Separation History and Physical Examination & Transitional Healthcare Benefit/TRICARE

1. Separation History and Physical Examination & Transitional Healthcare Benefit/TRICARE Element 40 & Element 41

2. Separation History and Physical Examination (SHPE) • Purpose: To explain the importance and timeframes for the SHPE to ensure all medical conditions developed during the service period that require ongoing care and documented in the member’s Service Treatment Record.

3. SHPE Standard • Must be completed by all Active Duty members separating from service • Reserve/Guard members with more than 180 active days must also complete SHPE before being released from active duty • Exam is completed for service members to document and be screened for medical care given by the VA

4. SHPE Standard • If members apply for VA benefits prior to separation through Benefits Delivered at Discharge (BDD), the VA will perform a Separation Health Assessment (SHA) in place of the SHPE • If members do not apply for VA benefits through BDD before separating, their Military Treatment Facility will conduct SHPE

5. SHPE Resources • SHPE form DD 2807-1 • NAVADMIN 187/16 • Tricare Patient Portal: https://www.tricareonline.com/tol2/prelogin/desktopIndex.xhtml

6. Transitional Healthcare Benefit/TRICARE • Purpose: To ensure TSMs are aware of the Transitional Assistance Management Program (TAMP) that can provide them with TRICARE like benefits for 180 days.

7. Transitional Health Care Standard • TAMP offers TRICARE-like benefits for up to 180 days for qualifying service members and their family members via TRICARE Reserve Select • Transitional Health Care is not automatic when separating from service • Service members must ensure that their family members are enrolled in DEERS in order to receive benefits

8. Transitional Health Care Standard • To be eligible, separating service members must meet the following criteria – • Involuntarily separated from Active Duty • Reservist separated from AD after more than 30 days of contingency operation • Member with sole survivorship discharge • Separated with agreement to join Selected Reserve of a Reserve Component immediately following last day of AD

9. Dental Coverage During TAMP • Dental care is provided on a Space A basis • VA provides one-time dental care for members who apply for TAMP 180 days after separation • Members will not receive dental care if it was given to them within 90 days of separating from AD

10. Health Insurance Marketplace • The Marketplace assists uninsured people in finding health coverage • If the TSM is enrolled in TRICARE or VA benefits, they are considered fully covered • If these do not apply to a Veteran, the Health Insurance Marketplace can provide coverage • Veteran’s dependents may also receive coverage from the Marketplace

11. Medical Care for Retirees • Can submit for retiree TRICARE plan up to 90 days before retirement • TRICARE Prime – Annual enrollment fee, assigned a PCM at a MTF, and usually not required to pay co-payments or file health care claims • TRICARE Select – Can use any TRICARE network provider, no referrals necessary; higher co-pays than Prime, and only reimbursed for network providers https://tricare.mil/Costs/HealthPlanCosts/TS

12. Medical Care for Retirees • US Family Health Plan – Contracted TRICARE program for eligible beneficiaries; offered through six non-profit plans in various regions throughout the country • TRICARE Young Adult – Unmarried, adult children that are too old for regular TRICARE coverage • TRICARE for Life – Members and family members entitled to Medicare Part A from a disability or 65th birthday are eligible; TRICARE becomes second payer after Medicare https://tricare.mil/Costs/HealthPlanCosts/TS

13. Medical Care for Retirees • It is important for retired members to have another insurance policy outside of TRICARE • TRICARE does not cover all costs • Tricare has an annual deductible • TRICARE has a yearly cap on non-covered expenses; members are responsible for costs up until that cap

14. Survivors of Active Duty Service Members • TRICARE provides coverage for family members when a sponsor passes away; health plan options are contingent upon: • Sponsor’s military status when he/she passes away • If the surviving member is a spouse or child – spouses remain eligible unless they remarry

15. Continued Health Care Benefit Program (CHCBP) • Premium based plan that: • Gives temporary health coverage for 18-36 months when TRICARE eligibility is lost • Serves as a bridge between loosing TRICARE and purchasing civilian health plan • Provides same coverage as TRICARE Select • Minimum essential coverage provided; must be purchased within 60 days of the loss of TRICARE eligibility https://tricare.mil/Costs/HealthPlanCosts/TS https://www.humanamilitary.com/chcbp

16. Resources • TRICARE: www.tricare.mil/mybenefit • TRICARE Changes: https://www.tricare.mil/About/Changes/General-TRICARE-Changes/Costs/Other • US Family Health Plans: http://www.usfhp.com • Purchasing CHCBP: https://www.tricare.mil/Plans/SpecialPrograms/CHCBP/PurchaseCHCBP • Marketplace Health Care: www.healthcare.gov/Veterans