1.0 DESCRIPTION
1.1 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 Market/Military Medical
Treatment Facility (MTF) care, for a defined period of time as indicated
on Defense Enrollment Eligibility Reporting System (DEERS).
1.2 The contractor
shall process claims for these individuals (including the former
active duty member) as Active Duty Family Members (ADFMs). While
the status of these individuals is neither active duty nor retiree/deceased,
cost-sharing for these individuals is as 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 calendar 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 The contractor shall be responsible
for confirming DEERS eligibility status.
2.3.3 The contractor
shall identify claims as TAMP and process them as ADFM claims by
using DEERS, after jurisdictional responsibility is established.
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.
2.3.4 The contractor
shall process claims that are submitted for medical services rendered
to the sponsor and the contractor can identify the claim as meeting
the transitional eligibility requirements. Otherwise the sponsor claims
indicating status as “active duty” and relationship as “self” shall
continue to be transferred to the military services.
2.3.5 The contractor shall process
claims 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 calendar days of the return to active duty status. If
reenrollment is accomplished within 90 calendar 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 calendar 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 calendar 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 calendar
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 calendar days before the expiration date of TAMP, but must
be submitted with the required initial payment no later than 90
calendar 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 calendar 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 calendar 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.