Eligibility And Enrollment
Chapter 10
Section 10.1
TRICARE
Coverage For Certain Members Of The National Guard (NG)
Issue Date: September 6, 2018
Revision:
1.0 DESCRIPTION
If an NG member and family
is TRICARE-eligible due to the sponsor being on full-time NG duty
and is placed on State Active Duty (SAD) orders for disaster response,
their TRICARE eligibility is removed. The State may request extension
of TRICARE eligibility for the NG member and family on a fully reimbursable
basis. This provision does not create any new class of beneficiaries
or changes in coverage.
2.0 BACKGROUND
National Defense Authorization
Act for Fiscal Year 2017 (NDAA FY 2017), Section 711 (Public Law
114-136) established authority to extend the period of time that
a Guardsman performing SAD in support of a disaster response is
considered to be on active duty as an Active Duty Service Member
(ADSM) for the purpose of TRICARE eligibility.
3.0 POLICY
3.1 During
a period in which a member of the NG is performing State disaster
response duty, the member may be treated as being on active duty
for a period of more than 30 calendar days for purposes of the eligibility
of the member and their family members for health care benefits
under the TRICARE program if:
• Disaster response duty immediately
follows a period in which the member served on full-time NG duty
(32 United States Code (USC) 502(f) including pursuant to Chapter
9 of Title 32); and
• The Governor of the State (to
include the four United States (US) Territories (or mayor of the
District of Columbia)) requests extension of TRICARE eligibility
for the member and family and agrees to reimburse Department of
Defense (DoD) for all health care services.
3.2 The State is responsible for
identifying these Guardsmen and providing their individual information
and period of state duty to the NG Bureau, who in turn will forward
this information to the Defense Manpower Data Center (DMDC) to continue
TRICARE eligibility in the Defense Eligibility Enrollment Reporting
System (DEERS).
3.3 For health
care provided by a civilian provider, claims shall be processed
under current TRICARE reimbursement rules.
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