Tricare Begins Enrollment for New Reserve Healthcare Benefit

By Sgt. 1st Class Doug Sample

USA American Forces Press Service WASHINGTON - Thousands of Reserve and Guard servicemembers 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 servicemembers who may want to purchase healthcare coverage.
"This is pretty attractive for the kind of coverage that's offered under Tricare," he said. "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 servicemembers who receive a 'delayed-effective-date' order," he added. For the most part, TRS helps make providing continuous health coverage a seamless process for servicemembers.
Lillie explained that after a servicemember 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, servicemembers 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 servicemembers 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.
Tricare (cont’d)
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.
Meanwhile, 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 servicemembers in the rank of E-4 and below is $50 per individual or $100 per family. The deductible for servicemembers 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.

President Signs Law Increasing Military Benefits

On May 11th the President signed the 2005 Emergency Supplemental Appropriations Act. The following are the benefits increases associated with this Act. Note many of the increased benefits are retroactive to October 2001, but many may end this fiscal year.
$25K to $100K for Traumatic injury protection: A servicemember who is insured (under SGLI) shall automatically be issued a traumatic injury protection rider that will provide for a payment not to exceed $100,000 if the member, while so insured, sustains a traumatic injury that results in a loss described below.
The maximum amount payable for all injuries resulting from the same traumatic event shall be limited to $100,000. If a member suffers more than 1 such loss as a result of traumatic injury, payment will be made in accordance with the schedule to be announced by the SecDoD for the single loss providing the highest payment.
A member who is issued a traumatic injury protection rider under subsection (a) is insured against such traumatic injuries, as prescribed by the Secretary, in collaboration with the Secretary of Defense, including, but not limited to—
(A) total and permanent loss of sight;
(B) loss of a hand or foot by severance at or above the wrist or ankle;
(C) total and permanent loss of speech;
(D) total and permanent loss of hearing in both ears;
(E) loss of thumb and index finger of the same hand by severance at or above the metacarpophalangeal joints;
(F) quadriplegia, paraplegia, or hemiplegia;
(G) burns greater than second degree, covering 30 percent of the body or 30 percent of the face; an
(H) coma or the inability to carry out the activities of daily living resulting from traumatic injury to the brain.
Changes to the Death Gratuity : The new law renames the death gratuity, payable to survivors of members of the Armed Forces killed while serving on active duty or inactive duty training, as fallen hero compensation.
Military Benefits (cont’d)
The New Law Increases the:
(1) maximum benefit under the Servicemen's Group
Life Insurance program from $250,000 to $400,000
(or lesser amounts as a member may elect); and
2) military death gratuity from $12,000 to $100,000. Provides a special death gratuity of up to $150,000 with respect to service designated by the Secretary of DoD as a combat operation or a zone of combat.
Provides an additional death gratuity of $150,000 for deaths that occur before the enactment of this Act in combat operations, in a combat zone, or in Operations Enduring Freedom or Iraqi Freedom.
Reserve Pay Differential: Reservists Pay Security Act of 2005 - The new law entitles Federal employees who are absent from their positions while on active duty in the regular uniformed services or National Guard to receive the amount of their Federal basic pay which, when taken together with their military pay and allowances, is no less than the amount of pay that they would have earned if there had been no interruption in their civilian employment. Expands reemployment rights of Federal employees on active duty in the uniformed services.
Reserve Affiliation Bonuses: The new law limits to $10,000 during FY 2005 the maximum bonus authorized in connection with a reserve affiliation agreement.
Hospitalization Issues: The new law prohibits members who are entitled to basic allowance for subsistence (BAS) from being charged for meals received in a military medical facility while undergoing medical recuperation or therapy or in a status of "medical hold" for an injury, illness, or disease incurred or aggravated while on active duty in Operations Iraqi Freedom or Enduring Freedom.
The new law also directs the Secretary of Defense to provide such individuals access to telephone service at or through such facility in the amount of $40 worth of calling minutes per month.
And the new law amends Federal military pay and allowances provisions to provide reimbursement for travel for the family of members of the Armed Forces hospitalized in the United States in connection with certain non-serious illnesses or injuries incurred in a combat operation or combat zone. Provides reimbursement funding from specified military accounts. Requires the Secretary to report to the defense committees if such expenses exceed $20 million in a fiscal year.