TRICARE for Reserve and Guard

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Some members of the National Guard and Reserve (collectively known as the Reserve Component, or RC), who are issued delayed-effective-date active duty orders for more than 30 days in support of a contingency operation, are eligible for "early" TRICARE medical and dental benefits beginning on the later of either: (a) the date their orders were issued or (b) 90 days before they report to active duty.

This early eligibility TRICARE benefit was introduced under Section 703 of the National Defense Authorization Act (NDAA) and the Emergency Supplemental Appropriations Act for Fiscal Year (FY) 2004 and made permanent by Section 703 of the NDAA for FY 2005. The Department of Defense implemented the early eligibility TRICARE benefit in July 2004.

TRICARE Eligibility for RC Members and Family Members

To be eligible for this early TRICARE benefit, RC members and family members must be registered and TRICARE eligible in the Defense Enrollment Eligibility Reporting System (DEERS). The member's Service personnel office is responsible for determining the member's eligibility for the early TRICARE benefit. The Services will notify and advise eligible RC members of their TRICARE medical and dental benefits when their delayed-effective-date active duty orders are issued.

RC members may verify their eligibility for TRICARE through the secure Guard and Reserve Web Portal Website (if the employer input page appears, click the "BACK" button located on the bottom of the "employer input page"). For assistance with an eligibility problem, members should contact their Service Point of Contact listed on the TRICARE Website.

If the RC member is issued delayed-effective-date active duty orders (for more than 30 days in support of a contingency operation) are cancelled prior to the member reporting to active duty, TRICARE coverage (eligibility) for the member and eligible family members terminates on the effective date the orders are cancelled.

Uniformed Services Employment Reemployment Rights Act (USERRA) protections for members that ensure an employer-sponsored health plan can be reinstated do not go into effect until the member actually reports for active duty. Therefore, members and their family members are strongly encouraged to consider retaining their employer's health plan coverage until the RC member actually reports for active duty, at which time the RC member and family members are fully covered by USERRA protections. Additional information on USERRA is available at http://www.esgr.org/employers2/thelaw.asp.

Filing Claims for Reimbursement

Claims submitted to TRICARE for reimbursement must be for a covered TRICARE benefit received during the member's period of eligibility. Members may validate their eligibility period on the secure Guard and Reserve Portal Website as detailed above. TRICARE network providers and many non-network TRICARE-authorized providers (participating) will file claims on the member's behalf. If a non-network TRICARE-authorized provider chooses not to participate on a particular claim, the member will be billed the normal charges. See the related TRICARE Fact Sheet, TRICARE Reserve Family Demonstration Program.

For dental claims, RC members must contact the Military Medical Support Office (MMSO) at 888-MHS MMSO (888-647-6676). The MMSO cannot, however, process dental claims for family members. Family members who are enrolled in the TRICARE Dental Program (TDP) must TDP claims filing procedures for dental claims.

The TRICARE Benefit for RC Members

RC members will not be enrolled into TRICARE Prime until they reach their final duty station location. Upon arrival, they should follow guidance at their final duty station regarding enrollment into one of the TRICARE Prime programs. If members are released earlier, or their orders are cancelled, no enrollment into TRICARE Prime will occur. Prior to departing their mobilization site, RC members should obtain the telephone number of the regional TRICARE contractor at their next duty station so they can contact the regional contractor upon arrival for guidance on how to enroll in TRICARE Prime.

During the early eligibility period, RC members residing inside the 50 United States who are TRICARE-eligible in DEERS will not be enrolled in the TRICARE Prime or TRICARE Prime Remote (TPR) programs. These members will receive health services in the same manner as any non-enrolled active duty service member. Emergency care for members does not require pre-authorization. Members should go to the nearest military or civilian emergency room or call 911 for emergency care. They also must contact the TRICARE Service Center within 24 hours of receiving treatment.

RC members in the early eligibility period who reside near a military treatment facility (MTF) or dental treatment facility (DTF) will use the MTF or DTF. RC members in remote areas (more than 50 miles or greater than one hour's drive time from the MTFs) will use TRICARE network providers or TRICARE-authorized providers if a network provider is not available. The primary care provider will provide routine health care without pre-authorization. If the primary care provider refers the RC member to a specialist (e.g. orthopedics, psychiatry), the RC member must request authorization from their TRICARE regional contractor or the MMSO at 888-MHS MMSO (888-647-6676) prior to the visit.

Prescription medications generally do not require an authorization; however, the service member must be listed as eligible in DEERS and use a TRICARE network pharmacy to obtain medications with no upfront cost. A list of TRICARE Service Centers, TRICARE network providers, TRICARE-authorized providers, TRICARE network pharmacies, and claims filing information can be found by clicking on the map (where the service members resides) that is located on the TRICARE Website and following the applicable links.

RC members residing outside the 50 United States during the early eligibility period, who are TRICARE-eligible in DEERS and are not enrolled in one of the TRICARE Prime programs available overseas, may receive health services at an MTF or DTF or by reimbursement through supplemental care rules or appropriate overseas programs (i.e., TRICARE Global Remote Overseas for urgent/emergency care).

Specialty Care for RC Members

RC members who need specialty medical care will be referred by their primary care provider to a specialist. The RC member must go through his/her local TRICARE Service Center for specialty medical care authorization.

Dental Services for RC Members

If the RC member was previously enrolled in the TDP prior to receiving delayed-effective-date active duty orders, he or she will be disenrolled from the TDP and will become eligible for the same dental services provided to active duty service members. RC members assigned to military bases will receive their dental care through their local DTF.

RC members in locations remote from DTFs are covered for dental care via the Tri-Service Remote Dental Program (RDP), through the MMSO. Members seeking covered routine and specialty dental services must contact the MMSO at 888-MHS-MMSO (888 647 6676) to determine covered benefits and treatment guidelines prior to receiving any services. Dental services may be obtained from any civilian dentist in the 50 United States. Information on the RDP program is also available at the MMSO Website.

The TRICARE Benefit for Family Members

When RC sponsors become eligible for TRICARE benefits as described above, their DEERS-eligible family members become eligible for care in MTFs on a space-available basis and coverage under TRICARE Standard/Extra.

Once RC family members become eligible in DEERS, they may enroll in TRICARE Prime or the TRICARE Prime Remote for Active Duty Family Members (TPRADFM) program, depending on their residence. There are no enrollment fees for RC family members to enroll in the TRICARE Prime or the TPRADFM program. However, to enroll in the TPRADFM program, the residential address shown in DEERS for the RC member and family members must be the same. Also, to be eligible for TPRADFM, family members must have resided with their RC member before the member departed for his/her duty station, mobilization site or deployment location, and the family member must continue to reside in the TPR location.

To enroll in TRICARE Prime or TPRADFM, or for additional information, beneficiaries may call or visit the local TRICARE Service Center or regional beneficiary counseling and assistance coordinator (BCAC) for assistance. For the locations of the nearest TRICARE Service Center and BCAC, beneficiaries may click on the map on the home page of the TRICARE Website at www.tricare.osd.mil, or call 888-DoD-CARE (888-363-2273).

TRICARE Overseas

RC members and family members who reside outside of the 50 United States should follow guidelines and enrollment procedures for the TRICARE Prime programs available overseas. For more information, beneficiaries may visit the TRICARE Overseas Website or click on the map on the TRICARE homepage.

The TRICARE Dental Plan benefit for RC Family Members

RC family members who are enrolled in the TDP will continue their enrollment at the premium share rate. Family members who are not enrolled are eligible to enroll in the TDP from the date of eligibility for the "early" TRICARE benefit at the premium share rate. To enroll, or for assistance in processing a dental claim, family members may contact the dental program administrator.

DEERS Eligibility Assistance

RC members with concerns regarding their eligibility for the early TRICARE benefit may contact their Service point of contact shown below for assistance.

Army National Guard
DEERS/RAPIDS Project Officer

National Guard Bureau(ARNG-ARP)
DSN: 327-4189 Commercial: 703-607-4189 Fax: 703-607-7184 Army Reserve
The Army Reserve DEERS Project Office
Toll-free: 1-800-325-4957, select option #1

Naval Reserve
Naval Reserve Center

Beneficiaries may obtain toll-free numbers from the bottom of the Welcome Aboard link at: http://www.navyreserve.navy.mil/Pages/default.aspx
If enroute: 866-U-ASK-NPC (866-827-5672)

Marine Corps Reserve
Procedures for Individual Marines:

Beneficiaries may correct their "early" TRICARE eligibility information if displayed incorrectly on the Guard and Reserve Portal Website.
Selected Marine Corps Reserve (SMCR) Unit Members
Beneficiaries may contact their SMCR unit administrative section.

Individual Mobilization Augmentee (IMA) or Individual Ready Reserve (IRR) Members:
Beneficiaries may contact their CMC (MPP-60) if they are member of the IMA or IRR
DSN: 378-9427
Commercial: 703-432-9427

Procedures for SMCR Units and Commandant of the Marine Corps (MPP-60)
After the beneficiary has verified that the service member's "early" TRICARE eligibility is displayed incorrectly on the Guard and Reserve Portal, they may contact the Marine Corps Liaison at the Defense Manpower Data Center to have the member's record corrected.

DSN: 878-2951 ext. 4224
Commercial: 831-583-2400 ext. 4224

Air National Guard
ANG/DPFO-DEERS/RAPIDS Project Officer, ANG/DPFOC
DSN: 327-1239
Commercial: 703-607-1239
Fax: DSN 327-0033
Comm. Fax: 703-327-0033

Air Force Reserve: Unit POC
Primary: HQ AFRC/DPX (PRC)
DSN: 497-1262/1252
Commercial: 478-327-1262/1252
Alternate: HQ AFRC/DPX
DSN: 497-1264
Commercial: 478-327-1264

IMA & IRR POCs:
Primary: HQ ARPC/XPC (PRC)
DSN: 926-7081
Commercial: 303-676-7081
Alternate: HQ ARPC/SC
DSN: 926-6386
Commercial: 303-676-6386

Emergency POC: AF/REPP
DSN: 425-6001
Commercial: 703-588-6001

For more information about medical care, dental care and other TRICARE benefits available to RC members and family members, beneficiaries may visit www.tricare.osd.mil/reserve or www.defenselink.mil/ra.

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