TRICARE Policy Manual 6010.60-M, April 1, 2015
Eligibility And Enrollment
Chapter 10
Section 2.1
TRICAREPrime And TRICARE Select Enrollment
Issue Date:May 15, 1996
Authority:32CFR 199.17
Revision:C-116, August 21, 2023
1.0POLICY (Through December 31,2017)
1.1Inorder to receive the expanded benefits and special cost-sharingof TRICARE Prime, all beneficiaries must take specific action toenroll. For Active Duty Service Members (ADSMs) located in areaswhere the TRICARE Program is implemented, enrollment in TRICAREPrime is mandatory. An enrollment action must be completed and officiallydocumented (enrollment form, the Government furnished web-basedself-service enrollment system/application transaction or telephonicrequest documented in the contractor’s call notes) to ensure DefenseEnrollment Eligibility Reporting System (DEERS) enrollment datais current and claims are processed expeditiously.
1.1.1EnrollmentProcedures
1.1.1.1No non-active duty beneficiaryshall be enrolled unless the beneficiary is shown as eligible onthe DEERS. All enrollments and re-enrollments shall be recordedon the DEERS.
1.1.1.2Enrollment may occur at anytime; however, the enrollment period shall coincide with the fiscalyear (i.e., the beneficiary’s initial enrollment expires on October1; all future enrollment periods will be October 1 to September30). Enrollment may be on an individual or family basis.
1.1.1.3The contractor shall collectenrollment fees from TRICARE Prime enrollees, as appropriate, andforwards all such fees to the Government.
1.1.1.4Payment of enrollment feesmay be made on an annual or quarterly basis by credit card and formonthly enrollment fee payments, by Electronic Fund Transfers (EFTs)or an allotment from retirement pay. No administrative fees arecharged to enrollees who choose to pay monthly or quarterly.
Note:Effective March 26, 1998, theTRICARE Prime enrollment fee is waived for those enrollees who haveMedicare Part B, regardless of age. Dual eligibles age 65 and older,who have an Active Duty (AD) sponsor or who are not entitled topremium-free Medicare Part A on their own record, or the recordof their current, former, or deceased spouse may enroll in TRICAREPrime. See the TRICARE Operations Manual (TOM), Chapter 6, Section 1.
1.1.1.5TRICARE Prime enrollments foreligible enrollees shall be automatically renewed upon the expirationof the enrollment unless the enrollee declines renewal, is no longereligible for TRICARE Prime enrollment or fails to pay the enrollmentfee on a timely basis.
1.1.1.6Family members of Reserve Component(RC) members who have been ordered to active duty for a period of31 days or more may enroll in TRICARE Prime. RCs include both reservistsand members of the National Guard. Members of the National Guardare included only if ordered to federal duty. All requirements ofthis and other services apply to these beneficiaries. Activatedmembers of RCs are treated the same as any other ADSM.
1.1.2Enrollment Protocols
1.1.2.1Beneficiaries, enrolling inTRICARE Prime or TRICARE Prime Remote (TPR), may apply to enrollin a Region other than their home of residence Region. All TRICAREPrime and TPR enrollment, Primary Care Manager (PCM) selection andutilization, and referral policies apply. See the TOM, Chapter 6, Section 1 and Chapter 16, Section 1. (Note: This paragraphdoes not apply to TOP Prime or TOP TPR beneficiaries.)
1.1.2.2No eligible beneficiary whor*sides in the TRICARE region shall be denied enrollment or re-enrollmentin, or be required to disenroll from, the TRICARE Prime programbecause of a prior or current medical condition.
1.1.2.3The contractor shall providebeneficiaries who enroll full and fair disclosure of any restrictionson freedom of choice that may be applicable to enrollees includingthe Point of Service (POS) option.
1.1.2.4TRICARE for Life (TFL) beneficiaries(retirees and their family member(s) who are age 65 and over andare eligible for both Medicare and TRICARE) cannot enroll in TRICAREPrime. However, any beneficiary who is enrolled in TRICARE Primeat the time they attain their Medicare entitlement based on agewill be permitted to enroll with a Market/Military Treatment Facility(MTF) through TRICARE Plus, to the extent capability and capacityexists in the Market/MTF. There shall be no TRICARE Plus affiliation withnetwork providers.
1.1.2.5Dual eligibles under age 65(retirees and their family member(s) who have Medicare Parts A andB) have TFL coverage but may elect to enroll in TRICARE Prime. Dualeligibles who are Active Duty Family Members (ADFMs) (any age) alsohave TFL but may elect to enroll in TRICARE Prime or TRICARE Select.See the TOM, Chapter 6, Section 1.
1.1.2.6TRICARE and the Military HealthSystem (MHS) beneficiaries who are not eligible to enroll in TRICAREPrime may register for the purpose of accessing space-availablecare in the Market/MTF and customer services. This registrationis NOT enrollment in TRICARE Prime and no TRICARE Prime program benefitsor services (other than access to customer services and networkproviders) applies to this beneficiary group.
1.1.3Retroactive Enrollment
For emergency cases that shouldbe placed under immediate case management, Market Directors/MTF Directorsmay approve exceptions on a case-by-case basis for retroactive enrollmentwith an effective date not earlier than the first day of the monththat the application is submitted. Chief, Managed Care Support ProgramSection (MCSPS) may approve exceptions on a case-by-case basis forretroactive enrollment to a network provider with an effective datenot earlier than the first day of the month that the applicationis submitted.
1.1.4EffectiveDate of Enrollment
1.1.4.1Aninitial enrollment period shall begin on the first day of the monthfollowing the month in which the enrollment request (enrollmentform, Government furnished web-based self-service enrollment system/applicationtransaction, or telephonic request received by the contractor) and enrollmentfee payment, if applicable, are received by the contractor. If therequest and fee are received after the 20th day of the month, enrollmentwill begin on the first day of the second month after the monthin which they were received by the contractor.
1.1.4.2Reenrollments for those whowere enrolled in TRICARE Prime immediately prior to a change intheir status:
1.1.4.2.1Whenan ADSM’s retirement date is established, a TRICARE Prime enrollmentrequest to reenroll (enrollment form, Government furnished web-basedself-service enrollment system/application transaction, or telephonicrequest received by the contractor) must be completed within 90 daysfollowing the member’s retirement. The effective date of reenrollmentshall be the date of retirement, which will result in seamless TRICAREPrime benefits with no break in coverage. Otherwise, the requestshall be considered an initial enrollment in TRICARE Prime and effectiveaccording to the provisions of paragraph 1.1.4.1.
1.1.4.2.2When an ADSM separates otherthan the first of the month, but continues to be eligible (e.g.,is the spouse of an ADSM; or is eligible for Transitional AssistanceManagement Program (TAMP)) they and any eligible family membersshall be allowed to reenroll in TRICARE Prime with no break in coverage.TAMP eligibles must request enrollment in TRICARE Prime (enrollmentform, Government furnished web-based self-service enrollment system/applicationtransaction, or telephonic request received by the contractor) priorto the expiration of their period of TAMP eligibility to reenrollin TRICARE Prime. Non-TAMP eligibles separating but who remain eligiblefor TRICARE must request enrollment in TRICARE Prime within 30 daysof their change in status. Otherwise, the request shall be consideredan initial enrollment in TRICARE Prime. The effective date of reenrollmentshall be the start date of TAMP eligibility or the date of the separationwhich will then result in seamless TRICARE Prime benefits with nobreak in coverage.
1.1.4.2.3TAMP eligible family memberswho were enrolled in TRICARE Prime immediately prior to their sponsor’schange in status to active duty may continue their enrollment inTRICARE Prime with no break in coverage if they request reenrollmentin TRICARE Prime (enrollment form, Government furnished web-basedself-service enrollment system/application transaction, or telephonicrequest received by the contractor) within 30 days of their sponsor’sreturn to active duty status. If they request reenrollment within30 days of the sponsor’s return to active duty status, the reenrollmentwill be retroactive to the date of the change in status from TAMPto active duty. If reenrollment is not accomplished within 30 daysof the sponsor’s return to active duty status, the twentieth ofthe month rule will apply. For information on the effective datesof enrollments for Service members, see the TOM, Chapter 6, Section 1.
1.1.5Beneficiaries shall be disenrolledwhen they are no longer eligible for TRICARE or when they do notsubmit payment for prescribed enrollment fees by the required date.
1.2Portability
Enrollees may transfer enrollmentwhen they move (within a contract area or outside a contract area). Thetransfer request or disenrollment may be submitted using an enrollmentform, the Government furnished web-based self-service enrollmentsystem/application transaction or telephonic request received anddocumented by the contractor. The losing contractor shall providecontinuing coverage until:
•The enrollee requests enrollmentin the new location;
•The enrollee disenrolls;
•The enrollee is no longer eligiblefor enrollment in TRICARE Prime; or
•The contractor shall disenrollthe beneficiary for failure to pay required enrollment fees, whichever occursfirst.
The authorization and referralrules of the losing contractor shall continue to apply until enrollmentis transferred or the beneficiary is disenrolled (see the TOM, Chapter 6, Section 2).
2.0Policy (Starting January 1,2018)
2.1In order to receive the expandedbenefits and special cost-sharing of TRICARE Prime and TRICARE Select,beneficiaries must take specific action to enroll in TRICARE. For ADSMs locatedin areas where the TRICARE Program is implemented, enrollment inTRICARE Prime is mandatory. An enrollment action must be completedand officially documented (enrollment form, the Government furnished web-basedself-service enrollment system/application transaction or telephonicrequest documented in the contractor’s call notes) to ensure DEERSenrollment data is current and claims are processed expeditiously.The enrolling contractor shall accept enrollment actions via themethods described in this paragraph.
2.2Beneficiaries eligible for,but not enrolled in TRICARE Prime or TRICARE Select, no longer have coverageunder the TRICARE Program (including the TRICARE retail pharmacyand mail order pharmacy programs). However, they maintain eligibilityfor space-available care in Markets/MTFs.
2.3Enrollment Procedures
2.3.1No non-active duty beneficiaryshall be enrolled unless they are shown as eligible on the DEERS.All enrollments and re-enrollments shall be recorded on the DEERS.
2.3.2Enrollmentwill occur during the TRICARE open season enrollment period priorto the beginning of each plan year, which operates with the calendaryear. An enrollment choice will be effective for the plan year.Beneficiaries may choose to enroll, change, or terminate TRICAREPrime or TRICARE Select coverage from the Monday of the second fullweek in November to the Monday of the second full week in Decemberof each calendar year. There is a limited grace period exceptionto this enrollment requirement for calendar year 2018, as providedin National Defense Authorization Act (NDAA) FY 2017, Section 701(d)(3),to give TRICARE Prime or TRICARE Select eligible beneficiaries anotherchance to adjust to this new requirement for annual enrollment endingon December 31, 2018. See TOM, Chapter 6, Section 1.
Note:In any given year, if the daterange detailed in paragraph 2.3.2 for the open season enrollmentperiod amounts to less than 30 days as required in 32 CFR 199.17(o)(1)(i), the Defense HealthAgency (DHA) will add days to the end of the date range detailedabove in order for the open season enrollment period to total 30days. The DHA will communicate the resulting final date range for theopen season enrollment period to the contractor for the years wheresuch added days are required.
2.3.2.1If electing to change theirTRICARE coverage during the TRICARE open season enrollment period,the newly elected coverage will begin on January 1 of the followingyear and will continue in effect until they lose eligibility orrequest to change their coverage when authorized.
2.3.2.2If a beneficiary chooses tonot elect to change their TRICARE coverage during the open enrollmentperiod, the coverage will be continued until the end of the nextcalendar year unless otherwise terminated.
2.3.3Qualifying Life Events (QLEs)
As an exception to the openenrollment period rule, enrollment changes can be made during theplan year for certain QLEs, to include:
•Marriage, divorce, or annulment;
•Birth or adoption of a child;
•Placement of a child by a courtin a member’s home;
•Change in sponsor status thatresults in ineligibility to continue existing TRICARE coverage;
•Gain or loss of command sponsorship(overseas only);
•Loss of sponsor or family membereligibility (age, Medicare, etc.);
•Relocation to a new country,and city (OCONUS), region or ZIP +4 code (date received or date specifiedby the beneficiary in the future) (self-attestation);
•Gain or loss of Other HealthInsurance (OHI) (self-attestation);
•Lossof Medicare entitlement (not applicable for loss of Medicare coveragefor failing to sign up on time for Medicare coverage or failingto pay Medicare premiums);
•For individualsunder age 65 and who gain entitlement to Medicare Part A and haveMedicare Part B;
•For family membersof a Medicare recipient who gains or loses Medicare entitlement;
•Death of a sponsor, spouseor child;
•Change in eligibility statusof any single family member in another family (e.g., joint service member);
•Upon reflection of delayedgain or loss of retroactive eligibility in DEERS (see paragraph 2.3.3.1.3 for exception);
•Change in family composition(gaining family only): Beneficiaries with multiple sponsors whose eligibilityto enroll is established from one sponsor to another in DEERS withoutevidence of any other QLE. However, this QLE cannot be used in theGovernment furnished web-based self-service enrollment system/application.Beneficiaries must contact the contractor to use this QLE.
•Government Directed PCM Changes:If a Market/MTF requires a TRICARE Prime enrollee to move from anetwork PCM to a Market/MTF PCM or vice versa, the enrollee maychoose to agree with the PCM change or may enroll in TRICARE Select.
•Government Directed Plan change:If the Government no longer offers a TRICARE enrolled health planin one or more areas, affected beneficiaries may elect to enrollin another qualified TRICARE health plan.
2.3.3.1Enrollment must be within 90days of the date of the QLE. Coverage starts as of the date of theQLE. Applicable enrollment fees must be paid for that period. ForQLEs resulting from address changes, the date ofrelocation will be the address effective date on DEERS. Thebeneficiary must report the address change within the 90 days followingtheir change of address. Whenever DEERS supports entryof a future effective date for a QLE event, DEERS will allow a QLEenrollment action up to 90 days prior to that date. The enrollmentaction will be effective the date of the QLE. This includes self-attest QLEswith a future effective date.
Note:Per the TOM, Chapter 6, Section 2, the contractorshall not process a retroactive disenrollment that allows avoidanceof POS cost-sharing provisions.
2.3.3.1.1EXCEPTION: ForUniformed Services retirements that occur on or after January 1,2018, upon request, the contractor shall enroll retired servicemembers and their family members into TRICARE Prime (if qualified)or TRICARE Select coverage retroactive to the date of retirementif the enrollment request is received within 12 calendar monthsof the retirement date and as long as all enrollment fees (if applicable)back to the retirement date are paid. The effective start date ofcoverage must be the member’s retirement date. However, if the effectiveretirement date occurred between January 1, 2018 and May 1, 2018,the contractor shall accept and process retroactive enrollment requestsif received by May 1, 2019, and charge appropriate enrollment feesretroactive to the effective retirement date. The effective coveragedate remains the date of retirement. Otherwise, for retroactive enrollmentrequests received after May 1, 2019, thatrequest a retroactive enrollment date greater than 12 months inthe past or request a start of coverage date other than the dateof retirement, then open season and QLE rules apply.
Note:This exceptiondoes not apply to Retired Reservists who become eligible to drawretired pay before their 60th birthday in accordance with 10 USC§1074(b)(2). If the Retired Reservist turns 60 (becomes eligiblefor TRICARE Prime and TRICARE Select) and the retirement has notbeen processed within 90 days of the QLE, the aforementioned exceptionshall apply.
2.3.3.1.2EXCEPTION: ForUnremarried Former Spouses (URFS) who become eligible for TRICARE astheir own sponsor on or after January 1, 2018, upon request, thecontractor shall enroll them into TRICARE Prime (if qualified) orTRICARE Select coverage retroactive to the date of eligibility asan URFS if the enrollment request is received within 12 calendarmonths of the initial eligibility date as an URFS and as long asall enrollment fees (if applicable) back to the initial URFS eligibilitydate are paid. The effective start date of coverage must be initialURFS eligibility date. However, if the effective date of their eligibilityas an URFS occurred between January 1, 2018 and May 1, 2018, thecontractor shall accept and process retroactive enrollment requestsif received by May 1, 2019. The effective coverage date remainsthe date of eligibility as an URFS. Otherwise, for retroactive enrollmentrequests received after May 1, 2019 that request a retroactive enrollmentdate greater than 12 months in the past or request start of coveragedate other than the date of eligibility as an URFS, then open seasonand QLE rules apply.
2.3.3.1.3EXCEPTION: Thecontractor shall, upon request, in the case of retroactive eligibility determinationsthat occur on or after January 1, 2018, enroll Service members andtheir family members into TRICARE Prime (if qualified) or TRICARESelect coverage retroactive to the date of eligibility as assignedin the Uniformed Services personnel systems as long as all enrollmentfees (if applicable) back to the retroactive eligibility date arepaid. The effective start date of coverage must be the date reflectedin DEERS as adjusted by the Uniformed Service. Without a retroactiveeligibility date reflected in Uniformed Services personnel systemsand DEERS, Open Season and QLE rules apply for retroactive enrollmentrequests received after January 1, 2018.
Note:The one year limitation onsubmittal of claims in the TOM, Chapter 8, Section 3, paragraph 2.1.1, iswaived for those retroactively enrolled with an effective coveragedate between January 1, 2018 and May 1, 2019. The contractor doesnot need to identify these claims; however, the contractor shalladjust claims when beneficiaries bring them to the contractor’sattention.
2.3.3.2A QLE for one beneficiary ina sponsor’s family permits a change in the sponsor’s enrollmentor other family member’s enrollment status during the QLE period.A specific QLE may only be used once to make a change in enrollmentstatus.
2.3.3.3Overlapping QLEs. If the beneficiaryhas more than one QLE that have overlapping 90-day periods, thebeneficiary will be allowed to pick which QLE to use. If the beneficiarychooses a later QLE, the previous QLEs will no longer be availableto use. For example: A beneficiary loses OHI on January 1st andhas a child on February 1st. Within 90 days for either QLE, thebeneficiary may change their enrollment status based upon the lossof OHI or for the birth of a child, whichever QLE they decide to use.If the beneficiary chooses to use the latter QLE to make an enrollmentchange, they may no longer use the earlier QLE (loss of OHI in thisexample). If the beneficiary makes a QLE enrollment status changebut then changes their mind, they must contact the contractor tomake the change if they are within the 90-day period of a validQLE. The beneficiary will be unable to take this action in the Governmentfurnished web-based self-service enrollment system/application.
2.3.3.4Enrollment choices made duringopen season can be changed if there is a QLE that happens betweenthat choice and December 31st of that year.
2.3.3.5The Director, DHA or designee,reserves the right to direct the contractor to change an enrollmentregardless of the QLE rules.
2.3.3.6Canceling a QLE event invalidatesthe QLE. If a projected QLE does not happen, the beneficiary canrequest the previous coverage to be reinstated as long as they arewithin 90 days of the projected QLE. In the Government furnishedself-service web-based enrollment system/application, once a QLEis selected (or declined) no more actions may be made based uponthat QLE. This includes future QLEs.
2.3.3.7A reinstatement of eligibilityis not a QLE. Extending the previous eligibility is not a QLE.
2.3.3.8Enrollment portability andPCM changes are not limited to the open enrollment period and donot require a QLE.
2.3.3.8.1A PCM change within region canoccur at any time even if address does not change. The regionalcontractor shall verify that PCM assignment complies with Market/MTFMemorandum of Understanding/Statement of Responsibilities (MOU/SOR).
2.3.3.8.2For overseas, in country movesshall be treated as PCM changes. This will be enforced when theTRICARE Overseas contractor receives the Policy Notification Transaction(PNT).
2.3.3.8.3TRICARE Prime Uniformed ServicesFamily Health Plan (USFHP) enrollees who are not otherwise TRICARE-eligible(i.e., grandfathered Medicare eligible beneficiaries who only havePart A) may only transfer enrollment from one USFHP to another USFHP;they may not transfer to a Managed Care Support Contractor (MCSC).
2.3.4The contractor shall collectenrollment fees from TRICARE Prime or TRICARE Select enrollees,as appropriate, and keeps or forwards all such fees to the Government,as required by the contract.
2.3.5Payment of enrollment feesmay be made on an annual or quarterly basis by credit card and formonthly enrollment fee payments, by EFTs or an allotment from retirementpay. No administrative fees are charged to enrollees who chooseto pay monthly or quarterly.
Note:Effective March 26, 1998, theTRICARE Prime enrollment fee is waived for those enrollees who haveMedicare Part B, regardless of age. Dual eligibles age 65 and older,who have an active duty sponsor or who are not entitled to premium-freeMedicare Part A on their own record, or the record of their current,former, or deceased spouse, may enroll in TRICARE Prime. See TOM, Chapter 6, Section 1.
2.3.6TRICARE enrollments for eligibleenrollees shall be automatically renewed upon the expiration ofthe enrollment unless the enrollee declines renewal, is no longereligible for enrollment or fails to pay the enrollment fee on atimely basis, as applicable.
2.3.7Family members of ActivatedMembers of RCs. Family members of RCs who have been ordered to activeduty for a period of 31 days or more may enroll in a TRICARE Primeoption as qualified or TRICARE Select. RCs include both reservistsand National Guard Service Members. National Guard Service Membersare included only if ordered to federal duty. All requirements ofthis and other services apply to these beneficiaries, includingautomatic enrollment. Activated members of RCs are treated the sameas any other ADSM.
2.4Enrollment Protocols
2.4.1Beneficiaries, enrolling in TRICAREPrime or TPR, may apply to enroll in a Region other than their homeof residence Region. All TRICARE Prime and TPR enrollment, PCM selectionand utilization, and referral policies apply. See TOM, Chapter 6, Section 1 and Chapter 16, Section 1. (Note: This paragraphdoes not apply to TOP Prime or TOP Prime Remote beneficiaries.)
2.4.2No eligible beneficiary whor*sides in a TRICARE region shall be denied enrollment or re-enrollmentin, or be required to disenroll from a TRICARE health plan becauseof a prior or current medical condition.
2.4.3The contractor shall providebeneficiaries who enroll full and fair disclosure of any restrictionson freedom of choice that may be applicable to TRICARE Prime (includingthe POS option) and TRICARE Select.
2.4.4TFL beneficiaries (retireesand their family members who are age 65 and older and are eligiblefor both Medicare and TRICARE) cannot enroll in TRICARE Prime (exceptionfor those Medicare eligible retirees over age 65 who were enrolledin USFHP TRICARE Prime prior to October 1, 2012). Retirees and theirfamily members under age 65 who have Medicare coverage can enrollin TRICARE Prime if they have Medicare Part B. TRICARE Prime enrollmentfees may be waived if the beneficiary has Medicare Part B. TRICAREPrime is not available for retirees overseas.
2.4.5Retirees, retiree family members,and survivors with any Medicare coverage at any age are not eligibleto enroll in TRICARE Select per 10 United States Code (USC) 1075(b)(1)(B).
2.4.6Family member(s) of ADSMs,including those with Medicare coverage (any age), may elect to enrollin TRICARE Select.
2.4.7Dual eligiblesunder age 65 (retirees and their family member(s) who have MedicareParts A and B) and dual eligibles who are ADFMs (any age) are eligibleto enroll in TRICARE Prime. See TOM, Chapter 6, Section 1.
2.4.8MHS beneficiaries who are noteligible to enroll in TRICARE Prime may elect to enroll with a Market/MTFPCM through the TRICARE Plus program to the extent capability andcapacity exists as determined by the Market/MTF.
2.5Automatic Enrollment Management
2.5.1Automatic Reinstatement ofCoverage
2.5.1.1DEERS will automatically enrollor change the enrollment of certain beneficiaries when a beneficiary’seligibility is updated by the Uniformed Services as described inthe TRICARE Systems Manual (TSM), Chapter 3, Section 4.2. The contractor shallreceive a PNT advising them of all changes. DEERS will not automaticallyapprove these PNTs.
2.5.1.2For beneficiaries with coveragethat has ended, DEERS will automatically update enrollment startand end dates of coverage when a beneficiary’s eligibility is updatedby the Uniformed Services.
2.5.1.3If fees or premiums are dueas a result of the reinstatement, the contractor shall give the beneficiaryup to 90 days from the date the coverage was automatically reinstatedto pay any required fees or premiums for any TRICARE health careplan.
2.5.2AutomaticEnrollment Of ADFMs (Effective January 1, 2018)
2.5.2.1Upon a Service member activation,including early activations or an ADFM is added while the sponsoris on active duty/early activation, DEERS will create a pendingTRICARE Prime enrollment with no PCM assigned for all TRICARE Primeeligible ADFMs whose residential address is within a ContinentalUnited States (CONUS) TRICARE Prime Service Area (PSA).
2.5.2.2Any ADFM whose residentialaddress is not within a CONUS PSA will not be enrolled into TRICAREPrime but will be auto-enrolled in TRICARE Select. See TOM, Chapter 24, Section 5 for details for overseas.
2.5.2.3A family member may be eligiblefor TRICARE Programs under multiple Social Security Numbers (SSNs);however, they may only be enrolled in one TRICARE Program at a time.Any family member that is already enrolled in another family willnot be auto-enrolled.
2.5.2.4DEERS will set the effective/begindate of enrollment to the eligibility begin date.
2.5.2.5Upon request from a beneficiaryor sponsor, the contractor may adjust any claims for beneficiariesauto-enrolled to apply TRICARE Prime benefits, not POS cost-sharingprovisions. See TOM, Chapter 6, Section 1.
2.6Group A and Group B Beneficiaries
2.6.1For purposes of enrollmentfees, cost-sharing, deductibles, and catastrophic caps, TRICARE Primeand TRICARE Select enrollees are classified in one of two groups:Group A if the sponsor’s initial enlistment or appointment in aUniformed Service was before January 1, 2018 and Group B if the sponsor’sinitial enlistment or appointment was on or after January 1, 2018.See TOM, Appendix A. However, if they become eligiblefor and elect to enroll in TRICARE Reserve Select (TRS), TRICARE RetiredReserve (TRR), TRICARE Young Adult (TYA), or Continued Health CareBenefit Plan (CHCBP), they will have Group B cost-shares, deductibles,and catastrophic caps regardless of when the sponsor entered UniformedServices for the first time.
2.6.2When RetiredReserve members become entitled to TRICARE at age 60 or are recalledto active duty before regular retirement (before age 60), theiroriginal date of enlistment or appointment determines whether theyand their family members have Group A or Group B cost-shares.
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