In order to purchase
TYA coverage, young adult dependents who meet the qualifications
listed in
paragraph 3.1 and must be listed in the Defense
Enrollment Eligibility Reporting System (DEERS) database. The Defense
Manpower Data Center (DMDC) will ensure that dependents meeting
the qualifications will be reflected as eligible to purchase or
continue TYA coverage if the uniformed service sponsor is eligible
for health care under Chapter 55, 10 USC or Chapter 58, 10 USC Section
1145(a), Transitional Assistance Management Program (TAMP). The
contractor shall rely solely upon DEERS to identify young adult
dependents qualified to purchase TYA coverage. The contractor shall
refer young adult dependents and uniformed service sponsors to a
Real-Time Automated Personnel Identification System (RAPIDS) site
if the dependent is not found in DEERS.
3.1
Dependent
Qualifications For Purchase Of TYA Coverage
A
young adult dependent qualifies to purchase TYA coverage if the
dependent meets the following criteria:
• Would be a dependent
child under Chapter 55, 10 USC Section 1072(2) but for exceeding the
age limit under that section; and
• Is a dependent under
the age of 26; and
• Is
not eligible for medical coverage from an eligible employer-sponsored
health plan from the young adult dependent’s employer as defined
in Section 5000A(f)(2) of the Internal Revenue Code of 1986; and
• Is not married; and
• Is not otherwise eligible
for care under Chapter 55, 10 USC or Chapter 58, 10 USC Section 1145(a),
TAMP; and
• Is
not a member of the uniformed services.
3.2 Eligibility
Of Uniformed Service Sponsor
3.2.1 Eligibility for TYA is only
determined by a proper eligibility response in DEERS. Based on the status
of the uniformed service sponsor, the ability to purchase may be
limited or not allowed based on the uniformed service sponsor’s
status and eligibility for medical care under Chapter 55, 10 USC
or Chapter 58, 10 USC Section 1145(a). In addition, young adult
dependents must meet all other qualifications shown in
paragraph 3.1.
3.2.2 Young adult
dependents of active duty members (including those called to active
duty for more than 30 days) may qualify to purchase TYA coverage
until the active duty sponsor’s date of separation or until the
young adult dependent reaches the age of 26, whichever comes first.
Upon the death of an active duty sponsor, former young adult dependents already
aged out of TRICARE are classified as Survivors and may qualify
to purchase TYA coverage up to the age of 26 but with Survivor (retiree)
cost-shares.
3.2.3 Young adult dependents of retired uniformed
service sponsors may qualify to purchase TYA coverage until they
reach the age of 26.
3.2.4 Young adult dependents of
uniformed service sponsors eligible to purchase TRS or TRICARE Retired
Reserve (TRR) may qualify to purchase TYA coverage only if the sponsor
is enrolled in TRS or TRR and until the young adult dependent reaches
age 26. Failure of the uniformed service sponsor to enroll in and
maintain enrollment in TRS or TRR or failure to pay TRS or TRR premiums
will result in the young adult dependent not being eligible to purchase
TYA coverage as of the date of the sponsor’s loss of enrollment
in TRS or TRR.
3.2.5 If the Selected Reserve sponsor
dies while enrolled in TRS, the young adult dependent may qualify
to purchase TYA coverage for up to six months after the date of
death of the Selected Reserve sponsor, or until the young adult
dependent reaches the age of 26, whichever comes first, but with Survivor
(retiree) cost-shares.
3.2.6 Young adult dependents of
a member of the Retired Reserve, who dies while in a period of TRR
coverage, may qualify to purchase new or continue existing TYA coverage
until the young adult dependent reaches the age of 26. If a member
of the Retired Reserve is not covered by TRR on the date of his
or her death, his or her surviving dependents do not qualify for
TYA coverage until the date on which the deceased member of the
Retired Reserve would have attained age 60, at which time they may qualify
to purchase TYA coverage until reaching the age of 26.
3.2.7 Young adult dependents of a member eligible
for TAMP coverage may qualify to purchase TYA coverage until the
TAMP coverage ends or the young adult dependent reaches age 26,
whichever comes first. If the member dies while covered under TAMP,
the young adult dependent may qualify to purchase TYA coverage to
the end of the TAMP coverage period or until the young adult dependent reaches
age 26, whichever comes first, with Active Duty Family Member (ADFM)
cost-shares.