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The new TRICARE Reserve Select program that started on April 26, 2005, provides some Reserve Component members* and their families continued access to TRICARE.
Reserve Component members called or ordered to active duty for more than 30 days in support of a contingency operation now have 180 days of health care coverage under the Transitional Assistance Management Program (TAMP) upon separation from duty and may also purchase further coverage under the new TRICARE Reserve Select heath plan.
What Is the Coverage?
Individuals who purchase TRICARE Reserve Select receive comprehensive coverage similar to the coverage available through TRICARE Standard and TRICARE Extra for active duty family member, including such TRICARE-covered services as:
- Urgent and emergency care, including ambulance services
- Family health care
- Obstetrics, gynecology and maternity services
- Clinical preventive services, including health screening and immunizations
- Behavioral health care, including partial hospitalization and residential treatment
- Annual eye examinations
- Durable medical equipment (DME) and supplies
- Ancillary services, such as laboratory and radiology
- Prescription drug coverage
They may receive care from any civilian TRICARE certified/authorized providers, TRICARE network or non-network. Care may also be accessed from an MTF on a space-available basis only. They also can fill prescription medications through MTF 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 on the TRICARE Web site at www.tricare.osd.mil/reserve/reserveselect.
The TRICARE Reserve Select card looks very similar to a TRICARE Prime card. Look for “TRICARE Reserve Select” at the top of the card. Make a copy of the card for the patient’s file as proof of enrollment. TRICARE Reserve Select requires that you collect the appropriate cost-share from the beneficiary at the time of the visit.
What Services under TRICARE Reserve Select Require Prior Authorization?
TRICARE Reserve Select beneficiaries require prior authorization from Humana Military for the following services:
- 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
- Home health services
- Hospice care
- Hysterectomy
- Inpatient nonemergency mental health admissions
- Outpatient mental health visits beyond the 8th visit or more frequently than one per week
- 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?
TRICARE Reserve Select beneficiary claims should be submitted to PGBA in the same manner as TRICARE Standard/Extra beneficiary claims. The claims address for submitting TRICARE Reserve Select 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 using their current methodologies.
Where Should I Direct Questions?
Humana Military administers TRICARE Reserve Select in the TRICARE South Region and provides customer service, including plan enrollment and claims payment.
You may contact Humana Military at 1-800-444-5445 or visit www.humana-military.com if you have questions or need additional information about TRICARE Reserve Select.
You may also visit www.tricare.osd.mil/reserve/reserveselect for more information on coverage offered by TRICARE Reserve Select.
Reserve Component members who meet the following qualifications may be eligible for the TRICARE Reserve Select program:
- The member is called or ordered in support of a contingency operation under Title 10 for a period of greater than 30 days. (This is retroactive to Reserve Component members who were called to active duty in support of a contingency operation on or after Sept. 11, 2001.)
- The member must have served continuously on active duty for 90 days or more under such call or order*—the length of time served determines the maximum period of coverage you may purchase under TRICARE Reserve Select.
* If the Reserve Component member is otherwise eligible, but did not serve continuously on active duty for 90 days under that call-up due to an injury, illness or disease incurred or aggravated while they were activated, they may be eligible for one year of coverage.
- The member agrees to serve in the Selected Reserve for a length of time (in whole years) equal to or less than the period of eligibility for TRICARE Reserve Select.
- If the member separated from qualifying active duty service after April 26, 2005, the member must (1) enter into a Service Agreement by the last day of active duty, (2) execute the Service Agreement with the Service/Reserve Component and (3) submit a completed enrollment form and initial premium payment to Humana Military so they receive it 30 days before the end of TAMP.
- If the member separated from qualifying active duty service on or before April 26, 2005, the member and the Service/Reserve Component must execute a Service Agreement no later than October 28, 2005.
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