JT

[Guest guest]

The provisions of the 2004 Temporary Reserve Health Benefit Program enhance

access to care for Reserve Component (RC) Service members and their families and

ultimately, improve our readiness as a fighting force.

a.. By law, Section 702 will be effective upon implementation of an enrollment

process and other administrative actions. Members will be eligible to enroll

themselves and their family members at that time. This benefit will be available

for persons not eligible for employer-provided coverage, or who are eligible

unemployment compensation recipients.

a.. Under Sections 703 and 704, some RC sponsors and family members may be

eligible for reimbursement of health care costs incurred before the temporary

program is implemented. For this reason, the Department of Defense encourages

families whose sponsors are deployed in support of a contingency operation to

save their health care receipts, claims and the explanation of benefits forms

for dates of service from Nov. 6, 2003.

a.. By law, the total cost of expenditures for implementing sections 702, 703

and 704 is limited to $400 million.

a.. Personnel and Readiness will ask the Services to identify, individuals who

will serve as full-time RC Beneficiary Counseling and Assistance Coordinators

(BCACs) in each of the 11 TRICARE regional offices. The RC BCACs will attend the

TRICARE Fundamentals Course to gain an understanding of the unique challenges

faced by RC families and will serve as advocates and problem solvers for RC

sponsors and family members needing assistance understanding their health care

options or using the TRICARE benefit.

Background

The recently enacted Emergency Supplemental Appropriations Act and the National

Defense Authorization Act for Fiscal Year 2004 authorized temporary health care

benefits and TRICARE eligibility for RC sponsors and family members. Several of

the new benefits are effective Nov. 6, 2003 through Dec. 31, 2004, whereas

others require implementing procedures and systems before they become available.

Total expenditures during Fiscal Year 2004 may not exceed the $400 million

specified by Congress for these programs.

Key Provisions Under the New Legislation Include:

Section 701: Medical and Dental Screening and Care for Members of Ready Reserve

Alerted for Mobilization

a.. Authorizes medical and dental screening and care in advance of mobilization.

a.. Guidance will be issued from OSD to Service Secretaries, alerting them to

new provisions and providing implementing instructions.

a.. Members of Ready Reserve will be notified of eligibility for medical/dental

screening coincident with notification of impending activation.

a.. There will be no charge to the member for any screening or care provided.

Section 702: Coverage for Ready Reserve Members under TRICARE

a.. This section introduces premium-based TRICARE coverage for persons not

eligible for employer-provided coverage, or who are eligible unemployment

compensation recipients.

a.. TRICARE plans to build on existing TRICARE mechanisms:

a.. Using the TRICARE regional contractors to determine eligibility and

collect premiums.

b.. Defense Enrollment Eligibility Reporting System (DEERS) to record

eligibility.

c.. TRICARE regional contractors to educate and enroll beneficiaries in

TRICARE options.

d.. Military facilities and civilian network providers to deliver health care

services.

e.. TRICARE regional contractors to process health care claims.

f.. Coverage would be effective when the member enrolls and pays premium.

Implementation timeline will be determined based on time needed to modify

contracts and systems and establish implementing rules and procedures.

Section 703: Earlier Eligibility Date for TRICARE Benefits for Members of

Reserve Components

a.. This section makes TRICARE coverage effective on the date a reservist

received a delayed-effective-date order for activation.

a.. Guidance will be issued from OSD to Service Secretaries, alerting them to

new provisions and providing implementing instructions.

a.. Upon issuance of a delayed-effective-date order, Service will transmit

eligibility records to DEERS, and Regional TRICARE contractor will initiate

education and enrollment activities for affected individuals--service member and

family.

a.. There will be a need to modify DEERS to record eligibility and track

expenditures for this benefit. Coverage is effective with issuance of qualifying

orders after November 6, 2003. Changes to DEERS will need to be implemented.

Section 704: Temporary Extension of Transitional Health Care Benefits

a.. This section changes the period for receipt of transitional health care

benefits from 60 or 120 days to 180 days for eligible beneficiaries.

a.. Guidance will be issued from OSD to Service Secretaries, alerting them to

new provisions and providing implementing instructions.

a.. DEERS will be modified to reflect extended transitional health care benefit.

a.. The extension to 180 days is applicable to all persons eligible for the

transitional benefit - this includes reservists being deactivated after

contingency call-up, other involuntary separations, and separations following

retention in support of contingency mission.

a.. Extensions are effective for persons deactivated/separated on or after

November 6, 2003, and are to be implemented as soon as DEERS can be modified.

a.. While DEERS modifications are being made, members and their dependents will

already be receiving these benefits under their previous 60 or 120 day benefit.

Section 705: Assessment of Health Care Needs of Reserves

This section requires GAO to conduct a comprehensive assessment of the health

care needs of reservists, incorporating information about the benefits included

in the FY 2004 National Defense Authorization Act, and to report to Congress by

May 1, 2004.

Section 706: Limitation on FY 2004 Outlays for 2004 Temporary Reserve Health

Benefit Programs

a.. This section prescribes a limitation of $400 million on FY 2004 outlays for

the benefits authorized in sections 702, 703, and 704.

a.. Adherence to this limitation will entail careful tracking of outlays as they

occur.

a.. DoD will adhere to the $400 million limitation in FY 2004 to avoid an

Anti-Deficiency Act violation

Section 707: TRICARE Beneficiary Counseling and Assistance Coordinators for

Reserve Component Beneficiaries

a.. Reserve components will appoint beneficiary counseling and assistance

coordinators to support reserve component members. Policy guidance to Services

will be issued shortly.

a.. This support will be part of an information campaign to inform affected

members and families about the new provisions and how to use their benefits.

a.. The transition to new TRICARE regions will enhance support for reserve

component members.

Section 708: Eligibility of Reserve Officers for Health Care Pending Orders to

Active Duty Following Commissioning

a.. This section makes newly commissioned officers eligible for health care,

pending orders to active duty, if the officer lacks other health coverage.

a.. Guidance will be issued to Services to implement this new provision.

a.. Individuals needing this coverage can be handled on a case-by-case basis.

Strategy:

a.. Phase I: Provide awareness of the 2004 Temporary Reserve Health Benefit

Program and plans for implementation.

a.. Phase II: Provide guidance on policy, benefit, and eligibility.

a.. Phase III: Provide implementation date and guidance for both claims

processing and BCAC assistance.

a.. Phase IV: Measure success of communications outreach through media,

beneficiary and congressional inquires.

For More Information:

Start dates for each portion of the pilot program will be available online via

the TRICARE Management Activity (TMA) Web site and the Reserve Affairs Web site.

TMA will also post news releases, frequently asked questions (FAQs) and updated

fact sheets online and distribute public affairs guidance to provide timely

information on the pilot program to all Reserve Component members and their

families.