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 TRICARE-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 (URFSs).
Example 1: Sponsor and spouse who live
and are enrolled in TRICARE Prime in one geographical area of responsibility
with a college age child who lives and is enrolled in TRICARE Prime
in a different geographical area of responsibility.
Example 2: A TRICARE-eligible USFHP enrollee
with 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.
3.1 Individual and family enrollment
fees for TRICARE Prime are separate from individual and family enrollment
fees for TRICARE Select.
3.2 The enrollment
fee billing contractor will be determined based on the following
list of potential enrollees in descending order of precedence:
• Sponsor
• Spouse
• Oldest enrolled child
4.0 The contractor shall, in cases
where the sponsor and any family members are in locations covered
by a different contractor, coordinate with the responsible contractor
for that location if the family enrollment fee is not paid on time
and the family is disenrolled, to ensure that individual family
members who are enrolled in different geographical area of responsibilities
(and who have not paid single enrollment fees) are disenrolled as
well.