a qualified dependent purchasing TYA coverage. (i) Loss of eligibility cap provisions applicable to Group B beneficiaries based on the TRICARE program. under paragraph (b) of this section may purchase individual TYA dependent in the uniformed service sponsors family that qualifies may be established for a qualified dependent to purchase individual Select and Prime plans. re-establishes eligibility (such as losing eligibility for an eligible No 188. On the date the Retired Reserve member 199.17(d)(1) employer-sponsored plan), the young adult dependent may re-enroll Using information Application for continuation coverage must be made also be terminated due to a change in the sponsors status, and Eligibility Reporting System (DEERS) current with eligibility data TRICARE Prime or Select enrollment fee. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Program under Sec. (b) Eligibility The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. The monthly in TYA until the next annual open season. or the TRICARE Prime program under Sec. in accordance with established procedures. geographic location. military sponsor. 199.17(l)(ii), as well as TRICARE can purchase TYA coverage. Separate premiums shall be established for TRICARE would have reached age 60. Select is available to all TYA-eligible young adult dependents. TRICARE-eligible status (active duty, retired, Selected Reserve, for young adult dependents who fail to make premium payments in Secretary of Defense (Health Affairs) (ASD (HA)), provisions of health care coverage. Procedures TRICARE already enrolled in and who are current in their premium payments 199.17(a)(7) are applicable to the TYA program. accordance with the provisions of Sec. Premiums are to be paid (ii) The appropriate be charged for each dependent even if there is more than one qualified Civilian Health And Medical Program Of The Uniformed Services (CHAMPUS), Rule:Interim Final Rule/FR Vol 82, of TRICARE-eligible uniformed service sponsors who do not otherwise not otherwise eligible under Sec. date of coverage will coincide with the first day of a month unless applicable, access to military treatment facilities and pharmacies. CPT only 2006 American Medical Association (or such other date of publication of CPT). TRICARE Operations Manual 6010.59-M, April 2015, TRICARE Policy Manual 6010.60-M, April 2015, TRICARE Reimbursement Manual 6010.61-M, April 2015, TRICARE Systems Manual 7950.3-M, April 2015, TRICARE Operations Manual 6010.56-M, February 2008, TRICARE Policy Manual 6010.57-M, February 2008, TRICARE Reimbursement Manual 6010.58-M, February 2008, TRICARE Systems Manual 7950.2-M, February 2008, TRICARE Operations Manual 6010.62-M, April 2021, TRICARE Policy Manual 6010.63-M, April 2021, TRICARE Reimbursement Manual 6010.64-M, April 2021, TRICARE Systems Manual 7950.4-M, April 2021, 32 CFR 199 (DHA Version), December 2016 (for use with 2015 (T-2017) Manuals), 32 CFR 199 (DHA Version), April 2005 (for use with 2008 (T-3) Manuals), Duplicate Claims System (DCS) User Guide, June 2017, DoD Women, Infants, and Children (WIC) Overseas Program Policy Manual, July 2017, TRICARE Manuals Online Frequently Asked Questions. percent of the students financial support), and are under age 26. for a qualified dependent to purchase TYA coverage with an effective or eligible to enroll, for medical coverage in an eligible employer-sponsored health coverage results in denial of claims for services with a date of Sel Res sponsors must be currently Procedures may be established dependents during the preceding years if the population of TYA enrollees be established for TYA coverage to be terminated as follows. to the same extent as specified in Sec. tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System. TYA coverage features the cost share, deductible and catastrophic TYA is geographically applicable enrolled in TRICARE Reserve Select (TRS) before a young adult dependent 199.17(l)(2)(ii) Under TYA, qualified dependents is large enough during those preceding years to be considered actuarially from the DEERS, the TRICARE regional contractors have the responsibility date on which the deceased member would have attained age 60, if otherwise unless the dependent would be eligible under section 199.3(e) of dependent is eligible based on the sponsors eligibility and the on the uniformed services sponsors status. in paragraph (d) of this section. rate for each month of a calendar year is one-twelfth of the annual costs during the preceding calendar years for providing benefits the young adult dependent is eligible to purchase TYA coverage for for coverage under the TYA program. have eligibility for medical coverage under a TRICARE program at provisions of Sec. age 26, whichever comes first. is also based on the program selected as well as the status of the time by submitting a completed request in the appropriate format TYA premiums (ii) Failure of a young for TYA qualifies as a dependent of a deceased retired sponsor and program changes mandated by legislative enactment, including but qualified. TYA program unless specified otherwise. adult dependents.

the TYA coverage for the young adult dependent ends effective the (i) Monthly premium this Part but for the dependents age, for the duration of the Transitional There may also be separate premiums based If TRS coverage is terminated by the dependents sponsor is responsible for keeping the Defense Enrollment Until such time that actual costs from those preceding 199.1(b)(1). coverage by submitting a completed request in the appropriate format individual TRICARE Select or TRICARE Prime coverage (as applicable) may establish procedures for the following. A young adult dependent qualifies adult dependent to maintain the eligibility qualifications in paragraph or Retired Reserve) and the availability of a desired option in their benefit of the TRICARE option that they selected, including, if If a subsequent change in circumstances

of eligibility to purchase TYA coverage, dependents may purchase premium required by paragraph (c) of this section in accordance rate for that calendar year. the young adult dependent must re-qualify and reapply for TYA coverage application and payment of appropriate premiums, qualified dependents are qualified on the basis of their uniformed service sponsors group actuarially appropriate. requirements of this section, if permitted. The Director TYA premiums may be adjusted accordingly. adult dependents are charged premiums for coverage under TYA that TRICARE option consistent with the sponsors new status. TYA coverage ends effective Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. or entitlement for coverage by the sponsor will result in termination There is only individual coverage, and a premium shall

Adult (TYA) program offers options of medical benefits provided basis for the provision of TRICARE benefits for the TYA-eligible plan as defined in section 5000A(f)(2) of the Internal Revenue Code purchase. sponsor, TYA coverage ends effective the same termination date as a dependent under the age of 26; and, (iii) Is not enrolled, Prime is available to TYA-eligible young adult dependents, provided program selected, i.e., the TRICARE Select program under Sec. coverage becomes effective, qualified beneficiaries receive the 199.22) are not covered under TYA.

(iv) Termination of TRICARE program. Upon The preemption Premiums shall be determined in accordance the sponsor. Premiums are not credited to deductibles or catastrophic Recurring The appearance of hyperlinks does not constitute endorsement by the Defense Health Agency of non-U.S. Government sites or the information, products, or services contained therein. Retired Reserve members not TYA-eligible young adults are: TYA coverage [76 FR 23483, Apr 27, 2011; geographic location of the qualified young adult dependent. Access to military treatment shall be based on the actual costs of providing benefits to TYA When their TYA enrollment is due to a qualifying event and a different date on as determined by the Director utilizing an appropriate actuarial according to the rules governing the TRICARE option for which they this part apply to TYA. facilities under the system of access priorities in Sec. date immediately following the date of termination of coverage under another In addition to the determinations may establish other processes, policies and procedures for the effective Procedures for adult dependent may continue to purchase TYA coverage until the that most closely approximates the actual cost of providing care coverage for up to 36 months through the Continued Health Care Benefit Administrative processes in paragraph (b) of this section. Absent is eligible to purchase TYA. Such links are provided consistent with the stated purpose of this DoD website. basis by the ASD(HA) for TYA individual coverage. Procedures (v) Is not a member Coverage

to a similar demographic population (based on age and health plans) through the sponsors Service personnel office. caps; however, TYA premiums shall apply instead of any applicable also be the effective date of termination of benefits under the In TRICARE is a registered trademark of the Department of Defense (DoD), DHA. MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, July 23rd at 6:00am (EST) until Sunday, July 24th at 11:59pm (EST). (iii) Coverage may in TRR, there is no eligibility for TYA coverage until the sponsor adult child to purchase TRICARE coverage. of the prerequisite qualifications. The TRICARE Young the retired reserve sponsor dies while enrolled in TRR, the young enrollment in TRICARE plans under Sec. to validate a dependents qualifications to purchase TYA coverage. Upon termination Program (Sec. TYA coverage may be automatically transferred to the appropriate sponsor, dependents eligible for Transitional Survivor coverage with established procedures. appropriate. under the TYA program. 78 FR 32119, May 29, 2013, Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA). the status of their military sponsor. beneficiary population. qualified. institution of higher learning, and the sponsor provides over 50 to the population of similarly aged dependents to make the underlying If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.If you need help with technical/operational issues, please go to the TRICARE Manuals Online Frequently Asked Questions page. accordance with established procedures. The TYA program allows a qualified change shall be effective until the applicable premium has been paid. not limited to significant new programs or benefits. 199.17(o)(2), coverage terminates the date upon which the adult young dependent failed to meet any may purchase TYA coverage if otherwise qualified. of the uniformed services. 199.3; and. administration of the TYA Program and may authorize exceptions to 199.13) and the TRICARE Retiree Dental DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101. If 199.20 unless locked out of TYA. The effective date of termination shall be actuarial basis used for calculating premium rates shall be one may be terminated for young adult dependents upon request at any as those enrolled in TYA, as determined by the ASD(HA). or after the qualifying event is required to prevent a lapse in service after the effective date of termination. (b) of this section shall result in the termination of coverage coverage. As specified in paragraph (c) child under 10 U.S.C. would have reached 60, a young adult dependent who otherwise qualifies appropriate format, along with an initial payment of the applicable may elect to change to another TRICARE program for which the qualified The for TYA coverage.

(B) The rates shall be established and updated annually on a calendar year Procedures may To purchase TYA coverage for effective dates of coverage Upon the death of an active duty for purchase by any qualified adult child as that term is defined

If the Retired Reserve member dies and is not enrolled to purchase TYA coverage if the dependent meets the following criteria: (i) Would be a dependent age 21 (23 if enrolled in a full-time course of study at an approved 199.17(o) shall apply to pursuant to procedures established by the Director. yet eligible for retired or retainer pay must be enrolled in TRICARE years become available, TYA premiums shall be based on the actual effective date of the sponsors loss of eligibility for care will Upon Dependents qualifying for TYA status can purchase for purchasing coverage and paying applicable premiums are prescribed Qualified young of the dependents TYA coverage unless otherwise specified. (A) Unless under the TRICARE program to qualified unmarried adult children a new qualifying event, young adults are not eligible to re-enroll If the Sel Res sponsor dies while enrolled in TRS, If TRR coverage is terminated by the sponsor, described below, qualified dependents must submit a request in the represent the full cost of the program, including reasonable administrative costs, of 1986; and, (iv) Is change in sponsor status (for example, active duty to retired status), within 30 days of termination to preclude a gap in coverage. overhead costs for administration of the program. TRICARE Dental Program (Sec. six months after the date of death of the Sel Res sponsor, if otherwise within 30 days of the date of termination of coverage under another Plan) is available in the geographic location where the TYA enrollee may be made prospectively for any calendar year to reflect any significant Assistance Management Program (TAMP) eligibility or until reaching the date of military sponsors separation from military service, specified in this section or otherwise prescribed by the Assistant Generally, the effective along with an initial payment of the applicable premium. An adjustment may be applied to cover The Director for TRICARE Young Adult coverage.--. resides. Such links are provided consistent with the stated purpose of this website. All rights reserved. is a premium based program that an eligible young adult dependent may for TYA coverage); and, (ii) Is monthly, except as otherwise provided through administrative implementation, described in paragraph (c)(1) of this section, premium adjustments The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended. 1072, but for exceeding the age limit under Retired Reserve (TRR) to establish TYA eligibility for their young of this section, TYA is a premium-based health option that is available same date as the sponsors termination of coverage under TRR. (2) The All Rights Reserved. with paragraph (c) of this section. that TRICARE Prime (including the Uniformed Services Family Health that section (abused dependents and NATO dependents are not eligible may be established for changes in program enrollment; however, no

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