The term “contractor” applies to the
Managed Care Support (MCS) contractor, TRICARE Overseas Program
(TOP) contractor, and Uniformed Services Family Health Plan (USFHP)
Designated Providers (DPs) whose enrollees are TRlCARE-eligible
for civilian care.
1.0 Split enrollment
involves different members of the same family enrolled in
the same health plan (TRICARE Prime or TRICARE Select) with
different contractors. Split enrollment does not apply
to unremarried former spouses.
Example: Sponsor
and spouse who live and are enrolled in TRICARE Prime in one region
and a college age child who lives and is enrolled in TRICARE Prime
in a different region or a TRICARE eligible USFHP enrollee and other
members of the same family enrolled in TRICARE Prime with one or
more contractors.
2.0 Split enrollment
provisions apply to TRICARE Prime and TRICARE Select enrollments in all
areas. Up to December
31, 2017, all catastrophic cap accumulations shall
be applied to the new enrollment period. Effective
January 1, 2018, enrollment fees are no longer credited to the catastrophic
cap.
3.0 A family
subject to enrollment fees will pay enrollment fees totaling no
more than the
family enrollment fee
s
according to the elected plan(s) regardless of the
enrollment locations of family members.
Individual
and family enrollment fees for TRICARE Prime are separate from individual
and family enrollment fees for TRICARE Select. The
enrollment fee billing contractor shall be determined based on the
following list of potential enrollees in descending order of precedence:
• Sponsor.
• Spouse.
• Oldest enrolled
child.
4.0 If the
family enrollment fee is not paid on time and the family is disenrolled,
individual family members who are enrolled in different regions
(and who have not paid single enrollment fees) shall be disenrolled
as well.