The contractor shall perform all
premium functions required for TRR. Retired Reserve members or survivors
are responsible for all premium payments for the type of coverage
elected (i.e., TRR member-only or TRR member-and-family). After
enrollment, only monthly premium payments are permitted. Premium-related
transactions shall be reported through the enrollment fee payment interface
or Catastrophic Cap and Deductible (CC&D) Fee Web (see the TSM,
Chapter 3).
5.1
Jurisdiction
For Premium Collection
5.1.1 The particular contractor servicing the residential
address for the TRR member or survivor shall perform premium collection
functions for the TRR member or survivor. The contractor shall identify
the financially responsible individual for survivor plans from the
survivors actually covered by TRR in descending order of precedence:
• Spouse.
• Oldest Enrolled
Child (or Legal Guardian as applicable).
5.1.2 Any
time the servicing contractor notices that a new residential address
is in the servicing area of another TRICARE contractor, the losing
contractor shall notify the TRR member or survivor within 10 calendar
days that they need to contact the servicing contractor in their
new area to transfer their coverage to the new area. A TRR member
or survivor may elect to provide an alternate mailing address, but
the servicing contractor shall be based on the TRR member’s or financially
responsible survivor’s residential, not alternate mailing address.
Any TRR member/financially responsible survivor may transfer regions
at any time. The gaining contractor shall perform the premium collections
for future payments.
5.1.3 All unsolicited Government
furnished policy notifications for TRR members or survivors will be
evaluated to determine if residential address changes require a
notification to the TRR member or survivor (see
paragraph 5.1.2).
5.2
Premium
Collection Processes
5.2.1 The contractor shall credit the TRR member
or survivor for premium payments received. In the case of a start
date of coverage at anytime other than the first of a month, the
first payment collected by the contractor shall include the prorated
amount on a daily basis necessary to synchronize billing to the
last day of the month. The daily prorated amount shall be equal
to 1/30th of the appropriate premium (rounded to the penny) regardless
of how many days are actually in the month. DEERS will automatically
prorate the premium due for the mid-month enrollments from the effective date
of coverage to the end of that first enrollment month, e.g., from
the 18th of the month to the 31st.
5.2.2 The contractor
shall collect monthly premium payments from TRR members or survivors
as appropriate and shall report the premium amount paid for those
payments to DEERS (see the TSM,
Chapter 3),
including any overpayments that are not refunded to the TRR member
or survivor. In the event that there are insufficient funds to process
a premium payment, the contractor may assess the account holder
a fee of up to 20 U.S. dollars ($20.00) which is retained by the
contractor. The contractor shall provide commercial payment methods
for TRR premiums that best meet the needs of beneficiaries while
conforming to
paragraphs 5.2.3 through
5.2.8.
5.2.3 Monthly
premiums must be paid through an automated, recurring electronic
payment through an Electronic Funds Transfer (EFT) or Recurring
Credit/Debit Card (RCC) (i.e., Visa/MasterCard) from a designated
financial institution. These are the only acceptable payment methods
for the recurring monthly premiums. An EFT payment or a RCC payment
shall be processed within the first five business days of the month
of coverage. The contractor shall advise TRR member or survivors
at the time of EFT/RCC election that an insufficient funds fee of
up to $20 U.S. may be assessed, if sufficient funds are not available.
5.2.4 TRR members
or survivors must make the required initial payment (as specified
in
paragraph 4.1)
at the time the TRR application is submitted to allow time for the
EFT/RCC to be established for subsequent monthly premium payments.
The contractor shall accept payment of the first installment by
personal check, cashier’s check, traveler’s check, money order,
or credit card (e.g., Visa/MasterCard).
5.2.5 The contractor shall establish
recurring monthly EFTs/RCCs and is responsible for obtaining and
verifying the information necessary to do so.
5.2.6 The contractor
shall initiate action to modify EFT/RCC payment amounts to support premium
changes.
5.2.7 When an administrative issue arises that stops
or prevents an automated monthly payment from being received by
the contractor (e.g., incorrect or transposed number provided by
the beneficiary, credit card expired, bank account closed, etc.),
the contractor shall grant the TRS member or survivor 30 days after
the paid-through date to provide information for a new automated
monthly payment method. The contractor may accept payment in accordance
with
paragraph 4.1 during this 30 day period in
order to preserve the TRS member’s or survivor’s enrollment status.
5.2.8 The
contractor shall directly bill the TRR member or survivor only when
a problem occurs in setting up or maintaining the EFT or RCC payment;
to include a fee of up to $20 U.S. due to insufficient funds. Bills
may be sent to the residential or alternate mailing address designated
by the TRR member or survivor. All bills shall specify that the
premium payment is due for receipt by the contractor no later than
the first business day of the month for the month of coverage. Premium
payments shall be made payable to the contractor servicing the member’s
or survivor’s coverage as specified in
paragraph 5.1. The contractor
shall terminate billing once the problem with EFT/RCC payment is
resolved.
5.3 Annual Premium Adjustment
5.3.1 Contractors
shall notify current TRR members or survivors in writing of any
annual premium adjustments no later than 30 days after the contractors
receive notification of the updated premiums.
5.3.2 For premium
adjustments that go into effect at any time other than January the
first, the Government will provide instructions about notification
of TRR members or survivors.
5.4
Premium
Adjustments From Changes Associated With QLEs
5.4.1 When a QLE is processed that
changes the premium, the effective date of the premium change shall
be the date of the QLE.
5.4.2 If the change from a QLE results
in an increase in the premium, the contractor shall notify the TRR
member or survivor of the increase and adjust the next premium amount
due, to include any underpaid amount (prorated to the day as specified
in
paragraph 5.2),
to the effective date of the change.
5.4.3 If the change from a QLE results
in a decrease in the premium, the contractor shall retain any overpaid
amount and apply it to subsequent electronic payments until all
of the overpayment is exhausted.