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TRICARE Reserve Select Health Plan (Article 17)
Understanding Your Role
Certain National Guard/Reserve1 members may purchase TRICARE Reserve Select coverage for themselves and their eligible family members.

What Is the Coverage?

Individuals who purchase TRICARE Reserve Select receive the same comprehensive coverage as active duty family members under TRICARE Standard and TRICARE Extra, including access to military hospitals and clinics on a space-available basis only. They may fill prescription medications through military pharmacies, the TRICARE Mail Order Pharmacy (TMOP) program or at TRICARE retail network and non-network pharmacies.

For more information about covered services, refer to the TRICARE Reserve Select Handbook online.

Members and their covered family members are issued a TRICARE Reserve Select card. Remember that you must collect the appropriate cost-share for visits.


What Services under TRICARE Reserve Select Require Prior Authorization?
Like other TRICARE coverage, the following services require prior authorization from Humana Military:
 
  • Adjunctive dental services
  • Admission or transfer to skilled nursing facilities (SNFs), rehab hospitals and long term acute care (LTAC) facilities
  • Blepharoplasty
  • Durable medical equipment (DME)—electronic hospital bed, continuous positive airway pressure (CPAP) machine, apnea monitor, patient lifts, pneumatic compressor, bone stimulator, continuous passive motion (CPM) machine, power vehicle or wheelchair, certain orthotics, certain prosthetics, any miscellaneous code if line item rental or purchase price is greater than $500
  • Electroconvulsive therapy (ECT)
  • Home health services
  • Hospice care
  • Hysterectomy
  • Inpatient nonemergency mental health admissions (including substance use)
  • Outpatient crisis intervention
  • Outpatient mental health visits beyond the eighth visit or more frequently than once per week
  • Psychoanalysis
  • Psychological and neuropsychological testing
  • Reduction mammoplasty
  • Septoplasty
  • Speech therapy
  • Transplants for solid organ and stem cell
  • Termination of pregnancy
  • Uvulopalatopharyngoplasty (UPPP)

Where Do I Submit TRICARE Reserve Select Claims?
As with all other TRICARE health plans, TRICARE network providers are required to file their claims electronically. Should a provider have to file a paper claim, it should be submitted to PGBA in the same manner as TRICARE Standard/Extra beneficiary claims. The claims address for submitting TRICARE Reserve Select paper claims is:
 

PGBA South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
TRICARE network providers should submit claims to Humana Military/PGBA the same way they do other TRICARE claims.

Where Should I Direct Questions?

Humana Military administers TRICARE Reserve Select in the TRICARE South Region and provides customer service, including enrollment, premium collection and claims payment.

You may contact Humana Military at 1-800-444-5445 or visit the TRICARE Reserve Select page if you have questions or need additional information about TRICARE Reserve Select.
 
1 National Guard/Reserve includes the Army National Guard, the Army Reserve, the Navy Reserve, the Marine Corps Reserve, the Air National Guard, the Air Force Reserve, and the U.S. Coast Guard Reserve.


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Last Reviewed:  February 2, 2007