TRICARE Your Military Health Plan

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1 TRICARE Your Military Health Plan TRICARE Benefits/Programs for the National Guard and Reserve During Deactivation Amber Graves March 11, 2012 Updated January 2011

2 Today s Agenda What Is TRICARE? TRICARE Eligibility Medical Coverage Other Important Information For Information and Assistance Photo courtesy of The National Guard 2

3 What Is TRICARE? TRICARE is the health care program for active duty service members, National Guard and Reserve members, retirees, family members, survivors, and certain former spouses worldwide. a network of military and civilian health care professionals working together to foster, protect, sustain, and restore health for those entrusted to their care. 3

4 What Is TRICARE? TRICARE Stateside Regions (50 United States & Washington, DC) TRICARE is available worldwide and managed regionally Health Net Federal Services, LLC TriWest Healthcare Alliance Corp. Humana Military Healthcare Services, Inc. 4

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7 TriWest Mobile Services TriWest Mobile Site TriWest Mobile App 7

8 TriWest Mobile Services SMS Alerts Mobile Site Mobile App Authorization and Referral notification Clams notification Notification when Fees are due View Authorizations and Referrals processed within last 30 days View Claims processed within last 30 days Make single-month credit card payment for amount due Register for TriWest.com account Password Help Describes Authorizations and Referrals and the process for getting care No content related to Claims No content related to Fees or Fee Payment Welcome to the West Region encourages registration and links to registration. No content related to Passwords Easy-to-Use Contact List Manager for Healthcare Provider TRICARE Plan summaries Life Change Events: what they are and what to do when they happen Health & Wellness information; Health Screenings and Immunization schedules 8

9 Mobile Support Delivered. For More Information Scan the bar code (at right) Text MOBILE to TriWest.com/GoRegister Scan the QR code with a mobile device to be taken directly to information about TriWest mobile tools. Confidential and Proprietary 9

10 TRICARE Eligibility Updating DEERS Keep your contact information up to date: Online: By Phone: By Fax: Visit an ID card-issuing facility: More information: Remember to register/update DEERS whenever there is a change in the family (marriage, birth, adoption, divorce, death, etc.) or when you move 10

11 TRICARE Young Adult To be eligible to enroll, dependents: Must have a current, TRICARE-eligible sponsor. Sponsors who qualify for TRICARE Reserve Select or TRICARE Retired Reserve must be enrolled in order for their young adult(s) to purchase or remain enrolled in TYA Standard. Must be unmarried. Must not yet be age 26. Must not be a member of the uniformed Services. Must not be eligible for medical coverage from the young adult s employer-sponsored health coverage. 11

12 Coverage Life Cycle Early Eligibility Service Member Direct Care Family Members Prime/Prime Remote Standard/Extra TRICARE Reserve Select Active Duty - Prime/Prime Remote Family Prime/Prime Remote Standard/Extra Transitional Assistance Management Program (if eligible) Continued Health Care Benefit Program 12

13 Medical Coverage Transitional Assistance Management Program (TAMP) Guard/Reserve active duty served more than 30 consecutive days in support of a contingency operation 180 days of transitional health care benefits Begins the day after you separate from active duty All beneficiaries covered as active duty family members; including the service member Reenrollment necessary for TRICARE Prime (where locally available) Photo courtesy of Flickr user Herald Post Note: TAMP does not cover Line of Duty (LOD) care. 13

14 Medical Coverage TAMP: Program Options TRICARE Standard: Available worldwide TRICARE Extra: Available in the U.S. TRICARE Prime: Available in Prime Service Areas (PSAs) US Family Health Plan (USFHP): Available in six designated areas in the United States Overseas information: 14

15 Medical Coverage TRICARE Standard and TRICARE Extra: Getting Care No referrals necessary Certain services require prior authorization In the event of an emergency, call 911 or go to the nearest hospital Locate a MTF for space-available care MTF locator: For TRICARE Extra, locate a TRICARE Network provider Contact the TRICARE regional contractor, check their website, visit a TRICARE Service Center (TSC) 15

16 Medical Coverage TRICARE Standard and Extra Costs TRICARE Option TRICARE Standard TRICARE Extra Deductible** Amount due each fiscal year before cost-sharing begins. Sponsor rank E1-E4: $50/single or $100/family Sponsor rank E5 & above: $150/single or $300/family Same Outpatient Cost-share 20%* 15% Inpatient Costs Inpatient Behavioral Health Care Catastrophic Cap $17.05/day ($25 minimum) Same $20/day ($25 minimum) $1,000 per family per fiscal year Same The federal fiscal year is Oct. 1- Sept. 30. *Non-network providers may charge up to 15% above the TRICARE allowable cha **Deductible is waived if activated was in support of a contingency operation. Get extra cost-savings with TRICARE Extra! 16

17 Medical Coverage TRICARE Prime: Enrollment Enroll via the Beneficiary Web Enrollment (BWE) site at Fill out the TRICARE Prime Enrollment Application and PCM Change Form (DD Form 2876): Note: Family members enrolled in TRICARE Prime during sponsor s activation period need to re-enroll when sponsor comes off active duty status 17

18 Medical Coverage TRICARE Prime Costs Enrollment Fees $0 Deductible* $0 Outpatient Costs* $0 Inpatient Costs* $0 Emergency Care $0 Catastrophic Cap $1,000 per family per fiscal year The federal fiscal year is Oct. 1- Sept. 30. *You ll pay higher out-of-pocket costs if you use the point of service option (POS). 18

19 Medical Coverage TRICARE Prime: Getting Care Affordable and comprehensive health care coverage Primary care manager (PCM) delivers most routine care 19

20 Medical Coverage TRICARE Reserve Select (TRS): Step 1 Qualify Selected Reserve Member may qualify if: Not eligible for, or enrolled in, Federal Employees Health Benefits (FEHB) program For more information, visit Log onto the Reserve Component Purchased TRICARE Application 1. Follow the instructions to qualify 2. If qualified, print-out and sign the completed DD Form , Reserve Component Health Coverage Request form If you have any questions regarding your TRICARE Reserve Select eligibility, please contact your Reserve Representative at 20

21 Medical Coverage TRICARE Reserve Select: Step 2 Purchase Mail 1. Signed and completed request form (DD Form ) 2. To TRICARE contractor address on form 3. Make initial premium payment as indicated on form Note: For continuous TRICARE coverage, purchase TRS up to 60 days before TAMP ends, but no later than 30 days after end Photo courtesy of the National Guard 21

22 Medical Coverage TRICARE Reserve Select: Getting Care No referrals necessary Certain services require prior authorization In the event of an emergency, call 911 or go to the nearest hospital Locate a MTF for space-available care MTF locator: For TRICARE Extra, locate a TRICARE network provider Contact the TRICARE regional contractor, check their website, visit a TRICARE Service Center (TSC) 22

23 BR414001BET0405W Medical Coverage TRICARE Reserve Select Costs Monthly Premiums TRS Member-only: $54.35 Annual Deductibles (per fiscal year) Cost-Shares (after annual deductible is met) Catastrophic Cap TRS Member and family: $ Rank E-4 & below: $50/individual or $100/family Rank E-5 & above: $150/individual or $300/family Network Provider: 15% Non-network Provider: 20% $1000 per enrollment (per fiscal year) 23

24 New Child Enrollment To have your newborn or newly adopted child covered under TRICARE Reserve Select (TRS): First: Register in DEERS The sponsor (or parent/guardian with power of attorney) must register the child in DEERS. Second: Submit the TRS Request Form Go to Select Qualifying Life Event (QLE) Submit the application to TriWest within 60 days of birth or adoption to have coverage start at birth or adoption. NOTE: If not enrolled in TRS within 60 days, the child s coverage will begin upon enrollment, not at birth or adoption. 24

25 TRICARE Assistance Program Life is stressful. Help is available. Confidential Non-reportable 24/7/365 Call, click or chat today TRIWEST 25

26 Other Important Information TRICARE Pharmacy Program Pharmacy Option MTF Pharmacy (up to a 90-day supply) TRICARE Pharmacy Home Delivery (up to a 90-day supply) Retail Network Pharmacy (up to a 30-day supply) Non-Network Retail Pharmacy (up to a 30-day supply) Generic Formulary Brand Name Non-Formulary $0 $0 N/A $0 $9 $25 $5 $12 $25 TRICARE Prime: 50% costshare after point-of-service deductible is met Other Programs: $12 or 20% of total cost (whichever is greater) after the annual deductible is met TRICARE Prime: 50% costshare after point-of-service deductible is met Other Programs: $25 or 20% of total cost (whichever is greater) after the annual deductible is met Express Scripts, Inc. website: 26

27 Other Important Information TRICARE and Other Health Insurance ADSMs: TRICARE is the sole source/primary payer of health care coverage when activated (or during early eligibility) ADFMs: TRICARE serves as the secondary payer If you have other health insurance (OHI): Fill out a TRICARE Other Health Insurance Questionnaire: ( Follow the referral and authorization rules for your OHI Tell your provider about your OHI and TRICARE Show him or her your insurance card 27

28 Other Important Information Family Members: TRICARE Dental Program (TDP) Voluntary, premium-based program Premiums depend on sponsor s status No 12 month lock-out for active duty family members Service Sponsor One Family Member More Than One Family Member Sponsor and Family Active Duty N/A $12.69 $31.72 N/A National Guard and Reserve Individual Ready Reserve $12.69 $31.72 $79.29 $91.98 $31.72 $31.72 $79.29 $ TDP website: 28

29 Guard & Reserve Resource Center 29

30 PP4111BEC05101W For Information and Assistance Stateside Regional Contractors TRICARE North Region Health Net Federal Services TRICARE ( ) TRICARE South Region Humana Military Healthcare Services TRICARE West Region TriWest Healthcare Alliance TRIWEST ( ) General Contact Information TRICARE Website: Contacts: MMSO: Overseas Regional Contractor International SOS Assistance, Inc. Eurasia-Africa: Latin America & Canada: Pacific: Singapore: Sydney: Connect with TRICARE Online! 30