Healthcare for Active Duty Military Families… “Keeping it Safe Here” Martin McCaffrey, MD, CAPT USN (Ret)

Military Ranking as as

What is TRICARE? Health care program for 9.2 million beneficiaries –120,000 births per year Integrated health care delivery system –Military treatment facilities (MTFs) –Civilian health care facilities Range of program options Comprehensive coverage Available worldwide

TRICARE Eligibility Beneficiary categories –Sponsors (active duty, National Guard, Reserve or retired service members) –Family members (spouses and unmarried children) –Survivors, certain former spouses and others Requirements –Registration in the Defense Enrollment Eligibility Reporting System (DEERS) –Valid Uniformed Services ID Card

Tricare Standard –Basic, comprehensive coverage –No enrollment required –Fee for service flexibility –Deductible Extra –Standard plus (access to Prime Network providers at TMA rates or Other Providers) Prime –Required for AD members –Must actively enroll –Assumption is all primary care at MTF –Referral/approval required for specialty care

Tricare North Contacts

TRICARE Standard Enrollment not required Care from non-network TRICARE- authorized providers –Provider may charge up to 15% above TRICARE allowable charge –May have to submit your own health care claims Referrals not required for specialty care Some services may require prior authorization MTF care on a space-available basis only

TRICARE Standard and Extra: Active Duty Families TRICARE Option TRICARE Standard TRICARE Extra Outpatient Deductible Amount due each fiscal year before cost-sharing begins. Sponsor rank E1-E4: $50/indivdual or $100/family Sponsor rank E5 & above: $150/individual or $300/family Outpatient Cost- share 20%*15% Inpatient Costs $14.80/day ($25 minimum) Inpatient Behavioral Health Care $20/day ($25 minimum) Catastrophic Cap $1,000 per family per fiscal year

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 No claims to file (in most cases)

TRICARE Prime Costs: Active Duty Families Enrollment Fees $0 Deductible*$0 Outpatient Costs* $0 Inpatient Costs* $0 Emergency Care $0 Catastrophic Cap $1,000 per family per fiscal year

Pharmacy Options and Costs Type of Pharmacy Formulary Non-Formulary (Tier 3) Gen (Tier 1) Brand (Tier 2) MTF (up to 90-day supply) $0$0N/A Mail order (up to 90-day supply) $3$9$22* Network (up to 30-day supply) $3$9$22* Non- network (up to 30-day supply) Prime/TPRADFM: POS fees apply All Others: $9 or 20%, whichever is more. Must meet deductible. Prime/TPRADFM: POS fees apply All Others: $22 or 20%, whichever is more. Must meet deductible.

Other Tricare Notes Transports –Authorization to non-MTF usually required Reimbursement for Travel –Beyond 100 mile radius eligible for travel support (Non-medical attendant: NMA) –Distance and allowances determined by TMA Tricare Support Center (TSC) at every base TMA website (

Command Contacts Every military member belongs to a unit or command –Multiple commands or units on a given base Every service member has an immediate NCO (E-5 above) or Officer –Rank dependent –Supervisor name/contact critical for all military families we care for –Some proactive, some not, weekly contact helpful for the family

Conversations With Commands Command has a mission AD member’s deploy In the perfect world, full family present for a difficult prenatal course, birth or NICU stay Most families understand this may not always be the case –Is AD member required back from a deployment? –When can the AD member deploy next? –AD Members generally want to deploy when it is medically reasonable

Notification of Deployed Family Member Service member's Command Red Cross –Messages to service members 24/7/365 –Service member’s full name, rank/rating, branch, social security number, military address and information about the deployed unit and the home base unit (for deployed service members only) –Drs. name, diagnosis, prognosis, current condition, life expectancy –Recommend service member presence? – Command Family Support Groups –Ombudsman (Navy, Army) –Key Volunteers (USMC) Family Support Services (all services) –

Preparing Families for Discharge Compassionate reassignment May get bills after hospitalization –Don’t panic –Call Tricare Service Directory (TSC) –TSCs throughout regions –Staffed with customer service reps –TSC locator on Tricare website Information – – – –Consider contacting STOMP for inservice

Must Do’s for Families as Discharge Approaches DEERS (Defense Enrollment Eligibility Reporting System) Tricare Coverage (must enroll for Prime) Exceptional Family Member Program ECHO Program

Exceptional Family Member Program (EFMP) Identifies family members with special medical and/or educational needs EFMP enrollment is mandatory and required immediately upon identification of a family member with special needs. Start this paperwork pre-discharge from NICU Documents the services they require Considers those needs during the personnel assignment process (especially when approving family members for accompanied travel to overseas locations) Involves the personnel and medical commands and the educational system

ECHO Program A supplemental program to the TRICARE Basic Program Provides eligible active duty family members with additional financial resources Focuses on integrated sets of services and supplies designed to assist in the reduction of the disabling effects of the beneficiary’s condition. Pays up to $2500/month after co-pay met Use public resources first

ECHO Deductibles

ECHO Program Qualifying conditions include: –Moderate to severe mental retardation –Serious disability –An extraordinary physical or psychological condition of such complexity that the beneficiary is homebound Families must apply through the EFMP office

ECHO Program Durable medical equipment Training for assistive technology Assistive communication devices 16 hours of respite care per month if receiving another ECHO benefit Training to give home meds Transportation Institutional care when required Medical and rehab services, prosthesis, orthopedic braces and appliances

ECHO Program Institutional care when required Medical and rehab services, prosthesis, orthopedic braces and appliances ECHO Home Health Care –In home health service needs not met under ECHO

Maternity (Prenatal) Benefit In 2002, NDAA approved maternity benefit for Tricare standard female enrollees Only non-AD eligible One time cost of $25 for ALL prenatal and maternity costs If father AD, infant eligible for Tricare Prime at birth Mother not able to enroll (re) in Prime for 1 year –Potentially risky if non-OB health issues develop

Maternity Leave AD mothers receive six weeks maternity leave –Not counted as regular leave Discuss with Command plan to allow time at home, especially if infant admitted to the NICU –Don’t consume all maternity leave during NICU stay –May need to consider returning to work during a long NICU stay Variable approach by Command’s re extended leave and TAD/TDY of AD Member to hospital

Supporting the Family Occasionally Command not supportive Failure to generate Command support –Service member has not informed us of full chain of command and other contact options –We have not contacted the proper people –The Command has significant problems with the service member –Absolutely cannot spare the service person Letter writing has great value Rarely are commands unwilling to support reasonable medical requests

Who We Are Healthcare for Active Duty Military Families… “Keeping it Safe Here”

Family Readiness = Force Readiness