TRICARE Reserve Select

Army Reserve: Drilling

Benefit Fact Sheet

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Summary:

TRICARE Reserve Select (TRS) provides qualified National Guard and Reserve members a premium-based healthcare plan, similar to TRICARE Standard and Extra, through payment of a monthly premium.

Beginning in January 2016, DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former Spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2015. An IRS Form 1095 documents you (and your Family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized Family members. The forms will be required to be reported with your 2015 federal tax return. DFAS will provide you with IRS Form 1095 series forms no later than Jan. 31, 2016.

Eligibility:

Army Reserve Soldiers on drilling status are eligible for TRICARE Reserve Select.

Benefit Highlights:

TRICARE Reserve Select (TRS) is available worldwide to most Selected Reserve (National Guard and Reserve) members and their Families when the military member is NOT on active duty orders or covered under the Transitional Assistance Management Program. To participate in TRS the military member must qualify for and purchase coverage. The payment of monthly premiums is required and failure to pay premiums on time may result in disenrollment and an enrollment lockout.

TRS offers comprehensive health care coverage that includes TRICARE's prescription drug coverage. Beneficiaries are able to visit any TRICARE-authorized provider or qualified host nation provider (if located overseas), and pay fewer out-of-pocket costs when choosing a provider in the TRICARE network (network providers are not available overseas). Under TRS, beneficiaries are able to utilize military treatment facilities (MTFs) on a space-available basis.

No referrals are required to seek specialized care but some types of care may require prior authorization. On some occasions you may be required to pay for health care services at the time they are received and then file for reimbursement, and submit health care insurance claims.

Enrollment in TRS is open; those who qualify can purchase coverage at any time of the year not just during an "open season".

TRICARE Reserve Select premium rates through December 31, 2016 are:

Type of Coverage

2016

Member Only

$47.90 per month

Member and Family

$210.83 per month


Costs that apply to TRICARE Standard and TRICARE Extra apply to active duty Family Members (ADFMs) apply to all individuals (including the Guard/Reserve member) covered under TRS. Premiums are adjusted on an annual basis, effective January 1.

Annual Outpatient Deductible: You must meet the annual outpatient deducible each fiscal year (October 1 - September 30) before cost sharing begins:

  • Sponsor Rank E4 and below: $50 per individual, but no more than $100 per Family
  • Sponsor Rank E5 and above: $150 per individual, but no more than $300 per Family

Cost Shares: You're responsible to pay a cost share based on the type of care and type of provider you see (network vs. non-network). Non-network providers may charge up to 15% above the TRICARE allowable charge. You are also responsible for these extra charges.

Some inpatient cost shares are subject to change each fiscal year (FY), October 1st through September 30th each year. The costs for care in the U.S. below are effective October 1, 2015.

Type of Care

Network Provider

Non-Network Provider

Ambulance Services

15% of negotiated fee

20% of allowable charge

Ambulatory Care (Same Day Surgery)

$25 per visit

$25 per visit

Behavioral Health

Inpatient: $20 per day ($25 minimum)

Outpatient: 15% of the negotiated rate

Inpatient: $20 per day ($25 minimum)

Outpatient: 20% of the negotiated rate

Clinical Preventive Services

$0 for the following services:

  • Cancer Screenings* (colorectal, breast, cervical and prostate)
  • Immunizations*
  • Well-Child visits for Children under age 6 (birth through age 5)
  • For all other preventive services: 15% of negotiated fee

    $0 for the following services:

  • Cancer Screenings* (colorectal, breast, cervical and prostate)
  • Immunizations*
  • Well-Child visits for Children under age 6 (birth through age 5)
  • For all other preventive services: Non-Network: 20% of allowable charge

    DME, Prosthetic Devices, Medical Supplies

    15% of negotiated fee

    20% of allowable charge

    Emergency Services

    15% of negotiated fee

    20% of allowable charge

    Home Health Care    

    $0

    $0

    Hospice Care

    $0

    $0

    Hospitalization (Inpatient)

    $18.00 per day ($25 minimum)

    $18.00 per day ($25 minimum)

    Immunizations

    $0

    $0

    Maternity (office visits and hospitalization for delivery planned in a hospital in an inpatient setting)

    $18.00 per day ($25 minimum)

    Note: This is one global fee for all of the maternity care and delivery.

    $18.00 per day ($25 minimum)

    Note: This is one global fee for all of the maternity care and delivery.

    Maternity (office visits for delivery planning in a TRICARE-authorized birthing center)

    $25 per visit

    $25 per visit

    Maternity (office visits for delivery planned at home or other setting)

    15% of negotiated fee

    20% of allowable charge

    Newborn Care

    The lower of the number of hospital days minus three multiplied by $18.00, or 25% of the total billed charges.

    The lower of the number of hospital days minus three multiplied by $18.00, or 25% of the total billed charges.

    Outpatient Visit

    15% of the negotiated rate

    20% of the allowable charge

    Skilled Nursing (Inpatient)

    $18.00 per day ($25 minimum charge)

    $18.00 per day ($25 minimum charge)

    *This includes the office visit for beneficiaries age 6 and older when a covered cancer screening or immunization is provided during the visit.

    Click here for overseas cost shares.

    Additional Information:

    For more information or to enroll:
    http://www.tricare.mil/Welcome/Plans/TRS.aspx

    Select your region to learn more about your payment options:

    TRICARE Information for Guard and Reserve Soldiers:
    www.tricare.mil/~/media/Files/TRICARE/Publications/FactSheets/Choices_NGR_FS.pdf

    TRICARE DEERS Information:
    http://www.tricare.mil/Welcome/Eligibility/DEERS

    Document Review Date: 29 March 2016