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TRICARE Reserve Select Coverage Details

Insurance

The TRICARE Reserve Select Program (TRS) is run like any other insurance program, you make monthly premium payments which authorizes you certain types of care at a discounted or free rate. If you go to a provder that participates in the program (known as an in-network provider) you will usually pay a lower copay than if you go to an out-of-network provider (the copay is that amount that you have to pay out-of-pocket when getting treatment). It is always best to go to an in-network provider whenever possible, because if you go to an out-of-network provider you may end up stuck with a very large bill, also if you go to an out-of-network provider you will have to pay the entire cost yourself and then file a claim with TRICARE to get reimbursed. The program also has a deductible, which is the amount you must pay out-of-pocket before any insurance payments begin.

Premiums

The current premiums are:

  • Member Only: $47.90 per month (changing to $47.82 January 1, 2017)
  • Member plus Family: $210.83 per month (changing to $217.51 January 1, 2017)

The premiums change every year on January 1. When you first enroll you must pay 2 months worth of premiums up front. This can be done by check, monty order, or credit/debit card. After that you need to set up a recurring electronic funds transfer from your bank or a recurring payment on your credit/debit card. If you stop paying your benefits will terminate the month after your last payment is received.

Cost Share/Co-pay

Cost Share (Co-pay) for TRICARE Reserve Select
Type of Care Network Provider Non-network Provider
Ambulatory Care (same day surgery) $25 per visit $25 per visit
Mental Health

Inpatient: $18.20/day ($25 minimum)

Outpatient: 15% of the negotiated rate

Inpatient: $18.20/day ($25 minimum)

Outpatient:20% of the allowable charge

Home Health Care $0 $0
Hospice Care $0 $0
Inpatient Services (hospitalization, skilled nursing1, etc) $18.20/day ($25 minimum) $18.20/day ($25 minimum)
Maternity Care

Global fee for office visits & hospitalization for delivery planned in a hospital: $18.20 ($25 minimum)

Office visits for delivery planned in a birthing center: $25 per visit

Office visits for delivery at home or another setting: 15% of the negotiated rate.

Global fee for office visits amp; hospitalization for delivery planned in a hospital: $18.20 ($25 minimum)

Office visits for delivery planned in a birthing center: $25 per visit

Office visits for delivery at home or another setting: 20% of the allowable rate.

Newborn Care The lower of the number of hospital days minus 3 multiplied by $18.20 or 25% of the total billed charges The lower of the number of hospital days minus 3 multiplied by $18.20, or 25% of total billed charges

Outpatient Services such as:

  • Ambulance Service
  • Durable Medical Equipment
  • ER Visits
  • Lab Services
  • Preventative Services2
  • X-rays
15% of the negotiated rate 20% of the allowable charge

1 Skilled nursing is only available in the U.S. and its territories

2 The following Preventive Services are available free of charge: colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6.

Annual Deductibles 

The annual deductible (the amount you must pay out-of-pocket before insurance begins paying) is:

  • Sponsor rank E4 and below: $50 per person with a maximum of $100 per family
  • Sponsor rank E5 and above: $150 per person with a maximum of $300 per family

For More Information and to Apply for Coverage

Visit TRICARE's website for more information. 

Related Topics

TRICARE Military Reserves National Guard

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