Reserve components participate in military conflicts and peacekeeping missions in areas such as Bosnia, Kosovo, and southwest Asia, and assist in homeland security. From fiscal year 1996 through fiscal year 2001, an average of about 11,000, or 1 percent, of the roughly 900,000 reservists were mobilized each year. The length of mobilizations can be as long as 2 years with the mean length of mobilizations for the 6-year period we reviewed being 117 days. As of April 2002, about 80,000, or 8 percent, of reservists had been mobilized for 1 year for operations related to September 11, 2001. At the same time, additional reserve personnel continued to be deployed throughout the world on various peacekeeping and humanitarian missions. The rights of mobilized personnel of the reserve components are protected under the Soldiers’ and Sailors’ Civil Relief Act of 1940 (SSCRA), as amended, and by the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), as amended. Included in these acts are protections related to health care coverage. For example, SSCRA provides protections for reservists who have individual health coverage. Specifically, for individually covered reservists returning from active duty, SSCRA requires private insurance companies to reinstate coverage at the premium rate they would have been paying had they never left. Under SSCRA, the insurance company cannot refuse to cover most preexisting conditions. During military service, USERRA protects reservists’ employer-provided health benefits. Specifically, for absences of 30 days or less (training periods typically last 2 weeks or less), health benefits continue as if the employee had not been absent. For absences of 31 days or more, coverage stops unless (1) the employee elects to pay for the coverage, including the employer contributions, or (2) the employer voluntarily agrees to continue coverage. Under USERRA, employers must reinstate reservists’ health coverage the day they apply to be reinstated in their civilian positions—even if the employers cannot put the employees back to work immediately. Reservists mobilized under federal authorities are covered by TRICARE, DOD's health care system. If they are ordered to active duty for 31 days or more, reservists are enrolled in Prime, TRICARE’s managed care option, and—like other active duty personnel—are required to receive care through TRICARE, either through 1 of 580 MTFs worldwide, or through TRICARE’s network of civilian providers. When reservists’ mobilization orders are for 31 to 178 days, their dependents are eligible for the Standard and Extra options—TRICARE’s fee-for-service and preferred provider options, respectively. Once eligible for TRICARE, reservists and their dependents also become eligible for prescription drug benefits. When reservists’ orders are for 179 days or more, dependents are eligible for health care under Prime. Under TRICARE, active duty personnel, including mobilized reservists, do not pay premiums for their health care coverage; however, depending on the option chosen, they may be responsible for copayments, deductibles, and enrollment requirements for their dependents. (For an overview of these benefits, see table 1.) Mobilized reservists are eligible for dental care through the military health care system. However, like active duty dependents, mobilized reservists’ dependents are only eligible for dental care if they participate in DOD’s voluntary dental insurance program, which requires enrollment and has monthly premiums. Because mobilized reservists’ dependents could be liable for two health coverage deductibles in 1 year—their civilian insurers’ deductible prior to mobilization and the TRICARE Standard or Extra deductible once mobilized—DOD has used authorities included in the National Defense Authorization Acts for 2000 and 2001 to provide financial assistance through several demonstration programs. For example, the Reserves Component Family Member Demonstration Project—available for those currently mobilized under DOD’s Operation Noble Eagle and Operation Enduring Freedom—eliminates the TRICARE deductible and the requirement that dependents obtain statements that inpatient care is not available in an MTF before obtaining nonemergency treatment from a civilian hospital. In addition, DOD may pay non-network physicians up to 15 percent more than the TRICARE rate for treating dependents of mobilized reservists—a cost that otherwise would be borne by dependents if physicians required this additional payment. Until recently, DOD had administered a transitional benefit program that provided demobilized reservists and their dependents 30 days of additional TRICARE coverage as they returned to their civilian health care. The 2002 NDAA extended the transitional period during which reservists may receive TRICARE coverage from 30 days to 60--120 days, depending on the length of active duty service. This change more closely reflects the 90 days that USERRA provides reservists to apply for civilian reemployment when they are mobilized for more than 181 days, and the change will provide health care coverage if they elect to delay return to their employment subsequent to demobilization. However, the 2002 NDAA did not provide any transitional benefit for dependents. Overall, the percentage of reservists with health care coverage when they are not mobilized is similar to that found in the general population—and, like the general population, most reservists have coverage through their employers. According to DOD’s 2000 Survey of Reserve Component Personnel, nearly 80 percent of reservists reported having health care coverage. In the general population, 81 percent of 18 to 65 year olds have health care coverage. Officers and senior enlisted personnel were more likely than junior enlisted personnel to have coverage. Only 60 percent of junior enlisted personnel, about 90 percent of whom are under age 35, had coverage—lower than the similarly aged group in the general population. Of reservists with dependents, about 86 percent reported having coverage. Of reservists without dependents, about 63 percent reported having coverage. More than three-quarters of reservists were provided health care coverage by their civilian employers’ health plans or their spouses’ health plans. (See fig. 1.) Some reservists were covered by more than one health plan. Most reservists maintained their civilian coverage when mobilized. Reservists generally maintained this coverage to better ensure continuity of health benefits and care for their dependents, sometimes at an additional cost. However, some reservists who dropped their civilian insurance to use TRICARE reported that their dependents had problems finding providers, establishing eligibility, understanding TRICARE’s benefits, and obtaining assistance when questions or problems arose. We found that such problems could be ameliorated through additional education and assistance targeted to reservists and their dependents. Because most reservists maintained their civilian coverage when mobilized, few dependents experienced disruptions in coverage. According to DOD’s 2000 survey, about 87 percent of reservists who had been mobilized at least once reported having civilian insurance at the time they were mobilized. The remaining 13 percent did not have civilian coverage. Of those who had civilian coverage, about 90 percent maintained it while mobilized. According to DOD officials and reservists we interviewed, many reservists maintained their civilian coverage to avoid disruptions associated with a change to TRICARE and to ensure that their dependents could continue seeing their current providers—who may not accept TRICARE reimbursements, either as network providers or under the Standard option. Preserving provider relationships was especially important to reservists whose dependents with special needs had specialists familiar with their care or to dependents who had long-standing relationships with civilian providers. Reservists we contacted reported varying financial arrangements for covering the costs of their civilian premiums while they were mobilized. USERRA does not require employers to continue paying their share of health insurance premiums when mobilizations extend beyond 30 days. However, employers continued to pay at least their portion of health insurance premiums beyond this 30-day period for about 80 percent of the reservists we contacted who maintained their employer-sponsored coverage. Sometimes, these employers paid all costs, both their own and the employee portion, while in other instances reservists continued to pay the employee portion of the premium. The remaining reservists paid the total insurance premium while mobilized. In the general population in 2001, the average employer-sponsored premium for a family plan was $588 per month with the employee generally paying about 26 percent of this premium. Mobilized reservists who used TRICARE reported a variety of problems that they and their dependents experienced when they tried to access the system. However, when DOD provided information and assistance targeted toward the situations reservists and their dependents face, these types of problems were more likely to be averted. The most common problems that reservists reported were difficulties they and their dependents had moving into the system—finding TRICARE providers, establishing eligibility, understanding TRICARE’s benefits, and obtaining assistance when questions or problems arose. While similar problems have been reported by other active duty personnel, reservists and their dependents are more likely to experience such problems because they often live in areas distant from MTFs, and their active duty service is brief and episodic. Of the 360 reservists with recent mobilization experience that we contacted, about 38 percent reported some kind of problem with TRICARE. One problem, constituting about a quarter of the reported problems, was finding a TRICARE provider. Mobilized reservists and their dependents can have more difficulty finding TRICARE providers because many do not live in areas where the network is robust. Compared to 5 percent of active duty personnel, about 70 percent of reservists live and work more than 50 miles (or an hour’s drive) from an MTF—areas DOD has designated as remote. Because DOD’s civilian contractors are generally not required to establish TRICARE civilian networks in these areas, a network of providers may not exist. Where networks do exist, provider choice may be limited.