1.0 DESCRIPTION
RC
members who are issued delayed-effective-date active-duty
orders become eligible for TRICARE up to 180 days before the active
duty commences, along
with their eligible family members, if the RC member is ordered
to active duty for a period of more than 30 days for a preplanned
mission under 10 United States Code (USC) 12304b or a contingency
operation under a provision of law referred to in 10 USC 101(a)(13)(B).
2.0 BACKGROUND
2.1 Section 703
of the National Defense Authorization Act (NDAA) for Fiscal Year
(FY) 2004 (Public Law 108-136) established temporary authority to
expand the period of time that an RC member is considered
to be on active duty for the purpose of TRICARE eligibility.
2.2 Section 703
of the NDAA for FY 2005 (Public Law 108-375) made the authority
permanent.
2.3 Section
702 of the NDAA for FY 2010 (Public Law 111-84) extended the maximum
period of early eligibility from 90 days to 180 days effective
October 28, 2009.
2.4 Section
511 of the NDAA for FY 2018 (Public Law 115-91) expanded the early
eligibility benefit to RC members, and their eligible family members,
called or ordered to active duty for more than 30 consecutive days
for a preplanned mission under 10 USC 12304b effective December
12, 2017.
3.0 POLICY
3.1 An RC
member who is issued a delayed-effective-date active-duty order
,
as described above, will be considered as being on
active duty for more than 30 days beginning on the later of the
date that is:
3.1.1 The
date of issuance of the order; or
3.1.2 One hundred and eighty days before the
date on which the period of active duty is to commence.
3.2 The secretaries
of the military departments are responsible for ensuring accurate
and timely submission of early TRICARE eligibility data to the Defense
Enrollment Eligibility Reporting System (DEERS) as specified in
DoDI 7730.54, “Reserve Component Common Personnel Data System” (RCCPDS).
The TRICARE Early Identification (EID) program for early TRICARE
eligibility transactional data defined in RCCPDS, based on the delayed-effective-date-active
duty order, is the authoritative source for establishing, maintaining,
and terminating early TRICARE eligibility in the DEERS. Uniformed services
personnel offices are responsible for ensuring that DEERS changes
have been effectuated to reflect correct eligibility information
for all affected individuals. If the delayed-effective-date active-duty
orders are rescinded before the active duty commences, the military
departments are responsible for terminating the member’s and dependents’
eligibility for TRICARE in DEERS.
3.3 Affected individual members of the
RC and their family members are eligible for TRICARE under this
section. The provisions available under the TRICARE Reserve and
NG family member benefits (
Chapter 10, Section 8.1) shall apply to those
eligible for care under this section. This eligibility includes family
member eligibility for TRICARE Prime/Overseas Prime and for TRICARE
Prime Remote (TPR)/Overseas Prime Remote for Active Duty Family
Members (ADFMs). This eligibility also includes Service Member eligibility
for TRICARE Prime with a Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) Primary Care Manager (PCM) if the member
lives near an MTF/eMSM; TPR for the member is not authorized during
this early eligibility period. A non-enrolled Service member may
seek covered primary care from a TRICARE authorized civilian provider.
Prior to obtaining any specialty care, the RC member should contact
the appropriate TRICARE regional or overseas contractor to request authorization.
3.3.1 The periods
of TRICARE eligibility for the affected individuals will be reflected
in DEERS. Contractors will continue to rely upon DEERS for eligibility
determination.
3.3.2 The contractor shall verify the
patient’s eligibility in DEERS.
3.4 In the event that the contractor
should become aware that payment has been made for services rendered
during a period for which the patient was subsequently determined
to be ineligible recoupment action shall be initiated. Recoupment
procedures are specified in TRICARE Operations Manual (TOM),
Chapter 11, Section 3 as appropriate.