1.0 The term
“contractor” applies to Uniformed Services Family Health Plan (USFHP)
Designated Providers (DPs) as well as to the Managed Care Support
(MCS) and TRICARE Overseas Program (TOP) contractors for purposes
of enrollment portability.
1.1 TRICARE Prime and TRICARE
Select enrollees retain coverage whenever they move or travel. Enrollment
portability provisions apply to TRICARE Prime/Select enrollees’
travel or relocation to or from all areas, where TRICARE Prime/Select is
available. The contractor for the region in which the beneficiary
is enrolled on Defense Enrollment Eligibility Reporting System (DEERS)
is responsible for providing continuing coverage and updating catastrophic
cap accumulations for the enrollee while the enrollee is traveling
or relocating, except in the case of care provided overseas (i.e.,
care outside of the 50 United States (U.S.) and the District of
Columbia). Civilian Health Care (CHC) while traveling or visiting
overseas shall be processed by the TRICARE Overseas Program (TOP)
contractor, regardless of where the beneficiary resides or is enrolled.
1.2 An enrollee
may transfer enrollment before or after moving either temporarily
or permanently to a new location using any of the enrollment options
in
Section 1. The losing contractor shall continue to
provide health care coverage until:
• The
enrollment is transferred to the gaining contractor;
• The
beneficiary is no longer eligible for enrollment in TRICARE Prime
or TRICARE Select;
• The
beneficiary disenrolls; or
• The
beneficiary is disenrolled due to failure to pay required enrollment
fees, whichever occurs first.
1.2.1 TRICARE Prime referral
and authorization rules continue to apply (see Chapter
8, Section 5). Under no circumstances
will retroactive disenrollment be allowed in order to avoid POS
cost-sharing provisions.
1.2.2 On the day the gaining contractor receives
either a beneficiary’s signed enrollment form, telephone portability
request, or a request via the Government furnished web-based self-service enrollment
system/application agreeing to a transfer of enrollment to the new
region, the beneficiary shall be considered enrolled at the new
location. TRICARE Prime enrollees should contact the new PCM, the
new region’s Health Care Finder (HCF), or the DP for health care
and health related assistance.
1.2.3 For enrollment requests received via the Government
furnished web-based self-service enrollment system/application,
the contractor shall modify the effective date to be the date the enrollment
was submitted.
1.2.4 The effective
date for transfer of enrollment may differ from the effective date
for initial enrollment. See
Section 1 for
information on initial enrollment in TRICARE Prime. For transfers,
the original enrollment period on DEERS will remain in effect.
1.3 Within
four calendar days of receipt of a beneficiary’s request for enrollment
transfer, the gaining contractor shall submit the transfer of enrollment
to DEERS using the Government-furnished systems application. See
Section 1 for effective date rules.
1.4 When enrollment
changes from one contractor to another prior to the annual renewal
for enrollees in beneficiary categories required to pay enrollment
fees the gaining contractor shall obtain information from the losing
contractor on fees that are being automatically paid and transition
these payment types in the least disruptive manner for the beneficiary. Enrollment
fees must be paid current prior to transfer of enrollment See
Section 1, for refunds of unused enrollment
fees.
1.5 USFHP Portability Guidelines
1.5.1 TRICARE Prime USFHP enrollees who are not otherwise
TRICARE-eligible (i.e., grandfathered Medicare
eligible beneficiaries who only have Part A) may only transfer enrollment
from one USFHP to another USFHP; they may not transfer to a MCS
Contractor (MCSC).
1.5.2 Beneficiaries enrolled
in TRICARE Prime coverage who reside in a zip
code where USFHP and MCSC Prime networks co-exist may elect
to change their PCM to the other network at any time by disenrolling
from their current contractor and re-enrolling with the other contractor. This
is to be viewed as a PCM change.
1.6 Enrollment portability and PCM changes are
not limited to the annual open enrollment period or require a
Qualifying Life Event (QLE) to occur.