Change in Eligibility Status

Deployment

Separating from Active Duty

Becoming Medicare-Eligible

Terminal Leave

DEPLOYMENT

As you and your sponsor prepare for deployment, follow these steps to ensure your family remains covered:

• Obtain a copy of your sponsor’s orders.
• Get a Power of Attorney so that you can make changes or update information in your sponsor’s absence.
• Have your sponsor complete an Authorization to Disclose form and a HIPAA Access Request form so you may access their health information (if needed) while they are away.
• Make any necessary financial arrangements for your enrollment fees (if applicable).
• Learn how to update your DEERS records. Make sure you have updated ID cards for each of your covered family members. You can update DEERS by:
  
  • Visiting an ID card-issuing facility
  • Calling 1-800-538-9552
  • Faxing changes to 1-831-655-8317
  • Mailing changes to:
    DMDC Support Office, Attn: COA
    400 Gigling Rd.
    Seaside, CA 93955-6771
    
• Make a list of important phone numbers:
  • Primary care manager or provider to call for appointments
  • TriWest Healthcare Alliance at 1-888-TRIWEST (874-9378)
  • Emergency room
  • Beneficiary counseling and assistance coordinator (BCAC)
  • Review your TRICARE plan information so you know how to access care
  • Learn how and where prescriptions can be filled

SEPARATING FROM ACTIVE DUTY

When your sponsor separates from active duty, TRICARE coverage may or may not continue, depending on the circumstances surrounding the separation. TRICARE offers two transitional health care options, the Transitional Assistance Management Program and the Continued Health Care Benefit Program. If your sponsor qualifies, these programs provide temporary coverage for eligible family members until you have a new health plan.

Transitional Assistance Management Program

The Transitional Assistance Management Program (TAMP) provides 180 days of transitional health care benefits to certain uniformed service members and their families, if the sponsor meets one of the following conditions:

• Involuntarily separates from active duty under honorable conditions
• Is a National Guard or Reserve member separating from active duty after a period of more than 30 consecutive days in active duty support of a contingency operation
• Separates from active duty following involuntary retention (stop-loss) in support of a contingency operation
• Separates from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency operation
• A member who receives a sole survivorship discharge
• A member who is separated from active duty who agrees to become a member of the Selected Reserve of the Ready Reserve of a reserve component

For those who qualify, the 180-day TAMP period begins upon the active duty sponsor's separation.  During TAMP, sponsors and family members are eligible to enroll in TRICARE Prime, TRICARE Prime Overseas or use TRICARE Standard and Extra or TRICARE Standard Overseas. 

Checklist for TAMP:

• Determine what TRICARE plan is available in your area by calling TriWest at 1-888-TRIWEST (874-9378).
• Update your military status in DEERS by:
  • Visiting an ID card-issuing facility
  • Calling 1-800-538-9552
  • Faxing changes to 1-831-655-8317
  • Mailing changes to:
    DMDC Support Office, Attn: COA
    400 Gigling Rd.
    Seaside, CA 93955-6771
    
• Enroll in TRICARE Prime, if applicable:
  • Complete the TRICARE Prime Enrollment Application and PCM Change Form . You may download and print this form or call 1-888-TRIWEST (874-9378) to request one be mailed to you. You may also visit your local TRICARE Service Center to pick one up.
  • Sign and date the form in either blue or black ink. Forms that are not signed and dated will be considered incomplete and will be returned to you, delaying enrollment and coverage.
  • Mail the form with your enrollment fee (annual family enrollment is $460) to:
    TriWest Healthcare Alliance
    P.O. Box 43590
    Phoenix, AZ 85080-3590

Continued Health Care Benefit Program

The Continued Health Care Benefit Program (CHCBP) is a premium-based health care program administered by Humana Military Health Care Services, Inc. (Humana Military).  CHCBP offers temporary transitional health coverage (18-36 months) after TRICARE eligibility ends.  If you qualify, you can purchase CHCBP within 60 days of loss of eligibility for either regular TRICARE or Transitional Assistance Management Program (TAMP) coverage.

CHCBP acts as a bridge between military health benefits and your new civilian health plan.  CHCBP benefits are comparable to TRICARE Standard with the same benefits, providers and program rules.  The main difference is that you pay premiums to participate.

Who is eligible?

Under certain circumstances, the following beneficiaries may be eligible:

• Former active duty service members released from active duty (under other than adverse conditions) and their eligible family members.  Coverage is limited to 18 months.
• Unremarried former spouses who were eligible for TRICARE on the day before the date of the final decree of divorce, dissolution or annulment.  Coverage is usually limited to 36 months; however, some unremarried former spouses may continue coverage beyond 36 months if they meet certain criteria. Contact Humana Military for details.
• Children who cease to meet the requirements of an eligible family member and were eligible for TRICARE on the day before ceasing to meet those requirements.  Coverage is limited to 36 months.
• Certain unmarried children by adoption or legal custody. Coverage is limited to 36 months.

BECOMING MEDICARE ELIGIBLE

Medicare eligibility is available for persons under 65 with certain disabilities, persons with end-stage renal disease and persons age 65 or older. Making the transition from TRICARE to TRICARE For Life (TFL) is seamless. As you become a dual-eligible beneficiary, you will notice some changes in your coverage:

• Enrollment in Medicare Part B is required to maintain TFL eligibility.
• Enrollment in TFL is automatic; If you are receiving Social Security benefits, you will transition smoothly to TFL upon your 65^th birthday; if you are not receiving Social Security benefits at the time of your 65^th birthday, you will need to visit the nearest Social Security office and enroll in Medicare.
• Medicare authorized providers are also TRICARE authorized.
• Claims are paid automatically between Medicare and TFL.
• TFL is a second-payer to Medicare.
• Enrollment in Medicare Part D is not necessary.
• TFL beneficiaries may continue to use any of the TRICARE pharmacy options.

To transition to TRICARE For Life:

• Enroll in Medicare Part B when first eligible.
  While Medicare Part A is optional, TFL eligibility hinges upon your enrollment in Medicare Part B. Once you are enrolled in TFL, you must maintain your Medicare Part B eligibility to remain TFL-eligible.
  
  If you already receive benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically receive Medicare Part A and be enrolled in Part B starting the first day of the month following your 65^th birthday.
  
  If you are not currently receiving Social Security or RRB benefits, you must file for Part A and enroll in Part B. To avoid the Medicare surcharge for late enrollment, enrollment in Part B must be completed during the Medicare Initial Enrollment Period (seven-month period that begins three months before your 65^th birthday, includes your birthday month, and ends three months after your 65^th birthday). The Social Security Administration will send you a letter notifying you of your Medicare entitlement several weeks after filing.
• Update DEERS.
  You must maintain your TRICARE eligibility by keeping DEERS up to date any time there is a life changing event, like becoming eligible for Medicare. Contact DEERS online at www.dmdc.osd.mil/rsl or call toll-free 1-800-538-9552.
• Advise your doctor(s) of your new change in coverage.
  As a TFL beneficiary, you will not need to submit a paper claim when you have a doctor’s visit (in most cases). The provider will submit the claim to Medicare. Medicare will then submit the claim to TRICARE once the Medicare portion is paid.
• Research if Medicare Part D is a better option for you than your current prescription coverage.

Terminal Leave

When a sponsor is in Terminal Leave status, the family remains covered under TRICARE Standard, Extra, Prime, Prime Remote or Prime Remote for Active Duty Family Members (TPRADFM). If you need care during leave, contact your Primary Care Manager or physician where you are enrolled or mobilized to obtain an authorization for care.You may obtain care at any military treatment facility (MTF) as long as you are on active duty, but you may not enroll or port to another MTF while on Terminal Leave. You will remain enrolled in the MTF where your Terminal Leave orders were created until your retirement or separation from the military. Family members may enroll in another MTF, even while the sponsor is on terminal leave.