1.0 DESCRIPTION
1.1 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 Medical
Treatment Facility (MTF) care, for a defined period of time as indicated
on Defense Enrollment Eligibility Reporting System (DEERS).
1.2 The contractor
shall process claims for these individuals (including the former
active duty member) as Active Duty Family Members (ADFMs). While
the status of these individuals is neither active duty nor retiree/deceased,
cost-sharing for these individuals is as 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 Time frames of
eligibilityThose eligible for
TAMP, eligibles in which the by
virtue of a member’s separation occurred occurring on
or after November 6, 2003, -
Transitional transitional health
care for TAMP eligibles shall be available for 180 calendar 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 The contractor shall be responsible
for confirming DEERS eligibility status.
2.3.3 The contractor
shall identify claims as TAMP and process them as ADFM claims by
using DEERS, after jurisdictional responsibility is established.
While the status of these individuals is neither active duty nor
retiree/deceased, for the purpose of cost-sharing, the claims for
these individuals shall be processed as ADFMs. Eligibility verification
of an active duty member who was separated involuntarily shall be
based solely on the DEERS response.
2.3.4 The contractor
shall process claims that are submitted for medical services rendered
to the sponsor and the contractor can identify the claim as meeting
the transitional eligibility requirements. Otherwise the sponsor claims
indicating status as “active duty” and relationship as “self” shall
continue to be transferred to the military services.
2.3.5 The contractor
shall process claims using the same rules and cost-shares that apply
to ADFMs per TRICARE Reimbursement Manual (TRM), Chapter
2, unless otherwise specified in Chapter 10, Section 8.1.
2.4 Change in eligibility
status of a beneficiary during an inpatient hospital stay (see the
TRM, Chapter 6, Section 2).
2.5 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.
2.4 TRICARE Prime (Before January
1, 2018)
2.4.1 Enrollment in TRICARE 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
TRICARE 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
TRICARE 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
TRICARE 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 TRICARE 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 calendar days of the return
to active duty status. If reenrollment is accomplished within 90
calendar 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 calendar
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
TRICARE Prime immediately
prior to activation (i.e., return to active duty) may choose to
enroll in
TRICARE 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 TRICARE 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.
If
not auto-enrolled in TRICARE Select, TAMP eligibles, including the
former Service members may elect to enroll or re-enroll in TRICARE
Prime, if qualified or TRICARE Select coverage within 90 calendar
days of their eligibility for TAMP.
2.7.3 TAMP eligibles
whose sponsor is called to active duty.2.7.3.1 A TAMP sponsor’s
re-activation to active duty status is a change in status, and is
a QLE that allows TAMP enrollees to elect their desired TRICARE
coverage within 90 calendar days of the activation.
2.7.3.2 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.
2.5.1.2 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
TRICARE Prime requirements), or TRICARE Select, within 90 days of
their eligibility for TAMP, for continuous coverage to begin. Otherwise,
TRICARE Prime coverage begins the day the request is submitted thereafter.
2.5.1.3 Members ordered to active
duty status for more than 30 days during TAMP eligibility 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.
Members on active duty for more than 30 consecutive days are automatically
enrolled in TRICARE Prime.
2.5.2 Effective Date of EnrollmentThe 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
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. See paragraph 2.5.1.2.
2.5.2.2 EXCEPTION: If a member
is unable to request enrollment/re-enrollment in TRICARE Prime or
to enroll in TRICARE Select due to their eligibility 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 For continuous TRICARE
coverage
with no break, an application
for TRS may be produced up to 90 calendar days before the expiration
date of TAMP, but must be submitted with the required initial payment
no later than 90 calendar 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 member.
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 member
with a Date of Service (DOS) during their active duty status reflected
in DEERS, while the member is under TAMP eligibility, shall be processed
under the Supplemental Health Care Plan (SHCP) (see the 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 calendar 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 calendar 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.