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TRICARE Operations Manual 6010.62-M, April 2021
Provider Certification And Credentialing
Chapter 6
Section 2
TRICARE Prime And TRICARE Select Enrollment Portability
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) for purposes of enrollment portability.
1.0  The contractor shall, for the geographic area of responsibility in which the beneficiary is enrolled on Defense Enrollment Eligibility Reporting System (DEERS), provide continuing coverage and update catastrophic cap accumulations for the enrollee while the enrollee is traveling or relocating, except in the case of care provided overseas (i.e., care outside of the 50 United States and the District of Columbia).
1.1  The TOP contractor, shall process Civilian Health Care (CHC) claims while the beneficiary is traveling or visiting overseas, regardless of where the beneficiary resides or is enrolled.
1.1.1  TRICARE Prime and TRICARE Select enrollees retain coverage whenever they move or travel.
1.1.2  Enrollment portability provisions apply to TRICARE Prime and TRICARE Select enrollees’ travel or relocation to or from all areas, where TRICARE Prime and TRICARE Select is available.
1.2  An enrollee may transfer enrollment before or after moving either temporarily or permanently to a new location using any of the enrollment options in Section 1.
1.2.1  The outgoing contractor shall continue to provide health care coverage until:
•  The enrollment is transferred to the gaining contractor;
•  The beneficiary is no longer eligible for enrollment in TRICARE Prime or TRICARE Select;
•  The beneficiary disenrolls; or
•  The beneficiary is disenrolled due to failure to pay required enrollment fees, whichever occurs first.
1.2.2  TRICARE Prime referral and authorization rules continue to apply (see Chapter 7, Section 5 and Chapter 8, Section 5). Under no circumstances will retroactive disenrollment be allowed in order to avoid Point Of Service (POS) cost-sharing provisions.
1.2.3  The contractor shall, on the day it receives either a beneficiary’s signed enrollment form, telephone portability request, or a request from the Government furnished web-based self-service enrollment system/application agreeing to a transfer of enrollment to the new geographic area of responsibility, consider the beneficiary enrolled at the new location, regardless of whether the appropriate updates have been performed in the Government-provided web-based application to DEERS.
1.2.4  TRICARE Prime enrollees should contact the new Primary Care Manager (PCM), the new geographical area of responsibility’s Health Care Finder (HCF), or the DP for health care and health-related assistance.
1.2.5  The contractor shall modify the effective date for enrollment requests received from the Government furnished web-based self-service enrollment system/application to be the date the enrollment was submitted.
1.2.6  The effective date for transfer of enrollment may differ from the effective date for initial enrollment. See Section 1 for information on initial enrollment in TRICARE Prime. For transfers, the original enrollment period on DEERS will remain in effect.
1.2.7  The contractor shall, when enrollment changes from one contractor to another prior to the annual renewal for enrollees in beneficiary categories required to pay enrollment fees, obtain information from the losing contractor on fees that are being automatically paid and transition these payment types in the least disruptive manner for the beneficiary.
1.2.8  Enrollment fees must be paid current prior to transfer of enrollment. See Section 1, for refunds of unused enrollment fees.
1.3  USFHP Portability Guidelines
1.3.1  TRICARE Prime USFHP enrollees who are not otherwise TRICARE-eligible (e.g., grandfathered Medicare eligible beneficiaries who only have Part A) may only transfer enrollment from one USFHP to another USFHP; they may not transfer to a MCS Contractor (MCSC).
1.3.2  Beneficiaries enrolled in TRICARE Prime coverage who reside in a ZIP code where USFHP and MCSC Prime networks co-exist may elect to change their PCM to the other network at any time by disenrolling from their current contractor and re-enrolling with the other contractor.
1.3.3  This is to be viewed as a PCM change.
1.4  Enrollment portability and PCM changes are not limited to the annual open enrollment period nor require a Qualifying Life Event (QLE) to occur.
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