Take advantage of new health benefits

activated reservists, have left thousands of reserve families unable to take full advantage yet of some new pre- and post-mobilization healthcare benefits.

The unusual circumstances have TRICARE officials advising reservists to save medical receipts, explanations of benefits and other documents that could be useful weeks or months from now in filing TRICARE claims for reimbursements once the full range of new benefits is available.

The benefits in question, called the Temporary Reserve Health Care Program, will improve access to care from the time reservists learn they will be mobilized through a new 180-period transition health period following active service.

President Bush signed the reserve health initiatives into law Nov. 6, 2003, as part of the $87 billion emergency spending bill for Iraq and Afghanistan. Several benefits even took effect that day. Despite the work of a special task force set up even before the law was signed, implementation has been difficult.

The biggest challenge has been modifying the Defense Enrollment Eligibility Reporting System, which is used to verify that beneficiaries are properly enrolled and deemed eligible for TRICARE. DEERS is being reprogrammed to recognize several new benefits and to identify as eligible thousands of individual reservists and their families.

Modifying DEERS also is critical for tracking the cost of the reserve health initiatives, said Rear Adm. Richard A. Mayo, deputy director for the TRICARE Management Activity.

Congress imposed a $400 million funding limit on those initiatives from Nov. 6, 2003, through Sept. 30, 2004.

The complexity of the task is reflected in details of the new benefits.

Pre-mobilization TRICARE

Coverage for Reserve or Guard members begins upon notice of a pending call-up, or receipt of a delayed-effective-date order for mobilization.

Family members are covered if the planned mobilization is to last longer than 30 days. Length of TRICARE coverage before activation can be up to 90 days, but only for individuals and who learned of mobilization on or after Nov. 6. Reservists previously had been eligible for TRICARE only when on active duty.

It is set to expire Dec. 31, unless Congress votes to extend it.

Longer transition coverage

Military transitional health coverage is lengthened to 180 days from 60 days or 120 days, depending on length of deployment under the old rules. The extra coverage applies to those deactivated or separated from service after Nov. 6, 2003. This benefit also is set to expire Dec. 31.

Pre-activation health screening

The services received authority to screen and provide needed medical and dental care to members of the Ready Reserve. Reservists previously had to be on active duty to be screened and receive care. This new authority is permanent.

TRICARE for certain drilling reservists

The most controversial initiative will open TRICARE to drilling reservists who either are unemployed or have no health insurance through current employers. About 170,000 are eligible but far fewer could elect to pay the premiums, to be set roughly at $420 a year for self coverage, $1,440 for self and family, plus usual co-payments and deductibles.

Dr. William Winkenwerder, assistant secretary of defense for health affairs, has criticized this initiative as ignoring differences "in duty and in sacrifice" between non-mobilized reservists and active duty.

He also bristles at the cost which could be "in the low billions," he said.

Mayo said he expects uninsured drilling reservists to begin enrolling in TRICARE by year's end, if the $400 million hasn't already been spent. After all, he said, that money must cover "the cost of implementing the changes to DEERS, the cost of contract modification, the marketing enrollment costs, in addition to the healthcare costs."

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

[email protected]