1.0 The term “contractor” applies
to Uniformed Services Family Health Plan (USFHP) Designated Providers
(DPs) as well as to the Managed Care Support (MCS) and TRICARE Overseas
Program (TOP) contractors for purposes of enrollment portability.
1.1 TRICARE Prime and TRICARE Select
enrollees retain coverage whenever they move or travel. Enrollment
portability provisions apply to TRICARE Prime/Select enrollees’
travel or relocation to or from all areas, where TRICARE Prime/Select
is available. The contractor for the region in which the beneficiary
is enrolled on Defense Enrollment Eligibility Reporting System (DEERS)
is responsible for providing continuing coverage and updating 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 (U.S.) and the District of
Columbia). Civilian Health Care (CHC) while traveling or visiting
overseas shall be processed by the TRICARE Overseas Program (TOP)
contractor, regardless of where the beneficiary resides or is enrolled.
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. The
losing 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.
1.2.1 TRICARE
Prime
referral and authorization rules
continue to apply
(see Chapter 8, Section 5). Under
no circumstances will retroactive disenrollment be allowed in order
to avoid POS cost-sharing provisions.
1.2.2 On the day the gaining contractor
receives either a beneficiary’s signed enrollment form, telephone
portability request, or a request via the Government furnished web-based
self-service enrollment system/application agreeing to a transfer
of enrollment to the new region, the beneficiary shall be considered
enrolled at the new location. TRICARE Prime enrollees should contact
the new PCM, the new region’s Health Care Finder (HCF), or the DP
for health care and health related assistance.
1.2.3 For enrollment requests received
via the Government furnished web-based self-service enrollment system/application,
the contractor shall modify the effective date to be the date the enrollment
was submitted.
1.2.4 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.
1.3 Within
four calendar days of receipt of a beneficiary’s request for enrollment
transfer, the gaining contractor shall submit the transfer of enrollment
to DEERS using the Government-furnished systems application. See
Section 1 for effective date rules.
1.4 When
enrollment changes from one contractor to another prior to the annual
renewal for enrollees in beneficiary categories required to pay
enrollment fees the gaining contractor shall 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. Enrollment fees must be paid current prior
to transfer of enrollment See
Section 1, for
refunds of unused enrollment fees.
1.5 USFHP Portability Guidelines
1.5.1 TRICARE Prime USFHP enrollees
who are not otherwise TRICARE-eligible (i.e., 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).
1.5.2 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. This
is to be viewed as a PCM change.
1.6 Enrollment portability and
PCM changes are not limited to the annual open enrollment period or require a
Qualifying Life Event (QLE) to occur.