Health

TRICARE

In response to the challenge of maintaining medical combat readiness while providing the best health care for all eligible personnel, the Department of Defense introduced TRICARE. TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. TRICARE brings together the health care resources of the Army, Navy and Air Force and supplements them with networks of civilian health care professionals to provide better access and high quality service while maintaining the capability to support military operations. TRICARE is being implemented throughout the U.S., Europe, Latin America and the Pacific as a way to:

• Improve overall access to health care for beneficiaries;
• Provide faster, more convenient access to civilian health care;
• Create a more efficient way to receive health care;
• Offer enhanced services, including preventive care;
• Provide choices for health care; and
• Control escalating costs.

Who is Eligible for TRICARE?

• Active duty members and their families;
• Retirees and their families; and
• Survivors of all uniformed services that are not eligible for Medicare.

If you have other primary health care insurance, TRICARE Prime may not be your best option. Health Benefits Advisors are available at your local TRICARE Service Center (TSC) or Military Treatment Facility to help you decide which option is best for you.

TRICARE offers three options: TRICARE Prime, TRICARE Standard, and TRICARE Extra. Additionally, TRICARE Prime Remote is the Prime benefit extended to those service members and their families who work and reside fifty (50) miles or more from a military treatment facility.

You should understand the difference between Standard, Extra, Prime and Prime Remote to determine whether you will use your TRICARE benefit or maintain your Employer-Sponsored Health Plan. You should also k now where to locate more information on the Web site.

TRICARE STANDARD
You choose your authorized TRICARE provider. You may be able to keep your current provider. The medical provider does not need to be a part of the TRICARE civilian network but must be a TRICARE authorized provider. You pay an annual deductible and 20 percent cost shares. Enrollment is not required to participate.

TRICARE EXTRA
You choose your medical provider from the list of TRICARE civilian providers who are part of the TRICARE network. You will be responsible for an annual deductible and 15 percent cost shares. The cost shares in TRICARE Extra are less than TRICARE Standard. There are no claim forms to file. You just pay your reduced cost share after satisfying the deductible. You may use a combination of the TRICARE Extra and TRICARE Standard programs at any time, depending on whether you choose providers inside or outside the network. Enrollment is not required.

The annual TRICARE Standard/Extra deductible, depending upon your status, is $50 – $300. If you are called in support of certain operations, your family’s deductible may be waived. For more information call your TRICARE Service Center (TSC).

TRICARE PRIME
This option is available to family members whose sponsor is on active duty for 179 consecutive days or more. Requires enrollment and grants exclusive access to the MTF. If enrollment is received between the first and 20th of the month, the effective date is the first of the following month. If received after the 20th, the effective date will be the first day of the subsequent month. Enrollment can be mailed or completed at your TSC. Under this plan, you may select or be assigned a Primary Care Manager (PCM) to provide or arrange for your family’s healthcare needs. You will also have access to additional wellness and preventive care services. (Family members living with their sponsor outside an MTF catchment area may be eligible for TRICARE Prime Remote Benefits.)

The main challenge for most eligible beneficiaries is deciding which TRICARE option, Prime, Extra or Standard, is best for them. Active Duty personnel are enrolled in TRICARE Prime and pay no fees. Active duty family members pay no enrollment fees, but they must choose a TRICARE option and apply for enrollment in TRICARE Prime. There are no enrollment fees for active duty families in TRICARE Prime.

If you do not know your region number, view the regional map to find your region number and phone number for more TRICARE information. You can link to current news releases with detailed information about changes to TRICARE coverage at https://www.tricare.osd.mil/NewsReleases/.

TRICARE Offers Benefits to Activated National Guard Members and Reservists
A full explanation of benefits can be found at https://www.tricare.osd.mil/. Demobilized members of the Reserve component and their dependents, who were activated in support of a contingency operation are eligible for the TRICARE transitional health care demonstration project. (Does not include full-time National Guard duty.)

Members of the reserves and National Guard who are called to active duty will be eligible for health care benefits under TRICARE, just as other active-duty service members are. Their families will also become eligible for TRICARE benefits, if the military sponsor’s active-duty orders are for a long-enough period of time.

Families of members called to active duty in response to the Sep 11, 2001 terrorist attacks are eligible for enhanced benefits under the TRICARE Reserve Family Demonstration Project.

TRICARE eligibility for the military sponsor begins on the effective date of their orders to active duty. Needed care will be provided by uniformed services medical treatment facilities, and by authorized civilian health care providers.

Families of activated reservists and National Guard members become eligible for health care benefits under TRICARE Standard or TRICARE Extra on the first day of the military sponsor’s active duty, if his or her orders are for a period of more than 30 consecutive days of active duty, or if the orders are for an indefinite period.

TRICARE Standard is the former CHAMPUS program with a new name. Benefits under TRICARE Standard are the same as they were for CHAMPUS.

For active-duty families, TRICARE Standard pays 80 percent of the TRICARE allowable charge for covered health care services that are obtained from authorized, non-network, civilian health care providers. Those who receive the care are legally responsible for the other 20 percent of the allowable charge, plus other charges billed by “non-participating” providers, up to the legal limit of 15 percent above the allowable charge. Providers who “participate” in TRICARE accept the TRICARE allowable charge as the full fee for the care they provide.

You’re Covered
When on military duty you are covered for any injury, illness or disease incurred or aggravated in the line of duty. This includes traveling directly to or from the place where you perform your military duty. When on active duty for more than 30 days, you have comprehensive health care coverage under TRICARE Prime.

Your Family Is Covered
When you are on active duty for more than 30 days, your family’s health and dental care needs are covered under several TRICARE options, all of which are designed to meet their needs.

Access To Care
The first step is to enroll or update you and all eligible family members in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is your key to all benefits. For more information, call DEERS, Monday-Friday, 9 a.m.-6:30 p.m. Eastern Time, at 1-800-538-9552 (California, 1-800-344-4162), or visit DEERS.

Reserve Component Members
Reserve component members (includes National Guard members on active duty under 32 U.S.C. 502 (f)) on active duty for more than 30 consecutive days, must enroll in TRICARE Prime. TRICARE Prime enrollment means on the effective date of your orders, you are eligible for medical and dental care at any Military Treatment Facility.

Family Members
Your family should decide now about health care coverage options if and when you are called to active duty. Family members are eligible for health care under either TRICARE Standard or TRICARE Extra when you are on active duty for more than 30 days. There is no need to enroll, just show your Military ID card. Make sure your family members’ DEERS records are up-to-date to prevent delays in treatment and claims processing. If you are on active duty for 179 consecutive days or more, your family members have the option to enroll in TRICARE Prime.

Before Receiving Deployment Notification
Enroll family members in DEERS and/or update information as needed. Get military ID cards for eligible family members. Get your will and other legal documents in order. Contact your command or unit family readiness representative for help with completing your family care plan. Review your TRICARE options. Review your civilian employer’s health and dental coverage options while on active duty. Determine costs and benefits of both TRICARE and civilian options before choosing one or the other.

Upon Receiving Deployment Orders
Confirm that your family’s DEERS information is current. Ensure that eligible family members have current ID cards. Give your family copies of your orders. Contact unit commander or reserve center for information on TRICARE. Contact your civilian employer to continue or discontinue your employer health and/or dental coverage. Contact your military legal assistance office to appoint your power of attorney and update your will. Contact your command or unit family readiness representative for help in updating your family care plan. Contact finance office to set up an allotment, if applicable. Make other financial arrangements as required. Review life insurance for spouse and yourself.

TRICARE Handbook
The TRICARE HANDBOOK provides TRICARE benefit information. Users can search for information on the TRICARE benefit either by subject search, or general search. In addition, you can go right to sections in the Handbook using the interactive Table of Contents (TOC), as well as print out the online version in its entirety.

Benefits Available During Demobilization
Reserve component members ordered to active duty for more than 30 days in support of a contingency operation (does not include full-time National Guard Duty) are entitled to transitional health care and dental benefits upon separation. Family members are not eligible for transitional dental benefits because they are eligible for dental benefits under the TDP. Members separated with less than six years of total active federal military service (as indicated on the DD 214) and eligible family members, are eligible for 60 days of transitional health care. Members separated with six years or more of total active federal military service and their eligible family members are eligible for 120 days of transitional health care.

Reserve component members are eligible for the Continued Health Care Benefit Program (CHCBP) when they lose military health benefits and their transitional health care benefit period has expired. They also may enroll their family members for this coverage. CHCBP provides benefits similar to TRICARE Standard for a specific period of time (up to 18 months for members and their family members). They must enroll within 60 days of the date that their transitional benefit period expires and pay quarterly premiums ($933 per individual, $1966 per family). For more information about CHCBP, individuals may call toll free: 1-800-444-5445, visit online at www.humana-military.com or write to Humana Military Healthcare Services Inc., Attn: CHCBP, P.O. Box 740072, Louisville, KY 40201.

When a Reserve Component Sponsor Retires
When reserve component members retire, they do not become eligible for TRICARE or space-available care in an MTF until they reach age 60 or are receiving retired pay. At that time, they and their family members may enroll in TRICARE Prime or they may use TRICARE Extra or TRICARE Standard. Retired reserve component members also become eligible for TRICARE For Life when they become eligible for Medicare at age 65 and enroll in Medicare Part B. In addition, retired reserve component members, and their spouses and dependent children are eligible for the TRICARE Retiree Dental Program, regardless of the sponsor’s age and whether the sponsor is receiving retired pay.

For more information about medical care, dental care and other benefits for reserve component members, and their eligible family members, interested parties may visit the TRICARE Web site. More information about the TRICARE Dental Programs is available on the TRICARE Dental Program Web site, and the TRICARE Retiree Dental Program Web site.

TRICARE DENTAL PROGRAM

The TRICARE Dental Program (TDP) is a voluntary dental insurance program for the Selected Reserve, Individual Ready Reserve, and all eligible uniformed services family members. To be eligible, you must have at least 12 months of service commitment remaining and participate in the program for at least 12 months after which enrollment is month to month.

Selected Reserve members are responsible for just 40 percent of the monthly premium; the government pays the rest. Other Reserve component members are responsible for the full premium. When called to active duty for more than 30 days, you are eligible for dental care at military treatment facilities free of charge, and thus are disenrolled from the TRICARE Dental Program.

Eligible family members are invited to enroll, even if the sponsor does not. Family members are responsible for the full premium, except when you are called to active duty for more than 30 days, which reduces the premium share to 40 percent; the government pays the rest. Although family members enroll under the sponsor’s Social Security number, there will be two separate premium payments – one for you, the sponsor, and one for family members. NOTE: Family members are not bound by the 12-month minimum enrollment commitment if the sponsor is ordered to active duty for a contingency operation as defined in law. In this case, you have 30 days from activation to submit the enrollment application. Family members must remain enrolled during the entire active duty period in support of the contingency operation.

Additional information on the TRICARE Dental Program is available at the United Concordia Companies, Inc. Web site at www.ucci.com, or call toll free 1-800-866-8499 for general information, or 1-888-622-2256 to enroll. To contact the Managed Care Support Contractor for your region, go the regional map.

Upon mobilization, reserve members become eligible for the same health care benefits that active duty service members receive, including dental benefits. As a result, Reserve Component members enrolled in the TDP who are activated for more than 30 days automatically are removed from the program and become eligible for dental care from military dental providers. Family members of mobilized reservists become eligible for the same lower premiums that active duty family members enjoy. Please visit the United Concordia’s Web site (the administrator of the program) for more information.

Active-duty, uniformed service family members, Selected Reserve and Individual Ready Reserve members and/or their family members are eligible for the TRICARE Dental Plan if the sponsor has at least 12 months remaining on his or her service commitment with the parent service at the time of enrollment. If the Defense Enrollment Eligibility Reporting System (DEERS) indicates less than 12 months remaining, United Concordia will validate the intent of those active duty, Selected Reserve or IRR members to continue their service commitment. The contractor for the TRICARE Dental Program is United Concordia. United Concordia’s toll free number is (800) 866-8499. You can also check out their web page by visiting them at https://www.tricare.osd.mil/dental/.

The Department of Defense has developed the TRICARE Selected Reserve Dental Program to provide low cost dental coverage. The DOD covers 60% of the premium and the soldier pays 40%. This means the soldier pays $4.36 per month for his/her dental coverage. The $4.36 can be deducted per month from his IDT Drill check.

To enroll the soldier can call 1-800-669-6614 for a form or Website:
www.humana-military.com

Eligible individuals are family members of active duty, Selected Reserve and Individual Ready Reserve service members, including spouses and unmarried children (natural, step, adopted and wards) under the age of 21 (eligibility ends at the end of the month in which they turn 21). Eligibility may be available after age 21 if:

• The dependent is enrolled full time at an accredited college or university and is more than 50 percent dependent on the sponsor for financial support. Eligibility continues until the end of the month in which the dependent turns 23 or the end of the month in which education terminates, whichever occurs first.
• The dependent has a disabling illness or injury that occurred before his or her 21st birthday, or between the ages of 21 and 23 while enrolled as a full time student, and was more than 50 percent dependent on the sponsor for financial support.
• Select Reserve and IRR service members.

The TDP is administered by United Concordia Companies Inc. (UCCI). For more information about the TDP, beneficiaries may access the benefit handbook online at www.ucci.com or by calling toll free 1-800-866-8499, 24 hours a day. Members residing outside the continental United States (OCONUS) should call 1-888-418-0466 (toll free). This telephone number is available in the following countries: Australia, Bahrain, Belgium, Bolivia, Columbia, Egypt, Germany, Greece, Iceland, Italy, Japan, Netherlands, Norway, Panama, Portugal, Saudi Arabia, South Korea, Spain, Switzerland, Turkey and the United Kingdom. At all other locations, members should call 1-717-975-5017. Representatives are available to assist members in English, German and Italian 24 hours a day, Monday through Friday.

Brochure for Reserve Component Members and Their Families
A new brochure is available for download: “Healthcare Benefits for Reserve Members on Active Duty for More than 30 Days and Their Families.” Members of the reserve component who are called to active duty for more than 30 days are eligible for TRICARE, the same as any active duty service member. Families of these individuals also may become eligible for TRICARE if the sponsor is called to active duty for more than 30 days. To ensure family members are eligible for TRICARE upon activation, sponsors should register their family members in the Defense Enrollment Eligibility Reporting System (DEERS).

For More Information
TRICARE is there for your family’s needs – in a variety of situations, including when traveling away from home or away at college. For more information about eligibility and benefits, or to enroll in TRICARE Prime or TRICARE Prime Remote, contact your local TRICARE Service Center.

See Also
Transitional Health Care Benefits for Service Members and Their Families
TRICARE Eligibility For Guard and Reserve Family Members
Reserve Component Personnel Need to Know About Medical Benefits
Slide Show Briefing: Health Benefits for Reserve Component Members and Their Families. (2Mb PPS file)
Download New brochure: “Healthcare Benefits for Reserve Members on Active Duty for More than 30 Days and Their Families”
Order brochures for your unit at the TRICARE Store. Just select the brochure and complete the mailing information.

POST-DEPLOYMENT HEALTH A DOD PRIORITY

DoD officials believe caring for service members after a deployment should be a national priority. They have taken the lessons learned since the Gulf War and devised a set of guidelines for healthcare professionals to care for service members with deployment-related health concerns.

Beginning March 1, 2002, healthcare providers will ask service members who seek medical care if their visit is related to concerns stemming from a deployment. If the service member answers, “yes,” the new guidelines require the provider to take certain steps, including a specific evaluation and arrange follow-up visits. Patients receiving routine check-ups or wellness visits would not be asked the deployment question.

After the 1990-1991 Gulf War, DoD realized veterans were suffering from unexplained health problems, typified by fatigue, diffuse pain, and sleep and memory problems. DoD officials realize deployment-related health conditions may not show up during or immediately after a deployment. DoD medical professionals are trying to do a better job of acknowledging patients’ concerns than has been done in the past. That is where the Clinical Practice Guideline for Post-Deployment Health Evaluation and Management comes in. The guidelines do not contain a strict definition of “deployment” since there are countless situations in which military service members might experience hazardous exposures — be they psychological, industrial or environmental. This is an evaluation for people who have been to what essentially amounts to a hazardous workplace — a deployment of some sort — in service to their country.

For more information on post-deployment healthcare, visit https://www.pdhealth.mil/.

STATE HEALTH DEPARTMENTS

State Health Departments can be accessed at:

STATE INSURANCE COMMISSIONS/DEPARTMENTS

State Insurance Commissions/Departments can be accessed at:

MEDICARE

Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney fa ilure treated with dialysis or a transplant). You can access the official Medicare website at https://www.medicare.gov/ where you can obtain information for health plans, nursing homes, dialysis facilities, Medigap policies, contacts, Medicare events, participating physicians, suppliers, and prescription assistance programs in your area.

SPECIAL VA HEALTH CARE ELIGIBILITY FOR COMBAT VETERANS

Effective immediately, the Department of Veterans Affairs (VA) has implemented policies and procedures for providing free health care services and nursing home care to combat veterans for a period of two years beginning on the date of separation from active military service.

What’s covered?
This benefit covers all illnesses and injuries except those clearly unrelated to military service; for example, a common cold, injuries from accidents that occurred after discharge, and disorders that existed before joining the military. Care may not be provided for any disability found to have resulted from a cause other than the military service in combat operations. Combat veterans seeking treatment for health conditions claimed to be related to combat operations are evaluated clinically by means of a physical examination and appropriate diagnostic studies. In making this determination, the physician must consider that the following types of conditions are not ordinarily considered to be due to occupational or military service: (1) Congenital or developmental conditions, for example, scoliosis, (2) Conditions which are known to have existed before military service, and (3) Conditions have a specific and well-established cause and that began after military combat service. Coverage extends for a two-year period following separation from active military service. Dental services are not included.

Who’s eligible?
Veterans are eligible if they served on active duty in a theater of combat operations during a period of war after the Gulf War or in combat against a hostile force during a period of “hostilities” after November 11, 1998 and have been discharged under other than dishonorable conditions. National Guard and Reserve members are also eligible for VA health care if they were ordered to active duty by a federal declaration, served the full period for which they were called or ordered to active duty, and have separated from active military service under other than dishonorable conditions. Active duty, National Guard and Reserve members who were activated to a combat mission and then separated from active duty receive a DD Form 214, which should show an award of the Armed Forces Expeditionary Medal. Individuals seeking services under this authority should bring their DD Form 214 when reporting to a VA health care facility.

What’s meant by “hostilities?”
“Hostilities” is defined as conflict in which Armed Forces members are subjected to the danger comparable to that faced in a period of war.

What’s changed?
Unlike other veterans who do not have VA-adjudicated service-connected conditions, veterans who qualify under this special eligibility authority are not subject to VA means testing or co-payment requirements. There is no burden placed on these veterans to prove that their health problems are related to their military service or prove that they have low income to qualify for cost-free VA health care.

What happens after the two years?
The co-payment status will depend on whether the veteran’s illness or injury is found to be service-connected or whether the veteran is otherwise qualified for VA health care. Each veteran will be enrolled for VA health care in the appropriate priority group. Some veterans – those in the lowest priority group – whose income is above the means test threshold must agree to make required co-payments. If the veteran does not agree to make co-payments, the veteran will be ineligible for VA care.

Where can a veteran get additional information?
Additional information is available at the nearest VA medical facility. The telephone number can be found in the local telephone directory under the “U.S. Government” listings. Veterans can also call toll-free: 1-800-827-1000 or 1-877-222-8387.