United States Army Warrant Officers Association

USAWOA ONLINE

TRICARE and More

  TRICARE,  TRICARE for Life, Dental, Pharmacy,

MEDICARE, MEDIGAP,

VA & CHAMPVA, & More

 

|  TRICARE Management Activity | General Information | Current News | Dental | Pharmacy | Hospice Care |

|  TRICARE for Life |  TRICARE for Guard & Reserve | Miscellaneous | Medicare/MEDIGAP | VA & CHAMPVA |

| Medical Evaluation Boards (MEB)/Physical Evaluation Boards (PEB) |

 Many files throughout this site are a PDF files. A free reader is available for download.

 TRICARE Management Activity

DOD Worldwide  TRICARE Information Center

(Toll-Free) 1-888-DoD-LIFE (363-5433), 1-877-DoD MEDS (363-6337) or 1-888-DoD-CARE (363-2273).

Operating Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (ET) (excluding federal holidays).

 

 TRICARE Information Now Housed Under One Internet Roof

TRICARE beneficiaries will get a pleasant surprise the next time they visit  TRICARE Online. The Web site has a new name, a new look and a new home. It's now part of  TRICARE.mil, the official Web site for all  TRICARE information.  TRICARE.mil at www.TRICARE.mil comprises five main content areas:

  • My Health ( TRICARE Online) -- personal health information & online appointment scheduling for TRICARE Prime;

  • My Benefit --  TRICARE benefit information;

  • MHS Staff -- resources for Military Health System staff members;

  • TRICARE Providers -- information for  TRICARE network providers; and

  • Pressroom -- the latest news about  TRICARE and the military health system.

 TRICARE Fact Sheets are available at www.TRICARE.mil/factsheets/

 

TRICARE Frequently Asked Questions Web Site www.TRICARE.mil/faqs/

 

To get  TRICARE answers, assistance via E-mail, send your message to

 TRICARE_Help@AMEDD.ARMY.MIL or QUESTIONS@tma.osd.mil

 

Want to receive  TRICARE For Life Information?

Send a message to TFL-ON@pasba2.amedd.army.mil (message subject and body may be left blank.

 

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Current News

 

No More Medicare Games (Courtesy MOAA Legislative Update: July 3, 2008 - used with permission)

    In last week's legislative update, we took everyone involved to task for failing to meet a July 1 legislative deadline to stop the 10.6% cut in Medicare and TRICARE payments scheduled to take effect on that date.

    Congress and the President agree that the fix is urgently needed, but they played political games up to and past the deadline, quibbling more over where the money was going to come from rather than on protecting Medicare and TRICARE beneficiaries' health care access.

    The President took a "my way or the highway" stance and threatened to veto any bill that cut any payments to the insurance companies that run Medicare Advantage -- even though the government pays those insurance companies up to 17% more than it pays under regular Medicare.

    The House passed a "take it or leave it bill" (H.R. 6331, which they knew the President had promised to veto) and left town.

    The Senate had been working on a compromise bill, but decided at the last minute to take up the House-passed bill. But they needed 60 votes to do that, and they could only muster 59. (See the list of senators who voted against it) And since the House had left, there was no way the Senate could make any alternative change on its own.

    So now what?

    First, the Pentagon has announced that TRICARE claims will continue to be processed under pre-July rates at least through the end of the summer. The law gives TRICARE the flexibility to do that. The Pentagon's assumption is that Congress will act reasonably shortly to reverse the cut, so there's no sense processing rate changes now if they're going to be reversed soon.

    Medicare doesn't have quite that much flexibility, but has announced that Medicare claims for service since July 1 will be held until July 15, giving Congress eight days to act once they return to work on July 7.

    So now the ball is back in Congress' court, and the clock is ticking louder than ever. Please visit MOAA's web site to send your legislators an updated message, urging them to put political and party differences aside and act quickly to protect seniors' and military beneficiaries' access to health care.

 

Army Medical Evaluation Boards (MEB)/Physical Evaluation Boards (PEB) - see Fact Sheet.

 

Tricare Now Covers Lap Band Surgery - Seriously overweight Tricare patients now will have coverage to undergo a new surgical option - so-called lap band surgery. Coverage is retroactive to Feb. 1, 2007 and patients who received the surgery since then may submit a claim for reimbursement. Additionally, individuals who require a second surgery as a result of complications also will be covered. Full details are provided in the Tricare Policy Manual.

 

Defense Department, VA to Share Electronic Health Records - WASHINGTON, Nov. 6, 2007 – The Departments of Defense and Veterans Affairs are building a system to allow the inter-department sharing of servicemembers’ electronic health information. The departments, which in 2001 began efforts to combine their data resources, are the world’s leaders in crafting a system to streamline electronic health information on such a large scale - see more.

 

New Online Resource for TRICARE Beneficiaries - Achieve Solutions is a new online educational resource that offers TRICARE beneficiaries a secure, safe environment to get information and educational materials, which are offered in both English and Spanish. Self-assessment tools on behavioral health, addiction and recovery, life events, and daily living skills also are available. TRICARE beneficiaries will be able to access self-referral tools, behavioral health program information, interactive self-assessment tools, health risk assessment tools, and benefits information. Additionally, this new tool provides beneficiaries privacy via VeriSign secure site, which encrypts all traffic to and from the server so visitors can be assured their Web history remains private. Achieve Solutions can be accessed through the behavioral health link in the beneficiary resources area of the Humana Military Healthcare Services (HMHS) Web site at http://www.humana-military.com/south/bene/HealthandWellness/behavioralhealth.htm. HMHS manages this benefit for all TRICARE beneficiaries.

 

TRICARE covers HPV vaccine - A new preventative vaccine for Human Papillomavirus (HPV) is now a  TRICARE-covered benefit. HPV is one of the leading causes of cervical cancer in women. The CDC recommends routine vaccination against HPV for girls 11 to 12 years old. Because the vaccine is new, however, it may not be available everywhere. Interested beneficiaries, or their parents, should contact their doctors to find out if they administer the HPV vaccine. Also, the new vaccine does not protect against every type of HPV infection and can't prevent all cervical cancers. The vaccination does not eliminate the need for screening pap smears, or reduce the importance of regular gynecological exams.

 

Paying for  TRICARE Prime - Retirees can pay their  TRICARE Prime enrollment fees through a monthly allotment from their retired pay. Retired pay allotments may be deducted from one of the following pay agencies: Defense Financial Accounting System (DFAS), U.S. Coast Guard, or U.S. Public Health Service. The allotment will be withdrawn electronically from your retired pay in increments of $38.33 for family coverage or $19.17 per individual coverage per month. Allotments are effective the first month following the quarterly payment. Allotments only can be deducted from certain pay agencies. Beneficiaries who receive survivor benefits from either retired or active duty sponsors are paid through a separate pay account and are not eligible for setting up an enrollment fee allotment. Former spouses, as well as retirees who choose to receive VA payments instead of retired pay, also are not eligible to pay by monthly allotment.

Military Treatment Facility (MTF) Locator - The locator includes hospitals and medical centers, and some branch clinics that treat active-duty service members and families.  In addition to expanding the search engine with options like MTF name, installation name, location, specialty, service and type of facility, it returns better search results with less navigation.  Include are standardized information for all MTF listings (appointments, pharmacy, special hours of operation, after-hours care and Beneficiary Counseling & Assistance Coordinator (BCAC) points-of-contact) and basic information that defines a MTF and links to catchment area information. Visit the web site at www.TRICARE.mil/mtf/.

 

 TRICARE global remote overseas contract - access to the  TRICARE Prime health care benefit has improved for active duty Uniformed Services sponsors and family members who are assigned to designated duty stations in remote locations where military treatment facilities are not available. Under the new contract, International SOS Assistance Inc., will coordinate and provide health care services and pay claims for active duty sponsors and family members assigned to overseas locations designated as remote. The coordination of health care services in the  TRICARE Pacific Region and designated sites in  TRICARE Europe began Sept. 1, 2003. Health care services for active duty personnel and family members assigned to the Latin America  TRICARE Region and the remaining sites in  TRICARE Europe began on Oct. 1, 2003. Specific designated site locations and start dates are available on the  TRICARE Web site at www.TRICARE.mil/overseas.

 

USFHP Fact Sheet - The Uniformed Services Family Health Plan (USFHP) (also known as " TRICARE Prime Designated Providers") offers the same health care benefits as  TRICARE Prime, using the same cost structure, to eligible individuals and families who live in six specific parts of the country.  The USFHP is a  TRICARE Prime enrollment option for eligible persons of all ages (even those 65 and older) who live in areas where it's offered. A fact sheet on USFHP has been updated with new information on program enrollment and provider contact addresses. To see the fact sheet, click on www.TRICARE.mil/factsheets/index.cfm?fx=showfs&file_name=USFHP%2Ehtm.

 

TRICARE Handbook at www.TRICARE.mil/TRICAREHandbook is available for viewing and or download. The new handbook highlights all three  TRICARE options - Prime, Standard and Extra --  an the many health care programs and benefits including  TRICARE for Life,  TRICARE Prime Remote for Active Duty Family Members,  TRICARE Plus, Travel Reimbursement, Chiropratic Care,  TRICARE Senior Pharmacy Program,  TRICARE Dental Program, Debt Collection Assistance Program, Beneficiary Counseling and more.

 

CAP  TRICARE Web Site at http://www.tricare.mil/cap - a user-friendly site which provides assistive technology accommodations to persons with disabilities within the Defense Department and other federal agencies. See News Release.

 

TRICARE Online is Gateway to Health Care Services and Information for Beneficiaries at www. TRICAREonline.com/ -  TRICARE Online is an Internet "gateway" to interactive services and information, designed to allow  TRICARE military health care beneficiaries to take command of their own health care in a common, secure, user-friendly electronic environment.

TRICARE SMART Site at www.TRICARE.mil/smart - online collection of latest and most relevant  TRICARE materials including publications for beneficiaries about  TRICARE's full range of health care programs.  

 TRICARE Europe - www.europe.TRICARE.mil/

Need help with  TRICARE? - Have a question? Send an E-mail to  TRICARE_Help@amedd.army.mil.  While the address may say 'Army', it is for all beneficiaries from all services. Get answers from a  TRICARE expert. You can also send questions to questions@tma.osd.mil. (See www.TRICARE.mil/ and www.armymedicine.army.mil/armymed/)

 

Deciding on Long-Term Care Insurance - The Office of Personnel Management recently announced that LTC Partners, formed by the Metropolitan Life and John Hancock insurance companies, has been selected to provide coverage to federal employees, military personnel, retirees, survivors, spouses and certain other family members. See web sites listed below for more information.

 

Government Long Term Care Insurance (LTC) Web Site at www.opm.gov/insure/ltc with all the latest information on implementation of LTC. The federal insurance carriers, LTC Partners, has also set up a web site at www.ltcfeds.com/ for information and registration.

 

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General Information

 

Waiving  TRICARE Deductibles and Cost Shares Is Illegal - Uniformed Services beneficiaries who use  TRICARE Standard and Extra are responsible, under law, to pay annual deductibles and cost-shares associated with their care. The law prohibits health care providers from waiving  TRICARE beneficiary deductibles or cost-shares and requires providers to make reasonable efforts to collect these amounts. Health care providers who offer to waive deductibles and cost-shares or who advertise that they will do so may be investigated for program abuse and suspended or excluded as authorized providers. One type of scheme comes in the form of a supplemental insurance program which covers co-payments or deductibles only for items or services provided by the entity offering the insurance. These programs can be identified when the 'insurance premium' paid by the beneficiary is insignificant and the premiums so low that they are not based upon actuarial risks, but instead are a sham used to disguise the routine waiver of co-payments and deductibles. Such a scam can result in excessive utilization of items and services. When Congress established beneficiary deductibles and cost-shares, their intent was to make the beneficiary a financial partner with the government. The cost-share encourages responsible beneficiary health care decisions when faced with choices, and acts to avoid waste of taxpayer dollars. Beneficiaries who have a financial risk associated with their health care decisions are more likely to choose cost-effective treatment for their medical conditions. Beneficiaries should contact their local  TRICARE Service Center for more information on deductibles and cost-shares. A list of  TRICARE Service Centers and telephone numbers is located at http://www.TRICARE.mil/TRICAREservicecenters/default.cfm. If beneficiaries suspect provider or insurance fraud, they may report it by e-mailing fraudline@tma.osd.mil.

 

There Is a One Year Deadline to File  TRICARE Claims -  TRICARE beneficiaries who file their own claims should remember that, with few exceptions, claims must be filed within one year of the date of medical service or from the date of discharge from an inpatient facility. Beneficiaries also have one year from the date they receive medication to file for reimbursement of pharmacy claims. Additionally, the one-year filing deadline applies to those who file on behalf of individuals with other health insurance (OHI). The deadline applies to  TRICARE Standard beneficiaries as well as to  TRICARE Prime enrollees who obtain emergency or urgent care outside of the  TRICARE region in which they are enrolled.  TRICARE Prime and Extra providers are required to file claims on a beneficiary's behalf, and must also meet the one year requirement.

     TRICARE beneficiaries who use non-network pharmacies to obtain their prescription drugs pay full price at the pharmacy and then must file a claim to obtain reimbursement. Beneficiaries have many options for obtaining a claim form (DD 2642): from a  TRICARE Service Center, Beneficiary Counseling and Assistance Coordinator or Health Benefits Advisor at their military treatment facility; by mail from the  TRICARE Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043; or online at www.TRICARE.mil/claims.

    By law, other health insurance (OHI) held by  TRICARE beneficiaries must be the first payer for covered benefits, including covered pharmacy services.  TRICARE pays first, however, when prescriptions not covered by OHI are covered by  TRICARE or when OHI coverage is exhausted. In either case, beneficiaries must obtain an Explanation of Benefits (EOB) from the OHI indicating their OHI does not cover the medication or that the benefit limits of the OHI have been reached. Beneficiaries must submit a DD 2642 form with the EOB, a copy of the itemized bill and, if a drug claim, a copy of the prescription to the appropriate  TRICARE contractor for reimbursement. Exceptions to the one-year timely claims filing deadline apply if one or more of the following situations occur:

  • The beneficiary was  TRICARE-eligible at the time of service, but eligibility was not reflected on the Defense Enrollment and Eligibility Reporting System until after the timely filing limit;

  • Retroactive preauthorization was received after the timely filing limit expired;

  • TRICARE Management Activity or the regional contractor made an administrative error;

  • A legal guardian responsible for managing the affairs of a mentally incompetent patient or a patient who is unable to communicate, was appointed after the timely filing date was reached;

  • The provider submits the claim as a  TRICARE-participating provider after changing from a non-participating provider;

  • The patient submitted a claim to their OHI in a timely fashion and the insurance plan was responsible for a delay beyond the one-year filing date; or

  • Medicare accepts  TRICARE for Life claims as timely.

  • For more information on exceptions to the one-year timely claims filing deadline and for claims requirements, beneficiaries may visit www.TRICARE.mil/claims . For additional information on where to file claims, beneficiaries should go to www.TRICARE.mil , click on their specific  TRICARE region, and obtain information regarding the  TRICARE Retail Pharmacy or the  TRICARE Mail Order Pharmacy, as appropriate.

Understanding the  TRICARE Appeals Process - more. (Courtesy The Military Family Network)

 

Providing the Best Available Health Care for Medical Holdovers - see Army Information Letter.

 

Certificate of Creditable Coverage Automatically Issued For Persons No Longer Eligible For  TRICARE - Starting Feb. 1, 2004, the Department of Defense Military Health System will begin automatically issuing a Certificate of Creditable Coverage to any former uniformed services sponsor or family member who loses eligibility for health care benefits under  TRICARE. Eligibility for  TRICARE may end as a result of a sponsor's separation from active duty status, divorce, demobilization if the sponsor is a member of the National Guard or Reserves, or a dependent child reaching age 21 (23 for full-time students). For persons no longer eligible for  TRICARE, the certificate serves as proof of previous health care coverage and limits the time another health care plan may exclude them from participating in a health care plan due to a preexisting medical condition. See www.TRICARE.mil/certificate/index.cfm for more information.

 

Have you or a loved one been deployed? Please! Tell your medical provider if you think a deployment has affected your health.  Is the health concern that causes you to seek care today related to deployment? Why to we ask you this? You will be asked this question each time you come for care, no matter if you are active duty, retired, family member, or veteran. We ask you so we can find and track these health issues early. Please!  Tell your provider if you think deployment has affected your health so we can protect and others. If no one asks you politely remind your provider to ask! What is deployment? Some examples are Military Liaison and training support, Humanitarian assistance, Low-intensity combat, Combat or war. If a family member of someone in the military, I don't deploy, why ask me? Even people who don't deploy have health questions about deployment or may be affected by the deployment of a loved one. Don't keep those concerns to yourself! We are here to help you with them - Army Medicine. 8/26/03

 

You can view and download general, regional, and detailed information from the Department of Defense  TRICARE site at www.TRICARE.mil or www.TRICAREonline.com on the web. The Army Medical Department has  TRICARE information at www.armymedicine.army.mil/armymed and click on the  TRICARE icon at the top.  TRICARE 

 

Claims Forms can be found at www.TRICARE.mil/ClaimForms/

 

Reciprocal Health Care Agreements - The United States has entered into agreements with other countries to provide health care for active duty personnel and their dependents on a reciprocal basis.  To view a list of participating countries, please go to www.TRICARE.mil/recip/  

 

 TRICARE and DEERS  - Did you know that if you change your status or address, and do not update your DEERS eligibility... Your prescriptions may not be filled. - Medical claims may be denied, and you will have to pay out of pocket. - You cannot make an appointment at a military treatment facility (MTF) or with a  TRICARE network provider - see more on this important subject!

 

 TRICARE Provider Directory - The  TRICARE Provider Directory Web site has been revamped to include basic descriptions that outline three  TRICARE options ( TRICARE Prime, Standard and Extra) and a link to a military treatment facility locator at www.TRICARE.mil/providerdirectory/  

 

Fact Sheets about  TRICARE benefits, services, etc., are available at www.TRICARE.mil/factsheets/ (click on Browse A-Z) -The  TRICARE Fact Sheets are designed for use by anyone who needs detailed information on particular  TRICARE topics. Beneficiaries, beneficiary counseling and assistance coordinators, customer service representatives and others responsible for explaining or understanding  TRICARE are encouraged to print out and save all the Fact Sheets to assist with questions or issues at hand, or to use for future reference.  All of the Fact Sheets reflect the most current information. Print versions are available at the bottom of each fact sheet. Fact Sheets covering the following topics are currently available at www.TRICARE.mil/factsheets/index.cfm?fx=show:  Appeals, Chiropractic Care Program, Defense Enrollment Eligibility Reporting System (DEERS),  Dual-Eligibility   Eligibility, FEHBP Demonstration Project, Health Insurance Portability and Accountability Act (HIPAA), How  TRICARE Changes When a Military Sponsor Retires or Dies, Maternity Care, Next Generation of  TRICARE Contracts, Pharmacy Program,  Point-of-Service Option, Portability, Privacy Practices, Regional Managed Care Support Contractors, Reserve Component Transitional Health Care Benefits, Travel Reimbursement,  TRICARE Basics,  TRICARE Dental Program,  TRICARE Dental Program Overseas,  TRICARE For Life,  TRICARE Online,  TRICARE Overseas Program,  TRICARE Plus,  TRICARE Prime Remote,  TRICARE Reserve Family Demonstration Project,  TRICARE Retiree Dental Program,  TRICARE Standard, Uniformed Services Family Health Plan, Women, Infants, and Children (WIC) Overseas Program.

 

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 TRICARE Dental

See Fact Sheet

In addition to the above  TRICARE medical resources, there are also  TRICARE Family Member Dental Plan and  TRICARE Retiree Dental Program as follows:

 

 TRICARE Retiree Dental Program sweetens benefit for members of the National Guard/ Reserve  - TMA grants waiver of 12-month waiting period for full scope of services - Eligibility for the  TRICARE Retiree Dental Program extends to all retirees of the Reserve and Guard and their family members, including "gray area" retired Reservists who are entitled to retired pay but will not begin receiving it until age 60. Although eligibility for this group has been in effect since the  TRDP first began in 1998, many retired Reserve and Guard members, and even more "gray area" retirees, still do not realize they are eligible. It is important to note that as with all new retirees, the 120-day period during which a "gray  area" retired Reservist can enroll in the TRDP to qualify for the 12-month waiting period waiver begins with his/her retirement effective date, not the date he/she reaches age 60. See Delta Dental Press Release.

 

 TRICARE Family Member Dental Plan (active duty)  - www.ucci.com/. Using the  TRICARE Dental Program Overseas:  The  TRICARE Dental Program, administered by United Concordia Companies, Inc. (UCCI), is offered outside of the continental United States (OCONUS) service area. The OCONUS service area includes all other countries, island masses, and territorial waters not in the continental United States (CONUS) service area (the 50 United States, District of Columbia, Canada, Puerto Rico, Guam and the U.S. Virgin Islands).  More information is available at www. TRICARE.mil/factsheets/index.cfm?fx=showfs&file_name=Dental%5FOverseas%2Ehtm  

 

What the Reserve Component Needs to Know About the  TRICARE Dental Program - The  TRICARE Dental Program offers a wide range of diagnostic and restorative dental services and is available to members and families of the Selected Reserve and Individual Ready Reserve. There are important differences in coverage for family members when their reserve component sponsors are activated versus when they are in reserve status. See Press Release.

 

 TRICARE Enhances Dental Benefits for Uniformed Services Retirees Dental benefits for uniformed services retirees and family members enrolled in the  TRICARE Retiree Dental Program (TRDP) have been enhanced. Beginning May 1, 2003, the mandatory enrollment period is reduced from 24 to 12 months. The annual maximum benefit per enrollee and lifetime maximum benefit for orthodontic care has been increased from $1000 to $1200. After the mandatory enrollment period ends, eligible enrollees which include uniformed services retirees and their family members; Medal of Honor recipients and their family members; and survivors and family members of deceased retirees or active duty sponsors who served on active duty for more than 30 consecutive days, may continue their enrollment in the TRDP on a month-to-month basis. During the mandatory 12-month enrollment period, TRDP enrollees are covered for basic restorative services, periodontics, endodontics, oral surgery and dental emergencies. After 12 months of continuous enrollment, TRDP enrollees are covered for cast crowns, cast restorations, full and partial dentures and orthodontics for adults and children. A directory of participating Delta Dental providers is available online at www.ddpdelta.org. Retirees and family members may also request a provider directory by calling the Delta Dental Customer Service number at (888) 838-8737. 

 

 TRICARE Retiree Dental Program Eligibility Includes "Gray Area" Retirees - Eligibility for the  TRICARE Retiree Dental Program (TRDP) extends to ALL retirees of the Reserve and Guard and their family members, including "gray area" retired Reservists who are entitled to retired pay but will not begin receiving it until age 60.  Although eligibility for this group has been in effect since the TRDP first began in 1998, many retired Reserve and Guard members, and even more "gray area" retirees, still do not realize they are eligible. Retired Reservists and Guard members, including "gray area" retirees, who would like more information about the TRDP can visit the web site at www.trdp.org or call the contract administrator, Delta Dental of California, at 1 (888) 838-8737 for a complete TRDP enrollment packet.

 

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 TRICARE Pharmacy and National Mail Order Pharmacy

See Fact Sheet

Pharmacy program makes saving $$$ easier – Nearly 20,000 TRICARE beneficiaries saved about $600,000 on their prescriptions in only two months after switching to mail order through the new Member Choice Center (MCC).    You can switch from retail to the TRICARE Mail Order Pharmacy (TMOP) by calling MCC at 1-877-363-1433 (in the U.S.).  Beneficiaries who do not have other health insurance and who are using a retail pharmacy can go online to www.express-scripts.com/TRICARE to complete the registration, without downloading or mailing forms, and request that their prescription be converted to mail order from retail.  What you could save     Your savings through TMOP could range from $24 a year for each regular formulary generic drug to as much as $176 a year for each non-formulary brand-name drug.  TMOP can also save you time and effort since you can order and receive prescriptions without leaving home.    DoD is saving money too, projecting a savings of about $6.9 million on the 39,500 prescriptions converted so far from retail to TMOP.  DoD could save up to $24 million a year with just a 1% shift of prescriptions from retail to mail order.  For more information, go to www.tricare.mil. (Courtesy Army ECHOES, Jan-Apr 2008)  

 

TRICARE Retail Pharmacy Program - the  TRICARE Retail Pharmacy (TRRx) contract takes effect for  TRICARE beneficiaries located in the 50 United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.  The contract, awarded last year to Express Scripts Inc. of Maryland Heights, Mo., has approximately 53,000 civilian pharmacies in the nationwide network.  In the past, the  TRICARE regional managed care support contractors provided retail pharmacy services. To use the new retail pharmacy program, as with all other DoD health programs, beneficiaries must be eligible and enrolled in the Defense Enrollment Eligibility Reporting System or DEERS - see Press Release.

 

TRICARE Comprehensive Pharmacy Benefit at www.TRICARE.mil/pharmacy contains information about the  TRICARE pharmacy benefit including: Options for having prescriptions filled under  TRICARE, Specific steps for having prescriptions filled, and Costs and copays for each pharmacy option. It also has a link to the National Mail Order Pharmacy (NMOP).

 

Wondering What Drugs are Available at the NMOP? visit the DoD National Mail Order Pharmacy Formulary at www.pec.ha.osd.mil/nmop/nmophome.htm contains all kinds of information about this benefit for the military, military families and retirees too! You can also check availability by calling Merck-Medco at 800-903-4680 or 614-421-8211.

 

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 TRICARE For Life

See Fact Sheet

TRICARE For Life Centralized Claims Service - Wisconsin Physicians Service is the centralized claims processing for all beneficiaries who are eligible for  TRICARE For Life. For information about current claims processors and to find your  TRICARE region, visit www.TRICARE.mil/main/chart.html. Beneficiaries may call (866) 773-0404 or (866) 773-0405 for information and/or claims processing assistance.

 

TRICARE For Life (TFL) is Medicare-wraparound coverage available to:

  • Medicare-eligible uniformed service retirees, including retired guard members and reservists,

  • Medicare-eligible family members and widows/widowers (dependent and parents-in-law are excluded),

  • Medicare-eligible Congressional Medal of Honor recipients and their family members

  • Certain Medicare-eligible unremarried former spouses.

For more on this program see www.TRICARE.mil/tfl/default.cfm.

 

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 TRICARE for Guard and Reserve

TRICARE Rules Afford Reservists More Flexibility - Under the new rules for TRICARE Reserve Select health insurance, eligible Reservists will have greater flexibility to terminate coverage at their discretion, as well as add or remove family members. The interim rules will take effect October 1, 2007 and apply to Reserve health care benefits approved by Congress as part of the 2007 Defense Authorization bill. Final rules will be issued in September after receipt of additional comment.

 

Guard, reserve health info Web site - National Guard and reserve service members may access information about their military health benefits online. TriWest Healthcare Alliance, one of the  TRICARE regional contractors, launched a new national Web site to help Guard and reserve members better understand what’s available through  TRICARE. The Web site provides: A video explaining benefits; A newsletter specifically for National Guard and reserve members; Post-deployment help and behavioral health resources for families; Links to support agencies and programs; and Resources for military leaders 6/7/07

 

TRICARE Fact Sheet: Benefits for Guard & Reserve Retirees & Their Families - see more. If you are a retired National Guard or Reserve member, you and your family members may be eligible for  TRICARE medical and dental benefits. For the purpose of these benefits, you may fall into one of the following categories:

> Retired Reserve not eligible for retired pay until age 60, often called, "Gray area retiree;"

> Retiree between age 60 and 65 receiving retirement pay; or

> Retiree age 65+ receiving retirement pay and social security benefits.

To view the full fact sheet, please visit: www.TRICARE.mil/Factsheets/viewfactsheet.cfm?id=350

 

TRICARE Open to All Drilling Guard/Reserve - The Pentagon has begun its open enrollment season for the newly expanded Guard and Reserve health plan,  TRICARE Reserve Select (TRS). All drilling Guard/Reserve members are eligible - for a price. For more information, visit the TRICARE Web site.

 

TRICARE Benefits Expanded for Mobilized RCs - Members of the Guard and Reserve with delayed-effective-date orders who serve on active duty in support of a contingency operation for more than 30 days are eligible for  TRICARE for up to 90 days prior to their activation date. Their families also are eligible. In addition, qualified members of the Guard and Reserves will be eligible for  TRICARE up to 180 days after their active duty service ends. To be qualified, RC members and their families must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and must be eligible for  TRICARE. To verify eligibility, visit www.dmdc.osd.mil/Guard-ReservePortal. For more information on the expanded  TRICARE benefit, go to at www. TRICARE.mil/reserve/

 

TRICARE Policies for Members of National Guard and Reserves - The first shortens the time reservists and Guardsmen must be activated -- from 179 days to 30 days -- for their families to be eligible for enrollment in  TRICARE Prime. The second important change is eligibility for  TRICARE Prime Remote - see Press Release for more. Also another Press Release outlines that starting March 10, 2003, Guard and Reserve family members, if their sponsor is on active duty (federal) orders for more than 30 days, are eligible to enroll in  TRICARE Prime and enjoy the access standards and cost shares associated with the Prime benefit. - see that Press Release for more. Guard and Reserve sponsors need to verify that DEERS information for themselves and their family members is accurate and up-to-date. They are encouraged to contact DEERS at the Defense Manpower Data Center Support Office toll free at (800) 538-9552. Sponsors and family members may also update their addresses in DEERS on the  TRICARE  Website at www.TRICARE.mil/DEERSAddress/ Future updates regarding benefits for members of the Guard and Reserve and their family members will be posted on the  TRICARE Website at www. TRICARE.mil/reserve.

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Hospice Care

 

    TRICARE HOSPICE CARE is available to beneficiaries who have received a terminal diagnosis.  Its function is to provide care for terminally ill patients with a life expectancy of six months or less if the illness runs its normal course. In particular, curative treatments are not covered, while personal care and home health aide services are covered.  It may include physician services, nursing care, counseling, medical equipment, supplies, medications, medical social services, physical and occupational services, speech and language pathology, and hospice short term inpatient care to manage acute or chronic symptoms or to control pain. Room and board are not covered under the  TRICARE hospice benefit; however, inpatient care is covered when needed. You cannot receive other  TRICARE services or benefits related to curative treatment of the terminal illness, unless the hospice election is formally revoked.

     The hospice, in conjunction with your regional contractor, is responsible for the arrangement of all care while you are under the hospice election. To formally revoke the hospice election, you must submit a signed and dated statement through the hospice provider. This does not alter your ability to elect and reenter hospice care at a later time. Hospice care can be provided in a Home, Hospice facility or Inpatient acute care facility.  Care can shift among these facilities without affecting the hospice benefit. For example, if you are receiving hospice care at home, but the family member caring for you is overwhelmed with caretaking responsibilities, you may choose to receive short term, inpatient respite care at a hospice facility in consultation with your hospice care team. This is an available option under the hospice benefit.

     Hospice care is managed by the hospice medical director, the hospice care team managing your case, and your primary care manager (PCM) or primary care provider, who are always in consultation with you and your family. Your case manager and PCM or primary care provider will assist in locating appropriate hospice care. A hospice evaluation does not require authorization. Only Medicare certified hospices are authorized to provide covered services to  TRICARE beneficiaries. You can locate a  TRICARE authorized hospice provider through your regional contractor.  There is no deductible for hospice care, and  TRICARE pays the cost of all covered services, except for small cost share amounts which may be collected by the individual hospice (at their option) for outpatient drugs and inpatient respite care.  Check with your regional contractor or hospice provider for specific cost information.

     Hospice care is provided in three benefit periods, each of which requires prior authorization from your regional contractor. The first two benefit periods are each 90 days long.  The first period begins on the day you sign a hospice election statement and both the attending physician and the hospice medical director sign a physician's certificate of terminal illness. Each subsequent period requires recertification of the terminal illness by the hospice medical director or the physician on your hospice care team.  The final benefit period is made up of an unlimited number of 60 day periods, each of which requires physician recertification of the terminal illness.

     You, your PCM or primary care provider, or a family member acting on your behalf can initiate hospice care. However, it is important to understand that the hospice cannot provide services without a referral from your PCM or primary care provider, prior authorization from your regional contractor, and certification of the terminal illness.  When considering hospice care, you should discuss the options with family members and your PCM or primary care provider. The hospice benefit also covers a consultation with the medical director of a Medicare certified hospice so you may ask questions and learn more about a specific hospice program.  You must complete and sign an "election statement," which the hospice provides, that indicates your full understanding of hospice care.  By signing this statement, you waive your right to any  TRICARE benefits associated with curative treatment of your illness. The election statement is then filed with your regional contractor. 

[Source:   TRICARE  Hospice Care Brochure

 

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MEDICARE/MEDIGAP

The Senate and the House of Representatives voted on Tuesday, July 15, 2008, to override the presidential veto of H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008. In addition to staving off cuts in Medicare reimbursement to physicians, the Act also makes modest improvements for Medicare beneficiaries.. Of immediate significance to Medicare beneficiaries, the law extends the Qualified Individual (QI) program, which expired on June 30, 2008, until December 31, 2009.The reauthorization of the QI program is made whole back to July 1. Beneficiaries will be reinstated in the program and need not reapply. The law also delays implementation of the DMEPOS competitive bidding program, which would otherwise have gone into effect on July 1, 2008, in 10 areas around the country.  For details on how H.R. 6331 affects beneficiaries, visit www.medicareadvocacy.org/Reform_08_07.10.HR6331.htm.

 

Medicare Part D Prescription Drug Benefit Enrollment and Premiums  -  TRICARE-Medicare beneficiaries who enroll in a Medicare prescription drug plan must pay the monthly Medicare prescription drug plan premium;  TRICARE does not reimburse Medicare premium costs. You may qualify for assistance from the Social Security Administration (SSA) paying the Medicare Part D premiums, deductibles and co-pays if you have limited income and limited resources. If you think you may qualify for Medicare's extra help, you may apply for it and still keep your  TRICARE pharmacy coverage. People with Medicare can enroll in a Medicare prescription drug plan during the initial open enrollment period (November 15, 2005-May 15, 2006). If you don't enroll during this initial period, each following year, you may enroll in a Medicare prescription drug plan between November 15th and December 31st.  For more information on Medicare Part D, visit the Medicare Web sites at www.cms.hhs.gov/partnerships or www.medicare.gov or call its 24-hour toll-free number at 1-800-MEDICARE (1-888-633-4227).

 

The MEDICARE website at www.medicare.gov provides the following search and compare features:

  • MEDICARE Health plans - helps comparison-shopping for a health plan to complement your Medicare coverage. It gives you a list of Managed Care Plans in your area, the costs, the benefits offered, and how the plans compare with each other.

  • MEDIGAP policies - helps locate supplemental insurance or "Medigap" policies that cover expenses not paid for by Medicare. It also gives you information on how to contact the insurance companies offering Medigap policies.

  • NURSING Home - help you compare nursing homes in your area by looking at their resident characteristics, state inspection results, and nursing staff information.

  • DIALYSIS Facility - helps locate and compare dialysis services available in your area. It offers locations of dialysis facilities, shifts that start after 5 p.m., adequacy of hemodialysis, anemia management, and patient survival information.

  • PARTICIPATING PHYSICIAN Directory - includes the names, addresses, and specialties of physicians participating in Medicare. These doctors are the doctors that accept Medicare assignment on Medicare claims and covered services.

  • HELPFUL Contacts - helps you find the names, telephone numbers, and Internet addresses of organizations that can give you answers to general questions on Medicare, other insurance programs, Medicare billing, Medicare fraud and abuse, and health care facilities in your area.

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VA Programs & CHAMPVA

VA LOCAL ACCESS:  The Department of Veterans Affairs is represented by numerous Regional offices (VARO), state Benefit Offices, Vet Centers, and medical facilities throughout the U.S. and its territories. Locations of these facilities can be found at:

For questions or information you get an email response by asking your question at https://iris.va.gov/scripts/iris.cfg/php.exe/enduser/home.php.  To talk to someone you can go to your local VA office or call the following:

  • VA Benefits: 1(800) 827-1000 for Burial; Civilian Health & Medical Program of the Department of Veterans Affairs (CHAMPVA); Death Pension; Dependency Indemnity Compensation; Direct Deposit; Directions to VA Benefits Regional Offices; Disability Compensation; Disability Pension; Education; Home Loan Guaranty; Life Insurance; Medical Care; Vocational Rehabilitation & Employment.

  • Education (GI Bill): 1(888) 442-4551

  • Health Care Benefits: 1(877) 222-8387

  • Income Verification and Means Testing: 1(800) 929-8387

  • Life Insurance: 1(800) 669-8477

  • Mammography Helpline: 1(888) 492-7844

  • Special Issues - Gulf War/Agent Orange/Project Shad/Mustard Agents and Lewisite/Ionizing Radiation: 1(800) 749-8387

  • Status of Headstones and Markers: 1(800) 697-6947

  • Telecommunications Device for the Deaf (TDD): 1(800) 829-4833

  • Suicide Call Center: 1(800) 273-TALK (8255).

[Source:  VA website www.vba.gov ]

 

Refill your Prescriptions Online! - You can use MyHealtheVet to refill your VA prescriptions and view your VA prescription history online! This service is designed exclusively for VA patients to manage medications prescribed by VA doctors. Online prescription refill has been the most popular request for My HealtheVet. So, you asked for it, and now it's here! You will need to be a registered user of My HealtheVet to use this new feature. Register Now to use Prescription Refill and many other features of My HealtheVet, including the Personal Health Journal, where you can record and track your health conditions online. Learn how to use Prescription Refill, it's easy!

 

CHAMPVA pays benefits for covered medical services to eligible beneficiaries who are 65 or older and enrolled in Medicare Parts A&B.  The "CHAMPVA for Life" benefit is payable after payment by Medicare or other third-party payers.  For services not covered by Medicare or other insurance, such as outpatient prescription medications, CHAMPVA will be the primary payer.

 

CHAMPVA beneficiaries who reached age 65 as of June 5, 2001, but were not enrolled in Medicare Part B on that date, will be eligible for this expanded benefit even though not enrolled in Medicare Part B.  There is no change in CHAMPVA coverage for those beneficiaries 65 and older who do not qualify for Medicare.

 

CHAMPVA For Life is a new benefit designed for spouses or dependents who are 65 or older.  They must be family members of veterans who have a permanent and total service-connected disability, who died of a service-connected condition or who were totally disabled from a service-connected condition at the time of death.  They also must have Medicare coverage.

 

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Miscellaneous

 

Smoking, Taking Control at www.committedquitters.com - for strategies, tips and techniques in the fight to quit smoking.

 

Change Your DEERS Address Easily at www.TRICARE.mil/DEERSAddress/. Don't forget the "s" in the http or you will not be able to get on the site.

 

Frequently Asked Questions on  TRICARE For Life see www.TRICARE.mil/ndaa/faq.htm - source for answers

MyTRICARE.com - Access your  TRICARE claims information on your time, at your place. The benefits of my TRICARE.com - It's safe, it's secure, it's simple, it's free. Register at www.myTRICARE.com. 

 

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USAWOA Online 9/4/2008