1.0 DESCRIPTION
RC members
who are issued delayed-effective-date active-duty orders become
eligible for TRICARE up to 180 days before the active duty commences, along
with their eligible family members, if the RC member is ordered
to active duty for a period of more than 30 days for a preplanned
mission under 10 United States Code (USC) 12304b or a contingency
operation under a provision of law referred to in 10 USC 101(a)(13)(B).
2.0 BACKGROUND
2.1 Section
703 of the National Defense Authorization Act (NDAA) for Fiscal
Year (FY) 2004 (Public Law 108-136) established temporary authority
to expand the period of time that an RC member is considered
to be on active duty for the purpose of TRICARE eligibility.
2.2 Section 703 of the NDAA for
FY 2005 (Public Law 108-375) made the authority permanent.
2.3 Section 702 of the NDAA for
FY 2010 (Public Law 111-84) extended the maximum period of early
eligibility from 90 days to 180 days effective October
28, 2009.
2.4 Section 511 of
the NDAA for FY 2018 (Public Law 115-91) expanded the early eligibility
benefit to RC members, and their eligible family members, called
or ordered to active duty for more than 30 consecutive days for
a preplanned mission under 10 USC 12304b effective December 12,
2017.
3.0 POLICY
3.1 An RC
member who is issued a delayed-effective-date active-duty order
,
as described above, will be considered as being on
active duty for more than 30 days beginning on the later of the
date that is:
3.1.1 The date of issuance of the
order; or
3.1.2 One hundred and eighty days
before the date on which the period of active duty is to commence.
3.2 The secretaries of the military
departments are responsible for ensuring accurate and timely submission
of early TRICARE eligibility data to the Defense Enrollment Eligibility
Reporting System (DEERS) as specified in DoDI 7730.54, “Reserve
Component Common Personnel Data System” (RCCPDS). The TRICARE Early
Identification (EID) program for early TRICARE eligibility transactional
data defined in RCCPDS, based on the delayed-effective-date-active
duty order, is the authoritative source for establishing, maintaining,
and terminating early TRICARE eligibility in the DEERS. Uniformed services
personnel offices are responsible for ensuring that DEERS changes
have been effectuated to reflect correct eligibility information
for all affected individuals. If the delayed-effective-date active-duty
orders are rescinded before the active duty commences, the military
departments are responsible for terminating the member’s and dependents’
eligibility for TRICARE in DEERS.
3.3 Affected
individual members of the RC and their family members are eligible
for TRICARE under this section. The provisions available under the
TRICARE Reserve and NG family member benefits (
Chapter 10, Section 8.1) shall apply to those
eligible for care under this section. This eligibility includes family
member eligibility for TRICARE Prime/Overseas Prime and for TRICARE
Prime Remote (TPR)/Overseas Prime Remote for Active Duty Family
Members (ADFMs). This eligibility also includes Service Member eligibility
for TRICARE Prime with a Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) Primary Care Manager (PCM) if the member
lives near an MTF/eMSM; TPR for the member is not authorized during
this early eligibility period. A non-enrolled Service member may
seek covered primary care from a TRICARE authorized civilian provider.
Prior to obtaining any specialty care, the RC member should contact
the appropriate TRICARE regional or overseas contractor to request authorization.
3.3.1 The periods of TRICARE eligibility
for the affected individuals will be reflected in DEERS. Contractors
will continue to rely upon DEERS for eligibility determination.
3.3.2 The contractor shall verify
the patient’s eligibility in DEERS.
3.4 In the event that the contractor
should become aware that payment has been made for services rendered
during a period for which the patient was subsequently determined
to be ineligible recoupment action shall be initiated. Recoupment
procedures are specified in TRICARE Operations Manual (TOM),
Chapter 11, Section 3 as appropriate.