In order
to purchase TYA coverage, young adult dependents who meet the qualifications
listed in
paragraph 3.1 and must be listed in the Defense
Enrollment Eligibility Reporting System (DEERS) database. The Defense
Manpower Data Center (DMDC) will ensure that dependents meeting
the qualifications will be reflected as eligible to purchase or
continue TYA coverage if the uniformed service sponsor is eligible
for health care under Chapter 55, 10 USC or Chapter 58, 10 USC Section
1145(a), Transitional Assistance Management Program (TAMP). The
contractor shall rely solely upon DEERS to identify young adult
dependents qualified to purchase TYA coverage. The contractor shall
refer young adult dependents and uniformed service sponsors to a
Real-Time Automated Personnel Identification System (RAPIDS) site
if the dependent is not found in DEERS.
3.1
Dependent
Qualifications For Purchase Of TYA Coverage
A young adult
dependent qualifies to purchase TYA coverage if the dependent meets
the following criteria:
• Would be a dependent child under Chapter
55, 10 USC Section 1072(2) but for exceeding the age limit under
that section; and
• Is a dependent
under the age of 26; and
• Is not eligible for medical coverage from
an eligible employer-sponsored health plan from the young adult
dependent’s employer as defined in Section 5000A(f)(2) of the Internal Revenue
Code of 1986; and
• Is not married;
and
• Is not otherwise
eligible for care under Chapter 55, 10 USC or Chapter 58, 10 USC
Section 1145(a), TAMP; and
• Is not a member of the uniformed services.
3.2 Eligibility
Of Uniformed Service Sponsor
3.2.1 Eligibility for TYA is only determined
by a proper eligibility response in DEERS. Based on the status of
the uniformed service sponsor, the ability to purchase may be limited
or not allowed based on the uniformed service sponsor’s status and
eligibility for medical care under Chapter 55, 10 USC or Chapter
58, 10 USC Section 1145(a). In addition, young adult dependents
must meet all other qualifications shown in
paragraph 3.1.
3.2.2 Young adult
dependents of active duty members (including those called to active
duty for more than 30 days) may qualify to purchase TYA coverage
until the active duty sponsor’s date of separation or until the
young adult dependent reaches the age of 26, whichever comes first.
Upon the death of an active duty sponsor, former young adult dependents
already aged out of TRICARE are classified as Survivors and may
qualify to purchase TYA coverage up to the age of 26 but with Survivor (retiree)
cost-shares.
3.2.3 Young
adult dependents of retired uniformed service sponsors may qualify
to purchase TYA coverage until they reach the age of 26.
3.2.4 Young adult
dependents of uniformed service sponsors eligible to purchase TRS
or TRICARE Retired Reserve (TRR) may qualify to purchase TYA coverage
only if the sponsor is enrolled in TRS or TRR and until the young
adult dependent reaches age 26. Failure of the uniformed service sponsor
to enroll in and maintain enrollment in TRS or TRR or failure to
pay TRS or TRR premiums will result in the young adult dependent
not being eligible to purchase TYA coverage as of the date of the sponsor’s
loss of enrollment in TRS or TRR.
3.2.5 If the Selected Reserve sponsor dies while
enrolled in TRS, the young adult dependent may qualify to purchase
TYA coverage for up to six months after the date of death of the
Selected Reserve sponsor, or until the young adult dependent reaches
the age of 26, whichever comes first, but with Survivor (retiree)
cost-shares.
3.2.6 Young
adult dependents of a member of the Retired Reserve, who dies while
in a period of TRR coverage, may qualify to purchase new or continue
existing TYA coverage until the young adult dependent reaches the
age of 26. If a member of the Retired Reserve is not covered by
TRR on the date of his or her death, his or her surviving dependents
do not qualify for TYA coverage until the date on which the deceased
member of the Retired Reserve would have attained age 60, at which
time they may qualify to purchase TYA coverage until reaching the
age of 26.
3.2.7 Young adult dependents of a member eligible
for TAMP coverage may qualify to purchase TYA coverage until the
TAMP coverage ends or the young adult dependent reaches age 26,
whichever comes first. If the member dies while covered under TAMP,
the young adult dependent may qualify to purchase TYA coverage to
the end of the TAMP coverage period or until the young adult dependent reaches
age 26, whichever comes first, with Active Duty Family Member (ADFM)
cost-shares.