TRS is a premium-based health plan offered by DoD that provides comprehensive health care coverage to members of the National Guard and Reserve who meet specific eligibility requirements.
Verifying TRS Coverage
After purchasing TRS, each member and covered family member receives a TRS enrollment card. You should make a photocopy of the front and back of the card for your files. Providers should verify patient eligibility by visiting MyHMHS for Providers or PGBA’s Web site.
Figures 4.3 and 4.4 show an example of the TRS enrollment card.
Figures 4.3 & 4.4 TRS Enrollment Card-Front and Back
TRS Coverage
TRS offers comprehensive coverage and patient cost-shares and deductibles similar to TRICARE Standard and TRICARE Extra. TRS members may access care from any TRICARE-authorized provider, hospital, or pharmacy—network or non-network.
See the Medical Coverage section for more information about TRICARE-covered benefits and costs. Prior Authorizations and Referrals
TRS members may access care from any TRICARE-authorized provider, network or non-network, without a referral.
TRICARE requires prior authorization* for certain services, e.g., inpatient admissions for substance use disorders or behavioral health, adjunctive dental care, home health services, hospice care, transplants, psychoanalysis, and psychotherapy after the initial eight behavioral health outpatient visits.
See the Health Care Management and Administration section of this handbook for more information. *View a list of services requiring prior authorization and how to submit and receive authorization before rendering care.
Claims and Reimbursement
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