HEALTH MATTERS A PUBLICATION FOR TRICARE BENEFICIARIES

Size: px

Start display at page:

Download "HEALTH MATTERS A PUBLICATION FOR TRICARE BENEFICIARIES"

Phyllis Teresa York
5 years ago
Views:

1 HEALTH MATTERS A PUBLICATION FOR TRICARE BENEFICIARIES Make 2019 TRICARE Enrollment Changes This Fall TRICARE Open Season Begins Nov. 12 Do you want to make enrollment changes to your or your family member s TRICARE plan? Your opportunity is just around the corner during TRICARE Open Season. Open season is an annual period when you can enroll in or change your health care coverage plan for the following year. TRICARE beneficiaries will experience open season for the first time Nov. 12 Dec. 10, TRICARE Open Season will occur each year from the Monday of the second full week in November to the Monday of the second full week in December. Enrollment choices made during this period will take effect on Jan. 1, During TRICARE Open Season, eligible non-active duty service members (ADSMs) may enroll in a new TRICARE Overseas Program (TOP) Prime or TOP Select plan (if living overseas), or a TRICARE Prime or TRICARE Select plan (if living stateside). Remember, active duty family members living overseas must be command-sponsored to be eligible for TOP Prime and TOP Prime Remote. Eligible retirees and their family members living overseas are only able to enroll in TOP Select. If you remain eligible and make no changes during TRICARE Open Season, then you will stay in the same plan for You may also change your type of enrollment, for example you may switch from individual to family coverage. If you need to enroll in or change your TRICARE Prime or TRICARE Select plan outside of TRICARE Open Season, you can only do so within 90 days of when you or a family member experience a Qualifying Life Event (QLE). A QLE is a specific life event, like getting married, having a baby, or retiring from active duty. After these events, your TRICARE options may also change. Whether during TRICARE Open Season or following a QLE, you have two ways to make an enrollment choice while you re overseas: By phone: Call your TOP Regional Call Center. Contact information is available at contactus/callus/overseasresources. By mail: Mail your enrollment form to International SOS Government (Continued on page 2) INSIDE THIS ISSUE Filling Prescriptions? You Have Options, page 2 TRICARE Retiree Dental Program Ending, FEDVIP Beginning, page 3 Enroll in FEDVIP During Federal Benefits Open Season, page 4 Keep Your DEERS Information Up to Date, page 5 Understanding Your Explanation of Benefits, page 6 Referrals Required to See Providers Outside of Your Military Hospital or Clinic, page 6 New Addition? Enroll Your Newborn for TRICARE Coverage, page 7 What You Need to Know for Coverage in 2019, page 8 Qualifying Life Events May Change Your TRICARE Options, page 9 FAQ Corner, page 10 An Important Note About TRICARE Program Information: At the time of publication, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law and federal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are amended. Military hospital and clinic guidelines and policies may be different than those outlined in this publication. For the most recent information, contact the TRICARE Overseas Program contractor, your TRICARE Service Center or your local military hospital or clinic. The TRICARE program meets the minimum essential coverage requirement under the Affordable Care Act.

2 HEALTH MATTERS (Continued from page 1) Services, Inc. Find forms at TRICARE Open Season doesn t apply to the premiumbased plans. These plans offer continuous open enrollment throughout the year: TRICARE Retired Reserve TRICARE Reserve Select TRICARE Young Adult Continued Health Care Benefit Program Also, TRICARE Open Season doesn t apply to TRICARE For Life (TFL). Coverage under TFL is effective the first date that an individual has Medicare Part A and Medicare Part B. This is your benefit. Take command of your health and prepare for TRICARE Open Season. Find more information about TRICARE Open Season at More information about QLEs is available at lifeevents. «Filling Prescriptions? You Have Options TRICARE offers several options for getting prescription drugs. To fill a prescription, you need a prescription and a valid uniformed services ID card or Common Access Card. Your options for filling prescriptions depend on the type of drug you need. If you live or travel in the Philippines, you re required to use a certified pharmacy. OPTIONS FOR FILLING A PRESCRIPTION Military pharmacies (usually located in military hospitals or clinics) TRICARE Pharmacy Home Delivery (not available in Germany due to country-specific legal restrictions) TRICARE retail network pharmacies (located in the U.S. and U.S. territories of Guam, Northern Mariana Islands, Puerto Rico, and U.S. Virgin Islands) DESCRIPTION OF OPTIONS For more pharmacy information, visit the TRICARE Overseas Program website at beneficiaries/resources/pharmacy and You can also call your TOP Regional Call Center with pharmacy questions. «No cost for up to a 90-day supply of most drugs Usually don t carry tier 3 drugs Usually accept prescriptions from military and civilian providers No costs for ADSMs up to a 90-day supply of tier 1 (generic drugs Copayments for non-adsms up to a 90-day supply of tier 2 and tier 3 drugs Must have an APO/FPO address or be assigned to a U.S. Embassy or Consulate Refills can be ordered online, by phone, or by mail Must have a prescription from a U.S. licensed provider Pay one copayment for each 30-day supply No need to file a claim Overseas pharmacies In Philippines Only Pay full price and file a claim to get money back With TOP Prime and TOP Prime Remote, you get 100% of your money back if using an overseas pharmacy to fill prescriptions covered by TRICARE With TOP Select, you pay a deductible and cost-shares Prescription drugs are only cost-shared when you get them at TRICARE-Certified retail pharmacies or TRICARE-Certified hospital-based pharmacies Prescription drugs purchased at your health care provider s office won t be cost-shared by TRICARE PAGE 2

TRICARE Retiree Dental Program Ending, FEDVIP Beginning Dental Coverage The TRICARE Retiree Dental Program (TRDP) ends on Dec. 31, 2018.

3 TRICARE Retiree Dental Program Ending, FEDVIP Beginning Dental Coverage The TRICARE Retiree Dental Program (TRDP) ends on Dec. 31, This means TRDP dental coverage for retirees will end this year. To have retiree dental coverage in 2019, you must enroll in a Federal Employees Dental and Vision Insurance Program (FEDVIP) dental plan. FEDVIP is offered by the U.S. Office of Personnel Management (OPM) and is available to federal civilian employees. New FEDVIP dental coverage affects retirees only. There is no impact on the Active Duty Dental Program, active duty service members, or active duty family members command-sponsored overseas. You will not be automatically enrolled in a FEDVIP plan when your TRDP plan ends. For 2019 coverage, you must enroll in a FEDVIP dental plan during the Federal Benefits Open Season, which runs from Nov. 12 through Dec. 10, Although Federal Benefits Open Season is held at the same time as the TRICARE Open Season (See Make 2019 TRICARE Enrollment Changes This Fall on page 1), enrollment for FEDVIP is managed by OPM. If you enroll during the 2018 Federal Benefits Open Season, your coverage will start on Jan. 1, Vision Coverage In addition to retiree dental coverage, most TRICARE beneficiaries will be eligible to purchase vision coverage through FEDVIP. To enroll in FEDVIP vision, you must be enrolled in a TRICARE health plan or have TRICARE For Life. FEDVIP offers great flexibility when selecting the right coverage for you and your family. There are four vision plan carriers and 10 dental carriers, some of which offer high option and standard option plans. You may choose to enroll in a dental plan, a vision plan, both, or neither. Adult children enrolled in or eligible for TRICARE Young Adult aren t eligible for FEDVIP. Also, beneficiaries enrolled in the Transitional Assistance Management Program are not eligible for FEDVIP. For more information, visit tricare. benefeds.com. On the website, you can: Check your eligibility for FEDVIP. Compare plans with the FEDVIP Plan Comparison Tool Get answers to frequently asked questions Sign up for alerts regarding important dates or updates to the website Note: TRICARE Open Season and Federal Benefits Open Season are separate events requiring separate enrollment. To learn more, visit tricare.benefeds.com. «PAGE 3

HEALTH MATTERS Enroll in FEDVIP During Federal Benefits Open Season You can enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) during the Federal Benefits Open Season, which

4 HEALTH MATTERS Enroll in FEDVIP During Federal Benefits Open Season You can enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP) during the Federal Benefits Open Season, which will run from Nov. 12 to Dec. 10, Your new coverage will begin on Jan. 1, Federal Benefits Open Season is for enrollment in FEDVIP. TRICARE Open Season is for enrollment in TRICARE Prime and TRICARE Select coverage. Family members of active duty service members who are enrolled in a TRICARE health plan are eligible for FEDVIP vision coverage. To enroll in FEDVIP, go to tricare. benefeds.com. This website is the secure online portal to enroll in a FEDVIP dental and/or vision plan. On the website, you can also read about the end of the TRICARE Retiree Dental Program and the new benefits available under FEDVIP, browse frequently asked questions, and compare FEDVIP national and international options with the plan comparison tool. After the Federal Benefits Open Season ends, you may only enroll in, change, or cancel FEDVIP coverage if you experience a FEDVIP qualifying life event (QLE). Any election in a FEDVIP plan remains in effect for the entire calendar year. Examples of FEDVIP QLEs include: Getting married Losing other dental or vision coverage Acquiring a family member Losing a family member Restoration of uniformed services pay or retirement pay after having it reduced, forfeited, or terminated Changing status from a uniformed services retiree to a uniformed services member on active duty For information on TRICARE QLEs, see Qualifying Life Events May Change Your TRICARE Options on page 9. For more information about FEDVIP enrollment, visit tricare.benefeds.com. «PAGE 4

5 Keep Your DEERS Information Up to Date Has either you or a family member experienced a Qualifying Life Event (QLE)? If so, you need to update your information in the Defense Enrollment Eligibility Reporting System (DEERS). To remain eligible for TRICARE coverage, you must keep your information current in DEERS. DEERS is a database of active duty and retired service members, their family members, and others who are eligible for TRICARE. Keeping your DEERS record updated is key to getting timely, effective TRICARE benefits. It s essential to update and verify your information in DEERS anytime you experience a QLE. This is especially true after you arrive at a new duty station or location. Remember, your Social Security number (SSN) and the SSN of each of your covered family members must be included in DEERS for your TRICARE coverage to be accurate. You have several options for updating and verifying DEERS information. You can make changes in person, by phone, online, or by mail. To add or remove family members, visit a local ID card office. Find an office near you at To update contact information, choose one of these options: Phone: Call (TTY/ TDD: ) or fax updates to Online: Log into milconnect at Mail: Mail updates to: Defense Manpower Data Center Support Office Attention: COA 400 Gigling Road Seaside, CA USA Only sponsors can add a family member in DEERS. Family members age 18 and older may update their own contact information. Find more information about DEERS on the TRICARE website at «TO REMAIN ELIGIBLE FOR TRICARE COVERAGE, YOU MUST KEEP YOUR INFORMATION CURRENT IN DEERS. PAGE 5

6 HEALTH MATTERS Understanding Your Explanation of Benefits Once a claim is processed, both you and your provider will receive an itemized statement with a breakdown of claim cost-shares and deductibles. This is an Explanation of Benefits (EOB). A TRICARE EOB is not a bill. It s only an itemized statement that shows what action TRICARE has taken on your claims. Your EOB will include the date you received the medical service along with the amount billed, covered, and paid. It will show any balance you owe your provider. It will also tell you how much has been credited toward your annual deductible and catastrophic cap. You should carefully review your EOB to make sure the information is correct. After reviewing your EOB, you can: Appeal certain decisions about your claims File an appeal within 90 days of the date of the EOB notice You can sign up to receive your EOB statements electronically. Request your paperless EOB through the secure claims portal at secure-claims-portal. Each time you receive an EOB, review it closely for accuracy based on the services you received and if available, compare it to the receipt or statement from the provider. «Referrals Required to See Providers Outside of Your Military Hospital or Clinic If you re an active duty service member (ADSM) enrolled in TRICARE Overseas Program (TOP) Prime, you need a referral or authorization for any nonemergency care given by anyone other than your primary care manager (PCM), or a military hospital or clinic provider. If you re a TOP Prime enrollee and need urgent care while traveling stateside, you should contact your TOP Regional Call Center for authorization. To ensure your urgent care visit is cashless and claimless, you must get authorization from the TRICARE overseas contractor. Additionally, if you have TOP Prime or TOP Prime Remote and you require urgent care while TDY or on leave status in the United States and District of Columbia, you may access urgent care without a referral or an authorization. ADSMs must follow up with their PCM in accordance with applicable Department of Defense and uniformed service regulations concerning ADSM care outside military hospitals and clinics. Routine care is generally not authorized while you re traveling. Exceptions may be made for unusual circumstances on a case-by-case basis with PCM referral and justification from the referring military facility. Although emergency care doesn t require prior authorization, you should contact your PCM and your TOP Regional Call Center as soon as possible. If you re admitted, you must call your PCM or TOP Regional Call Center before leaving the facility, preferably within 24 hours or on the next business day. This will help in the event that you need to coordinate authorization, continued care, and payment. Without a referral or authorization, your care will follow the TOP point-of-service (POS) rules, assuming the service would otherwise be covered under TRICARE. TOP Prime-enrolled active duty family members (ADFMs) are required to follow established referral and authorization procedures prior to obtaining specialty care to avoid incurring POS cost-shares and deductibles. This includes all nonemergency outpatient specialty medical services and all inpatient care (including inpatient mental health care), with some exceptions. Call the TOP Regional Call Center for Health Care Finder services to ensure access to quality care. TOP Prime ADFMs who visit a civilian provider other than their PCM will have their claims processed as POS. Visit for more information about the point-ofservice option. «PAGE 6

New Addition? Enroll Your Newborn for TRICARE Coverage After a birth or adoption, you need to register your child in the Defense Enrollment Eligibility Reporting System (DEERS).

7 New Addition? Enroll Your Newborn for TRICARE Coverage After a birth or adoption, you need to register your child in the Defense Enrollment Eligibility Reporting System (DEERS). Active duty service members and active duty family members overseas have 120 days to register their newborn in DEERS. A birth certificate, certificate of live birth from the hospital, record of adoption, or letter of placement of your child into your home by a recognized placement or adoption agency or the court is required. You don t need a Social Security number to register a newborn in DEERS, but you ll need to update their DEERS record as soon as you have one. If the newborn isn t registered in DEERS after the 120th day from birth, he or she will be reverted to direct care. This means the newborn is only eligible for care at a military hospital or clinic on a space-available basis. If this occurs, all claims from overseas civilian providers will be denied. Once a newborn is registered in DEERS, you will have 90 days to enroll, change, or transfer your newborn s enrollment to TRICARE Overseas Program (TOP) Prime or TOP Prime Remote (if eligible and command-sponsored). If you take no action, your child s enrollment will default to TOP Select. When the active duty sponsor enrolls the newborn in TOP Prime or TOP Prime Remote, coverage is backdated to the date of birth and the family may ask the TOP contractor to re-process any claims that either were denied or should be processed under TOP Prime or TOP Prime Remote. In 2018, families can enroll in a TRICARE plan at any time. In 2019, families will have to wait for a Qualifying Life Event or the annual TRICARE Open Season. For more information, visit and «PAGE 7

HEALTH MATTERS TRICARE is implementing an open season for enrollment.

31. Many TRICARE-eligible beneficiaries will qualify for the Federal Employees Dental and Vision Insurance Program (FEDVIP). I am a(n).

At retirement, coverage ends. Learn about your options and what to do at www.tricare.mil/retiring You do not qualify to purchase a FEDVIP vision plan. You will continue to get care as you do now.

Active Duty Family Member *Not including adult children enrolled in TRICARE Young Adult You can change plans during the 2018 TRICARE Open Season. You must enroll during Federal Benefits Open Season.

8 HEALTH MATTERS TRICARE is implementing an open season for enrollment. You can only enroll in TRICARE Prime or TRICARE Select or switch plans during TRICARE Open Season or after a Qualifying Life Event (QLE). The TRICARE Retiree Dental Program (TRDP) is ending on Dec. 31. Many TRICARE-eligible beneficiaries will qualify for the Federal Employees Dental and Vision Insurance Program (FEDVIP). I am a(n)... I Want to Change My TRICARE Plan I Want to Enroll in a FEDVIP Vision Plan I Want to Enroll in a FEDVIP Dental Plan Active Duty Service Member You can only change plans if you re retiring. At retirement, coverage ends. Learn about your options and what to do at You do not qualify to purchase a FEDVIP vision plan. You will continue to get care as you do now. You do not qualify to purchase a FEDVIP dental plan. You will continue to get care as you do now. Active Duty Family Member *Not including adult children enrolled in TRICARE Young Adult You can change plans during the 2018 TRICARE Open Season. You must enroll during Federal Benefits Open Season. You do not qualify to purchase a FEDVIP dental plan. You can get your dental care through the TRICARE Dental Program. Reserve Component Member or Family Member enrolled in TRICARE Reserve Select No action needed. This doesn t apply to you. You must enroll during Federal Benefits Open Season. You do not qualify to purchase a FEDVIP dental plan. You can get your dental care through the TRICARE Dental Program. Retired Service Member or Family Enrolled in TRICARE Prime, TRICARE Select SM You can change plans during the 2018 TRICARE Open Season. You must enroll during Federal Benefits Open Season. TRDP ends Dec. 31, You must enroll in a FEDVIP dental plan during Federal Benefits Open Season to maintain coverage. Retired Service Member or Family Member using TRICARE For Life No action needed. This doesn t apply to you. You must enroll during Federal Benefits Open Season. TRDP ends Dec. 31, You must enroll in a FEDVIP dental plan during Federal Benefits Open Season to maintain coverage. To learn more about TRICARE Open Season, visit For a full description of FEDVIP plans and coverage options, visit tricare.benefeds.com. TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.

9 Qualifying Life Events May Change Your TRICARE Options Did you or a family experience a life change recently? Certain changes in your life, such as getting married, having a baby, moving, or becoming Medicare eligible are called Qualifying Life Events (QLEs). QLEs may mean different TRICARE options are available to you, allowing you to enroll in or change your TRICARE health plan coverage within 90 days of the QLE. QLEs include both military and family changes. When you experience a QLE, the first step is to update your information in the Defense Enrollment Eligibility Reporting System (DEERS). Then, if you meet the eligibility requirements, you may change or update your enrollment. If one beneficiary in a sponsor s family experiences a QLE, any member of the family may change his or her enrollment status during the QLE period. QLEs play an important role in determining whether and when you can apply for new coverage or change from your current health plan. Learn more about QLEs at mil/lifeevents. For information about upcoming changes to TRICARE, visit «CERTAIN CHANGES IN YOUR LIFE, SUCH AS GETTING MARRIED, HAVING A BABY, MOVING, OR BECOMING MEDICARE ELIGIBLE ARE CALLED QUALIFYING LIFE EVENTS (QLES). PAGE 9

10 HEALTH MATTERS TRICARE OVERSEAS PROGRAM CONTACT INFORMATION FAQ Corner PAGE 10 How long do I have to submit a claim? Claims for care received overseas may be filed within three years of the date of service or within three years of the date of an inpatient discharge. However, filing claims as soon as possible will help ensure the necessary information is readily available to accurately process your claim completely. Claims for care received in the United States or U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands) must be filed within one year of the date of service or the date of an inpatient discharge. Again, filing your claims as soon as possible is recommended. Send your claims to the TRICARE Overseas Program (TOP) claims processor for the overseas area where you live. If you receive care while traveling, file your TRICARE claims in the overseas area where you live, not the area where you received care. For more information, visit beneficiaries/claims. How do I know which TRICARE plans I m eligible for? Your plan options vary depending on who you are. You can use the TRICARE Plan Finder to help you discover which TRICARE plan is right for you and your family based on your beneficiary category. The TRICARE Plan finder is available at You may also choose multiple plans and compare their features side by side at Remember to update the Defense Enrollment Eligibility Reporting System (DEERS) following any life changes, such as moving, getting married, or having a baby. These life changes may change which TRICARE options are available to you. I received orders to move stateside. How do I find out what region I ll be in? You can view a map of the TRICARE regions at Hover your mouse over the words West Region or East Region for a list of the states that make up each region. If you still aren t sure, call the region you suspect you re in and confirm with a customer service representative. If you re TOP Prime or TOP Prime Remote, you can contact the TOP Regional Call Center and press option 4 for assistance with portability, transferring stateside, and moving between overseas locations. Remember to update your information in DEERS with your new address after moving. «TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. INTERNATIONAL SOS GOVERNMENT SERVICES, INC. EURASIA-AFRICA TOP Regional Call Center (overseas) (stateside) tricarelon@internationalsos.com Medical Assistance LATIN AMERICA AND CANADA TOP Regional Call Center (overseas) (stateside) tricarephl@internationalsos.com Medical Assistance PACIFIC TOP Regional Call Centers 1 Singapore: (overseas) (stateside) sin.tricare@internationalsos.com Sydney: (overseas) (stateside) sydtricare@internationalsos.com Medical Assistance 1 Singapore: Sydney: REPORT FRAUD AND ABUSE (toll-free) (direct) (fax) TOPProgramIntegrity@ internationalsos.com QUALITY ASSURANCE, GRIEVANCES, APPEALS AND COMPLIMENTS/ COMMENDATIONS Grievances_Appeals.htm TOPGlobalQualityAssu@internationalsos.com 1. For toll-free contact information, visit Only call Medical Assistance numbers to coordinate overseas emergency care ISSUE 2 NE3145BEG10181W

ION FHOR TRMICARAT. November December 2018

ION FHOR TRMICARAT. November December 2018 HA PUBELAICATLT ION FHOR TRMICARAT E BENTEEFICIRARSIES Make 2019 Health Plan Changes Now During TRICARE Open Season In 2019, a Qualifying Life Event is Required To Change Plans If you want to make enrollment