1.0 DESCRIPTION
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
Treatment Facility (MTF) care, for
a defined period of time as indicated on Defense Enrollment Eligibility
Reporting System (DEERS). While the status of these individuals
is neither active duty nor retiree/deceased, for the purpose of
cost-sharing, the claims for these individuals (including the former
active duty member) shall be processed as Active Duty Family Members
(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 days 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 For those eligible for
TAMP by virtue of a member’s separation occurring on
or after November 6, 2003, transitional
health care for TAMP eligibles shall be available for 180 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 Contractors shall be responsible
for confirming DEERS eligibility status.
2.4 TRICARE Prime (Before January
1, 2018)
2.4.1 Enrollment in Prime. TAMP eligibles
may enroll or re-enroll in TRICARE Prime.
2.4.2 Effective Date of Enrollment
in TRICARE Prime is as follows:
2.4.2.1 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.
2.4.2.2 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.
2.4.2.3 TAMP eligibles whose sponsor
is called to active duty.
2.4.2.3.1 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 days of the return to active duty status. If reenrollment
is accomplished within 90 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 days of the return to active duty status, the enrollment
will be effective the date the request is received or postmarked.
2.4.2.3.2 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.
2.4.2.3.3 For information on the effective
dates of enrollments for Service members, see the TRICARE Operations
Manual (TOM),
Chapter 6, Section 1.
2.4.2.4 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.
2.5 TRICARE Prime And TRICARE Select
(Effective January 1, 2018)
2.5.1 Enrollment
2.5.1.1 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.
2.5.1.2 TAMP eligibles
not auto-enrolled in TRICARE Select, including former Active Duty
Service Members (ADSMs), may request to enroll or re-enroll in TRICARE
Prime if meeting Prime requirements, or TRICARE Select, within 90
days of their eligibility for TAMP.
2.5.1.3 Re-activation
to active duty status is a change in status and is a QLE that allows
eligible TAMP family members to elect their desired TRICARE coverage
within 90 days of the activation. Sponsors on active duty for more
than 30 consecutive days are automatically enrolled in TRICARE Prime.
2.5.2 Effective Date of Enrollment.
The
effective date of enrollment/re-enrollment in TRICARE Prime shall
be the start date of TAMP eligibility.
2.5.2.1 When an ADSM
separates on a day other than the first of the month, but continues
to be eligible (e.g., is the spouse of an ADSM or is eligible for
TAMP), they and eligible family members shall be allowed to enroll/re-enroll
in TRICARE Prime with no break in coverage.
2.5.2.2 EXCEPTION: An
enrollment exception will be allowed for a Service member who is
unable to request enrollment/re-enrollment in TRICARE Prime or to
enroll in TRICARE Select due to a delayed DEERS eligibility update.
Specifically, if the eligibility is not reflected in DEERS accordingly
within submission deadlines due to a Government/administrative error,
and has their eligibility restored thereafter, the Defense Health
Agency (DHA) will notify the contractor to process the request.
The Service member will be allowed to enroll with no break in coverage.
2.5.3 Other Enrollment
Options2.5.3.1 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 days before the expiration date of TAMP, but must be submitted
with the required initial payment no later than 90 days after the
expiration date of TAMP.
2.5.3.2 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.
2.6 Claims And Reimbursements2.6.1 Once jurisdictional
responsibility is established, the contractor shall have the capability
by using DEERS to identify claims as TAMP and process them as ADFM
claims; including those for the sponsor.
2.6.2 Claims shall
be processed by the contractor using the same rules and cost-shares
that apply to ADFMs per TRICARE Reimbursement Manual (TRM), Chapter
2, unless otherwise specified in Section 8.1.
2.6.3 Claims for the
sponsor with a DOS during a sponsor’s active duty status reflected
in DEERS, while the sponsor is under TAMP eligibility, shall be
processed under the SHCP (see TOM, Chapter
17).
2.6.4 For processing
claims when change in eligibility status of a beneficiary occurs
during an inpatient hospital stay see the TRM, Chapter 6, Section 2.
2.6.5 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.
2.7 Dental Coverage
2.7.1 Dental benefits for TAMP-eligibles
are limited to space available care in the Dental Treatment Facility
(DTF).
2.7.2 Effective January 27, 2012,
dental benefits for RC members discharged from active duty after
more than 30 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 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.
2.7.3 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.