Enrollment
Chapter 6
Section 3
Split Enrollment
Revision: C-52,
August 30, 2019
The
term “contractor” applies to the Managed Care Support (MCS) contractor,
TRICARE Overseas Program (TOP) contractor, and Uniformed Services
Family Health Plan (USFHP) Designated Providers (DPs) whose enrollees
are TRlCARE-eligible for civilian care.
1.0 Split enrollment
involves different members of the same family enrolled in the same
health plan (TRICARE Prime or TRICARE Select) with different contractors.
Split enrollment does not apply to unremarried former spouses.
Example: Sponsor and spouse who live and are enrolled
in TRICARE Prime in one region and a college age child who lives
and is enrolled in TRICARE Prime in a different region or a TRICARE
eligible USFHP enrollee and other members of the same family enrolled
in TRICARE Prime with one or more contractors.
2.0 Split enrollment
provisions apply to TRICARE Prime and TRICARE Select enrollments
in all areas.
3.0 A family subject to enrollment fees
will pay enrollment fees totaling no more than the family enrollment
fees according to the elected plan(s) regardless of the enrollment
locations of family members. Individual and family enrollment fees
for TRICARE Prime are separate from individual and family enrollment
fees for TRICARE Select. The enrollment fee billing contractor shall
be determined based on the following list of potential enrollees
in descending order of precedence:
• Sponsor.
• Spouse.
• Oldest enrolled
child.
4.0 If the family enrollment fee is
not paid on time and the family is disenrolled, individual family members
who are enrolled in different regions (and who have not paid single
enrollment fees) shall be disenrolled as well.
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