TRICARE

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TRICARE
TRICARE For Life (TFL) 2007
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TRICARE Regions
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TRICARE Regional Contractors

• TRICARE North (Health Net)
• 1-877-TRICARE (1-877-874-2273)
• TRICARE South (Humana)
• 1-800-444-5445
• TRICARE West (TriWest)
• 1-888-TRIWEST (1-888-874-9378)

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TRICARE Options

• Triple Options
• TRICARE Prime
• TRICARE Extra
• TRICARE Standard
• Other Programs
• TRICARE Prime Remote
• TRICARE Overseas
• TRICARE Plus
• TRICARE For Life

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TRICARE Eligibility

• DEERS
• Active duty retirees
• Medal of Honor recipients
• Family members
• Unmarried children to age 21 23 if full-time
  student
• Certain survivors
• Certain former spouses
• TRICARE For Life eligibility requires Medicare
  Part B

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DEERS

• Defense Enrollment Eligibility Reporting System
• Defense Manpower Data Center Support Office (DSO)
• Phone [phone]
• Fax [phone]
• Mail DSO (Attn COA or TFL), 400 Gigling Road,
  Seaside, CA 93955-6771
• Web www.tricare.mil/DEERS

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Making Changes in DEERS

• Demographic changes (address, phone)
• Can be done in person by phone, fax or mail or
  online
• To add or remove a family member
• Sponsor responsibility
• Personnel / ID Card Office
• Birth, death, adoption, marriage, divorce
• Documentation required
• Certificates
• Decrees

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DEERS (Continued)

• Unremarried Former Spouses
• Former spouses SSN used to verify eligibility
  (20/20/20 rule)
• Not eligible if covered by an employer-sponsored
  health plan
• Personnel / ID Card Office
• Stepchildren eligibility

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Military Treatment Facility Priorities for Care

• Active duty
• Active duty family members in Prime
• Retirees, family members survivors in Prime
• TRICARE Plus enrollees (where available)
• Active duty family members not in Prime
• Retirees, family members survivors not in Prime
• Other eligible beneficiaries

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TRICARE Medicare Dual Eligibility

• Medicare Part A entitlement
• Under age 65 disability or end-stage renal
  disease
• Age 65
• TRICARE eligibility
• Must purchase Medicare Part B
• Except active duty family members
• TRICARE is second payer to Medicare
• Dual eligibility TFL

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TRICARE For Life

• Became law October 1st, 2001
• Eligibility
• Medicare-eligible beneficiaries age 65 and over
  disability end-stage renal disease
• Sponsors, family members, widows, widowers,
  certain former spouses
• Eligible for Medicare Part A, and enrolled in
  Medicare Part B
• Eligibility current in DEERS

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TRICARE For Life - Costs

• No enrollment fees for TFL
• Medicare Part B premiums
• 93.50/month for 2007
• Income-based
• Increase annually

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Health Care for SeniorsBefore Since TFL Began
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TRICARE For Life Who Pays for What
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TFL - Enrollment in Medicare Part B

• Required to receive TRICARE For Life benefits
• Initial 7-month enrollment period
• Annual general enrollment period
• January 1st March 31st
• Special enrollment situations
• Premium surcharge/penalty

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Claims Processing for TFL Dual-Eligible
Beneficiaries

• Claims processor
• Wisconsin Physician Services (WPS)
• www.tricare4u.com
• Providers file claims with Medicare
• Medicare forwards claims to WPS
• Explanations of Benefit (EOB) from both Medicare
  TRICARE

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Using TFL with Other Health Insurance (OHI)

• Examples of OHI
• Employer-sponsored health insurance
• Medigap other supplemental health insurance
  policies
• TRICARE does not pay second to Medicare if there
  is OHI
• Medicare pays first, OHI second, TRICARE last
• May have to file paper claims with TRICARE for
  payment/reimbursement

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Catastrophic Cap

• Annual (fiscal year) out-of-pocket expenses for
  covered services
• Active duty families - 1000/family
• Retirees families - 3000/family
• Includes TFL beneficiaries

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Catastrophic Cap (continued)

• Exclusions
• Does not apply to active duty personnel
• Out-of-pocket expenses under TRICARE Prime
  point-of-service option
• Any amount charged by non-participating providers
  above the TRICARE allowable charge
• Medicare premiums

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TRICARE Plus

• Primary care enrollment program at select MTFs
• NMCP Internal Medicine Clinic
• Enrollment by invitation only
• No enrollment fees or co-pays
• Same primary care access-to-care standards as
  TRICARE Prime
• Limitations
• Continued availability not guaranteed
• Specialty care not included nor guaranteed

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Pharmacy

• Eligibility
• Options
• MTF Pharmacy
• TRICARE Mail Order Pharmacy
• TRICARE Retail Network Pharmacy
• Non-network Retail Pharmacy

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Pharmacy Costs
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Skilled Nursing Facility (SNF) Care

• Medicare TRICARE covered benefit
• Medically necessary skilled nursing care
  rehabilitative services
• Requires preceding qualifying hospital stay
• SNF requires Medicare certification
• SNF requires TRICARE participation agreement

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Long-Term Care

• Not the same as Skilled Nursing Facility (SNF)
  Care
• Often called Custodial Care
• For patients who need assistance with activities
  of daily living
• Not a covered benefit by Medicare or TRICARE
• Purchasing Long Term Care Insurance is an option
  for beneficiaries

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Hearing Aids

• Not a covered benefit under TRICARE or TFL for
  retirees
• Retiree-At-Cost Hearing Aid Purchase Program
  (RACHAPP)
• At select MTFs
• NMCP ENT Clinic (Audiology)
• Referral required
• Retiree only
• Retiree family members do not qualify

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TRICARE Online

• Current Features
• Online MTF appointing
• Rx checker
• TRICARE information
• Personal health journal
• Medical library
• Health wellness links
• Healthy life style tools
• MTF facility clinic pages
• Provider pages
• Secure access

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TRICARE Online

• Future Features
• Pharmacy refills
• Routine pharmacy renewal requests
• Routine lab requests
• Online enrollments
• Patient/provider messaging
• Appointment reminders
• Health assessments
• Access to electronic health record

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Dental

• TRICARE Dental Program (TDP)
• For active duty family members, National Guard
  Reserve members their families
• United Concordia is the contractor
• TRICARE Retiree Dental Program (TRDP)
• For retirees their families, Medal of Honor
  recipients their families, certain survivors
  former spouses
• Delta Dental Plan of California is the contractor

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TRICARE Sustaining the Benefit

• Major expansions in the TRICARE benefit
• Proposed changes to the TRICARE benefit
  phase-in
• Increase TRICARE Prime enrollment fees (applies
  only to eligible retirees under the age of 65)
• Create TRICARE Standard enrollment fees
  increase deductibles (applies only to eligible
  retirees under the age of 65)
• Change some pharmacy co-payments

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TRICARE Assistance Information

• Beneficiary Counseling Assistance Coordinators
  (BCACs/HBAs)
• Located at most MTFs
• TRICARE Service Centers (TSCs)
• Health Net Federal Services
• Located at major MTFs
• Telephone resources
• Internet resources

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TRICARE Assistance Information - BCACs

• Boone Branch Health Clinic, NAB Little Creek
• [phone]
• Kenner Army Health Clinic, Fort Lee
• [phone]
• Langley 1st Medical Group, Langley AFB
• [phone]
• McDonald Army Community Health Clinic, Fort
  Eustis
• [phone]
• Naval Medical Center Portsmouth
• [phone]
• Northwest Branch Health Clinic, NavComSta NW
• [phone]

• Oceana Branch Health Clinic, NAS Oceana
• [phone]
• Sewells Point Branch Health Clinic, Norfolk
  Naval Base
• [phone]
• TRICARE Prime Clinic Chesapeake
• [phone]
• TRICARE Prime Clinic Virginia Beach
• [phone]/6711
• Yorktown Branch Health Clinic, Naval Weapons
  Station
• [phone]
• Yorktown Coast Guard Health Clinic
• [phone]

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TRICARE Assistance Information - TSCs

• TRICARE Service Centers
• Health Net Federal Services
• 1 (877) TRICARE (874-2273)
• Locations
• Naval Medical Center Portsmouth
• Kenner Army Health Clinic
• Langley 1st Medical Group
• McDonald Army Community Health Clinic

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TRICARE Assistance Information Telephone s

• TRICARE Service Center (Health Net Federal
  Services)
• 1-877-TRICARE (1-877-874-2273)
• TRICARE Mail Order Pharmacy (Express Scripts)
• 1-866-DoD-TMOP (1-866-363-8667)
• TRICARE Retail Pharmacy (Express Scripts)
• 1-866-DoD-TRRx (1-866-363-8779)
• Hampton Roads Appointment Center
• 1-866-MIL-HLTH (1-866-645-4584)
• TRICARE Online
• 1-800-600-9332 or 1-210-767-5250
• TRICARE Dental Program (United Concordia)
• 1-800-866-8499
• TRICARE Retiree Dental Program (Delta Dental)
• 1-888-838-8737
• TRICARE For Life
• 1-866-773-0404 (or TTY/TDD callers use
  1-866-773-0405)

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TRICARE Assistance Information Internet

• DEERS www.tricare.mil/DEERS
• Health Net Federal Services www.healthnetfederals
  ervices.com
• Naval Medical Center Portsmouth www-nmcp.mar.med.
  navy.mil
• Reserve Affairs www.defenselink.mil/ra
• TRICARE Claims Information
• PBGA www.mytricare.com
• TRICARE For Life (WPS) www.wps.com
• TRICARE Dental Information
• Active Duty Family Member Dental
  Program www.TRICAREdentalprogram.com
• Retiree Dental Program www.trdp.org
• TRICARE For Life Information
• Claims (Wisconsin Physician Services) www.wps.com
• Information www.tricare4u.com
• Medicare Social Security www.ssa.gov
• TRICARE Management Activity (TMA) www.tricare.mil
• TRICARE Online (Appointments) www.tricare.mil
• TRICARE Pharmacy Information
• Mail Order Pharmacy Program www.express-scripts.c
  om/TRICARE
• Retail Pharmacy Program www.tricare.mil/pharmacy

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Health Net Web Site

• www.healthnetfederalservices.com
• Features
• TRICARE Prime enrollment, benefit, policy and
  cost-share information
• Information about referrals and authorizations
  for specialty care
• Claims information
• AudioHealth Library featuring hundreds of
  recorded health topics which can help you stay
  healthy
• Online TRICARE Service Center
• TRICARE Service Center Directory
• Health Net Provider Network Directory

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Thank You!