Military Health System

3.1  The TOP contractor shall process TRS and TRR enrollment applications and collect premium payments for TRS/TRR enrollment.

3.2  The TOP contractor shall process claims for TRS and TRR members enrolled overseas (regardless of where the care was rendered), and for TRS and TRR members enrolled in the 50 U.S. and the District of Columbia who receive health care services in an overseas location. This includes claims for prescriptions unless these claims are otherwise covered by the TRICARE Pharmacy (TPharm) contract. TOP TRS and TRR claims shall be processed as TRICARE Select since TRS and TRR members are not eligible for TOP Prime or TOP Prime Remote. The TOP TRS coverage features the deductible, catastrophic cap and cost-share provisions of the TRICARE Select plan applicable to Group B Active Duty Family Members (ADFMs) for both the TRS member and the member’s covered family members. The TOP TRR coverage features the deductible, catastrophic cap and cost-share provisions of the TRICARE Select plan applicable to Group B retired members and dependents of retired members.

3.3  The TOP contractor shall not develop purchased care sector provider networks to support the TRS or TRR beneficiary population.

3.4  The TOP contractor shall not provide Guarantee of Payment or implement other business processes to provide TRS or TRR enrollees with cashless, claimless service.

3.5  The TOP contractor shall not make appointments with purchased care sector providers for TRS or TRR enrollees. However, upon beneficiary request, the contractor shall provide the TRS enrollee with the name, telephone number, and address of purchased care sector network or non-network providers of the appropriate clinical specialty located within the beneficiary’s geographic area.