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TRICARE Reserve Select Handbook

TRICARE Reserve Select Handbook

TRICARE Reserve Select Handbook

Important Information

TRICARE Reserve Select Web Site:

www.tricare.mil/reserve/reserveselect

Reserve Affairs Web Site:

www.defenselink.mil/ra

Guard/Reserve Portal Address:

https://www.dmdc.osd.mil/appj/trs/index.jsp

TRICARE National Web Site:

www.tricare.mil

TRICARE Mail Order Pharmacy:

1-866-DoD-TMOP (1-866-363-8667)

TRICARE Retail Network Pharmacy:

1-866-DoD-TRRX (1-866-363-8779)

TRICARE North Region Contractor

Health Net Federal Services, LLC (Health Net):

1-800-555-2605

Health Net Web Site:

TRICARE South Region Contractor

www.healthnetfederalservices.com

Humana Military Healthcare Services, Inc. (Humana Military):

1-800-444-5445

Humana Military Web Site:

TRICARE West Region Contractor

www.humana-military.com

TriWest Healthcare Alliance, Corp.(TriWest):

1-888-TRIWEST (1-888-874-9378)

TriWest Web Site:

www.triwest.com

TRICARE Overseas (TRICARE Europe,TRICARE Latin America and Canada, and TRICARE Pacific)

Overseas Toll-Free Number:

1-888-777-8343

Overseas Web Site:

www.tricare.mil/overseas

An Important Note About TRICARE Program Changes

At the time of printing, the information in this handbook is current. It is important to remember that TRICARE policies and benefits are governed by public law. Changes to TRICARE programs are continually made as public law is amended. For the most recent information, contact your regional contractor or local TRICARE Service Center. More information regarding TRICARE, including the Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices, can be found online at www.tricare.mil.

TRICARE Reserve Select TRICARE Reserve Select (TRS) is a premium- based health plan that qualified

TRICARE Reserve Select

TRICARE Reserve Select (TRS) is a premium- based health plan that qualified National Guard and Reserve members may purchase unless eligible for coverage under the Federal Employees Health Benefits program (FEHB). If either the member or spouse is eligible to purchase the FEHB then the member and family are not eligible to purchase TRS.

We use the terms National Guard and Reserve throughout this handbook to include:

Army National Guard

Army Reserve

Navy Reserve

Marine Corps Reserve

Air National Guard

Air Force Reserve

U.S. Coast Guard Reserve

TRS offers coverage similar to TRICARE Standard and TRICARE Extra, and a monthly premium will be charged. You will receive comprehensive coverage with access to TRICARE-authorized providers. Annual deductibles, cost-shares, and a catastrophic cap apply. You may access care from a military treatment facility (MTF) on a space-available basis only. You may fill prescriptions through the MTF, the TRICARE mail-order pharmacy, and TRICARE retail network and non-network

1

pharmacies. Costs for prescription medications vary depending upon the pharmacy option you choose and the medication’s availability on the uniform formulary.

For more information about TRS coverage, visit www.tricare.mil/reserve/reserveselect. For more information about the National Guard and Reserve and the Selected Reserve, visit the Reserve Affairs Web site at www.defenselink.mil/ra.

Programs Not Available with TRICARE Reserve Select

. Programs Not Available with TRICARE Reserve Select If you are enrolled in TRS, you may
. Programs Not Available with TRICARE Reserve Select If you are enrolled in TRS, you may

If you are enrolled in TRS, you may not participate in the following programs:

Special Supplemental Food Program

TRICARE Extended Care Health Option (ECHO)

TRICARE Global Remote Overseas (TGRO)

TRICARE Prime

TRICARE Prime Remote (TPR)

TRICARE Prime Remote for Active Duty Family Members (TPRADFM)

TRICARE Prime Overseas

TRICARE Puerto Rico Prime

TRICARE Reserve Family Demonstration Project

US Family Health Plan (USFHP)

Your TRICARE Regional Contractor

Your TRICARE Regional Contractor
Your TRICARE Regional Contractor

We often refer to your regional contractor throughout this handbook and describe differences in each region. In cases where there are regional differences, refer to the information specific to your region. Besides offering toll-free customer service telephone lines and Web sites, each regional contractor operates TRICARE Service Centers throughout the region, typically at or near military installations, which offer customer service support. The following descriptions of each TRICARE region include contact information for each regional contractor.

WEST NORTH SOUTH
WEST
NORTH
SOUTH

TRICARE North Region

The TRICARE North Region includes Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin, and portions of Iowa (Rock Island Arsenal area), Missouri (St. Louis area), and Tennessee (Ft. Campbell area).

Regional

Health Net Federal Services, LLC (Health Net)

contractor

Phone

1-800-555-2605

Web site

www.healthnetfederalservices.com

TRICARE South Region

The TRICARE South Region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee (excluding the Ft. Campbell area), and Texas (excluding the El Paso area).

Regional

Humana Military Healthcare Services, Inc. (Humana Military)

contractor

Phone

1-877-298-3408

Web site

www.humana-military.com

2

TRICARE West Region

The TRICARE West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington, and Wyoming.

Regional

TriWest Healthcare Alliance Corp. (TriWest)

contractor

Phone

1-888-TRIWEST (1-888-874-9378)

Web site

www.triwest.com

TRICARE Overseas

TRS is available overseas. The TRICARE overseas areas include TRICARE Europe, TRICARE Latin America and Canada (TLAC), and TRICARE Pacific. The TRICARE South Region contractor, Humana Military, handles enrollment, billing, and customer support services for these overseas areas.

Regional

Humana Military Healthcare Services, Inc. (Humana Military)

contractor

Phone

1-877-298-3408

Web site

www.humana-military.com

TRICARE Europe includes Africa, Europe, and the Middle East. TLAC includes Canada, the Caribbean Basin, Central and South America, Puerto Rico, and the Virgin Islands. TRICARE Pacific includes Asia, Australia, Guam, India, Japan, Korea, New Zealand, and remote Western Pacific countries.

TRICARE Service Centers (TSCs) can provide information about locating a provider or accessing health care in overseas locations. Contact the TRICARE Area Office in your overseas area to locate a TSC near you.

TRICARE Area Office Contact Information

The U.S. Department of State provides several useful resources, including a Web site listing U.S. Embassies and Consulates. A TRICARE point of contact is located at each U.S. Embassy and Consulate. Locate a U.S. Embassy or Consulate at www.usembassy.gov.

 

TRICARE Europe

TLAC

TRICARE Pacific

Phone

Toll-free: 1-888-777-8343, Option 1

Toll-free: 1-888-777-8343, Option 3

Toll-free: 1-888-777-8343, Option 4

Comm.: 011-49-6302-67-7432

Comm.: 1-706-787-2424

Comm.: 011-81-6117-43-2036

DSN: 496-7432

DSN: 773-2424

DSN: 643-2036

Remote Sites: 011-65-6-338-9277

Fax

Comm.: 011-49-6302-67-6374

1-706-787-3024

Comm.: 011-81-6117-43-2037

DSN: 496-6374

DSN: 643-2037

E-mail

teurope@europe.tricare.mil

tricare15@se.amedd.army.mil

TPAO.CSC@oki10.med.navy.mil

Online

www.tricare.mil/europe

www.tricare.mil/tlac

www.tricare.mil/pacific

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Table of Contents

1. Getting

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Finding a Provider

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TRICARE Reserve Select Wallet Card

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Emergency Care

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Care at a Military Treatment Facility

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Prior Authorization for Care

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Getting

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Getting Care Overseas

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2. Covered

Services, Limitations, and

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Outpatient Services

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. Clinical Preventive Services

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.10

Behavioral Health Care Services

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Pharmacy Services

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Maternity Services

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Dental Services

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Services or Procedures with Significant Limitations

 

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Exclusions

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3. Claims

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Health

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Pharmacy Claims

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Coordinating Benefits with Other Coverage

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Explanation of Benefits

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.24

4. Changes

to Your TRICARE Reserve Select Coverage

. Coverage for Newborns or Adopted Children

Changes to Your Coverage

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. When TRICARE Reserve Select Coverage Ends

 

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.27

TRICARE Reserve Select Survivor Coverage

 

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5. Information and Assistance

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Qualifying for TRICARE Reserve Select

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. Beneficiary Counseling and Assistance Coordinators

Customer Service

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Updating DEERS

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Appealing a Decision

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.31

. Reporting Suspected Fraud and Abuse

Filing a

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4

6. Acronyms.

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