TRICARE Briefing March Medically Ready Force Ready Medical Force

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Kristina Russell
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1 TRICARE Briefing March 2018 Medically Ready Force Ready Medical Force

2 DEERS and TRICARE 2

3 ID Card and Wallet Cards 3

4 TRICARE Stateside Regions 4

5 TRICARE For Life Region

TRICARE-eligible Active duty Service members Active duty family members Retired Service members (including Retired Reserve members who are age 60) and their

6 TRICARE-eligible Active duty Service members Active duty family members Retired Service members (including Retired Reserve members who are age 60) and their family members National Guard and Reserve members and their family members Medal of Honor recipients and their family members Survivors and eligible former spouses 6

7 Provider Types 7

8 TRICARE Program Options Those Eligible for TRICARE TRICARE Program Options Active duty service members TRICARE Prime TRICARE Prime Remote Active duty family members Family members of National Guard and Reserve (NGR) members NGR members on active duty orders for more than 30 days NGR members, retired Reservists, and their family members Retired service members and their family members Retired Reservist (at age 60) and their family members Medal of Honor recipients and their family members Survivors and eligible former spouses TRICARE Prime TRICARE Prime Remote TRICARE Select TRICARE For Life (TFL) US Family Health Plan (USFHP) TRICARE Young Adult (TYA) TRICARE Reserve Select TRICARE Retired Reserve TYA TRICARE Prime TRICARE Select TFL USFHP TYA 8

9 Enrollment Changes Open Enrollment Season Nov. 12 through Dec. 10, 2018 TRICARE coverage starts Jan. 1, 2019 Change to another health plan or do nothing and stay in the same plan Outside of the Open Enrollment Season Only change health plans within 90 days of a Qualifying Life Event (QLE), such as getting married, divorced, having a baby, or moving Newborns and adoptees must be registered in DEERS within 90 days in the U.S. and 120 days overseas All newborns must be enrolled in a plan within 90 days of their registration in DEERS 9

10 Enrollment - Scenarios ADSM s baby is born on March 22, The baby s claims process as TRICARE Prime from DOB up to day 90. Scenario 1: Baby is registered in DEERS on May 2 (within 90 days of DOB) Baby is auto-enrolled in Prime because he lives in a PSA and coverage is backdated to March 22, Scenario 2: Day 91, baby is still not registered in DEERS Contractor denies any claims with DOS after 90 days from DOB Baby is registered in DEERS on July 2 (over 90 days from the DOB) Baby is auto-enrolled in Prime because he lives in a PSA and coverage is backdated to March 22, 2018 Any claims denied due to eligibility from day 91 to the date the baby was autoenrolled may be reprocessed as Prime upon the family s request 10

TRICARE Prime Available in specific areas Must enroll Enrollment fees apply for non- ADFMs No claims to file Referrals needed for specialty care Military

11 TRICARE Prime Available in specific areas Must enroll Enrollment fees apply for non- ADFMs No claims to file Referrals needed for specialty care Military hospitals and clinics first option for specialty care Most care from PCM Lowest costs Annual announcement of health plan changes 11

12 TRICARE Select Replaced TRICARE Standard Must enroll Enrollment fees apply for some beneficiaries Freedom to choose providers Deductible, co-pays, and cost shares apply Referrals aren t needed Some services require prior authorization 12

13 US Family Health Plan TRICARE Prime option 6 service areas Must enroll Enrollment fees apply for some beneficiaries Can t use military hospitals or clinics or military pharmacies 13

14 Urgent Care TRICARE Prime Enrollees As of Jan. 1, 2018, enrollees don t need a referral for urgent care Can get urgent care from any TRICARE authorized urgent care center or network provider Doesn t apply to active duty Service members (unless enrolled in TRICARE Prime Remote) TRICARE Select Enrollees Enrollees don t need a referral for urgent care Can get urgent care from any TRICARE authorized urgent care center or provider Enrollees will pay network or non-network copays or cost shares, depending on the type of provider they see 14

15 Enrollment Costs 15

16 Enrollment Costs 16

17 Yearly Deductible 17

18 Yearly Catastrophic Cap 18

19 Costs for Covered Services 19

20 Costs for Covered Services (cont.) 20

21 Costs for Covered Services (cont.) 21

22 Costs for Covered Services (cont.) 22

23 Costs for Covered Services (cont.) 23

24 Costs for Covered Services (cont.) 24

25 TRICARE Pharmacy Program Costs 2/1/

26 Active Duty to Retirement What Changes? New uniformed services ID card Retiring is a Qualifying Life Event (QLE) Must enroll in a TRICARE plan for civilian care coverage Enroll within 90 days of retirement Pay retiree costs for care Extended Care Health Option (ECHO) is no longer available If entitled to Medicare Part A, must have Medicare Part B 26

27 Active Duty to Retirement - Scenarios ADSM (who enlisted before Jan 1, 2018) and family are enrolled in TRICARE Prime. ADSM retires effective Jan 5, Sponsor and family default to Direct Care Only on Jan 5, Scenario 1: They enroll in Prime on February 5 (within 90 days); coverage is backdated to Jan 5, Family is responsible for TRICARE Prime annual enrollment fee back to Jan 5, The fee is pro-rated. Scenario 2: They attempt to enroll in Prime on May 15; contractor denies the enrollment because the request was received more than 90 days after the date of retirement. The sponsor and family remain Direct Care Only until the next open season or QLE. 27

Active Duty to Retirement Medicare Special enrollment period (SEP): Anytime the sponsor is on active duty or within the first 8 months following the month the sponsor s active duty status ends or the

28 Active Duty to Retirement Medicare Special enrollment period (SEP): Anytime the sponsor is on active duty or within the first 8 months following the month the sponsor s active duty status ends or the month TRICARE coverage ends, whichever comes first Buying Part B: While on active duty or during month 1 of the SEP Part B starts the 1st day of the month in which the individual enrolls During months 2-8 of the SEP Part B starts the 1st day of the month following the month in which the individual buys Part B Part B must be in effect on the first day of retirement 28

29 No Longer Getting SSDI Returning to work What happens to Medicare status? 29

30 TRICARE For Life No enrollment or enrollment fees Automatically covered Medicare is the primary payer 30

31 TRDP Transition to FEDVIP The TRICARE Retiree Dental Program ends December 31, 2018 Starting November 2018, eligible beneficiaries may sign up for the Federal Employees Dental and Vision Insurance Program (FEDVIP) 31

32 Resources 32

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