1.0
Enrollment
1.1 The TRICARE Regional Offices
(TROs) will, on an as needed basis, but at least semi-annually, provide
the contractor with an update to the TRICARE Prime Remote (TPR)
directory of units whose members are eligible for enrollment in
the program according to
Section 1, paragraph 3.0.
1.2 An enrollment request must
be submitted by either the Service member or the Service member’s
unit commander for each Service member enrolling in the TPR Program.
The effective date for TPR Program enrollment is the date the Service
member or the Service member’ s unit commander submitted the enrollment
request. An official enrollment request includes those with:
• An original
signature;
• An electronic signature offered
by and collected by the contractor;
• A verbal
consent provided vial telephone and documented in the contractor’s
call notes; or
• A self-attestation by the beneficiary
when using the Government furnished web-based self-service enrollment
system/application.
A Service member signature
is not required to make enrollment changes using the Enrollment Portability
process outlined in
Chapter 6, Section 2, paragraph 1.4. A signature
in not required to complete the enrollment.
1.3 Service member enrollment in
the TPR Program will be for the tour of duty. Enrollment transfers or
disenrollments will occur upon change of duty location out of the
region, transfer into an Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM)/clinic Prime Service Area (PSA), retirement,
or separation from the service. The Service member is responsible
for notifying the contractor when an enrollment transfer is needed.
The contractor shall follow enrollment portability and transfer
procedures in
Chapter 6, Section 2.
1.3.1 If
at any point during the enrollment period the contractor determines
or is advised that a Service member is no longer eligible for TPR,
the contractor shall notify (letter, telephone call, or e-mail) the
Service member of the discrepant enrollment immediately.
1.3.2 If
the discrepant enrollment is not corrected within 30-days of the
notification date, the contractor shall disenroll the Service member
from TPR effective the first of the month after the 30-day notification
period. The contractor shall use the address in Defense Enrollment
Eligibility Reporting System (DEERS) to reassign the Service member
to TRICARE Prime at an MTF/eMSM utilizing the MTF/eMSM enrollment
guidelines.
1.4 The
contractor shall record the Service member’s TPR enrollment in the
DEERS
via Government furnished web-based system/application. The TPR enrollment
card is provided by Defense Manpower Data Center (DMDC). When processing
TPR enrollment requests from Service member astronauts, the contractor
shall not assign the astronauts to a network or other TRICARE authorized
Primary Care Manager (PCM). The National Aeronautics and Space Administration
(NASA) providers shall provide primary care for the Service member
astronauts and the contractor shall use the PCM (unassigned) procedure
when enrolling Service member astronauts into the TPR program. The
contractor shall coordinate referrals and authorizations from the
NASA providers for TPR enrolled Service member astronauts in accordance
with
Section 2, paragraph 5.2 and its subordinate
paragraphs.
2.0 Primary Care Manager (PCM)
Assignment
At
the time of enrollment, a Service member will select (or will be
assigned) a PCM in the local community, if available. A Service
member without an assigned PCM may use a local TRICARE-authorized
provider for primary care.
3.0 Beneficiary Education
3.1 Enrollment in the TPR Program
is mandatory for Service members who qualify for the program (see
Section 1, paragraph 2.0); therefore, the
contractor shall limit educational activities for TPR-enrollees
to distributing the informational materials provided by the Government.
The TROs will determine the initial supply (if hard copies are used)
of materials required and the contractor shall forward materials
to the TPR Program Units. The contractor shall include enrollment
request options (enrollment forms, the Government furnished web-based
self-service enrollment system/application transactions, and telephonic
requests documented in the contractor’s call center notes), for
the TPR Program in the Service member informational materials.
3.2 Educational issues include
the PCM concept (and what procedures to follow when a network PCM
is not assigned), how to access care in and out of the area using
the contractor, how to access specialty care through the contractor
and Specified Authorization Staff (SAS), and information on filing medical
claims.
3.3 The
Government will provide all TPR enrollees with information about
how to obtain self-care manuals (hard or electronic versions). The
contractor shall give TPR-enrolled Service members and their family
members the option of participating in health promotion and wellness
programs offered by the contractor in MTF/eMSM PSAs.
3.4 Educational activities in the
TPR Program areas shall involve the joint efforts of the service
unit of the Service member, the SASs, the Service Medical Departments,
the TROs, and the contractor. The contractor shall distribute Defense
Health Agency (DHA)-supplied educational materials unique to the TPR
Program. Contractor shall consider multiple, contemporary avenues
of access (for example, e-mail, World Wide Web (WWW), telephone,
texting, smart phone applications, and other social media) to distribute
these educational materials to the Service member and their beneficiaries.
If the contractor uses traditional mail, the contractor is responsible
for postage, envelopes, and mailing costs for distributing educational
material.