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TRICARE® Your Military Health Plan

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Presentation on theme: "TRICARE® Your Military Health Plan"— Presentation transcript:

1 TRICARE® Your Military Health Plan
TRICARE Benefits TRICARE Reserve Select TRICARE Retired Reserve TRICARE Retiree Entitlement Presenter Tips Review slides before briefing Print out briefing with notes prior to presentation Ensure “slide show” setting Delete any slides that do not apply to your audience You may add slides from other briefings as appropriate for your audience Estimated Briefing Time: 15–20 minutes Recommended Handouts: (available at TRICARE Retired Reserve brochure TRICARE Resources for the National Guard and Reserve flyer TRICARE Reserve Select brochure TRICARE Choices for the National Guard and Reserve brochure Briefing Objectives: Increase awareness of TRICARE benefits for National Guard and Reserve members and families Tell beneficiaries the necessary steps for accessing the TRICARE benefit Optional Presenter Comments: Welcome to the TRICARE Benefits/Programs for National Guard and Reserve Members New to TRICARE/Active Less Than 30 Days briefing for members who are new to TRICARE and on inactive duty status. The goal of today’s presentation is to give you information about your TRICARE benefit. Denise Binkley Beneficiary Service and Education Representative Updated January 2011 1

2 TRICARE Stateside Regions (50 United States & Washington, DC)
What Is TRICARE? TRICARE is available worldwide and managed regionally Health Net Federal Services, LLC TriWest Healthcare Alliance Corp. TRICARE is available worldwide and managed regionally. There are three TRICARE regions in the United States—TRICARE West, TRICARE North, and TRICARE South. Your benefits are the same regardless of where you live, but you will have different customer service contacts based on your region. Because you are in the [West, North, South] region, your contractor is [TriWest Healthcare Alliance; Health Net Federal Services; Humana Military Healthcare Services]. [TriWest; Health Net; Humana Military] partners with the Military Health System to provide you with health, medical, and administrative support including customer service, claims processing, and authorizations for certain health care services. Customer service information for each region will be provided at the end of this presentation. While TRICARE programs and services exist overseas and I’ll provide you with contact information to learn more about TRICARE overseas, we’ll focus on stateside regions for this particular presentation. Humana Military Healthcare Services, Inc. 2

3 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 Once you and your family are registered in DEERS, be sure to keep addresses and other contact information up to date for all family members. Keeping DEERS information current, especially your address, is critical to ensuring uninterrupted TRICARE coverage for you and your family. While only the sponsor can add or remove family members in DEERS, both the sponsor and adult family members can update contact information. Anytime there is a change in family status, marriage, birth, adoption, divorce, death, etc., the sponsor must update DEERS. Promptly update your information when any change occurs, regardless of whether or not you are on active duty at the time. You can contact DEERS online, by phone, or by fax. For more information, go to If you prefer to update your information in person, you can visit an ID card-issuing facility. Note: Be sure to register newborn or newly adopted children in DEERS within 60 days of birth or adoption. Prompt registration of children in DEERS can minimize delays or problems with coverage and claims processing. 3

4 TRICARE Reserve Select
When you retire, you have new health care choices. While on active duty, you could only be enrolled in TRICARE Prime or TRICARE Prime Remote. Now you will have many of the same choices as your family members. This portion of our seminar will discuss you new health care options and explain differences that your family members will see after you retire. Note: If you were enrolled in TRICARE Prime Remote and your family was enrolled in TRICARE Prime Remote for Active Duty Family Members, these options are no longer available to you. BR402101BET0504C

5 TRICARE Reserve Select (TRS): Step 1 – Qualify
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” Follow the instructions to qualify If qualified, print-out and sign the completed DD Form , Reserve Component Health Coverage Request form TRICARE Reserve Select, or TRS, is a premium-based health plan available for purchase by qualified members of the Selected Reserve. You will not qualify for TRS if you are eligible for the Federal Employees Health Benefits, or FEHB, program based on your civilian employment or if you are enrolled in FEHB through a family member. You can visit the Reserve Component Purchased TRICARE Application to determine your qualification. Any questions regarding eligibility, especially if you or your spouse is a Federal employee and may be eligible for FEHB, contact your Reserve Component personnel office. If you have any questions regarding your TRICARE Reserve Select eligibility, please contact your Reserve Representative at 5

6 TRICARE Reserve Select: Step 2 – Purchase
Medical Coverage TRICARE Reserve Select: Step 2 – Purchase Mail Signed and completed request form (DD Form ) To TRICARE contractor address on form 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 With TRICARE Reserve Select, you can purchase either member-only or member-and-family coverage. To purchase coverage, visit the Reserve Component Purchased TRICARE Application website. Follow the instructions to complete, print, and sign the Reserve Component Health Coverage Request form, which is DD Form Note: Handwritten forms will NOT be accepted. Mail the completed and signed form along with the first month’s premium payment. If you wish to continue TRICARE coverage with no lapse and qualify to purchase TRICARE Reserve Select, you must do so within 60 days of the end of your TAMP period for uninterrupted coverage, but no later than 30 days after TAMP ends. It is best to apply for TRS before your TAMP ends. Note: Any premium payment that is late or not made at all, will result in a 12-month lock-out. Photo courtesy of the National Guard 6

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. Coverage begins on the first day of the first or second month following postmark of your TRS Request Form. For example, if your TRS Request Form is postmarked in July, you may select coverage to begin on the first of the next month, August, or you may select that coverage begin the first of the second month, which would be September.

8 TRICARE Reserve Select: Getting Care
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) TRICARE Reserve Select beneficiaries have the flexibility to visit any TRICARE-authorized provider, which is a doctor or other provider who is approved to provide care to TRICARE beneficiaries. Although referrals are not required for most health care services, some services require prior authorization to determine medical necessity. Visit your regional contractor’s website for information about authorization requirements. In the event of an emergency, call 911 or go to the nearest emergency room. Referral or prior authorization is not required, but, if admitted, contact your regional contractor within 24 hours or the next business day to coordinate ongoing care. TRICARE Reserve Select beneficiaries may also receive care at military hospitals and clinics on a space-available basis, but space is very limited. 8

9 TRICARE Reserve Select: Getting Care
Medical Coverage 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 However, your out-of-pocket costs will be lower if you see a TRICARE network provider, thus utilizing TRICARE Extra. A network provider is a TRICARE-authorized provider who has an agreement with your regional contractor to accept TRICARE rates as payment in full and file claims on your behalf. To find a network provider, visit or contact your regional contractor toll free or visit the nearest TRICARE Service Center. If you plan to see a non-network provider, ask if he or she is authorized and accepts TRICARE before receiving care. If they are not an authorized TRICARE provider, invite them to become so. 9

10 TRICARE Reserve Select Costs
Medical Coverage Monthly Premiums TRS Member-only: $53.16 TRS Member and family: $197.76 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 $1000 per enrollment With TRICARE Reserve Select, you are responsible for monthly premiums, an annual deductible, cost-shares, and copayments. Premiums are monthly payments due the first of every month for TRS members. The 2011 premiums are $53.16 for member-only coverage and $ for member-and-family coverage. These rates are effective through December 31, Note: It is important to know that any premium payment that is late or not made at all, will result in a 12 month lock-out period. Your deductible is the amount you pay out-of-pocket per year before your TRICARE coverage begins and is based on the sponsor’s pay grade. The deductible for E4s and below is $50 per individual and $100 per family. The deductible for E5s and above is $150 per individual or $300 per family. BR414001BET0405W

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 Life-changing events that affect your family composition include: Birth or adoption of a child Placement of a child in the legal custody of the member by an order of the court Divorce or annulment Death of a spouse or family member Last family member becomes ineligible (e.g., child ages out) You must take one of the following actions to change your TRS coverage: Purchase new coverage Change in type of coverage Terminate existing coverage When you experience a change to your family composition you must take specific actions on your TRS coverage. If the qualifying life event changes your type of coverage, for example, member-only coverage becoming member-and-family coverage, you will be responsible for paying the change in premium. You must report all changes in family composition to a military personnel office with Real-Time Automated Personnel Identification System (RAPIDS) capability to appropriately update DEERS. You must also submit a TRS Request Form to your regional contractor no later than 60 days after the date of the qualifying life event. The effective date of coverage is the date the qualifying life event occurred (i.e., date of marriage, date of birth, etc.).

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. If you decide you no longer want TRS coverage, do not just stop making payments. You must take action to terminate/disenroll from TRS: Log on to the Guard and Reserve Web Portal Complete the TRS Request Form. Mail your completed TRS Request Form to your TRICARE regional contractor. The contractor will process your request and return any excess premium amounts paid within 10 days of receipt of the termination request. You can request to disenroll/terminate coverage at any time. A one-year TRS purchase lockout from the effective date of the termination will apply to all family members under the sponsor’s Social Security number. A termination of coverage request initiated by the member is effective the last day of the month the request was postmarked/received.

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 Your TRS coverage will be automatically terminated if you and your family members become eligible for a non-premium TRICARE program (e.g., TRICARE Prime). When your eligibility for the non-premium TRICARE program ends, you must re-enroll in TRS within 60 days to continue uninterrupted TRICARE coverage. Members who lose Selected Reserve status are no longer qualified for TRS, and coverage will be terminated immediately upon notification of the status change. Your payment is due no later than the 30th day of each month. Your payment will apply to the following month of coverage. Failure to pay monthly premiums on time will result in termination of coverage. You will be responsible for any medical bills for care received after coverage was terminated. Termination of coverage due to non-payment will also result in a TRS purchase lockout for one year or until the overdue premiums are paid, whichever is longer. As of September 30, 2007, TRS coverage will be terminated for those members currently enrolled in the three-tiered TRS program who gain eligibility for other TRICARE programs (e.g., activated for greater that 30 days, Early Identified Deployers [EID] status, or Transitional Assistance Management Program [TAMP]). Contact your regional contractor for questions about terminating TRS coverage.

15 TRICARE Assistance Program
Life is stressful. Help is available. Confidential Non-reportable 24/7/365 Call, click or chat today. 1-888-TRIWEST

16 TRICARE Dental Program (TDP)
Other Important Information TRICARE Dental Program (TDP) Voluntary, premium-based program Premiums depend on sponsor’s status Service Sponsor One Family Member More Than One Family Member Sponsor and Family Active Duty N/A $12.69 $31.72 National Guard and Reserve $79.29 $91.98 Individual Ready Reserve $111.01 The TRICARE Dental Program, or TDP, is a voluntary, premium-based dental program available to you and your family. TDP is administered by United Concordia Inc. Monthly premiums depend on your duty status. As you can see on this chart, costs are lower when you are activated for more than 30 consecutive days. These premiums apply through July 31, Note: Premiums are typically subject for renewal or change on February 1st of each calendar year, but the current contract for TDP is under a six-month extension. Most TDP care is provided by participating dentists in civilian networks. You can use the “Find a Participating Dentist” tool on the TDP website to find a dentist, or you can obtain services from a nonparticipating dentist, which may result in higher costs. TDP website: 16

17 TRICARE Retired Reserves
When you retire, you have new health care choices. While on active duty, you could only be enrolled in TRICARE Prime or TRICARE Prime Remote. Now you will have many of the same choices as your family members. This portion of our seminar will discuss you new health care options and explain differences that your family members will see after you retire. Note: If you were enrolled in TRICARE Prime Remote and your family was enrolled in TRICARE Prime Remote for Active Duty Family Members, these options are no longer available to you. 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 1223. 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 Standard TRICARE Extra Outpatient Deductible Amount due each fiscal year before cost-sharing begins. $150/individual or $300/family Outpatient Cost-share 25%* 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 By visiting a network provider when you can, you can save 5% on outpatient cost-shares. Additionally, non-network providers may charge up to 15% above the TRICARE allowable charge—an amount you are responsible for. The dollar amounts on this slide are for fiscal year 2007 and are subject to change on Oct. 1 each year. The federal fiscal year is Oct. 1- Sept. 30. * Non-network providers may charge up to 15% above the TRICARE allowable charge. Get extra cost-savings with TRICARE Extra!

22 TRICARE Retired (Entitlement Coverage)
When you retire, you have new health care choices. While on active duty, you could only be enrolled in TRICARE Prime or TRICARE Prime Remote. Now you will have many of the same choices as your family members. This portion of our seminar will discuss you new health care options and explain differences that your family members will see after you retire. Note: If you were enrolled in TRICARE Prime Remote and your family was enrolled in TRICARE Prime Remote for Active Duty Family Members, these options are no longer available to you. BR402101BET0504C

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? You will need to make several decisions when you retire. These are just a few examples of the questions you may ask yourself. The answers to these questions will determine the TRICARE options you have for you and your family. BR402101BET0504C

24 TRICARE Standard 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 Another option now available to you is TRICARE Standard. TRICARE Standard offers the freedom for you to seek care from any TRICARE-authorized provider. After meeting an annual deductible, you will be responsible for a 25 percent cost-share—slightly higher than with TRICARE Extra. You don’t have to enroll in TRICARE Standard; in most cases, you simply select your doctor at time of need, pay for services, and submit the paperwork to TRICARE for reimbursement for covered services. When using TRICARE Standard, you may continue to seek care in an MTF, which is usually available on a space-available basis. In many areas, space-available appointments are becoming increasingly difficult to obtain. 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 You are responsible for an annual deductible with TRICARE Standard each fiscal year (October 1–September 30). After your annual deductible has been met, your cost-share is 25 percent for TRICARE Standard—slightly higher than with TRICARE Extra. If your family members were using TRICARE Standard while you were still on active duty, they will notice a 5 percent increase (20 percent to 25 percent) upon your retirement. In addition to your cost-share, you may be responsible for up to 15 percent above the TRICARE allowable charge for services if the provider does not participate in TRICARE. You may also have to file your own claims if your provider does not participate in TRICARE. The amount paid toward your deductible is listed on the Explanation of Benefits (EOB) statement. You receive this statement in the mail each time a claim is processed. BR402101BET0504C

26 TRICARE Extra 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 Active duty service members are not eligible to use TRICARE Extra. But, as a retired service member, you now have that option. If you decide not to enroll in TRICARE Prime, deciding to use TRICARE Extra is the next best choice for you. TRICARE Extra is a preferred provider option (PPO). With TRICARE Extra, you choose civilian physicians and specialists from a list of providers who have joined the TRICARE network and have agreed to provide care at approved rates. Also, with TRICARE Extra, you must pay an annual deductible before TRICARE will begin sharing costs, after that deductible has been reached, you are responsible for discounted cost-shares—20 percent for retirees and their families. Because network providers have contractually agreed to accept TRICARE’s negotiated rate as payment in full, you will not be responsible for any additional charges for covered benefits when using the TRICARE Extra option. Additionally, since you’ll be seeing a TRICARE network provider, you will not have to file your own claims. BR402101BET0504C

27 Cost-shares after deductible has been met
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 You are responsible for an annual deductible with TRICARE Extra each fiscal year (October 1–September 30). After your annual deductible has been met, your cost-share is 20 percent for TRICARE Extra. If your family members were using TRICARE Extra while you were still on active duty, they will notice a 5 percent increase (15 percent to 20 percent) upon your retirement. Network providers are not allowed to balance bill, so you will only be responsible for your cost-share for the services rendered—they cannot bill for anything above the TRICARE allowable charge. To locate a network provider and begin using TRICARE Extra, visit the provider directory online at or contact your regional contractor for assistance. When using TRICARE Extra, you may continue to seek care in an MTF, which is usually available on a space-available basis. In many areas, space-available appointments are becoming increasingly difficult to obtain. BR402101BET0504C

28 TRICARE Extra vs. Standard
Any TRICARE network provider Cost-share: 20% of negotiated rate Providers will file claims for you Not responsible for additional charges for covered benefits 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 In comparing the two plans, the similarities are same deductible, no enrollment, and no monthly or annual premiums.The differences are: Provider Type: A network provider is first a TRICARE-authorized provider, then he/she is certified as a network provider. TRICARE Extra—Network Provider (who is first TRICARE-authorized) TRICARE Standard—TRICARE-authorized only Cost-Share: 20 percent after meeting deductible for TRICARE Extra 25 percent for Standard and you may have to pay up to 15 percent above the TRICARE allowable charge if provider does not participate in TRICARE (TRICARE will not share the cost of this amount) Both options allow for care at the MTF on a space-available basis. You do not have to use either of these options exclusively. You can use TRICARE Extra or TRICARE Standard together—depending on which type of provider you visit—network or TRICARE-authorized. BR402101BET0504C

29 Access standards for care Most care received from primary care manager
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 TRICARE Prime is a managed care option offering the most affordable and comprehensive health care. TRICARE Prime is available in areas near an MTF and where regional contractors have established TRICARE Prime networks. To use TRICARE Prime, you must enroll. Active duty service members are required to enroll in TRICARE Prime. TRICARE Prime is portable and easy to transfer when you move. And, if you have family members living in separate locations (i.e. college students, children living with a custodial parent, etc.) you can all enroll in TRICARE Prime with a single enrollment fee (when applicable) with TRICARE Prime’s split enrollment feature. Beneficiaries eligible for TRICARE Prime include active duty service members and their families, retired service members and their families, National Guard or Reserve members called to active duty on federal orders for more than 30 consecutive days and their families, survivors, certain former spouses and other eligible beneficiaries such as Medal of Honor recipients and their families.

30 Outpatient visit: $12 copayment
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 TRICARE Prime is your best option if you are residing in a TRICARE Prime Service area, so deciding where to live after you retire is an important decision. If you are taking a job that offers comprehensive health care, you should compare the employer-sponsored plan with TRICARE Prime and decide which offers the most coverage at the best value for you. We mentioned the changes in TRICARE Prime earlier. It’s important to note that TRICARE Prime coverage for you and your family does not change. What we’ll highlight now are those things that do change. To participate in TRICARE Prime, retirees and their family members pay annual enrollment fees of $230 for an individual or $460 for a family. Payments can be made in annual, quarterly, or monthly installments. If you enroll to the MTF, you will not pay any copayments for outpatient care in the MTF. When enrolled to a network provider or visiting a network specialty provider, however, you are responsible for a small copayment per visit. Primary care services incur a $12 copayment for retirees and their family members. Check with your regional contractor for other copayment requirements or consult the TRICARE Choices booklet. BR402101BET0504C

31 Each fiscal year—$3,000 for all retirees and family members
Catastrophic Cap Each fiscal year—$3,000 for all retirees and family members TRICARE Prime TRICARE Extra TRICARE Standard The catastrophic cap limits your out-of-pocket liability on copayments, cost-shares, and deductibles. The catastrophic cap for all retirees is as follows: • Fiscal year (October 1–September 30)—$3,000 TRICARE Prime TRICARE Extra TRICARE Standard BR402101BET0504C

32 TRICARE Prime Point-of-Service (POS) Option
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 The Point-of-Service (POS) Option under TRICARE Prime allows enrollees the freedom to seek and receive nonemergent health care services from any TRICARE-authorized civilian provider, in or out of the network, without requesting a referral from their PCM or your regional contractor. When TRICARE Prime enrollees choose to use the POS option, all requirements applicable to TRICARE Standard apply except the requirement for a Nonavailability Statement (NAS). POS claims are subject to outpatient deductibles and cost-shares, and is the most costly TRICARE option to the enrollee. BR402101BET0504C

33 POS Cost-shares and Deductibles
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 Annual outpatient deductibles are $300 for an individual and $600 for a family, 50 percent cost-shares for outpatient and inpatient claims, and excess charges up to 15 percent over the allowed amount. The 50 percent cost-share continues to be applied even after the catastrophic cap has been met. 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 The TRICARE Retiree Dental Program (TRDP) is a voluntary dental insurance program administered and underwritten by the Federal Services division of Delta Dental Plan (DDP) of California, located in Sacramento, California. The TRDP offers comprehensive, cost-effective dental coverage for uniformed services retirees and their eligible family members, as well as certain surviving family members of deceased active duty sponsors, and Medal of Honor recipients and their immediate family members and survivors. The retiree dental program requires that the sponsor be enrolled in order for family members to enroll unless the sponsor is 100 percent disabled, covered by his/her employer, or has a debilitating disease. Other details of TRDP benefits, requirements, and restrictions can be found at the TRDP Web site at 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 Delta Dental handles all the enrollments. There is an initial 12-month commitment for new enrollees after which enrollment may be continued on a month-to-month basis. There is a 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 $150 deductible cap per family
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 The annual deductible is $50 per person with a $150 deductible cap per family. The annual maximum coverage is $1,200 per person. The deductible and maximum do not apply to the diagnostic and preventive services or to dental accident procedures or orthodontia. For more information about the TRICARE Retiree Dental Plan, call toll-free at , or visit DeltaSelect USA online at BR402101BET0504C

37 TRICARE and Other Health Insurance
Other Important Information TRICARE and Other Health Insurance 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) 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 If you have other health insurance, or OHI, and you choose to purchase TRICARE Reserve Select, TRICARE is your secondary payer. That means when your family member goes to the doctor, the doctor files a claim with your other health insurance first and TRICARE pays what is left, up to the TRICARE-allowable charge. Note: Does not apply to Medicaid and certain other state programs. If your other health insurance runs out, or for services covered by TRICARE that are not covered by your OHI, TRICARE becomes your primary payer. If you have other health insurance: Fill out a TRICARE Other Health Insurance Questionnaire and follow the guidelines for submission. You can download the questionnaire from TRICARE.mil, or you can pick one up at your TRICARE Service Center. Because your other health insurance pays first, you must follow their rules for getting care. Make sure your provider knows you have other health insurance and TRICARE. Keeping your regional contractor and health care providers informed about your other health care coverage will allow them to better coordinate your benefits. Note: Unlike OHI, supplemental insurance pays after TRICARE pays its portion of the bill, reimbursing you for out-of-pocket medical expenses paid to civilian providers based on the plan’s policies. Remember that you have a $1,000 catastrophic cap when considering supplemental insurance. 37

38 TRICARE Pharmacy Program
Other Important Information Pharmacy Option Formulary Non-Formulary Generic Brand 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) 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 Other Programs: $22 or 20% of total cost (whichever is greater) after the annual deductible is met You may use the TRICARE pharmacy benefit unless you are enrolled in the US Family Health Plan. To have a prescription filled, you will need the prescription, a valid uniformed services ID card, and up-to-date information in DEERS. Note: Pharmacies are legally permitted to copy military and dependent ID cards to verify TRICARE eligibility. You will normally receive a generic drug rather than a brand-name drug. Your doctor or other provider must justify medical necessity for you to receive a brand-name medication if a generic version is available. Pharmacy costs depend on the pharmacy option you choose, whether the drug is generic or brand name, and whether it’s listed in the TRICARE formulary, which is the list of drugs covered by TRICARE. There is no copayment when you fill a prescription at a military pharmacy. If you have recurring prescriptions, such as allergy or blood pressure medicine, you can use TRICARE Pharmacy Home Delivery to order up to a 90-day supply by phone, online, or by mail. TRICARE Pharmacy Home Delivery copayments are $3 for generic formulary drugs, $9 for brand-name formulary drugs, and $22 for non-formulary drugs. If you need a prescription filled immediately, your best option is find one of TRICARE’s 60,000 plus retail network pharmacies. The costs are the same as TRICARE Pharmacy Home Delivery, but only for a 30-day supply. To find a retail network pharmacy, visit the Express Scripts website provided at the bottom of the screen. The most expensive option is a non-network retail pharmacy. Express Scripts, Inc. website: 38

39 TRICARE Mail Order Pharmacy (TMOP)
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 1-866-DoD-TMOP ( ) TRICARE Mail Order Pharmacy is available for prescriptions that beneficiaries take on a regular basis. Beneficiaries may receive up to a 90-day supply for most medications. TMOP is administered by Express Scripts, Inc. Through this program, beneficiaries mail their health care provider’s written prescription, along with the appropriate copayment, to TMOP, and the medications will be sent directly to the beneficiary. Prescriptions may be refilled by mail, phone, or online. NOTE: For non-formulary prescriptions, you are responsible for a $22 cost-share with TMOP.  For more information about TMOP, you may visit the Express Scripts Web site at or call DoD-TMOP ( ). BR402101BET0504C

40 Guard & Reserve Resource Center
All TRICARE Prime/Prime Remote, TRICARE Reserve/Select, and Standard beneficiaries are eligible to register If the beneficiary is not the sponsor, he/she must have the sponsor’s SSN to register Beneficiaries must have a record in DEERS, and info provided at time registration MUST MATCH what is on file with DEERS Registered beneficiaries have access to minor dependent information. Registered beneficiaries DO NOT automatically have access to spouse or dependent (18 +) medical information. Each family member must register on Registered beneficiaries may grant account access to other registered family members. No sensitive diagnosis information is displayed on the portal. 40

41 For Information and Assistance
Stateside Regional Contractors Overseas Regional Contractor International SOS Assistance, Inc. Eurasia-Africa: Latin America & Canada: Pacific: Singapore: Sydney: TRICARE North Region Health Net Federal Services 1-877-TRICARE ( ) TRICARE South Region Humana Military Healthcare Services TRICARE West Region TriWest Healthcare Alliance 1-888-TRIWEST ( ) Connect with TRICARE Online! The following contact information provides the stateside and overseas regional contractors, as well as other important information outlets. Remember, your regional contractor is tied to where you reside. General Contact Information TRICARE Website: Contacts: MMSO: PP4111BEC05101W 41

42 Conclusion Comments/Questions?


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