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UTAH NATIONAL GUARD
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TRICARE Medical

TRICARE Offers Benefits to activated Reservists and National Guard members. Family members of Reserve Component members (National Guard and Reserve) ordered to active duty for more than 30 days under 10 U.S.C. or 32 U.S.C. are eligible for TRICARE

Members of the reserves and National Guard who are called to active duty will be eligible for health care benefits under TRICARE, just as other active-duty service members are. Their families will also become eligible for TRICARE benefits, if the military sponsor's active-duty orders are for a long-enough period of time.

Families of members called to active duty in response to the Sep 11, 2001 terrorist attacks are eligible for enhanced benefits under the TRICARE Reserve Family Demonstration Project.

TRICARE eligibility for the military sponsor begins on the effective date of their orders to active duty. Needed care will be provided by uniformed services medical treatment facilities, and by authorized civilian health care providers.

Families of activated reservists and National Guard members become eligible for health care benefits under TRICARE Standard or TRICARE Extra on the first day of the military sponsor's active duty, if his or her orders are for a period of more than 30 consecutive days of active duty, or if the orders are for an indefinite period.

TRICARE Standard is the former CHAMPUS program with a new name. Benefits under TRICARE Standard are the same as they were for CHAMPUS.

For active-duty families, TRICARE Standard pays 80 percent of the TRICARE allowable charge for covered health care services that are obtained from authorized, non-network, civilian health care providers. Those who receive the care are legally responsible for the other 20 percent of the allowable charge, plus other charges billed by "non-participating" providers, up to the legal limit of 15 percent above the allowable charge. Providers who "participate" in TRICARE accept the TRICARE allowable charge as the full fee for the care they provide.

Persons who use TRICARE Standard or Extra pay annual deductibles for outpatient care of $150 for one person, and $300 for a family (for active-duty military sponsors who are E-4 and below, the amounts are $50 for one person, and $100 for a family). TRICARE Extra features discounted cost-shares (15 percent of negotiated fees) when TRICARE network providers are used, but it's available only in the same geographic areas as the HMO-type health care option, TRICARE Prime.

Families of reserve/National Guard members who are called to active duty for 179 days or more may enroll in TRICARE Prime or may be eligible for TRICARE Prime Remote. But enrollment forms must be completed, and military medical facilities and/or TRICARE Prime network providers must be used.

Since many reserve families may have continuing relationships with providers who aren't in the TRICARE networks, enrolling in TRICARE Prime (and thereby having to use only providers who are part of the TRICARE Prime network) may not be the best choice for these families. TRICARE Standard may work better for them.

Also, persons who are covered by other health insurance (such as a civilian employer's health plan) should be aware that TRICARE pays after those plans have made their payments for health care services. The only time TRICARE is not second payer is when Medicaid (a public assistance program) is involved, or if the patient has a health care insurance policy that is specifically designated as a TRICARE supplemental policy. In those cases, TRICARE pays before the other insurance.

TRICARE Standard users should make sure that the provider from whom they seek health care has been certified by the regional TRICARE contractor as an authorized provider of care for TRICARE patients (check with the provider, or with the regional TRICARE contractor). If they receive services from a provider who is not authorized, the cost of services-even though they might otherwise be covered by the program-will not be shared by the government.

Activated reservists/National Guard members should check with their reserve centers or unit commanding officers to make sure that all information about themselves and their family members is current and accurate in the Defense Enrollment Eligibility Reporting System (DEERS) data base. Incorrect information can result in delayed claims processing, problems with the use of retail pharmacies and the National Mail Order Pharmacy (NMOP) benefit, and other difficulties. For information about DEERS enrollment, contact the DEERS Telephone Center from 6 a.m.-5 p.m., Pacific Time, toll-free, at 1-800-334-4162 (California only), 1-800-527-5602 (Alaska and Hawaii only), or 1-800-538-9552 (all other states).

If you're an activated reservist or National Guard member, you can get more information about your family's TRICARE Standard benefits from the TRICARE Standard Handbook. To get one, check with your nearest uniformed services hospital or clinic, or any TRICARE service center. Or, write to the TRICARE Management Activity, 16401 E. Centretech Pkwy., Aurora, CO 80011-9043.

You can also get information from the TRICARE Web site or from the Reserve Affairs Web site.

The TRICARE Dental Program (TDP) is a voluntary dental insurance program for the Selected Reserve, Individual Ready Reserve, and all eligible uniformed services family members. To be eligible, you must have at least 12 months of service commitment remaining and participate in the program for at least 12 months after which enrollment is month to month.

Selected Reserve members are responsible for just 40 percent of the monthly premium; the government pays the rest. Other Reserve component members are responsible for the full premium. When called to active duty for more than 30 days, you are eligible for dental care at military treatment facilities free of charge, and thus are disenrolled from the TRICARE Dental Program.

Eligible family members are invited to enroll, even if the sponsor, does not. Family members are responsible for the full premium, except when you are called to active duty for more than 30 days, which reduces the premium share to 40 percent; the government pays the rest. Although family members enroll under the sponsor’s Social Security number, there will be two separate premium payments — one for you, the sponsor, and one for family members. NOTE: Family members are not bound by the 12-month minimum enrollment commitment if the sponsor is ordered to active duty for a contingency operation as defined in law. In this case, you have 30 days from activation to submit the enrollment application. Family members must remain enrolled during the entire active duty period in support of the contingency operation.

Additional information on the TRICARE Dental Program is available at the United Concordia Companies, Inc. Web site at www.ucci.com, or call toll free 1-800-866-8499 for general information, or 1-888-622-2256 to enroll. To contact the Managed Care Support Contractor for your region, go the regional map