1.0 DESCRIPTION
RC members who
are issued delayed-effective-date active-duty orders become eligible
for TRICARE up to 180 days before the active duty commences, along
with their eligible family members, if the RC member is ordered
to active duty for a period of more than 30 days for a preplanned
mission under 10 United States Code (USC) 12304b or a contingency
operation under a provision of law referred to in 10 USC 101(a)(13)(B).
2.0 BACKGROUND
2.1 Section
703 of the National Defense Authorization Act (NDAA) for Fiscal
Year (FY) 2004 (Public Law 108-136) established temporary authority
to expand the period of time that an RC member is considered
to be on active duty for the purpose of TRICARE eligibility.
2.2 Section
703 of the NDAA for FY 2005 (Public Law 108-375) made the authority
permanent.
2.3 Section 702 of the NDAA for FY 2010 (Public
Law 111-84) extended the maximum period of early eligibility from
90 days to 180 days effective October 28, 2009.
2.4 Section 511 of the NDAA for FY
2018 (Public Law 115-91) expanded the early eligibility benefit to
RC members, and their eligible family members, called or ordered
to active duty for more than 30 consecutive days for a preplanned
mission under 10 USC 12304b effective December 12, 2017.
3.0 POLICY
3.1 An RC
member who is issued a delayed-effective-date active-duty order
,
as described above, will be considered as being on
active duty for more than 30 days beginning on the later of the
date that is:
3.1.1 The date of issuance of the order; or
3.1.2 One hundred
and eighty days before the date on which the period of active duty
is to commence.
3.2 The secretaries of the military
departments are responsible for ensuring accurate and timely submission
of early TRICARE eligibility data to the Defense Enrollment Eligibility
Reporting System (DEERS) as specified in DoDI 7730.54, “Reserve
Component Common Personnel Data System” (RCCPDS). The TRICARE Early
Identification (EID) program for early TRICARE eligibility transactional
data defined in RCCPDS, based on the delayed-effective-date-active
duty order, is the authoritative source for establishing, maintaining,
and terminating early TRICARE eligibility in the DEERS. Uniformed services
personnel offices are responsible for ensuring that DEERS changes
have been effectuated to reflect correct eligibility information
for all affected individuals. If the delayed-effective-date active-duty
orders are rescinded before the active duty commences, the military
departments are responsible for terminating the member’s and dependents’
eligibility for TRICARE in DEERS.
3.3 Affected individual members
of the RC and their family members are eligible for TRICARE under this
section. The provisions available under the TRICARE Reserve and
NG family member benefits (
Chapter 10, Section 8.1) shall apply to those
eligible for care under this section. This eligibility includes family
member eligibility for TRICARE Prime/Overseas Prime and for TRICARE
Prime Remote (TPR)/Overseas Prime Remote for Active Duty Family
Members (ADFMs). This eligibility also includes Service Member eligibility
for TRICARE Prime with a Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) Primary Care Manager (PCM) if the member
lives near an MTF/eMSM; TPR for the member is not authorized during
this early eligibility period. A non-enrolled Service member may
seek covered primary care from a TRICARE authorized civilian provider.
Prior to obtaining any specialty care, the RC member should contact
the appropriate TRICARE regional or overseas contractor to request authorization.
3.3.1 The periods
of TRICARE eligibility for the affected individuals will be reflected
in DEERS. Contractors will continue to rely upon DEERS for eligibility
determination.
3.3.2 The contractor shall verify
the patient’s eligibility in DEERS.
3.4 In the
event that the contractor should become aware that payment has been
made for services rendered during a period for which the patient
was subsequently determined to be ineligible recoupment action shall
be initiated. Recoupment procedures are specified in TRICARE Operations Manual
(TOM),
Chapter 11, Section 3 as appropriate.