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Tricare and married military-affiliated couples.

Dual-eligibility households--those where the husband and wife have served or are serving in the military--face some special challenges when using their military health-care benefits. The principal problems faced by these households are the management of their benefits relative to their claims being processed.

If you are a Reservist married to an active-duty member, another Reservist, a retired military member or a retired active-duty member now serving in the Reserve, you may have experienced the misfortune of having some health-care claims denied and frustration of trying to untangle that web. Arming yourself with information and taking proactive actions will help you navigate these challenges and have an impact on the amount of out-of-pocket costs you will pay.

The bottom line is you must take an active role in determining your benefit entitlements. In general, married military-affiliated couples are enrolled under each other's record to establish that a relationship exists. Depending on the situation, entitlements are either activated or inactivated.

For example, if a Reserve member is a dependent under a retiree's record with benefits activated, they both would receive medical benefits under that record. If that Reserve member is activated for more than 30 days and enters an extended active-duty period or a subsequent Transitional Assistance Management Program period, she needs to have her entitlements under the retiree sponsor terminated. This action negates the eligibility under the retiree sponsor and allows the entitlement to reflect only under the Reserve member's record. In other words, if the couple wants the retired member to receive active-duty medical benefits under the activated Reserve member's status, they need to activate the entitlements for the retiree (and any other dependents) in the Reserve member's Defense Enrollment Eligibility Reporting System record.

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At this point, the retiree may elect to disenroll from the paid Tricare Prime program and enroll as a family member under the activated sponsor. Financially, this is practical, as the annual premium and co-pays for Tricare Prime under the retiree benefit are eliminated while the Reservist is on active-duty orders. Those using Tricare Standard no longer pay the higher deductibles and co-pays. Also, the annual catastrophic cap is lowered from $3,000 to $1,000 per fiscal year.

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Even if the retiree doesn't disenroll and keeps his paid Tricare Prime enrollment, he should consider disenrolling the activated Reserve spouse so the Tricare records don't show two different enrollments for the Reserve member when she picks up her own entitlement.

There is no automated process in DEERS or Tricare to make changes to who entitlements are applied. As a Reservist, that means you must assertively take action when your status changes between active duty and inactive duty. The process can become increasingly complicated when there are dependent children involved and no action is taken to instruct DEERS on how to reflect their benefit.

You can go to your military personnel flight for changes to DEERS. Don't forget to contact a Tricare service center or your managed care support contractor for Tricare enrollments. This should prevent any issues with eligibility and lab proper claims processing.

Transitional Health-Care Benefit Update

Before 2012, reserve component members who separated from active duty after serving for more than 30 days in support of a contingency operation were entitled to dental care under the Transitional Assistance Management Program in the same manner as a dependent. This consisted of only space-available dental care in a military dental treatment facility and was very limited.

As of Jan. 27, the law changed. Now, reserve component members who are on active duty for more than 30 days in support of a contingency operation and then 'separate receive the same dental care under TAMP as members of the uniformed services on active duty for more than 30 days. This enhanced benefit does not apply to the member's dependents.

Lt. Col. Alexander Alex

(Anyone who has a question regarding a benefit as it relates to a Reserve member or family beneficiary member may e-mail the Tricare advisor at Alexander.Alex@us.af.mil.)
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Title Annotation:From the TRICARE Advisor
Author:Alex, Alexander
Publication:Citizen Airman
Date:Jun 1, 2012
Words:669
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