Military Health System

1.1  TRICARE Plus is a Market/Military Medical Treatment Facility (MTF)-based program designed to allow Military Health System (MHS) beneficiaries not enrolled in a TRICARE Prime option an opportunity to obtain a primary care coordinator within the Market/MTF and to be assured access to Market/MTF primary care appointments meeting TRICARE Prime primary care access standards.

1.2  Market Directors/MTF Directors will determine the number of TRICARE Plus enrollees at their Market/MTF.

1.3  TRICARE Plus enrollment will be available in Composite Health Care System (CHCS)/MHS Genesis for appointment clerks to appropriately book Market/MTF appointments for TRICARE Plus enrollees in accordance with the criteria established by Market Directors/MTF Directors (see https://manuals.health.mil/pages/DownloadManualFile.ashx?Filename=Definitions.pdf for the TRICARE Plus definition).

2.1  The contractor shall return incomplete forms or any application for which enrollment or disenrollment cannot be effected, for any reason other than internal contractor systems or process problems, while completed and approved enrollment or disenrollment forms for TRICARE Plus will be sent to the regional contractor by the Markets/MTFs no less frequently than weekly.

2.2  The Market/MTF is responsible for ensuring that the enrollment form is complete with validated eligibility through Defense Enrollment Eligibility Reporting System (DEERS) before submitting the forms to the contractor.

2.3  The contractor shall not correct or complete any TRICARE Plus enrollment or disenrollment application on behalf of a beneficiary.

2.4  The Market/MTF maintains responsibility for capacity for TRICARE Plus enrollment and will ensure that the capacity is reflected on the DEERS Primary Care Manager (PCM) Repository.

2.5  The contractor shall ensure that all TRICARE Plus enrollments received are entered in the Government-furnished web-based enrollment system/application.

2.6  TRICARE Plus enrollments cannot be completed using the Government furnished self-service web-based enrollment system/application.

2.7  The contractor shall ensure that all initial enrollments for beneficiaries over the age of 64 begin on the date the contractor enters the TRICARE Plus application or the first day the beneficiary loses eligibility for TRICARE Prime, whichever is later.

2.8  The contractor shall ensure that all initial enrollment periods for beneficiaries under age 65 begin on the date after disenrollment from TRICARE Prime or the date the contractor enters the TRICARE Plus application, whichever is later. Enrollment in TRICARE Plus requires disenrollment from TRICARE Prime.

2.9  Enrollment in TRICARE Plus-With Direct Care (DC) Only and TRICARE Plus-With TRICARE For Life (TFL) is not limited to the open enrollment period and does not require a Qualifying Life Event (QLE).

3.1  The contractor shall process TRICARE Plus disenrollments in accordance with paragraph 2.1.

3.2  Beneficiaries may disenroll from TRICARE Plus at any time.

3.3  Disenrollment forms will be sent to the contractors by the Markets/MTFs no less frequently than weekly.

4.1  TRICARE Plus enrollment is not portable between Markets/MTFs.

4.2  Beneficiaries who wish to change their TRICARE Plus enrollment to a different Market/MTF will have the same opportunity to enroll at the new Market/MTF as any other beneficiary without an established relationship with a primary care coordinator.

4.3  There is no priority stemming from previous enrollment in TRICARE Plus.

5.1  The contractor shall provide the name, telephone number, and address of providers within the enrollee’s geographic area when care is not available at a Market/MTF.

5.2  TRICARE Plus enrollees may contact the contractor for assistance with locating network and non-network providers.

5.3  The contractor shall not make appointments with providers for TRICARE Plus beneficiaries.

5.4  The contractor shall advise TRICARE Plus-With DC Only enrollees, that TRICARE will not cost-share on any care provided by civilian providers.