RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

TRICARE URFS 1 September 14, 2008

Posted by Service Officer on September 14th, 2008

Since 1 OCT 03, the Defense Enrollment Eligibility Reporting System (DEERS) reflects TRICARE eligibility for URFS (Unremarried Former Spouses) under his/her own name and Social Security Number (SSN), not his/her former sponsor’s. The URFS now use their own name and SSN to schedule medical appointments and to file TRICARE claims. As an URFS of a uniformed service member, you may be eligible for continued benefits if you do not remarry, are not covered by an employer-sponsored health plan and meet certain requirements. If a URFS remarries, the loss of benefits remains applicable even if the remarriage ends in death or divorce. However, if the URFS remarries a uniformed service active duty or retired member, he or she becomes TRICARE-eligible under his/her new sponsor.

There are eligibility requirements that URFS must meet.

1. Situation 1–20/20/20 Rule: Medical benefits are extended, and continue as long as requirements continue to be met, to an URFS when:

§ The parties had been married for at least 20 years

§ The member performed at least 20 years of service creditable for retired pay

§ There was at least a 20-year overlap of the marriage and service

2. Situation 2–20/20/15 Rule: Medical benefits are extended to an URFS, if divorce occurred before 1 APR 85, when:

§ The parties had been married for at least 20 years

§ The member performed at least 20 years of service creditable for retired pay

§ There was at least a 15-year overlap of the marriage and service

Note: If the divorce occurred on or after 29 SEP 88, these 20/20/15 former spouses qualify for medical benefits for one year from the date of the divorce decree.

Benefits are:

- TRICARE Prime: This is a managed care option similar to a civilian health maintenance organization and is offered only in certain geographical locations. TRICARE Prime offers fewer out-of-pocket costs than any other TRICARE option. TRICARE Prime enrollees receive most of their care from a military treatment facility (MTF), augmented by the TRICARE contractor’s provider network. TRICARE Prime enrollees are assigned a primary care manager (PCM). It is important to note that the URFS are no longer covered by the family plan status, since he/she is now a sponsor in his/her own right, under his/her own social security number. Therefore, he/she becomes responsible for his/her enrollment fees at the retirees rate, even though the former spouse may still be on active duty.

- TRICARE Standard: Under this plan, you can see the TRICARE authorized provider of your choice. (People who are happy with coverage from a current civilian provider often opt for this plan.) But having this flexibility means that care generally costs more than Prime (Standard requires a 25% cost share of the TRICARE allowed amount and has a $150 individual fiscal year deductible). Treatment may also be available at a MTF, if space allows and after TRICARE Prime beneficiaries have been served. Furthermore, TRICARE Standard may be the only coverage available in some areas.

- TRICARE Extra: Under this option, you will choose a doctor, hospital, or other medical provider listed in the TRICARE Prime provider directory. The advantages of TRICARE Extra include the fact that cost-shares are five percent less than TRICARE Standard (Extra requires a 20% cost share of the TRICARE allowed amount and consists of a $150 individual fiscal year deductible); there is no balance billing or enrollment fee; and there are no claims forms to file. The disadvantages of TRICARE Extra are you have no PCM; your provider choice is limited; you pay the deductible and the cost shares; and the option is not universally available.

- TRICARE for Life (TFL): This is Medicare-wraparound coverage. A single, nationwide contract provides claims processing, customer service and administrative services for individuals who are eligible for both TRICARE and Medicare, regardless of whether they are over or under age 65. Under TFL, TRICARE becomes second payer to Medicare: you must be eligible for Medicare Part A, and enrolled in Part B. For more TFL information refer to http://www.tricare.osd.mil/tfl/default.cfm.

- Pharmacy– under this benefit, you are eligible for the basic MTF Pharmacy services, TRICARE Mail Order Pharmacy, TRICARE Retail Pharmacy, and Non-network Pharmacy option. For more information on pharmacy benefits refer to http://www.tricare.osd.mil/pharmacy/default.cfm.

- Dental – URFS are not eligible for TRICARE dental coverage.

[Source: The URFS Tricare Fact Sheet Sep 08 ++]

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