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TRICARE
TRICARE: Uniformed Service Health Benefits Program
TRICARE is the Department of Defense health care program. You have the following options to choose from:
TRICARE Prime
TRICARE Extra
TRICARE Standard (formerly known as CHAMPUS)
TRICARE for Life (for retirees ages 65 and older)
National Mail Order Program (NMOP)
TRICARE Dental
TRICARE Prime. This HMO-like option offers the scope of coverage available under CHAMPUS, and additional preventive and primary care services. This enrollment option provides its customers with advantages of managed health care, such as assignment to primary care manager and assistance in making specialty appointments and claims filing. Although this option is voluntary for all beneficiaries eligible for CHAMPUS, all active duty personnel will be enrolled in the program and continue to receive most of their care in military treatment facilities.
Active duty family members, retirees, and their family members and survivors can enroll for a minimum of one year and agree to receive their health care services coordinated through their TRICARE Primary Care Manager. Medicare-eligible beneficiaries are not eligible for enrollment in Prime, therefore they should obtain Medicare supplements. All Medicare-eligible beneficiaries and those CHAMPUS-eligible beneficiaries who are not enrolled in TRICARE Prime remain eligible for care in Military Treatment Facilities on a space available basis.
Basically, beneficiaries who enroll in TRICARE Prime agree to use military treatment facilities and designated civilian provider networks, in accordance with the enrollment provisions. Prime enrollees are permitted to seek medical care outside the network but will incur a sizeable annual deductible of $300 per person or $600 per family and have to pay half of what is determined to be a reasonable cost for the treatment.
TRICARE Standard. (Same as the standard CHAMPUS) This option offers beneficiaries maximum choice in choosing their health care provider (subject to non-availability statement requirements), but at the highest out-of-pocket cost to the beneficiary. You continue to pay the CHAMPUS deductibles and cost shares. In addition you continue to be eligible to receive care in the military treatment facility on a space available basis. After you have paid your deductible, TRICARE Standard will pay 80% of the allowable charge for outpatient services and supplies for active duty families and 75% of the allowable charge for retirees and their families.
TRICARE Extra. When Standard CHAMPUS-eligible beneficiaries want to maintain their freedom of choice but elect to occasionally use network providers then their coverage becomes known as TRICARE Extra. You will receive a 5% discount off the TRICARE Standard cost shares when using a network provider. However as with TRICARE Standard, TRICARE Extra users must meet the annual CHAMPUS deductible before cost sharing begins. CHAMPUS beneficiaries do not enroll in TRICARE Extra, but may participate on a case-by-case basis using the TRICARE network providers. You will continue to be eligible for military medical treatment facility care on a space available basis.
For more detailed information on the various TRICARE options please contact your closest military treatment facility, TRICARE 1-800-982-0032, or call the Office of the Assistant Secretary of Defense (Health Affairs) at 703-695-3350.
TRICARE Survivor Benefits for Active Duty Family Members
TRICARE-eligible family members, whose sponsor dies while on active duty will continue to receive TRICARE benefits.
Survivor Benefits During the Three-Year Survivor Benefit Period
During the three years following a sponsor's death, surviving spouses and children under 21 years of age (23, if enrolled in a full-time course of study in an institution of higher learning) remain eligible for TRICARE Prime without enrollment fees and copayments. Surviving family members may enroll in TRICARE Prime where offered, but lose eligibility for TRICARE Prime Remote for Active Duty Family Members, if enrolled in that program at the time of the sponsor's death. Surviving family members who are not enrolled in TRICARE Prime may use TRICARE Extra or Standard, but are subject to the appropriate active duty cost shares and annual deductible requirements for each program. During the three-year survivor benefit period, surviving family members are protected from having to pay out-of-pocket expenses of more than $1,000 per fiscal year for TRICARE allowable charges for covered services.
Active duty family members who accompanied their sponsor on orders outside of the continental United States (OCONUS) and reside in that location at the time of their sponsor's death are eligible for three-year transitional health care benefits under the TRICARE Overseas Program Prime.
Surviving family members who choose to live OCONUS should check with the overseas TRICARE Service Center, as their benefits will differ slightly from those available in the United States.
TRICARE FOR LIFE
Medicare-eligible uniformed services retirees, their spouses and survivors who are age 65 and over are entitled to expanded health care benefits under legislation signed into law. President Clinton signed the FY2001 National Defense Authorization Act for Fiscal Year 2001, Public Law 106-398 (the Act) on October 30, 2000. The legislation included a number of health care provisions that collectively represent the most significant change to military health care benefits since the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) was established by Congress in 1966.
Important Features:
- A pharmacy benefit will be provided to our dual-eligible military retiree/Medicare-eligible personnel effective April 1, 2001. All retirees who became Medicare-eligible prior to April 1, 2001, will receive this benefit. All retirees who become Medicare-eligible on or after April 1, 2001, must be enrolled in Medicare Part B to receive this benefit. This benefit includes national mail order and retail pharmacy services. (Section 711 of the Act.) See information below.
- Medicare-eligible beneficiaries become eligible for TRICARE effective October 1, 2001. Medicare will be first payer, and TRICARE will be the second payer. All beneficiaries must be enrolled in Medicare Part B for TRICARE to serve as second payer. (Section 712 of the Act.) · The health care entitlement for Medicare-eligible beneficiaries will be funded, beginning in fiscal year 2003, through the Department of Defense Medicare-eligible Retiree Health Care Fund established by the Department of Treasury. (Section 713 of the Act.)
- The TRICARE Prime Remote (TPR) program will be expanded to active duty family members throughout the continental United States by October 1, 2001. In the interim, the Department will implement a program to waive co-payments and deductibles of TPR active duty family members. (Section 722 of the Act.)
- An Individual Case Management Program for Persons with Extraordinary Conditions (ICMP-PEC) was funded with a cap of $100 million. In appropriate cases, the program allows waiver of TRICARE limitations on health care coverage, including coverage of custodial care services for persons with exceptional conditions. (Section 701 of the Act.)
- The chiropractic health care demonstration became a permanent benefit for active duty personnel at designated MTFs worldwide. A five-year phased-in implementation will begin in 2001. (Section 702 of the Act.)
What Do You Need to Do Now?
- Enroll in Medicare part B: Beneficiaries should enroll in Medicare Part B, if they have not already enrolled. Beneficiaries who have not enrolled may be required to pay a surcharge (adjusted for age) to join Part B. Beneficiaries with questions regarding Medicare and Part B can visit any Social Security Administration (SSA) office, call the Social Security Administration (SSA) toll-free number, 1-800-772-1213, or call the toll-free Medicare number, 1-800-633-4227. They also can find information on the Medicare Web site at www.medicare.gov.
- Don't Drop Supplemental Policies Yet: Because of the delayed effective dates, any decision to drop a Medicare supplemental insurance policy (known as Medigap) based on the new law is premature. Tricare is working with the Health Care Financing Administration (HCFA), and The Military Coalition (TMC) and the National Military & Veterans Alliance (NMVA) to provide the most accurate information on what should be considered before any supplemental policy is dropped.
- Update Information in DEERS: Beneficiaries should have up-to-date information in the Defense Enrollment Eligibility Reporting System (DEERS). In the coming months, Tricare will mail information to beneficiaries who have received this new entitlement. To ensure that they are not overlooked, eligible beneficiaries must have the most accurate family and beneficiary data in DEERS. Eligible beneficiaries may update their addresses in DEERS in a number of ways, listed below.
- Visiting local personnel offices that have an ID card facility,
- Calling the Defense Manpower Data Center Support Office (DSO) Telephone Center at 1-800-538-9552. The best time to call the Telephone Center is Wednesday - Friday, between 9 - 3 (Pacific Time) to avoid delays.
- Faxing address changes to 1-831-655-8317 o Mailing the change information to the DSO, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771
- Visiting a military treatment facility o Emailing information to addrinfo@osd.pentagon.mil and include the following information:
- Sponsor's Name and Social Security Number
- Name(s) of other family members affected by the address change
- Effective date of address information
- Telephone number (to include area code), if available
To change information other than address data, however, beneficiaries may only visit an ID card facility, mail or fax changes with appropriate documentation to the address/numbers provided above. To learn what documentation is required, call an ID card facility or the DSO toll-free number, 1-800-538-9552. The hours of operation for DSO are Monday-Friday (excluding Federal Holidays), 0600-1530 (Pacific Time).
NATIONAL MAIL ORDER PROGRAM (NMOP)
The Department of Defense announced that on April 1, 2001, uniformed services beneficiaries 65 years of age and older will begin receiving pharmacy benefits provided by the 2001 National Defense Authorization Act (NDAA). The new program will limit out-of-pocket costs and increase access to the National Mail Order Program (NMOP) and retail pharmacies that are part of the Department of Defense (DoD) network, which include many major chain drug stores, for an estimated 1.4 million beneficiaries. In addition, they may use non-network retail pharmacies.
Beneficiaries who are 65 years of age and older will not pay enrollment fees or annual premiums for their TRICARE pharmacy benefits, but they will pay modest co-pays when they use NMOP and retail network pharmacies. In addition, beneficiaries will also be able to use non-network pharmacies, but this option will entail a slightly higher co-pay and deductible. In the past, only those beneficiaries who were eligible for Base Realignment and Closure (BRAC) benefits and the Pharmacy Redesign Pilot Program (PRPP) were able to enjoy modest out-of pocket costs through the NMOP and retail pharmacy network. The BRAC pharmacy benefit and the Pharmacy Redesign Pilot Program are replaced by the new program.
By law, to use the TRICARE retail and mail order benefit, beneficiaries age 65 and over must be eligible for Medicare Part A and enrolled in Part B. There is an exception: Those who turn 65 before April 1, 2001, are eligible for the benefit, even if they are not enrolled in Medicare Part B.
Retired beneficiaries living overseas can use their TRICARE benefit at overseas pharmacies, but they will need to submit their pharmacy claims for reimbursement. They also will be able to utilize the NMOP, if certain requirements are met. Federal and state legal restrictions apply to the prescribing, dispensing and mailing of prescription drugs, so the NMOP can only mail to APOs and FPOs, which are part of the U.S. Postal Service. Also, the NMOP can only fill prescriptions written by providers licensed to practice in the United States.
The NMOP offers the largest discount to DoD beneficiaries. It is convenient for filling prescriptions for chronic conditions like high blood pressure or diabetes. The retail network pharmacy program can be used for short-term, immediate use medications. Lists of TRICARE network pharmacies will be available from regional TRICARE contractors. Beneficiaries who use non-network pharmacies will have to meet an annual deductible, incur a higher co-pay, and pay the entire bill up front, and then file a claim for appropriate reimbursement.
TRICARE Retiree Delta Dental Program
The TRICARE Retiree Delta Dental Program is administered by the Federal Services division of Delta Dental Plan of California with the same high level of quality, service, and dependability for which Delta is known. The enhanced program is designed especially to provide Uniformed Services retirees and their families with optimum dental coverage at an affordable cost.
You may enroll in the TRICARE Retiree Delta Dental program at any time. Rates are based on geographical areas and are available at the web site www.trdp.org. Simply enter your zip code to obtain your local rates.
The plan's basic coverage limit is $1,000 per year per patient and only a $50 per year deductible per enrollee. In addition, you will have a separate $1,000 annual coverage amount for dental accident services and a $1,000 lifetime maximum for orthodontic services with no deductible. Payments for most diagnostic and preventive services, such as exams and cleanings, are not charged against your maximum and do not require a deductible.
Coverage for cast crowns, bridges, and partial/full dentures is available after 12 months of continuous enrollment in the program. During the second 12 month period, Delta pays 30% of these services. After 24 months of continuous enrollment, the percentage that Delta will pay for these services increases to 50%. Note: Enrollment within 120 days of effective retirement date allows full benefit rates and services.
To enroll in the program, simply visit the web site to obtain an enrollment form or call toll free at 1-888-838-8737 between 7am and 5pm Pacific Time, Monday through Friday.
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