, TAMP covers members and eligible family members for 180 days immediately following the member’s release from active duty service.
Changes to Tier 1 Coverage (Qualifying Life Events)
After Tier 1 coverage begins, members may only make a change to the type of coverage they purchased (Tier 1 member-only or Tier 1 member and family coverage) if they experience a qualifying life event. A qualifying life event may occur from a change in family composition such as marriage, birth, adoption of a child, placement by court order of a child as a legal ward in the member’s home, divorce or annulment, death of a spouse or family member, or the aging out of a child. A loss of coverage from a government or non-government sponsored health plan may also count as a qualifying life event.
Another type of qualifying life event is associated with a change in employment status when Reserve Component member or family member gains or loses employment that provides health coverage, becomes reemployed after a break in employment, returns to pay status after employer-sponsored coverage terminates during a leave-without-pay status, becomes employed or reemployed after serving on active duty as a member of a Reserve Component, or changes employment status that creates a change in the employer’s contribution to the health plan premiums, such as a moving from full-time to part-time status or the reserve. The effective date is the date of the qualifying life event.
TRS Coverage for Newborns
Newborns born to members under TRS member-only coverage are covered automatically for 60 days from birth. Members who desire to maintain newborn coverage beyond the initial 60 days must register the child in the Defense Enrollment Eligibility Reporting System (DEERS). They also must submit a TRS request form with the new premium payment amount for member and family member coverage to their regional contractor. Newborns born to members already under TRS member and family coverage are covered automatically for the first 365 days after birth. To continue coverage after this first year, the member must register the child in DEERS and submit a request form to the regional contractor to renew coverage.
Other TRICARE Benefits and TRS
Reserve Component members may be called or ordered back to active duty at any time. For members called or ordered to active duty for 30 days or less, their TRS Tier 1 coverage and premiums continue uninterrupted. If the TRS member returns to active duty for more than 30 days, the member and eligible family members will receive the same benefit as active duty service members and family members. (If the active duty period is in support of a contingency operation, they may qualify for the 90 day early TRICARE benefit as well.) Members are not required to make TRS premium payments while they are covered by another TRICARE benefit. TRS coverage and Tier 1 premiums will resume either on the day following release from active duty, the day after TAMP benefits end, whichever is later, or the day after coverage by the other TRICARE benefit stops.
TRS Survivor Benefit―Tier 1 Only
Effective January 6, 2006, survivors of deceased Reserve Component members, who at the time of death were covered under Tier 1, may purchase new or continue Tier 1 coverage for up to six months from the date of the member’s death. After the member’s Reserve Component reports the member’s death to DEERS, the member’s survivors will receive a letter describing the benefit and any required action they must take to purchase or continue TRS coverage. The surviving family members of a Reserve Component member who dies while serving on active duty receive the active duty family member survivor benefit.
Access to Care Overseas
TRS coverage is available outside the 50 United States. The TRICARE South regional contractor, Humana Military Healthcare Services Inc., handles TRS overseas enrollment, premium billing and collection, claims processing and customer service support for these areas. Contact information for the TRS overseas claims processor is available at www.humana-military.com.
Customer Service Support
Health Net Federal Services, www.hnfs.net/bene/home/, provides TRS customer service support for TRS members in the TRICARE North region. TriWest Healthcare Alliance, www.triwest.com, provides customer service support for members in the TRICARE West region, and Humana Military Healthcare Services Inc., www.humana-military.com, provides customer service support for members in the TRICARE South region and overseas. For more information on TRS and Tier 1 coverage, Reserve Component members may visit www.tricare.osd.mil/reserve/reserveselect.
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