Presentation on theme: "TRICARE Benefits TRICARE Reserve Select TRICARE Retired Reserve TRICARE Retiree Entitlement Denise Binkley Beneficiary Service and Education Representative."— Presentation transcript:
TRICARE Benefits TRICARE Reserve Select TRICARE Retired Reserve TRICARE Retiree Entitlement Denise Binkley Beneficiary Service and Education Representative Updated January 2011 TRICARE ® Your Military Health Plan
2 TRICARE Stateside Regions (50 United States & Washington, DC) What Is TRICARE? TriWest Healthcare Alliance Corp. Humana Military Healthcare Services, Inc. Health Net Federal Services, LLC TRICARE is available worldwide and managed regionally
3 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 TRICARE Eligibility
TRICARE Reserve Select BR402101BET0504C
5 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 Medical Coverage If you have any questions regarding your TRICARE Reserve Select eligibility, please contact your Reserve Representative at
6 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 Medical Coverage 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
7 Continuous Open Enrollment If you qualify, you may purchase TRS coverage to begin in any month throughout the year. Coverage begins on the first day of the first or second month after the postmark date of your TRS Request Form. The member can choose which month he or she wishes to begin coverage.
8 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) Medical Coverage
9 TRICARE Reserve Select: Getting Care For TRICARE Standard, locate a non-network TRICARE-authorized provider – Check your phone book or – Ask provider’s office, “Do you accept TRICARE?” If not, invite the provider to become TRICARE authorized Give your provider the phone number of your regional contractor or send them to Medical Coverage
10 TRICARE Reserve Select Costs Monthly PremiumsTRS Member-only: $53.16 TRS Member and family: $ Annual Deductibles (per fiscal year) Rank E-4 & below: $50/individual or $100/family Rank E-5 & above: $150/individual or $300/family Cost-Shares (after annual deductible is met) Network Provider: 15% Non-network Provider: 20% Catastrophic Cap (per fiscal year) $1000 per enrollment BR414001BET0405W Medical Coverage
11 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 https://www.dmdc.osd.mil/appj/trs/index.jsp – 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.
12 Changes to TRS Coverage Change in family composition – Marriage, divorce, newborn, etc. Take one of the following actions – Purchase new coverage – Change type of coverage (e.g., member-only to member-and-family) – Terminate coverage If change impacts type of coverage (e.g., member-only to member-and-family), premium increase (or decrease) is effective based on date of change
13 Disenrollment from TRS You must submit a TRS Request Form to disenroll from TRS. Do—Log on to the “Reserve Component Purchased TRICARE Application” to complete the TRS Request Form. Do—Mail your completed TRS Request Form to your TRICARE regional contractor. Don’t—Stop paying premiums. Note: If you are activated for more than 30 days you will automatically be disenrolled from TRICARE Reserve Select – Do Not fill out a disenrollment form.
14 Termination of TRS Coverage Failure to pay premiums Loss of Selected Reserve status Gain eligibility for other TRICARE program May purchase TRS again if you qualify at time of purchase
15 TRICARE Assistance Program Life is stressful. Help is available. Confidential Non-reportable 24/7/365 Call, click or chat today TRIWEST Care
16 TRICARE Dental Program (TDP) Other Important Information Voluntary, premium-based program Premiums depend on sponsor’s status ServiceSponsor One Family Member More Than One Family Member Sponsor and Family Active DutyN/A$12.69$31.72N/A National Guard and Reserve $12.69$31.72$79.29$91.98 Individual Ready Reserve $31.72 $79.29$ TDP website:
TRICARE Retired Reserves BR402101BET0504C
18 TRICARE Retired Reserve (TRR) TRICARE Retired Reserve (TRR) is a premium-based healthcare plan available to eligible retired members of the National Guard and Reserves, their families and qualified survivors. Members pay a monthly premium and are responsible for annual deductibles and cost-shares. Members of the Retired Reserve of a Reserve Component are eligible for TRR when they are: – Qualified for non-regular retirement under 10 U.S.C., Chapter – Not yet age 60. – Not eligible for, or enrolled in, the Federal Employees Health Benefits (FEHB) program.
19 TRR Monthly Premium Effective for coverage beginning January 1, 2011, TRR monthly premiums are: – $ for Member-only coverage – $1, for Member and family coverage The monthly premium amount could change every year on January 1. Send in payment for the first two month’s premium with the enrollment form. You can pay the initial premium payment by credit/debit card and sign up for automatic monthly credit/debit card payments on the application.
20 TRR Coverage Termination Termination Due to Nonpayment – Your premium payment is due no later than the last day of the month for the next month’s coverage. Failure to pay overdue premium amounts will result in a termination of coverage due to nonpayment. A 12-month TRR purchase lockout will go into effect. Your TRR coverage will automatically terminate for the sponsor and family members when: – You (the sponsor) reach age 60 (or for surviving family members, when the sponsor would have reached age 60). – You (the sponsor) are recalled to active duty service for more than 30 days. If eligible, you may qualify for and purchase TRR after the loss of any other TRICARE coverage.
21 TRICARE Standard and Extra Costs: Retirees, Their Families and All Others TRICARE Option TRICARE StandardTRICARE Extra Outpatient Deductible Amount due each fiscal year before cost-sharing begins. $150/individual or $300/family Outpatient Cost-share25%*20% Inpatient Costs Check with your regional contractor about inpatient behavioral health costs. Lesser of $535/day or 25% of charges plus 25% of professional fees Lesser of $250/day or 25% of charges plus 20% of professional fees Catastrophic Cap $3,000 per family per fiscal year Get extra cost-savings with TRICARE Extra! The federal fiscal year is Oct. 1- Sept. 30. * Non-network providers may charge up to 15% above the TRICARE allowable charge.
23 Decision Process Where will you live? Will you accept employment? How is your health (and family)? What health plans are available? Cost of competing health plans? Insurability? Do I need supplemental insurance? BR402101BET0504C
24 Fee-for-service option No enrollment required Seek care from any TRICARE-authorized provider Responsible for annual deductibles and cost- shares— highest out-of-pocket expense May have to pay provider then file claim for reimbursement TRICARE Standard BR402101BET0504C
25 TRICARE Standard—Costs Annual deductible – $150 individual/$300 for family Cost-shares after deductible has been met – 25% of allowed charges May be responsible for up to 15% above the TRICARE allowable charge for services if providers do not participate in TRICARE May have to pay provider then file claim for reimbursement BR402101BET0504C
26 Preferred provider option (PPO) No enrollment required Seek care from any TRICARE network provider Responsible for annual deductibles and discounted cost-shares Providers will file claims for you May seek care in an MTF on a space-available basis TRICARE Extra BR402101BET0504C
27 TRICARE Extra—Costs Annual deductible – $150 individual/$300 for family Cost-shares after deductible has been met – 20% of negotiated rate Providers cannot charge more than the negotiated rate for services rendered BR402101BET0504C
28 Standard Any TRICARE- authorized provider Cost-share: 25% of allowable charge May have to file claims Nonparticipating providers may charge up to 15% above allowable charge for services Extra Any TRICARE network provider Cost-share: 20% of negotiated rate Providers will file claims for you Not responsible for additional charges for covered benefits TRICARE Extra vs. Standard BR402101BET0504C
29 TRICARE Prime Enrollment required – Portable: Easy to transfer when you move – Split enrollment: Families can enroll together in different regions Access standards for care Most care received from primary care manager Minimal out-of-pocket costs
30 TRICARE Prime Enrollment fees – Individual: $230 per year – Families: $460 per year Network provider fees – Outpatient visit: $12 copayment – Inpatient visit: $11 per day ($25 minimum) – Emergency services: $30 copayment – Behavioral health outpatient visit: $25/individual $17/group – Behavioral health inpatient visit: $40 per day BR402101BET0504C
31 Catastrophic Cap Each fiscal year—$3,000 for all retirees and family members – TRICARE Prime – TRICARE Extra – TRICARE Standard BR402101BET0504C
32 Freedom to use any TRICARE-authorized provider In or out of network—no referrals needed Nonavailability statement is not necessary Subject to higher deductibles and cost-shares Point-of-service option is more costly to the enrollee TRICARE Prime Point-of-Service (POS) Option BR402101BET0504C
33 Annual outpatient deductibles are $300 for an individual and $600 for a family 50% cost-shares for outpatient and inpatient claims Excess charges up to 15% above the TRICARE allowable charge The 50 percent cost-share continues to be applied even after the catastrophic cap has been met POS Cost-shares and Deductibles BR402101BET0504C
34 TRICARE Retiree Dental Program Voluntary dental insurance program administered by the Federal Services division of Delta Dental Plan Available to: – Retired service members and their eligible family members – Certain surviving family members of deceased active duty sponsors – Medal of Honor recipients and their immediate family members and survivors BR402101BET0504C
35 TRDP—Enrollment Delta Dental handles all enrollments There is an initial 12-month commitment for new enrollees after which enrollment may be continued on a month-to-month basis 30-day grace period from the coverage effective date during which voluntary termination of enrollment is allowed without further enrollment obligation provided that no benefits have been used BR402101BET0504C
36 TRDP—Costs Annual deductible – $50 per person – $150 deductible cap per family Annual maximum coverage – $1,200 per person Deductible and maximum do not apply to: – Diagnostic and preventive services – Dental accident procedures or orthodontia For more information: – – or BR402101BET0504C
37 TRICARE serves as the secondary payer. If you have other health insurance (OHI): – Fill out a TRICARE Other Health Insurance Questionnaire (www.tricare.mil/mybenefit/Forms.do)www.tricare.mil/mybenefit/Forms.do – Follow the referral and authorization rules for your OHI – Tell your provider about your OHI and TRICARE – Show him or her your insurance card TRICARE is the sole payer for the Guard/Reserve sponsor when activated (or during early eligibility) – No payment is sought from OHI for the sponsor’s care TRICARE and Other Health Insurance Other Important Information
38 TRICARE Pharmacy Program Other Important Information Pharmacy Option Formulary Non-Formulary GenericBrand Name MTF Pharmacy (up to a 90-day supply) $0 N/A TRICARE Pharmacy Home Delivery (up to a 90-day supply) $3$9$22 Retail Network Pharmacy (up to a 30-day supply) $3$9$22 Non-Network Retail Pharmacy (up to a 30-day supply) TRICARE Prime: 50% cost- share after point-of-service deductible is met Other Programs: $9 or 20% of total cost (whichever is greater) after the annual deductible is met TRICARE Prime: 50% cost- share after point-of-service deductible is met Other Programs: $22 or 20% of total cost (whichever is greater) after the annual deductible is met Express Scripts, Inc. website:
39 Convenient home delivery (FPO or APO for overseas locations) – Low Cost Generic medication—$3 for up to a 90-day supply Brand name medication—$9 for up to a 90-day supply Non-formulary medication—$22 for up to a 90-day supply Note: Up to a 30-day supply for controlled substances – Free Shipping and Handling – For more information: Visit DoD-TMOP ( ) TRICARE Mail Order Pharmacy (TMOP) BR402101BET0504C
40 Guard & Reserve Resource Center
41 TRICARE North Region Health Net Federal Services TRICARE ( ) TRICARE South Region Humana Military Healthcare Services TRICARE West Region TriWest Healthcare Alliance TRIWEST ( ) Stateside Regional Contractors For Information and Assistance General Contact Information TRICARE Website: Contacts: MMSO: Connect with TRICARE Online! PP4111BEC05101W Overseas Regional Contractor International SOS Assistance, Inc. Eurasia-Africa: Latin America & Canada: Pacific: Singapore: Sydney: