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Medical Benefits
Under certain circumstances Reservists and their families are entitled to the same medical care under the Military Health Care System as the families of active duty members. These circumstances are:
- The Reserve component member is ordered to or extended on active duty for more than 30 days. Eligibility begins the day the member commences or is extended on active duty.
- The Reserve component member medically retired due to a service-connected injury or disease incurred or aggravated while on active duty.
- The reservist has completed 20 years of qualifying service, reached age 60 and started to draw retire pay. The Reservist in this category and eligible family members are entitled to medical benefits until the Reservist reaches age 65 when they are eligible for Medicare.
- The Reservist died on active duty or as a result of a condition incurred or aggravated while on active duty.
Who is eligible?
A legal dependent of a Reserve component member in one of the circumstances
listed above who is registered in the Defense Enrollment Eligibility Systems
(DEERS) is eligible to receive medical treatment in the Military Health
Care System. A legal dependent is defined in section 1072 of title 10,
United States Code:
- Spouse and unmarried children under 21.
- Older children with severe physical or mental handicaps are also entitled.
- Children not yet 23 years old who are full time students at an accredited college and must depend on the military parent for more than half of their support.
The family member must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). This is done when the family member is issued an Identification Card.
How does it work?
Eligible family members may be treated on a space available basis at any Military Medical Treatment Facility (MTF). This availability is often very limited; therefore a desirable option is to enroll in Tricare.
Tricare is the Military Health Care System. It is similar to civilian Health Maintenance Organizations. It is organized by regions; each region is run by a lead agent, normally a Commander of a Military Health Care Facility. Each region is composed of military and civilian companies to help provide care. Tricare offers three plans: Prime, Standard, and Extra.
Here is a brief description of each option:
- Enrollment is required
- Patients receive care through a Primary Care Manager, who treats them or refers them to a specialist for care.
- Uses military facility and or civilian network
- No enrollment fees for active duty families
- Annual enrollment fee for retirees, family members and survivors
- No deductibles or claim forms for patients.
- No enrollment required
- No Primary Care Manager
- Patient may seek care from civilian sources
- Deductibles and co-payments
- Widest choice of providers
- Most expensive care
- No enrollment required
- No primary Care Manager
- Copay is less than Standard
- Provider choice limited to contracted network
- Care may be sought from MTF on space available basis
To expedite access to MTF care, eligible family members should provide their military ID card and a copy of their sponsor's orders when attending an appointment.
When the Guard family is covered by a civilian or employer health plan, TRICARE is the second payer.
Information on the three TRICARE options (Prime,Extra and Standard) is available from the Health Benefits Advisor at any MTF or on the web page at www.tricare.osd.mil