Tricare Prime Update

Posted: September 12, 2011 in Uncategorized
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Split enrollment allows eligible family members who do not live with their sponsor to enroll in TRICARE Prime as long as they reside in an area where TRICARE Prime is available. Split enrollment is especially helpful for families with college students, children living with former spouses or families that are otherwise separated. Children who are TRICARE-eligible based on their sponsor‘s status remain eligible until reaching age 21 (or age 23 if enrolled in a full-time course of study at an approved institution of higher learning, and if the sponsor provides at least 50 percent of the financial support). Your college student‘s TRICARE Prime coverage ends if his or her Defense Enrollment Eligibility Reporting System (DEERS) record is not updated before reaching age 21. For information on extending benefits for your college student, refer tohttp://www.tricare.mil/deers .
To use split enrollment, complete and sign a TRICARE Prime Enrollment Application and PCM Change Form (DD Form 2876). Send the form to the family member‘s new regional contractor at:
-North Region: Health Net Federal Services, LLC, P.O. Box 870143, Surfside Beach, SC 29587-9743
-South Region: Humana Military Healthcare Services, Inc.,Attn: PNC Bank, P.O. Box 105838, Atlanta, GA 30348-5838
– West Region: TriWest Healthcare Alliance, P.O. Box 43590, Phoenix, AZ 85080-3590
The form should be sent within 30 days of the move. You must notify each family member‘s regional contractor of the split enrollment status and establish one family enrollment fee, if applicable. TRICARE Prime enrollments follow the ―20th of the month rule.‖ Applications received by your regional contractor by the 20th of the month will become effective at the beginning of the following month (e.g., an enrollment received by Dec. 20 would become effective Jan. 1). If the application is received after the 20th of the month, coverage will become effective on the first day of the month following the next month (e.g., an enrollment received on 27 DEC would become effective on 1 FEB).
To use the split enrollment option, you must notify the regional contractor in each region to establish a primary payer, usually the sponsor, if you pay enrollment fees. If your child enrolls separately in TRICARE Prime after arriving at college, and no other family members are enrolled in TRICARE Prime, it is considered a single enrollment. If the child enrolls and there are other family members enrolled elsewhere, your TRICARE Prime family enrollment fee remains the same. Your regional contractors will coordinate enrollment fees and billing statements. Student enrollment in TRICARE Prime is automatically renewed after one year, unless the renewal offer is declined. An unpaid enrollment fee will cause the entire family to be disenrolled. A 12-month lockout will result if you have been disenrolled for non-payment.
Except for emergencies, your family member must receive care from his or her assigned primary care manager (PCM). A uniformed services identification card helps provide proof of coverage, and the TRICARE Prime enrollment card should be shown at the time of care. PCMs must provide specialty care referrals to avoid using the TRICARE Prime point-of service (POS)* option, which results in higher costs. If your child does not continue enrollment in TRICARE Prime, he or she will be automatically covered by TRICARE Standard and TRICARE Extra as long as his or her DEERS information is current. Visit http://www.tricare.mil if you have questions about using TRICARE Standard and TRICARE Extra. After ―aging out‖ of TRICARE coverage under the sponsor, adult children, until reaching age 26, may be eligible to extend TRICARE coverage by purchasing TRICARE Young Adult, a premium-based health care plan. Visit http://www.tricare.mil/tya for more information. [Source: TRICARE Health Matters Fall 2011 ++]
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