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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 Unemployed, Uninsured, or Self-employed Selected Reservists.
TRICARE Reserve Select (TRS)
Tier 2 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 2 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 Step 1 may vary by Reserve Component, members should contact their Reserve Component unit or personnel office without delay for 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 2 premium rate if he or she meets the following conditions.
· Is one of the following:
a. An eligible unemployment compensation recipient as determined by state law.
b. An employee whose employer does not offer a health plan to anyone working for the employer.
c. In a category of employees not offered an employer-sponsored health benefit plan based on hours, duties, employment agreement, or such other characteristic, other than membership in the Selected Reserve.
d. Self-employed as reported to the IRS (not including Selected Reserve Income).
· Does one of the following to qualify under Tier 2:
a. Qualifies during the annual open season.
b. Submits documentation sufficient to verify they experienced a
qualifying life event (such as a change in family composition, change in family employment, or change in family health plan coverage) or
c. Qualifies as a new accession in the Selected Reserve.
· Executes a Service Agreement for service from the begin date of TRS coverage to the end date of coverage.
· Is a member of the Selected Reserve on the start date of TRS coverage.
Step 2―Purchasing TRS
To purchase TRS coverage, Selected Reserve members must:
1. Login to the Guard-Reserve portal and print a personalized TRS request form (application to purchase TRS), which is available only online.
2. Complete the TRS request form according to the instructions on the form.
3. Submit the completed TRS request form with the correct one-month premium payment to the TRICARE regional contactor by the applicable deadline.
The TRICARE regional contractor will not process the request form if the member fails to enclose the correct payment or if the form is incomplete or inaccurate. The contractor will notify the member if the request form has errors. Any delays in processing the form may cause the member to miss applicable deadlines and the opportunity to purchase coverage. Request forms received by the regional contractor outside of the annual “open season,” unless for a qualifying life event or new accession, will be returned to the member along with any premium payments received.
Qualified members newly assigned to the Selected Reserve have up to 60 days after date of accession into the Selected Reserve to submit a completed TRS request form and premium payment to their TRICARE regional contractor. Selected Reserve members who experience a qualifying life event have up to 60 days from the date of the event for the regional contactor to receive their completed request form and correct premium payment. After processing the request form, members will receive a welcome letter, TRS Handbook and a TRS wallet card for each family member covered under Tier 2. The wallet card contains telephone numbers and information to assist members with their health care coverage.
When Coverage Begins
Tier 2 coverage begins Oct. 1, 2006, for members whose TRS request form is postmarked before Sept. 25, 2006. Coverage begins Jan. 1, 2007, for members whose TRS request form is postmarked between Sept. 26 and Nov. 25, 2006.
Tier 2 Premiums and Payment
Monthly Tier 2 premiums for calendar year 2006 are $145.29 for member-only coverage and $451.42 for member and family coverage. Premiums are adjusted annually on Jan. 1 and will be posted on the TRICARE Web site 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. Failure to pay premiums on time will result in termination of coverage. Members also will be required to pay any overdue amounts and may reapply for TRS coverage during the next open season.
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.
Changes to Tier 2 Coverage (Qualifying Life Events)
After Tier 2 coverage begins, members may request certain actions outside of the open season period if they experience a qualifying life event. Members may submit a request to purchase new coverage, terminate coverage, or change type of coverage. A qualifying life event may occur as a result of a change in family composition such as marriage, birth or 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 the 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 moving from full-time to part-time status. The effective date of the change is the date of the qualifying life event.
TRS Coverage for Newborns
Newborns born to members already 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 the first year, the member must register the child in DEERS and submit a TRS Request form to their TRICARE 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 2 coverage and premiums continue uninterrupted. For members who return to active duty for more than 30 days, they and their eligible family members will receive the same TRICARE benefit as active duty service members and their family members. (If the active duty period is in support of a contingency operation, the members and their eligible family members also may qualify for the early (90 day) 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 2 premium payments will resume either on the day following the members’ release from active duty, the day after coverage under the Transitional Assistance Management Program ends, whichever is later, or the day after coverage by another TRICARE benefit ends if the coverage was stopped in the same calendar year. Otherwise, members may qualify and purchase coverage under the rules for a qualifying life event or open season.
Tier 2 Survivor Benefits
There are no TRS survivor benefits under Tier 2 coverage. Survivors and eligible family members of a Selected Reservist will remain covered under Tier 2 through last day of the month in which the member’s death occurs, at which time TRS coverage for these family members will end.
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. Additional information is available at www.humana-military.com.
Customer Service Support
Health Net Federal Services, www.hnfs.net/bene/home, provides 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 2 coverage, Reserve Component members may visit www.tricare.osd.mil/reserve/reserveselect.
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