1.0 DESCRIPTION
The TAMP establishes TRICARE eligibility for
specific categories of beneficiaries. The sponsors and their family
members are eligible for continued TRICARE medical benefits including
enrollment/re-enrollment in TRICARE Prime or TRICARE Select, services
and supplies provided under the Extended Care Health Option (ECHO),
and Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM)
care, for a defined period of time as indicated on Defense Enrollment
Eligibility Reporting System (DEERS). While the status of these
individuals is neither active duty nor retiree/deceased, for the purpose
of cost-sharing, the claims for these individuals (including the
former active duty member) shall be processed as Active Duty Family
Members (ADFMs).
Note: In this section, references to TRICARE Select
coverage are effective for services received on or after January
1, 2018.
2.0 POLICY
2.1 Covered Groups (Section
1145 of Title 10, United States Code (10 USC 1145)). Members, as determined
by their Service personnel office and indicated in DEERS, and their
eligible family members who meet the criteria below are entitled
to medical benefits under TRICARE to the same extent as those available
to ADFMs.
2.1.1 A member who is involuntarily separated from
active duty as defined in 10 USC 1141.
2.1.1.1 This includes
a member who is provided a voluntary separation incentive under 10
USC 1175(j).
2.1.1.2 This includes
a member who is separated from active duty and receives voluntary separation
pay, and not entitled to retired or retainer pay upon separation,
under 10 USC 1175a(e)(2)(A).
2.1.2 A member of a Reserve Component
(RC) who is separated from active duty after serving more than 30
consecutive day either in support of a contingency operation or
for a preplanned mission. Preplanned mission was added by Public
Law 115-91, effective December 12, 2017.
2.1.3 A member who is separated
from active duty for which the member is involuntarily retained
under 10 USC 12305 (also referred to as “stop loss”) in support
of a contingency operation.
2.1.4 A member who is separated
from active duty pursuant to a voluntary agreement of the member
to remain on active duty for a period of less than one year in support
of a contingency operation under 10 USC 1145(a)(2)(D).
2.1.5 A member
who receives a sole survivorship discharge as defined in 10 USC 1174(i).
This provision was added by Public Law 110-317, effective August
29, 2008.
2.1.6 A member who is separated from active duty
who agrees to become a member of the Selected Reserve of the Ready
Reserve of an RC. This provision was added by Public Law 110-417, effective October
14, 2008.
2.2 Time frames of eligibility
for TAMP eligibles in which the member’s separation occurred on
or after November 6, 2003 - Transitional health care for TAMP eligibles
shall be available for 180 days beginning on the date on which the
member is separated from active duty.
2.3 Determining Eligibility
2.3.1 Eligibility
determinations for coverage must be based on DEERS determinations.
2.3.2 Contractors
shall be responsible for confirming DEERS eligibility status. Once
jurisdictional responsibility is established, the contractor shall
have the capability by using DEERS to identify these claims as TAMP
and process them as ADFM claims. While the status of these individuals
is neither active duty nor retiree/deceased, for the purpose of
cost-sharing, the claims for these individuals shall be processed
as ADFMs. Eligibility verification of an active duty member who
was separated involuntarily shall be based solely on the DEERS response.
For those claims that are submitted for medical services rendered
to the sponsor and if the contractor can identify the claim as meeting
the transitional eligibility requirements, the contractor shall
process the claim. Otherwise the sponsor claims indicating status
as “active duty” and relationship as “self” shall continue to be
transferred to the military services. Claims shall be processed
by the contractor using the same rules and cost-shares that apply
to ADFMs per TRICARE Reimbursement Manual (TRM),
Chapter 2,
unless otherwise specified in
Chapter 10, Section 8.1.
2.4 Change
in eligibility status of a beneficiary during an inpatient hospital
stay (see the TRM,
Chapter 6, Section 2).
2.5 In cases
involving the existence of Other Health Insurance (OHI) for family
members and/or sponsors, treat as double coverage as required by
the TRM.
2.6 TRICARE
Prime (Before January 1, 2018)
2.6.1 Enrollment in Prime. TAMP
eligibles may enroll or re-enroll in TRICARE Prime.
2.6.2 Effective
Date of Enrollment in TRICARE Prime is as follows:
2.6.2.1 TAMP eligibles
(including the former active duty member) who were enrolled in Prime immediately
prior to their change in status may continue their enrollment in
TRICARE Prime with no break in coverage. A reenrollment application
must be completed prior to the TAMP expiration period in order to
continue with TRICARE Prime. The effective date shall be the date
the sponsor separated from active duty as the intent is to ensure
that Prime coverage is seamless. See
Section 2.1 for
further information on the effective date of enrollment.
2.6.2.2 TAMP eligibles
who were not enrolled in Prime (including TRICARE Prime Remote (TPR)
and TRICARE Prime Remote Active Duty Family Member (TPRADFM)) immediately
prior to their change in status may choose to enroll in TRICARE
Prime while receiving TAMP coverage but such enrollment is subject
to the “twentieth of the month rule”. That is, if an application
for an initial enrollment is received after the twentieth day of
the month, Prime enrollment will begin on the first day of the second
month after the month in which the application was received by the
contractor. See
Section 2.1 for further information on the
effective date of enrollment.
2.6.2.3 TAMP eligibles
whose sponsor is called to active duty.
2.6.2.3.1 TAMP eligible
family members who were enrolled in Prime immediately prior to their sponsor’s
change in status to active duty may continue their reenrollment
in TRICARE Prime with no break in coverage if they reenroll in TRICARE
Prime within 30 days of the return to active duty status. If reenrollment
is accomplished within 30 days of the return to active duty status,
the reenrollment will be retroactive to the date of the change in
status from TAMP to active duty. If reenrollment is not accomplished
within 30 days of the return to active duty status, the twentieth
of the month rule will apply.
2.6.2.3.2 TAMP eligible
family members not enrolled in Prime immediately prior to activation (i.e.,
return to active duty) may choose to enroll in Prime but such initial
enrollment is subject to the twentieth of the month rule. That is,
if an application for an initial enrollment in Prime is received
after the twentieth of the month, Prime enrollment will begin on
the first day of the second month after the month in which the application
was received by the contractor. See
Section 2.1 for
further information on effective date of initial enrollments and
reenrollments.
2.6.2.3.3 For information
on the effective dates of enrollments for Service members, see the TRICARE
Operations Manual (TOM),
Chapter 6, Section 1.
2.6.2.4 While the
TPR and TPRADFM are not available to TAMP eligibles, these programs
are considered a “Prime-like” benefit and enrollment or reenrollment
in Prime shall be available to them as stated above.
2.7 TRICARE Prime And TRICARE
Select (Effective January 1, 2018)
2.7.1 Enrollment
A
change in status listed in
paragraph 2.1 is a Qualifying Life Event (QLE).
As such,
TAMP-eligible members and family members
may be auto-enrolled in TRICARE Select. If not auto-enrolled in TRICARE
Select, TAMP eligibles
, including
the former Service member
s may
elect to enroll or re-enroll in TRICARE Prime
, if
qualified or
TRICARE Select
coverage within
90 days of their eligibility for TAMP.
2.7.3 TAMP eligibles whose sponsor is called to active
duty.
2.7.3.1 A TAMP sponsor’s re-activation to active duty
status is a change in status, and is a QLE that allows TAMP enrollees
to elect their desired TRICARE coverage within 90 days of the activation.
2.7.3.2 While the TPR and TPRADFM are not available
to TAMP eligibles, these programs are considered a “Prime-like”
benefit and enrollment or reenrollment in Prime shall be available
to them as stated above.
2.8 TRICARE Reserve Select (TRS) may be available
for purchase by members of the Selected Reserve as specified in
the TOM,
Chapter 22, Section 1. In order to continue
TRICARE coverage with no break, an application for TRS may be produced
up to 90 days before the expiration date of TAMP, but must be submitted
with the required initial payment no later than 90 days after the
expiration date of TAMP.
2.9 The Continued Health Care Benefit Program (CHCBP)
may be available to members (and their dependents) after the expiration
of TAMP entitlement. See
Section 4.1 for
further information.
2.10 Dental
Coverage
2.10.1 Dental
benefits for TAMP-eligibles are limited to space available care
in the Dental Treatment Facility (DTF).
2.10.2 Effective January 27, 2012, dental benefits
for RC members discharged from active duty after more than 30 days
in support of a contingency operation are available in the same
manner as a member of the uniformed services on active duty for
more than 30 days. This requires care to be provided in both military
DTFs and authorized private sector dental care. This care will run
concurrently with the member’s TAMP coverage.
2.10.3 The TRICARE Dental Program (TDP) is a voluntary
dental insurance program that is available to ADFMs, Selected Reserve,
and Individual Ready Reserve (IRR) members, and their eligible family members.
The TDP is not part of the benefits offered under TAMP. Sponsors
who were enrolled in the TDP prior to being activated, who then
return to Reserve status, may be eligible to re-enroll in the TDP.