Tricare begins enrollment for new reserve healthcare benefit

27 Apr 2005 | - Sgt. 1st Class Doug Sample

Thousands of Reserve and Guard service members can now qualify to purchase more healthcare coverage for themselves and their families under a new Tricare program that began April 26.

Tricare, the military's health care provider, is now accepting enrollment for its new Tricare Reserve Select health plan, said Steve Lillie, Tricare's deputy chief of operations.

Congress authorized the new healthcare benefit for Reserve Component members under the fiscal 2005 National Defense Authorization Act as a way of providing health coverage to RC members burdened by the current war. Lillie said the premium-based plan will be offered as an option to more than 400,000 eligible service members who may want to purchase healthcare coverage.

"This is pretty attractive for the kind of coverage that's offered under Tricare," said Lillie. "It's an excellent comprehensive health plan with comprehensive pharmacy coverage at a reasonable price. I think this will be attractive for many people compared to what they can get through employment."

Currently, RC members ordered to active duty for a period of more than 30 days are covered under one or more of several Tricare programs. "Health coverage is also provided up to 90 days prior to activation for service members who receive a 'delayed-effective-date' order," he added.

For the most part, TRS helps make providing continuous health coverage a seamless process for service members.

Lillie explained that after a service member is released from active duty, the Transitional Assistance Management Program then picks up their health coverage for 180 days, and if purchased, TRS coverage begins immediately afterwards.

"Everything is seamless until you get to TRS because it's an optional program that requires premiums," Lillie said. "We can't make that completely seamless -- there are steps that you have to follow to qualify and purchase coverage."

To be eligible for TRS, service members must have been called or ordered to active duty in support of a contingency operation since Sept. 11, 2001, and they must execute a "Service Agreement" through the Guard and Reserve Web Portal to serve in the Selected Reserves.

In addition, Guard members must have served "under an order from the president, not from their governor," Lillie explained. And they must have served continuously on active duty for 90 days or more under such an order, unless they were injured or became ill while activated.

He said service members may be eligible for one year of health coverage for every year of service commitment in the service agreement, up to a maximum of one year for every 90 days of prior service on active duty in support of a contingency operation.

The Service Agreement through the Guard-Reserve portal is a vital first step in qualifying is to enter into continued service in the Selected Reserve. That is done through the member's Reserve unit. That Service Agreement must be executed between the member and the Reserve component before the member can purchase TRICARE Reserve Select coverage.

Lillie added the cost for the plan is $75 for TRS member-only coverage and $233 for TRS member and family member coverage, which is reasonable compared to that of civilian health plans.

The annual cap for catastrophic illnesses is another good benefit. According to the plan, this cap limits out-of-pocket expenses to $1,000 per year. "The typical private insurance program might have a catastrophic cap of $4,000 or $5,000," Lillie said.

In many aspects, TRS may even be better than some civilian health maintenance organization or preferred provider-type insurance plans, he said.

TRS provides access to any provider that treats Tricare patients without referrals required, Lillie explained. "So it's broader; it provides more freedom of choice than an HMO plan," he said.

For Reserve and Guard members, Tricare Reserve Select health coverage will be much the same as the Tricare Standard and Extra their families may have received while on active duty.

In addition to typical inpatient and outpatient care, Tricare Reserve Select covers urgent and emergency care, and ambulance services; family healthcare; obstetrics, gynecology and maternity services; and clinical preventive services, including health screening and immunizations.

The plan also covers behavioral health care, annual eye examinations; ancillary services, such as laboratory and radiology; and prescription drug coverage.

"The principal difference between their coverage while on active duty and their Tricare Reserve Select coverage is there is some cost sharing for the time when they go to the doctor or get hospitalized," Lillie pointed out. "It's comparable to a civilian healthcare plan, and it's identical to Tricare Standard.

"The member and the family will pay a 20-percent cost share when they visit a non-network doctor," he said. "They also have a deductible to satisfy at the start of each federal fiscal year."

Lillie said the deductible for service members in the rank of E-4 and below is $50 per individual or $100 per family. The deductible for service members E-5 and above is $150 per individual or $300 per family.

"Our reservists and guardsmen who are called to duty and their families deserve this great new benefit for their service to their country," said Lillie. "We are glad that we can offer Tricare Reserve Select to qualified members and their families.  It is good for them and good for the Reserve and National Guard forces."
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