1.0 GENERAL
All TRICARE requirements regarding eligibility,
enrollments, re-enrollments, disenrollments, and transfers shall
apply to the TOP unless specifically changed, waived, or superseded
by the provisions of this section; the TRICARE Policy Manual (TPM),
Chapter 12; or the TRICARE contract for health
care support services outside the 50 United States (U.S.) and the
District of Columbia (hereinafter referred to as the “TOP contract”).
See
Chapter 6; the TPM,
Chapter 10;
and the TRICARE Systems Manual (TSM) for additional instructions.
2.0 Eligibility
Eligibility for TRICARE is verified via the
Defense Enrollment Eligibility Reporting System (DEERS). The DEERS
record will indicate the dates of eligibility. Except for newborns,
only those beneficiaries who are shown as eligible on DEERS will
be enrolled or receive benefits under the TOP. If a beneficiary’s
date of birth is within 365 days of the contractor’s query to DEERS,
the contractor shall consider the newborn to be eligible for TRICARE
benefits. In addition to DEERS eligibility, TOP Active Duty Family
Members (ADFMs) shall demonstrate Command Sponsorship to be eligible
for TOP Prime and TOP Prime Remote enrollment unless a specific
exception exists. The TOP contractor shall verify DEERS eligibility
(and Command Sponsorship, where required) prior to enrolling beneficiaries
into TOP.
Note: Family members of the Armed Forces
of foreign North Atlantic Treaty Organization (NATO) or Partnership
For Peace (PFP) nations are not eligible for the TOP.
3.0 Enrollment
Processing
3.1 TOP Prime and TOP Prime Remote are available
to Service members and certain ADFMs in overseas locations as described
below. These programs are similar, but not identical, to TRICARE
Prime and TRICARE Prime Remote (TPR)/TRICARE Prime Remote for ADFMs
(TPRADFMs) in the U.S. TOP Prime enrollees shall normally be enrolled
to a Military Treatment Facility (MTF) Primary Care Manager (PCM), but
enrollment to a purchased care sector PCM may be authorized when
MTF capacity is reached. TOP Prime enrollment procedures shall be
established in the Statements of Responsibilities (SORs) between the
TOP contractor and the MTF Commander. TOP Prime Remote enrollees
shall be enrolled to a remote Defense Medical Information System
(DMIS) code with assignment to a purchased care sector PCM or to
the TOP contractor, according to the specific regional enrollment
procedures established in the SORs between the contractor and the
TRICARE Area Office (TAO) Directors.
3.2 Unless a specific exception
exists, enrollment to TOP Prime or TOP Prime Remote is available only
to Service members who are permanently assigned overseas, and to
ADFMs who are Command Sponsored and accompanying their sponsor on
his/her overseas tour, or on orders in an overseas location (see
paragraph 5.1 for
additional information regarding Command Sponsorship). This includes activated
Reserve Component (RC) Service members who are on orders to an overseas
location for more than 30 days, and their Command Sponsored ADFMs
who accompany the RC member on his/her overseas tour or are on orders
in an overseas location. See
paragraph 5.0 for additional details on family member
eligibility.
3.3 Non-Command Sponsored ADFMs, retirees, and
retiree family members are not eligible for TOP Prime or TOP Prime
Remote enrollment in any overseas location. ADFMs who are not Command Sponsored
or on military orders as described in this section will be covered
by TOP Standard (for services received through December 31, 2017).
Effective January 1, 2018, a beneficiary not enrolled in Prime must
be enrolled in Select (subject to any grace period during calendar
year 2018) with services received on or after January 1, 2018, covered
by Select (see
Section 19). Because TRICARE for Life (TFL) beneficiaries
are not eligible to enroll in Select, if the TFL beneficiary is
not allowed to enroll in Prime their services received on or after
January 1, 2018, shall be covered under TRICARE Standard (see TRICARE
Reimbursement Manual (TRM),
Chapter 2)
as if TRICARE Standard was still being implemented.
3.4 Enrollment
may occur at any time after TOP eligibility has been established,
and normally remains effective during the overseas tour of the sponsor.
Annual re-enrollment is not required for TOP Prime or TOP Prime
Remote. Once enrolled, beneficiaries remain enrolled in these programs
until:
• They
disenroll;
• Transfer
enrollment to another TRICARE region/program;
• Lose eligibility
for TRICARE, TOP Prime, or TPR; or
• The 61st calendar
day following the end of the overseas tour (see
paragraph 12.5).
3.5 The
TOP contractor shall perform all enrollment-related activities for
TOP Prime, TOP Prime Remote, TRICARE Plus, TRICARE Young Adult (TYA),
TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR) and
effective January 1, 2018, TOP Select in overseas locations. These
activities may include validation of eligibility, enrollment, re-enrollment,
disenrollment, transfers, updating information in DEERS, clearing
enrollment discrepancies, assigning or changing PCMs, collecting
Other Health Insurance (OHI) information, and related enrollment
functions. The contractor shall use the approved TRICARE enrollment
request options for enrollment activities. Enrollment shall be accomplished
within five working days of receipt of a complete TRICARE enrollment
request.
Note: Overseas insurance plans such as
German Statutory Health Insurance, Japanese National Insurance (JNI),
Philippines Phil Health, and Australian Medicare, etc., are considered
OHI.
3.6 Enrollments
for TOP Prime or TOP Prime Remote are effective on the date the
enrollment request is received (and appropriate Command Sponsorship
orders are received or attested to, when applicable), unless a retroactive
enrollment has been authorized by the TAO Director or designee.
For telephonic enrollments, the TOP contractor will collect the
Military Sponsor’s Order Number and date on the orders and document
in the contractor’s call notes. By providing the Order Number and
date on the orders, the Sponsor and/or ADFM attests to command sponsorship.
For TOP emergency cases that should be placed under immediate case
management, TOP MTF Commanders and/or the TAO Directors may approve
exceptions on a case-by-case basis for retroactive TOP enrollment.
Except for administrative errors, the effective date for retroactive
enrollments shall not be earlier than the first day of the month
that the application is submitted (see the TPM,
Chapter 10, Section 2.1).
• An officially signed
enrollment request includes those with (1) an original signature,
(2) an electronic signature offered by and collected by the contractor,
or (3) a verbal consent provided via telephone and documented in
the contractor’s call notes. A signature is not required to make
enrollment changes by phone as long as the verbal request is documented.
A signature from a Service member is never required to complete
Prime enrollment as enrollment in Prime is mandatory per TPM,
Chapter 10, Section 2.1, paragraph 1.1.
3.7 The contractor
shall follow guidance from the TAO Directors and the MTFs regarding
PCM assignment when enrolling beneficiaries into TOP Prime. The
MTF enrollment area encompasses a 40-mile radius or a one-hour drive
time from the MTF. TOP Prime Remote beneficiaries will be enrolled
to the appropriate DMIS code for the beneficiary’s remote overseas
location. TOP Prime Remote enrollees in Canada will follow guidance
applicable to the U.S. and Canada Reciprocal Health Care Agreement, and
may be assigned to a Canadian Forces Health Facility for their primary
care.
3.8 Newborn/Adoptee
Claims
3.9 The provisions
of
Chapter 6, Section 1 and the TPM,
Chapter 10, Section 2.1 regarding Prime enrollment
fees shall not apply to TOP Prime or TOP Prime Remote. There are
no enrollment fees associated with TOP Prime or TOP Prime Remote.
4.0 Enrollment
Policy For Service MEMBERS
4.1 Except as described in
paragraph 4.2,
all Service members who are permanently assigned to an overseas
duty location must be enrolled into the TOP program that is available
in their area. This includes RC Service members who are called to
active duty for more than 30 consecutive days with a final assignment
to an overseas duty station.
4.2 Service
members assigned to operational forces with assigned organic medical
assets may be enrolled to an operational forces’ DMIS ID affiliated
with its “Parent” DMIS. This includes activated RC members on duty
in combatant theaters of operation with existing or embedded organic
medical treatment and support capabilities for health care. Enrollment
to a Service or Region-specific operational forces’ DMIS for all
Service members should occur prior to deployment.
4.3 Since a
signature from an ADSM is never required to complete Prime enrollment,
the TOP contractor shall accept enrollment spreadsheet (with all
applicable information) as a valid process for enrolling Service
members into TOP Prime or TOP Prime Remote.
5.0
Enrollment
Policy For ADFMs
5.1 ADFMs
who have Permanent Change of Station (PCS) orders to accompany the
sponsor overseas or service-funded orders to relocate overseas without
the sponsor are eligible for TOP Prime or TOP Prime Remote enrollment.
In order to enroll in these programs, ADFMs must meet the definition of
Command Sponsorship in the Joint Travel Regulation (JTR), Volume
I, Appendix A (available at
https://www.defensetravel.dod.mil/Docs/perdiem/JTR.pdf) unless
one of the following exceptions exists:
5.1.1 If the Service member and
his/her Command Sponsored ADFM(s) are enrolled in TOP Prime or TOP
Prime Remote, and the sponsor is reassigned on unaccompanied PCS
orders to a location that does not permit Command Sponsored family
members, the family member(s) may retain their TOP enrollment for
a period based on the length of the sponsor’s unaccompanied orders
(but not to exceed two years). In order to retain TOP enrollment
in this situation, the family member(s) must continue to be Command
Sponsored and may not relocate elsewhere during the sponsor’s PCS
move.
5.1.2 If the ADFM(s) are authorized to relocate to
an overseas location per the sponsor’s PCS orders in accordance
with JTR U5222, or per Noncombatant Evacuation Orders without the
sponsor, then the ADFM(s) are eligible for enrollment in the appropriate
TOP program consistent with their orders.
5.1.3 If the ADFM(s) resided in
an overseas location prior to the activation/mobilization of a RC sponsor,
then the ADFM(s) are eligible for enrollment in the appropriate
TOP program based on the residential mailing address of the sponsor
prior to activation/mobilization. The ADFM(s) must have had the
same overseas residential address as the sponsor at the time of
activation/mobilization.
5.1.4 If the ADFM(s) are currently
enrolled in TOP Prime or TOP Prime Remote, and the family has a
newborn or adopts a child, then the new family member is eligible
to enroll in the same TOP program.
5.1.5 If the ADFMs are eligible
for Transitional Survivor benefits (see
paragraph 6.0).
5.2 ADFMs who
choose to reside overseas but are not Command Sponsored as defined
in the JTR, and who do not meet any of the exceptions listed above,
are not eligible for enrollment in TOP Prime or TOP Prime Remote.
These ADFMs are eligible for TRICARE Standard (effective January
1, 2018, may elect to enroll in TOP Select), TRICARE Plus (where
available) or MTF care on a space-available basis only. ADFMs may
not retain Prime enrollment to a stateside Managed Care Support
Contract (MCSC) while residing overseas.
5.3 Effective January 1, 2018,
once registered in DEERS, newly eligible ADFMs residing in an overseas
area are automatically enrolled into TOP Select and have 90 days
after the auto enrollment to change their enrollment to TOP Prime/TOP
Prime Remote if desired and if command sponsored.
5.4 Eligibility for TOP enrollment normally requires
the family to be accompanied by the sponsor; therefore, a family
member cannot relocate within the overseas region, relocate to another
overseas region, or relocate from a overseas location to an overseas
location and transfer enrollment except as specified under the exceptions
in this section.
5.5 The TOP
contractor shall verify that all of the above requirements are met
(including DEERS eligibility check and validation of Command Sponsorship/military
orders, if required) prior to enrolling an ADFM into TOP Prime or
TOP Prime Remote.
5.6 The process for identifying ADFMs who are Command
Sponsored may vary by Service. This is a Service personnel decision
and as such, these processes may change over the life of the contract.
The TOP contractor may accept any current, valid method of identifying
Command Sponsorship to meet the TOP enrollment requirements (e.g.,
Navy ADFMs who are not listed on the sponsor’s orders, but who are
in receipt of a letter from the Navy Personnel Services Division
(PSD)).
5.7 ADFMs may
request enrollment to an MTF that is not located at the sponsor’s
assigned installation; however, only requests for enrollment within
the same TAO region as the sponsor’s assigned location will be considered.
All ADFM enrollments are subject to the MTF’s enrollment/empanelment
guidelines.
6.0
Enrollment
Policy For Transitional Survivors
The general
provisions of TPM,
Chapter 10, Section 7.1 regarding Transitional
Survivors shall apply to the TOP. Specific guidelines for Overseas
Transitional Survivor benefits are listed below.
6.1 TOP Prime/TOP
Prime Remote enrollment policy provisions which require command sponsorship
shall not apply to Transitional Survivors whose sponsors died on
or after October 7, 2001.
6.2 Transitional Survivors whose
sponsors died on or after October 7, 2001 and who choose to remain
in an overseas location are eligible for TOP Prime/TOP Prime Remote
enrollment during the Transitional Survivor period, regardless of
whether they remain at their original residence or relocate to another
overseas location. These Transitional Survivors are also eligible
for health care benefits under TRICARE Standard and effective January
1, 2018, may elect to enroll in TOP Select.
6.3 Transitional
Survivors whose sponsors died on or after October 7, 2001 and who
choose to return to the U.S. from an overseas location are eligible
for TRICARE Prime (in TRICARE Prime service areas) or TPRADFMs (in
remote locations) during the Transitional Survivor benefit period.
These Transitional Survivors are also eligible for health care benefits
under TRICARE Standard/Extra and effective January 1, 2018, may
elect to enroll in TOP Select.
6.4 Transitional Survivors whose
sponsors died on or after October 7, 2001 and who choose to move
from a stateside location to an overseas location are eligible for
TOP Prime or TOP Prime Remote enrollment during the Transitional
Survivor benefit period.
6.5 Transitional Survivors whose
sponsors died on or after October 7, 2001 are eligible for enrollment
and claims reprocessing per TPM,
Chapter 10, Section 7.1. Transitional Survivors
are also eligible for enrollment fee refunds (if applicable) per
TPM,
Chapter 10, Section 7.1.
6.6 If the
Transitional Survivors are not enrolled in TOP Prime, the Transitional
Survivor’s priority for appointments at overseas MTFs will be the
same as that of ADFMs who are not enrolled in TOP Prime.
6.7 At the
end of the Transitional Survivor period, survivors lose their eligibility
for enrollment in TOP Prime/TOP Prime Remote (in overseas locations)
and TRICARE Prime/TPRADFM (in remote locations) in the 50 U.S. and
the District of Columbia.
7.0 Enrollment
Plan
The TOP contractor, in consultation
with the TAO Directors and MTF Commanders, shall develop and implement
a TOP enrollment plan. The TOP enrollment plan shall establish enrollment goals
and describe the methods to be used to accomplish these goals. The
TOP enrollment plan shall be submitted to the Defense Health Agency
(DHA) Contracting Officer (CO) in accordance with the instructions
in
Chapter 6, Section 1. The TOP enrollment plan
shall be submitted not less than 90 calendar days prior to the start
of each health care delivery period. At a minimum, the TOP enrollment plan
shall include the following:
7.1 A description of the contractor’s
process for informing beneficiaries about the availability of TOP
enrollment options (TOP Prime and TOP Prime Remote).
7.2 A description
of any unique conditions and resources which may impact enrollment
activities by MTF area and TOP geographic region, along with a description
of the contractor’s plan for overcoming any potential barriers to
effective and efficient enrollment of eligible beneficiaries.
7.3 A description
of the contractor’s process for verification of eligibility prior
to enrollment (including verification of command sponsorship status,
when required for enrollment).
7.4 A description of the contractor’s
process for enrollment of beneficiaries on the DEERS using an automated
Government-furnished systems application, including the contractor’s
process for ensuring that enrollment data remains up-to-date and
accurate.
7.5 A description of the contractor’s process for enrollment
for TOP Prime, TOP Prime Remote, TOP Select, described in the TPM,
Chapter 10, Sections 2.1 and
3.1. The contractor may propose multiple methods
of enrollment; however the plan must include the opportunity for
enrollment at TRICARE Service Centers (TSCs), at Government-specified
locations for arriving/deploying units (per
Section 11, paragraph 5.2), via the TOP Point
of Contact (POC) program, by telephone, and by mail.
7.6 The TOP
contractor shall provide TOP-enrolled beneficiaries with full and
fair disclosure of any restrictions on freedom of choice that apply
to TOP enrollees, including the POS options.
8.0 Assignment
Of PCM
8.1 Unless the Government has approved enrollment
to a purchased care sector PCM, TOP Prime enrollees will be assigned
to a PCM in a local Department of Defense (DoD) MTF. TOP Prime enrollees may
not select an MTF Partnership Provider for a PCM.
8.2 The MTFs
will maintain current PCM lists and will make these lists available
to the TOP contractor on a regular basis as determined in the SOR.
MTF PCM lists will contain sufficient detail to facilitate new enrollments
or PCM reassignments until capacity is optimized per MTF guidance.
8.3 The TOP
contractor shall assign TOP enrollees to a PCM at the time of enrollment
via the Government furnished web-based enrollment system/application
per the SOR, access standards, and/or other specific Government
guidance. The Government furnished web-based enrollment system/application
will only display PCMs with available capacity. TOP Prime beneficiaries
must enroll to an overseas DMIS with assignment to an MTF PCM. TOP
Prime Remote beneficiaries must enroll to a civilian PCM, the contractor’s
call center(s), or a Canadian Forces Health Facility (in Canada). Appointments
will be provided within the TRICARE Prime access standards.
8.4 MTF Commanders
may establish specific MTF enrollment/empanelment guidelines for
their facilities. The TOP contractor shall enroll TOP Prime beneficiaries
and assign PCMs according to these MTF guidelines. Upon receipt
of a completed TRICARE enrollment request, the contractor shall
attempt to enroll the beneficiary according to the identified preferences
(e.g., specific provider, gender or specialty preference). If the
beneficiary’s PCM preferences are incompatible with MTF enrollment/empanelment
guidelines, the beneficiary shall be enrolled according to MTF guidelines.
If the preferred PCM is not available (no capacity), the contractor
will use the default PCM for that MTF. If there is no PCM capacity
in the MTF, the contractor shall contact the MTF for instructions.
8.5 A significant
number of MTF PCMs rotate or move each year. This will require the
TOP contractor to move the enrollment panels associated with those
PCMs. Through a Government-provided application, the contractor
shall perform batch PCM reassignments based on the parameters established
by the MTF. Those parameters include DMIS ID to DMIS ID, PCM ID
to PCM ID, Health Care Delivery Plan (HCDP), sex of beneficiary,
Unit Identification Code (UIC) (active duty only), age of beneficiary,
sponsor Social Security Number (SSN) (for family moves) and name
of beneficiary. The contractor will perform MTF PCM reassignment
moves within three working days of the effective date of the PCM’s
reassignment. The contractor will also perform PCM reassignment,
as necessary, in response to Service member reassignments or turnover
in purchased care sector PCMs.
8.6 The TOP contractor shall enroll
TOP Prime Remote beneficiaries to the appropriate enrollment DMIS
ID based on beneficiary location. The contractor shall list the
name of the assigned remote location/site or the purchased care
sector PCM, as appropriate.
9.0 Enrollment
Procedures
9.1 No TRICARE-eligible beneficiary shall be denied
enrollment or re-enrollment in, or be required to disenroll from,
the TOP Prime/TOP Prime Remote program because of a prior or current
medical condition.
9.2 The TOP contractor shall be
responsible for enrollment processing and for coordinating enrollment
processing with the MTF, the appropriate TAO Director, and DEERS.
The contractor shall enter enrollments into DEERS through the Government
furnished web-based enrollment system/application according to the
provisions of the TSM,
Chapter 3.
The contractor shall perform the following specific functions related
to enrollment processing:
9.2.1 The contractor shall collect
TOP Prime enrollment requests at the MTFs TSCs, or other sites mutually
agreed to by the contractor, TAO Director, and the MTF Commander,
or by mail, telephone, Government furnished web-based self-service
enrollment system/application, or other secure means determined
by the contractor. The contractor shall collect TOP Prime Remote
service area enrollment requests by mail, telephone, or other secure
means determined by the contractor.
9.2.2 At the time of enrollment
processing, the contractor shall access DEERS to verify eligibility of
applicants and shall update the residential mailing address and
any other fields for which they have update capability on DEERS.
If the enrollment request does not contain a mailing address, the enrollment
request shall be developed for a mailing address. Enrollees may
submit a temporary address (e.g., unit address) until a permanent
address is established. Temporary addresses must be updated with
the permanent address when provided to the contractor by the enrollee
in accordance with the TSM,
Chapter 3, Section 4.2. The contractor shall
not input temporary addresses not provided by the enrollee. If the
DEERS record does not contain an address, or if the enrollment request
contains information different from that contained on DEERS in fields
for which the contractor does not have update capability, the contractor
shall contact the beneficiary within five calendar days outlining
the discrepant information and requesting that the beneficiary contact
their military personnel information office for assistance in updating
the DEERS record.
9.2.3 Unless the Government has
waived the signature requirement, enrollment requests must be submitted
by the sponsor, spouse, or other legal guardian of the beneficiary
via one of the official enrollment request options (see
paragraph 3.6).
Note: The Government furnished web-based self-service
enrollment system/application is not currently available overseas.
9.4 TOP Prime/TOP
Prime Remote enrollment may occur at any time during the period
of TOP eligibility and shall remain effective until the enrollee
transfers enrollment to another region, disenrolls, or becomes ineligible
for TOP Prime/TOP Prime Remote or the TRICARE program. Effective
January 1, 2018, see
Chapter 6, Section 1,
for enrollment periods and effective coverage dates.
9.5 TOP Prime/TOP
Prime Remote enrollment may be on an individual or family basis.
Single enrollment may be changed to family due to marriage or birth
of a child at any time during the TOP enrollment period. A new TOP
enrollment period shall be established for the family. Effective
January 1, 2018, see
Chapter 6, Section 1,
for enrollment time-frames.
9.6 Enrollment fees are not required
for TOP Prime or TOP Prime Remote. Effective January 1, 2018, see
TRM,
Chapter 2, for enrollment fee information.
9.7 Service
members and ADFMs on PCS assignment in Canada (not at the request
of the Canadian Government) may enroll in TOP, but must pay up front
for all health care and file a claim with the TOP contractor for
reimbursement.
10.0 Enrollment
of Family Members Of E-1 Through E-4
10.1 The provisions of
Chapter 6, Section 1 regarding enrollment
of family members of E-1 through E-4 shall apply to the TOP, except
that TOP Prime/TOP Prime Remote shall be effective the date that
the enrollment is requested as long as it coincides with dates of
eligibility. See
Chapter 6, Section 2,
for effective enrollment dates on or after January 1, 2018. See
TPM,
Chapter 10, Section 2.1, for QLE information.
10.2 The provisions of
Chapter 6, Section 2 regarding
enrollment portability shall apply to the TOP, except that stateside-enrolled
retirees and retiree family members may not transfer Prime enrollment to
an overseas location.
11.0 Split Enrollment
The provisions of
Chapter 6, Section 3 regarding
split enrollment shall apply to TOP Prime and TOP Select (effective
January 1, 2018).
12.0 Disenrollment
12.1 ADFMs shall be disenrolled from TOP Prime/TOP
Prime Remote when:
• The enrollee requests
disenrollment;
• The
enrollee transfers enrollment to a new TRICARE region;
• The enrollee loses
eligibility for TOP Prime or TOP Prime Remote;
• The enrollee loses
TRICARE eligibility in DEERS; or
• The enrollee has not
requested enrollment transfer/disenrollment within 60 calendar days following
the end of the overseas tour.
12.2 Service members shall be disenrolled from TOP
Prime/TOP Prime Remote when:
• The enrollee transfers
enrollment to a new TRICARE region;
• The enrollee loses
TRICARE eligibility in DEERS; or
• The enrollee has not
requested enrollment transfer/disenrollment within 60 calendar days following
the end of the overseas tour.
12.3 ADFMs who are enrolled in TOP Prime/TOP Prime
Remote may disenroll at any time. They will not be permitted to
make another enrollment until after a 12-month period if they have
already changed their enrollment status from enrolled to disenrolled
twice during the enrollment year (October 1 to September 30) for
any reason. ADFMs with sponsors E-1 through E-4 are exempt from these
enrollment lock-out provisions. See
Chapter 6, Section 1 for
guidance regarding enrollment lock-outs. Effective January 1, 2018,
see TPM,
Chapter 10, Section 2.1, for QLE information
and
Chapter 6, Sections 1 and
2,
for enrollment eligibility and time-frames.
12.4 Service members cannot voluntarily disenroll
from TOP Prime or TOP Prime Remote if they remain on permanent assignment
in an overseas location where these programs are offered. Service member
enrollment in TOP Prime or TOP Prime Remote continues until they
transfer enrollment to another TRICARE region/program or lose eligibility
for TOP/TRICARE.
12.5 TOP
Prime/TOP Prime Remote enrollees must either transfer enrollment
or disenroll within 60 calendar days of the end of the overseas
tour when the Service member departs to a new area of assignment.
The TOP contractor shall provide continuing coverage until:
• The
enrollment has been transferred to the new location;
• The enrollee disenrolls;
or
• When
enrollment transfer or disenrollment has not been requested by the
TOP Prime/TPR enrollee by the 60th day, the TOP contractor shall
automatically disenroll the beneficiary on the 61st calendar day
following the end date of the overseas tour from TOP Prime/TPR. Until
December 31, 2017, the disenrolled ADFM TOP Prime or TOP/TPR beneficiary
will revert to TRICARE Standard. Effective January 1, 2018, ADFMs
disenrolled from TOP Prime or TOP TPR will be only eligible for
space available care at military treatment facilities.
13.0 TRICARE Eligibility Changes
13.2 The TOP contractor shall include full and complete
information about the effects of changes in eligibility and sponsor
rank in beneficiary materials and briefings.