TRICARE Reserve Select

Army Reserve: Drilling

Benefit Fact Sheet

Summary

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

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 2020. 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. According to the IRS, these forms are not required to prepare or file income tax returns but will be available via myPay no later than 31 January 2021.

Eligibility

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

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 effective 1 January 2021

Type of Coverage

2021

Member Only

$47.20 per month

Member and Family

$238.99 per month


Costs that apply to TRICARE Select; 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:

  • $52 per individual, but no more than $105 per Family

Sponsor Rank E5 and above:

  • $158 per individual, but no more than $317 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 January 1, 2021

Deductibles

Deductible

E1-E4: $52 per individual and $105 per family

E5 & above: $158 per individual and $317 per family

Catastrophic Cap

Catastrophic Cap

$1058

Health Plan Costs

Outpatient Visit - Primary

Network: $15

Non-network: 20%

Outpatient Visit - Specialty

Network: $26

Non-network: 20%

Urgent Care

Network: $21

Non-network: 20%

Emergency Services

Network: $42

Non-network: 20%

Laboratory and X-Ray

Network: $0

Non-network: 20%

Ambulance Services

Outpatient:
Network: $15
Non-network: 20%

Inpatient: 20%

Ambulatory Surgery (Same Day)

Network: $26

Non-network: 20%

Mental Health (Inpatient)

Network: $63 per admission

Non-network: 20%

Mental Health (Outpatient/Partial Hospitalization) - Primary Care

Network: $15

Non-network: 20%

Mental Health (Outpatient/Partial Hospitalization) - Specialty Care

Network: $26

Non-network: 20%

Mental Health (Residential Treatment Facility)

Network: $26/day

Non-network: $52/day

Clinical Preventive Services

$0

Durable Medical Equipment, Prosthetics, and Medical Supplies

Network: 10%

Non-network: 20%

Home Health Care

$0

Hospice Care

$0 (Medical equipment and pharmacy are billed separately)

Hospitalization (Inpatient Care)

Network: $63 per admission

Non-network: 20%

Immunizations

$0

Maternity (Delivery/Inpatient)

Network: $63 per admission

Non-network: 20%

Maternity (Delivery/Birthing Center)

Network: $26

Non-network: 20%

Maternity (Home) - Primary

Network: $15

Non-network: 20%

Maternity (Home) - Specialty

Network: $26

Non-network: 20%

Newborn Care

Network: $0

Non-network: 20%

Skilled Nursing

Network: $26

Non-network: $52

Click here for overseas cost shares.

Additional Information

For more information or to enroll:
https://tricare.mil/Plans/HealthPlans/TRS?sc_database=web

https://milconnect.dmdc.osd.mil/milconnect/

Select your region to learn more about your payment options:

TRICARE Information for Guard and Reserve Service members:
https://tricare.mil/RESERVE

TRICARE DEERS Information:
https://tricare.mil/DEERS

Document Review Date: 20 January 2021