This Briefing is: UNCLASSIFIED 49th Fighter Wing TRICARE BRIEFING MSgt Donna Williams Flight Chief, TOPA 7 Nov 06

UNCLASSIFIED What We Will Cover Important Terms TRIWEST vs. TOPA DEERS FIRST Healthcare Options Provided/Explained Dental/Pharmacy Important Changes/Information Questions

UNCLASSIFIED Terms You Should Know TRICARE:Health care plan TRIWEST:Health care contractor WPS:Wisconsin Physician Services The Subcontractor for TRIWEST who pays claims for western region DEERS:Defense Enrollment Eligibility Reporting System PCM:Primary Care Manager CHCS/AHLTA:Composite Health Care System The DoD’s master medical computer program HIPAA:Health Ins Portability/Accountability Act NOPP:Notice of Privacy Practices

UNCLASSIFIED TRIWEST vs. TOPA TRIWEST: Claims Assistance, Billing Issues, Referrals, and Enrollment Issues What is available in your area? Peterson AFB: TRICARE Service Center with walk-in service only Buckley AFB: TRICARE Service Center USAF Academy: TRICARE Service Center with walk-in service only TOPA (TRICARE Operations and Patient Administration): Medical TDY Orders

UNCLASSIFIED DEERS FIRST! DoD-wide personnel tracking system You must be enrolled in DEERS for care DEERS information must be correct Medical computer systems (CHCS/AHLTA) pull info from DEERS How Can I Update This Information? Telephone: (800) Mail: DSO, ATTN: COA 400 Gigling Road Seaside, CA Fax: (831) In person – Locate the nearest MPF ( Online –

UNCLASSIFIED Healthcare Options Provided and Explained Three Options 1.TRICARE Prime (and TRICARE Prime Remote) 2.TRICARE Extra 3.TRICARE Standard or CHAMPUS

UNCLASSIFIED TRICARE PRIME Advantages Lowest cost (and no cost to AD member) Priority access to the MTF Portability: Travels with you No claims to file Requires Enrollment Cost $230 (single) $460 (family) - RETIREES Co-pays and catastrophic cap ($1K/$3K) Payments made annually, quarterly, or monthly

UNCLASSIFIED TRICARE PRIME REMOTE Gives AD and family members in remote areas access to care (available only in certain locations) No out of pocket expenses Exception: prescriptions $3 or $9 AD can file claim for reimbursement thru Express Scripts Requires enrollment TPR website – Based on residence and work address Eligibility Requirements: AD must be on full time orders w/permanent duty assignment who lives and works more than 50 mi./1 hr. drive time from MTF Family member must live with sponsor May request a waiver from unit CC to TRICARE Regional Ofc

UNCLASSIFIED TRICARE EXTRA TRICARE providers who agree to accept 5% less than non-network providers average rate Advantages No claims to file No enrollment fees Discounted cost shares Access to the MTF (Space Available) Costs Deductibles (E1-E4 - $50/$100) (E5 and up $150/$300) Catastrophic cap (AD - $1K/Ret - $3K) 15% Cost share and co-pay for AD families and 20% for retired members and their families

UNCLASSIFIED TRICARE STANDARD Fee for Service: See the TRICARE provider of your choice Advantages No enrollment fees Can seek care at the MTF (Space Available) Freedom to seek care from ANY TRICARE-authorized provider Disadvantage: Most costly of the three TRICARE options Costs Deductibles (E1-E4 - $50/$100) (E5 and up $150/$300) Catastrophic cap (AD - $1K/Ret - $3K) 20% Cost share and co-pay for AD families and 25% for retired members and their families

UNCLASSIFIED Dental Benefit Active Duty: Contact the Military Medical Support Office (MMSO) at Family Members: United Concordia Sponsor must have 12 months service remaining for eligibility United Concordia - or (888) www.ucci.com To enroll/make changes online - Telephone - (888) For Retirees – TRICARE Retiree Dental (Delta Dental) or (888) www.trdp.org Costs Include (monthly): Single - $10.51 Family - $26.27

UNCLASSIFIED Pharmacy Benefit 1.MTF: No Cost 2.TRICARE Mail Order Pharmacy (TMOP) $3/$9/$22 for prescriptions Convenience Can get a 90-day supply/30-day for controlled substances 3.TRICARE Network Retail Pharmacy Max 30-day supply 4.Non-network Retail Pharmacy $9 or 20% (whichever is greater) of full retail cost once annual deductible is met Max 30-day supply Drawbacks Takes 10 – 14 days to process, fill, and ship If AD and asked to pay – seek reimbursement thru Express Scripts Register at Express Scripts, Inc. (

UNCLASSIFIED How to Make An Appointment Find a civilian provider who accepts TRICARE Prime Call and confirm that they accept TRICARE Prime & that they are accepting new patients Contact provider to set up appointment You can self-refer for: Annual Pap Smears Annual Eye Exams – every 2 years for dependents/AD every year Annual Mammograms – annually for women over 40; if under 40, it requires a referral (unless special circumstances exist)

UNCLASSIFIED Other Information Pregnancy PCM gives global authorization: See your PCM Covers entire pregnancy in addition to 4 to 6 weeks post partum Newborns You have 5 business days to enroll newborns in DEERS! Newborns are covered as TRICARE Prime for 60 days following birth, AS LONG AS 1 member in the family is TRICARE Prime After 60 day period, TRICARE Standard TRICARE Standard coverage ends 365 days following the birth, if not enrolled in DEERS Adoptions AD: if you have an active adoption case, you can enroll the child in DEERS w/adoption paperwork (even if the child is warded to you)

UNCLASSIFIED Other Information, CONT. Advance Directives Ensure your desired medical instructions are followed when you are incapacitated (i.e., if suffering from an irreversible coma & you request life-sustaining treatment not be rendered to prolong life). Must be filed in the medical record It is your responsibility to ensure civilian providers have your Advance Directives. For questions, see your local Legal Office TRICARE on Line Electronic version of “Taking Care of Yourself/Child” Handbook(s) Includes: Personal health journal, 18M pages of medical, health, drug interaction, and fitness information TRICARE benefit information Website:

UNCLASSIFIED Notice Of Privacy Practices Describes what information the Medical Group may share and with whom we may share it All MDG Staff are trained on this issue. Patients should read it to be knowledgeable and confident about the safety of their personal information

UNCLASSIFIED Spouses do NOT Automatically Have Access to Another Spouse’s Record The patient must “authorize” their spouse access to their health information Fill out authorization form when you check into your appointment or see TOPA

UNCLASSIFIED DD FORM 2870 DD MDG Overprint Enter “Spouse’s name” in block 6a Check block 7 “SPOUSE” The staff must Witness the patient’s signature, i.e., sign your name in block 11a or The form may be notarized File original in record (Part 3) Provide copy to patient/spouse

UNCLASSIFIED Legal Authority of Children JOINT CUSTODY: Court has awarded “custody designation” to both parents STEP PARENTS: No legal authority. However, a step parent who has adopted the child or acting in loco parentis has legal authority OUT-OF-HOME PROVIDER (OHP): Similar to “foster parent” – may or may not have legal authority BIOLOGICAL PARENT: You must ensure that the court has awarded “custody designation” to biological parent NOTE: A step parent (without any legal authority) may bring a child to the MTF for an appointment, however, the guardian has no legal authority to participate in medical decision-making events Parents can access their child’s medical record or request a copy (17 years or less); however, exceptions may apply for children seeking care without parental consent as permitted by NM Statute (i.e., treatment of STD)

UNCLASSIFIED Who Ya Gonna Call? - Toll-free number: TRIWEST - Website: - Claims mailing address: West Region Claims P.O. Box Madison, WI Toll-free claims number: Claims website: - TRICARE Regional Office website:

UNCLASSIFIED Thanks For Having Us QUESTIONS?