Congratulations on Your New Baby!

Transcription

1 Information for New Parents Tidewater Congratulations on Your New Baby! Inside... A checklist of things to do Information about TRICARE eligibility, DEERS and ID cards A comparison of TRICARE Prime, Extra and Standard Points of contact for TRICARE help and information An overview of Pediatric services available at Naval Medical Center Portsmouth Fiscal Year 2014 Version McDonald Army Health Center 576 Jefferson Avenue Newport News, Virginia (757) mcdonald.narmc.amedd.army.mil/default.aspx Naval Medical Center Portsmouth Naval Support Activity 620 John Paul Jones Circle Portsmouth, Virginia (757) rd Medical Group 77 Nealy Avenue Hampton, Virginia (757)

2 Things to Do Limited Power of Attorney. A Power of Attorney will be needed to register the new baby in DEERS if the sponsor is deployed. A Legal Service Office can help. Proof-of-Birth Letter. This will be available for pick-up from the Hospital Admissions Office before you leave the hospital and may be used in place of the birth certificate to register the baby in DEERS. Official Birth Certificate. A request to the Virginia Bureau of Vital Statistics for the original birth certificate takes 3 to 5 weeks to process. The Birth Registrar ( ) will give you the forms before you leave the hospital. DEERS Registration. The sponsor, or other parent with a Power of Attorney, must register the baby in DEERS at a military personnel office or ID card-issuing facility. See the next page for more information. Establish Paternity. If paternity is an issue, testing should be done as soon as possible after the baby s birth. Paternity establishment forms are available from the hospital s admissions office. Paternity testing is not covered by TRICARE and is not done at any military treatment facility. Testing will be at your own expense. An unwed, pregnant dependent daughter is eligible for TRICARE benefits, including maternity care, until age 21 (or 23, if a full-time student). The newborn, however, will not be eligible for TRICARE unless the newborn s father is a service member and registers the baby in DEERS; the unwed daughter s sponsor legally adopts the child; or Secretary of the Navy Designee status is authorized. Select a Doctor. Plan ahead and decide on a TRICARE Prime primary care manager for your baby before your child is born. Depending on where you live and the availability of providers, your new baby s doctor may be with a military treatment facility or civilian practice. The TRICARE Service Center ( ) staff can help you find a provider and will help with the enrollment process. Prime Enrollment. Newborns are covered under Prime for the first 60 days as long as one additional family member is already in Prime. If the baby is not registered in DEERS and enrolled in Prime during the first 60 days, claims will start processing as TRICARE Standard on day 61. Using TRICARE Standard will result in out-of-pocket expenses for deductibles and copayments. DEERS registration and Prime enrollment are two separate processes. Child Care & Post-Delivery Care & Assistance. If the sponsor is deployed and you have other children, plan ahead and make arrangements for child care while you are in the hospital, for help getting home, and for help getting to and from follow-up medical appointments for you and your baby.

3 DEERS & ID Cards TRICARE Eligibility Your baby should be registered in DEERS (Defense Enrollment Eligibility Reporting System) as soon as possible after birth to establish TRICARE eligibility, and allow enrollment into TRICARE Prime. DEERS registration can be done by the sponsor (or other parent, with a Power of Attorney) at a military personnel office or ID card facility. You will need: DD Form 1172 (ID Card Application) Proof-of-Birth Letter or Official Birth Certificate Parents Marriage Certificate The baby must also be added to Page 2 of the sponsor s Personnel Record. Newborns of unwed dependent daughters are not eligible for TRICARE benefits unless: The newborn s father is a service member & registers the baby in DEERS; The unwed daughter s sponsor legally adopts the newborn; or Secretary of the Navy Designee status is authorized (space-available care) Call the Defense Manpower Data Center (DMDC) at , or visit a personnel office for help. To find a personnel office or ID card-issuing facility near you, call the toll-free number, or visit DMDC online: To schedule an appointment with an ID Card Office to register your newborn in DEERS, go to: rapids-appointments.dmdc.osd.mil When Both Parents are Service Members Decide which parent will be designated as the sponsor Call or visit a Beneficiary Counseling and Assistance Coordinator (Health Benefits) Office or TRICARE Service Center to discuss your options Get an Authorization to Disclose Information form, which the nondesignated parent will need for appointments, referrals, enrollment, claims or other health care-related matters

4 TRICARE Choices and Costs Active Duty Family Members TRICARE Prime (Managed care) TRICARE Extra (Preferred provider) TRICARE Standard (Fee-for-service)* Annual Deductible Enrollment Fee Civilian Outpatient Visit Emergency Care Civilian Inpatient Admission Civilian Inpatient Behavioral Health Civilian Inpatient Skilled Nursing Facility Care None (unless Point-of-Service option is used) No cost No cost E-4 & below: $50/individual or $100/family None 15% of negotiated fee 20% of allowable charges Greater of $17.35/day or $25 per admission Greater of $20/day or $25 per admission Greater of $17.35/day or $25 per admission Catastrophic Cap Retirees, Family Members & Others $1000 per family per fiscal year (01 October 30 September) Prime Extra Standard* Annual Deductible Enrollment Fee (FY-2014) None (unless Point-of-Service option is used) $273.84/individual; $547.68/family $150/individual or $300/family None Civilian Outpatient Visit $12 Emergency Care $30 Outpatient Behavioral Health Visit $25 (individual visit) $17 (group visit) 20% of negotiated fee 25% of allowable charges Civilian Inpatient Admission Greater of $11/day or $25 per admission No separate cost share for separately billed professional charges Lesser of $250/day, or 25% of negotiated charges; plus 20% of negotiated professional fees Lesser of $698/day, or 25% of negotiated charges; plus 25% of negotiated professional fees Civilian Inpatient Skilled Nursing Facility Care Greater of $11/day or $25 per admission Lesser of $250 or 20% of billed charges for institutional services; plus 20% of separately billed professional charges 25% of allowable charges for institutional services; plus 25% of separately billed professional charges Civilian Inpatient Behavioral Health $40/day No separate cost share for separately billed professional charges 20% of total charge; plus 20% for separately billed professional charges High volume hospital 25%/ day Low volume hospital lesser of $213/day or 25% of billed charges Catastrophic Cap $3000 per family per fiscal year (01 October 30 September) *TRICARE Standard non-participating providers may balance-bill up to 15% above the TRICARE maximum allowable charge for covered services. Balance billing costs do not apply towards the catastrophic cap.

5 TRICARE Information and Assistance Beneficiary Counseling and Assistance Coordinators in Tidewater Naval Medical Center Portsmouth Building 3, 3rd Floor, 620 John Paul Jones Circle Portsmouth, VA (757) /2611 Monday Friday, 7:00 a.m. 3:30 p.m. Branch Health Clinic, Dam Neck Annex 1885 Terrier Avenue Virginia Beach, VA (757) , Mon - Fri, 7 a.m. - 3:30 p.m. Branch Health Clinic, Norfolk Naval Station Sewell s Point, 1721 Taussig Boulevard Norfolk, VA (757) Branch Health Clinic, JEB Little Creek Boone Clinic, 1035 Nider Boulevard Norfolk, VA (757) /8185 Branch Health Clinic, NAS Oceana Naval Air Station Oceana 1550 Tomcat Boulevard Virginia Beach, VA (757) (Option 7) Monday Friday, 7:00 a.m. 3:20 p.m. Branch Health Clinic, NWS Yorktown Naval Weapons Station Yorktown P.O. Box 90 Yorktown, VA (757) Branch Health Clinic, Northwest Annex Naval Support Activity Northwest Annex 4501 Relay Road Chesapeake, VA (757) TRICARE Prime Clinic Virginia Beach 2100 Lynnhaven Parkway, Suite 201 Virginia Beach, VA (757) /6711 Monday Friday, 7 a.m. 3:45 p.m. TRICARE Prime Clinic Chesapeake 1011 Eden Way North, Suite 8 Chesapeake, VA (757) Monday Friday, 7:30 a.m. 4 p.m. 633rd Medical Group 77 Nealy Avenue Hampton, VA (757) McDonald Army Community Health Center 576 Jefferson Avenue Newport News, VA (757) USCG Training Center Route 238 Yorktown, VA (757) /2345 Other Helpful Phone Numbers at Naval Medical Center Portsmouth Admissions Office (757) /1510 Birth Registrar (757) Emergency Room (757) Information Desk (757) Patient Information (757) Pharmacy (757) Secretary of the Navy Designee Office (757) /7754 Women s Health (OB/GYN) - (757)

6 Outpatient Primary Care Medical Homeport Inpatient Care Neonatal Intensive Care Unit Newborn Nursery Pediatric Inpatient Ward Pediatric Intensive Care Unit Specialty Clinics Pediatric Services at Naval Medical Center Portsmouth Academic Pediatrics Adolescent Medicine Allergy/Immunology Anesthesiology Cardiology Children s Oncology Group Critical Care Cystic Fibrosis Center Dentistry Ear, Nose & Throat (ENT) Specialty Clinics (continued) Pediatric Clinic, Building 2, 2nd Floor, Customer Service Representative (757) Neurodevelopmental Pediatric Clinic, Building 3, 2nd Floor (757) Emergency Medicine Gastroenterology General Pediatrics Hematology/Oncology Infectious Disease Neonatology Nephrology Neurodevelopmental Pediatrics Neurology Nutrition Occupational Therapy Ophthalmology Orthopedics Psychiatry & Psychology Pulmonology Radiology Social Work Speech Therapy Surgery Internet Resources TRICARE DEERS NMCP Pharmacy Military Treatment Facility Appointments and Specialty Referral Status Hampton Roads Appointment Center Mon Fri, 6 a.m. 8 p.m. S, S & Holidays, 7 a.m. 3:30 p.m. 1-(866)