1.0
Enrollment
1.1 The TRICARE
Regional Offices (TROs) will, on an as needed basis, but at least
semi-annually, provide the contractor with an update to the TRICARE
Prime Remote (TPR) directory of units whose members are eligible
for enrollment in the program according to
Section 1, paragraph 3.0.
1.2 An enrollment
request must be submitted by either the Service member or the Service member’s
unit commander for each Service member enrolling in the TPR Program.
The effective date for TPR Program enrollment is the date the Service
member or the Service member’ s unit commander submitted the enrollment
request. An official enrollment request includes those with:
• An
original signature;
• An electronic signature
offered by and collected by the contractor;
• A verbal consent provided
vial telephone and documented in the contractor’s call notes; or
• A self-attestation
by the beneficiary when using the Government furnished web-based
self-service enrollment system/application.
A Service member signature is not required
to make enrollment changes using the Enrollment Portability process
outlined in
Chapter 6, Section 2, paragraph 1.4. A signature
in not required to complete the enrollment.
1.3 Service
member enrollment in the TPR Program will be for the tour of duty.
Enrollment transfers or disenrollments will occur upon change of
duty location out of the region, transfer into an Military Treatment
Facility (MTF)/Enhanced Multi-Service Market (eMSM)/clinic Prime
Service Area (PSA), retirement, or separation from the service.
The Service member is responsible for notifying the contractor when
an enrollment transfer is needed. The contractor shall follow enrollment
portability and transfer procedures in
Chapter 6, Section 2.
1.3.1 If at any point during the enrollment
period the contractor determines or is advised that a Service member
is no longer eligible for TPR, the contractor shall notify (letter,
telephone call, or e-mail) the Service member of the discrepant
enrollment immediately.
1.3.2 If the discrepant enrollment
is not corrected within 30-days of the notification date, the contractor
shall disenroll the Service member from TPR effective the first
of the month after the 30-day notification period. The contractor
shall use the address in Defense Enrollment Eligibility Reporting System
(DEERS) to reassign the Service member to TRICARE Prime at an MTF/eMSM
utilizing the MTF/eMSM enrollment guidelines.
1.4 The contractor
shall record the Service member’s TPR enrollment in the
DEERS
via Government furnished web-based system/application. The TPR enrollment
card is provided by Defense Manpower Data Center (DMDC). When processing
TPR enrollment requests from Service member astronauts, the contractor
shall not assign the astronauts to a network or other TRICARE authorized
Primary Care Manager (PCM). The National Aeronautics and Space Administration
(NASA) providers shall provide primary care for the Service member
astronauts and the contractor shall use the PCM (unassigned) procedure
when enrolling Service member astronauts into the TPR program. The
contractor shall coordinate referrals and authorizations from the
NASA providers for TPR enrolled Service member astronauts in accordance
with
Section 2, paragraph 5.2 and its subordinate
paragraphs.
2.0 Primary
Care Manager (PCM) Assignment
At the time
of enrollment, a Service member will select (or will be assigned)
a PCM in the local community, if available. A Service member without
an assigned PCM may use a local TRICARE-authorized provider for
primary care.
3.0 Beneficiary
Education
3.1 Enrollment in the TPR Program is mandatory
for Service members who qualify for the program (see
Section 1, paragraph 2.0); therefore, the
contractor shall limit educational activities for TPR-enrollees
to distributing the informational materials provided by the Government.
The TROs will determine the initial supply (if hard copies are used)
of materials required and the contractor shall forward materials
to the TPR Program Units. The contractor shall include enrollment
request options (enrollment forms, the Government furnished web-based
self-service enrollment system/application transactions, and telephonic
requests documented in the contractor’s call center notes), for
the TPR Program in the Service member informational materials.
3.2 Educational
issues include the PCM concept (and what procedures to follow when
a network PCM is not assigned), how to access care in and out of
the area using the contractor, how to access specialty care through
the contractor and Specified Authorization Staff (SAS), and information
on filing medical claims.
3.3 The Government will provide
all TPR enrollees with information about how to obtain self-care manuals
(hard or electronic versions). The contractor shall give TPR-enrolled
Service members and their family members the option of participating
in health promotion and wellness programs offered by the contractor
in MTF/eMSM PSAs.
3.4 Educational activities in
the TPR Program areas shall involve the joint efforts of the service
unit of the Service member, the SASs, the Service Medical Departments,
the TROs, and the contractor. The contractor shall distribute Defense
Health Agency (DHA)-supplied educational materials unique to the TPR
Program. Contractor shall consider multiple, contemporary avenues
of access (for example, e-mail, World Wide Web (WWW), telephone,
texting, smart phone applications, and other social media) to distribute
these educational materials to the Service member and their beneficiaries.
If the contractor uses traditional mail, the contractor is responsible
for postage, envelopes, and mailing costs for distributing educational
material.