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TRICARE covers Reserve Component family

  • Published
  • By Brian P. Smith
  • TriWest Healthcare Alliance
TRICARE provides healthcare coverage for families of a drilling Reserve Component sponsor before, during and after active duty. During activation and deployments, the family may use TRICARE Prime, Prime Remote or Standard and Extra. When National Guard or Reserve sponsors are not on active duty, they may be eligible to purchase and enroll in TRICARE Reserve Select (TRS).

TRICARE Reserve Select
TRS includes medical and behavioral health coverage and access to TRICARE pharmacy benefits. TRS allows enrollees to choose any TRICARE-authorized or network provider for health care. TriWest Healthcare Alliance, the Department of Defense contractor that administers TRICARE in 21 western states, offers a provider directory at www.triwest.com. Families may be able to see a doctor at a military treatment facility (MTF) when space is available.

Sponsors who are eligible for or enrolled in a Federal Employees Health Benefits plan are not eligible for TRS coverage. More information about the TRS plan and eligibility is at TriWest's Guard and Reserve Resource Center (www.triwest.com/ngr).

Costs
As part of the TRS enrollment, a premium payment is due to TriWest each month - $47.51 for individual coverage and $180.17 for family coverage.

The amount of the annual deductible is based on the sponsor's rank. Once the annual deductible is met, the patient will pay cost-shares. Cost-shares are a percentage of the TRICARE-allowed amount for covered services. A TRICARE network provider will have lower cost-shares than a non-network provider.

TRS includes a $1,000 maximum out-of-pocket cap (the most your family will pay including the deductible and cost-shares, but not monthly premiums) for TRICARE-covered services each fiscal year, Oct. 1 to Sept. 30. TRICARE cost information can be found at www.tricare.mil/costs.

Becoming Eligible
The sponsor's unit or service certifies TRICARE eligibility. Family members must be entered into the Defense Enrollment Eligibility Reporting System (DEERS) before they are eligible for any TRICARE benefits. Keep the family's DEERS records up to date to help minimize issues with eligibility or claims. Visit www.tricare.mil/deers to learn how and where to update the DEERS record.

Qualify and Enroll
The TRS enrollment process begins at the National Guard and Reserve Web Portal (https://www.dmdc.osd.mil/appj/trs/index.jsp). Fill out the application online and print a copy. Sign the completed form and send (mail to TriWest Healthcare Alliance, P.O. Box 42048, Phoenix, AZ 85080-2048 or fax to 1-866-441-8843) it with the first month's premium payment to TriWest. TRS coverage can be purchased at any time.