1.0 DESCRIPTION
The TAMP establishes TRICARE
eligibility for specific categories of beneficiaries. The sponsors and
their family members are eligible for continued TRICARE medical
benefits including enrollment/re-enrollment in TRICARE Prime or
TRICARE Select, services and supplies provided under the Extended Care
Health Option (ECHO), and Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) care, for a defined period of time as
indicated on Defense Enrollment Eligibility Reporting System (DEERS).
While the status of these individuals is neither active duty nor
retiree/deceased, for the purpose of cost-sharing, the claims for
these individuals (including the former active duty member) shall
be processed as Active Duty Family Members (ADFMs).
Note: In this section, references
to TRICARE Select coverage are effective for services received on or
after January 1, 2018.
2.0 POLICY
2.1 Covered
Groups (Section 1145 of Title 10, United States Code (10 USC 1145)).
Members, as determined by their Service personnel office and indicated
in DEERS, and their eligible family members who meet the criteria
below are entitled to medical benefits under TRICARE to the same
extent as those available to ADFMs.
2.1.1 A member
who is involuntarily separated from active duty as defined in 10
USC 1141.
2.1.1.1 This includes a member who
is provided a voluntary separation incentive under 10 USC 1175(j).
2.1.1.2 This includes a member who
is separated from active duty and receives voluntary separation
pay, and not entitled to retired or retainer pay upon separation,
under 10 USC 1175a(e)(2)(A).
2.1.2 A member
of a Reserve Component (RC) who is separated from active duty after
serving more than 30 consecutive day either in support of a contingency
operation or for a preplanned mission. Preplanned mission was added
by Public Law 115-91, effective December 12, 2017.
2.1.3 A member who is separated from
active duty for which the member is involuntarily retained under
10 USC 12305 (also referred to as “stop loss”) in support of a contingency
operation.
2.1.4 A member who is separated from
active duty pursuant to a voluntary agreement of the member to remain
on active duty for a period of less than one year in support of
a contingency operation under 10 USC 1145(a)(2)(D).
2.1.5 A member who receives a sole
survivorship discharge as defined in 10 USC 1174(i). This provision
was added by Public Law 110-317, effective August 29, 2008.
2.1.6 A member who is separated from
active duty who agrees to become a member of the Selected Reserve
of the Ready Reserve of an RC. This provision was added by Public
Law 110-417, effective October 14, 2008.
2.1.7 A
member who completes orders of more than thirty continuous days
of qualifying full-time National Guard Duty in support of the Government
coronavirus (COVID-19) response. This provision was added by Public
Law 116-283, Section 733, effective January 1, 2021.
2.2 Time frames of eligibility
for TAMP eligibles in which the member’s separation occurred on
or after November 6, 2003 - Transitional health care for TAMP eligibles
shall be available for 180 days beginning on the date on which the
member is separated from active duty.
2.3 Determining
Eligibility
2.3.1 Eligibility determinations
for coverage must be based on DEERS determinations.
2.3.2 Contractors shall be responsible
for confirming DEERS eligibility status. Once jurisdictional responsibility
is established, the contractor shall have the capability by using
DEERS to identify these claims as TAMP and process them as ADFM
claims. While the status of these individuals is neither active duty
nor retiree/deceased, for the purpose of cost-sharing, the claims
for these individuals shall be processed as ADFMs. Eligibility verification
of an active duty member who was separated involuntarily shall be
based solely on the DEERS response. For those claims that are submitted
for medical services rendered to the sponsor and if the contractor
can identify the claim as meeting the transitional eligibility requirements,
the contractor shall process the claim. Otherwise the sponsor claims
indicating status as “active duty” and relationship as “self” shall
continue to be transferred to the military services. Claims shall
be processed by the contractor using the same rules and cost-shares
that apply to ADFMs per TRICARE Reimbursement Manual (TRM),
Chapter 2, unless otherwise specified in
Chapter 10, Section 8.1.
2.4 Change in eligibility status
of a beneficiary during an inpatient hospital stay (see the TRM,
Chapter 6, Section 2).
2.5 In cases involving the existence
of Other Health Insurance (OHI) for family members and/or sponsors,
treat as double coverage as required by the TRM.
2.6 TRICARE Prime (Before January
1, 2018)
2.6.1 Enrollment in Prime. TAMP eligibles
may enroll or re-enroll in TRICARE Prime.
2.6.2 Effective
Date of Enrollment in TRICARE Prime is as follows:
2.6.2.1 TAMP eligibles (including the
former active duty member) who were enrolled in Prime immediately
prior to their change in status may continue their enrollment in
TRICARE Prime with no break in coverage. A reenrollment application
must be completed prior to the TAMP expiration period in order to
continue with TRICARE Prime. The effective date shall be the date
the sponsor separated from active duty as the intent is to ensure
that Prime coverage is seamless. See
Section 2.1 for
further information on the effective date of enrollment.
2.6.2.2 TAMP eligibles who were not
enrolled in Prime (including TRICARE Prime Remote (TPR) and TRICARE
Prime Remote Active Duty Family Member (TPRADFM)) immediately prior
to their change in status may choose to enroll in TRICARE Prime
while receiving TAMP coverage. See
Section 2.1 for further
information on the effective date of enrollment.
2.6.2.3 TAMP eligibles whose sponsor
is called to active duty.
2.6.2.3.1 TAMP eligible family members
who were enrolled in Prime immediately prior to their sponsor’s
change in status to active duty may continue their reenrollment
in TRICARE Prime with no break in coverage if they reenroll in TRICARE
Prime within 90 days of the return to active duty status. If reenrollment
is accomplished within 90 days of the return to active duty status,
the reenrollment will be retroactive to the date of the change in
status from TAMP to active duty. If reenrollment is not accomplished
within 90 days of the return to active duty status, the enrollment
will be effective the date the request is received or postmarked.
2.6.2.3.2 TAMP eligible family members
not enrolled in Prime immediately prior to activation (i.e., return
to active duty) may choose to enroll in Prime. See
Section 2.1 for
further information on effective date of initial enrollments and
reenrollments.
2.6.2.3.3 For information on the effective
dates of enrollments for Service members, see the TRICARE Operations
Manual (TOM),
Chapter 6, Section 1.
2.6.2.4 While the TPR and TPRADFM are
not available to TAMP eligibles, these programs are considered a
“Prime-like” benefit and enrollment or reenrollment in Prime shall
be available to them as stated above.
2.7 TRICARE
Prime And TRICARE Select (Effective January 1, 2018)
2.7.1 Enrollment
A change in status listed in
paragraph 2.1 is
a Qualifying Life Event (QLE). As such, TAMP-eligible members and
family members may be auto-enrolled in TRICARE Select. If not auto-enrolled
in TRICARE Select, TAMP eligibles, including the former Service
members may elect to enroll or re-enroll in TRICARE Prime, if qualified
or TRICARE Select coverage within 90 days of their eligibility for
TAMP.
2.7.3 TAMP
eligibles whose sponsor is called to active duty.
2.7.3.1 A TAMP sponsor’s re-activation
to active duty status is a change in status, and is a QLE that allows
TAMP enrollees to elect their desired TRICARE coverage within 90
days of the activation.
2.7.3.2 While the TPR and TPRADFM are
not available to TAMP eligibles, these programs are considered a
“Prime-like” benefit and enrollment or reenrollment in Prime shall
be available to them as stated above.
2.8 TRICARE Reserve Select (TRS)
may be available for purchase by members of the Selected Reserve
as specified in the TOM,
Chapter 22, Section 1. In order to continue
TRICARE coverage with no break, an application for TRS may be produced
up to 90 days before the expiration date of TAMP, but must be submitted
with the required initial payment no later than 90 days after the
expiration date of TAMP.
2.9 The Continued Health Care Benefit
Program (CHCBP) may be available to members (and their dependents)
after the expiration of TAMP entitlement. See
Section 4.1 for
further information.
2.10 Dental Coverage
2.10.1 Dental benefits for TAMP-eligibles
are limited to space available care in the Dental Treatment Facility
(DTF).
2.10.2 Effective January 27, 2012,
dental benefits for RC members discharged from active duty after
more than 30 days in support of a contingency operation are available
in the same manner as a member of the uniformed services on active
duty for more than 30 days. This requires care to be provided in
both military DTFs and authorized private sector dental care. This
care will run concurrently with the member’s TAMP coverage.
2.10.3 The TRICARE Dental Program
(TDP) is a voluntary dental insurance program that is available to
ADFMs, Selected Reserve, and Individual Ready Reserve (IRR) members,
and their eligible family members. The TDP is not part of the benefits
offered under TAMP. Sponsors who were enrolled in the TDP prior
to being activated, who then return to Reserve status, may be eligible
to re-enroll in the TDP.