TRICARE is… - Health Net Federal Services

Report
TRICARE
®
Your Military Health Plan
TRICARE Overview for Retired Reserve
Members and Their Eligible Family
Members
Presenter Name
Month DD, YYYY
Updated October 2011
1
Today’s Agenda
• TRICARE Overview
• Medical Coverage
• Other Important Information
• For Information and Assistance
Photo courtesy of the National Guard
22
What Is TRICARE?
TRICARE is…
… the health care program serving active duty service
members, National Guard and Reserve members, retirees,
family members, survivors, and certain former spouses
worldwide.
… a network of military and civilian health care
professionals working together to foster, protect, sustain,
and restore health for those entrusted to their care.
33
What Is TRICARE?
TRICARE Stateside Regions (United States and Washington, DC)
Health Net
Federal
Services, LLC
TriWest
Healthcare
Alliance
Humana
Military
Healthcare
Services, Inc.
44
What Is TRICARE?
TRICARE Overseas Program (TOP)
The TRICARE Overseas Program is managed through three
geographic areas
Latin America and Canada
Eurasia-Africa
Pacific
Central and South America,
the Caribbean Basin, Canada,
Puerto Rico, and the U.S. Virgin Islands
Europe, Africa, and
the Middle East
Asia, Guam, Australia,
New Zealand, and Western
Pacific remote countries
International SOS Assistance, Inc. administers
the TRICARE Overseas Program
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TRICARE Eligibility
Register Your Family in DEERS
Registration in DEERS is key to TRICARE eligibility
Register your family members in the Defense Enrollment Eligibility
Reporting System (DEERS)
– In person at a uniformed services identification (ID)
card-issuing facility: www.tricare.mil/deers
– By sending changes and required documentation to:
Defense Manpower Data Center Support Office
400 Gigling Road
Seaside, CA 93955-6771
66
TRICARE Eligibility
Register Your Family in DEERS
• To register your family in DEERS, proper documentation is
required and can include:
– Marriage certificate
– Divorce decree
– Adoption papers
– Birth certificate
• You can verify eligibility in one of three ways:
– Go to www.dmdc.osd.mil/appj/address/
– Visit your local military treatment facility’s (MTF’s) Patient
Administration Office
– Contact your service’s personnel office
77
TRICARE Eligibility
Updating DEERS
• Remember to register/update in DEERS whenever there is a
change in the family (marriage, birth, adoption, divorce, death, etc.)
or when you move
• Keep your contact information up to date:
– Online: www.dmdc.osd.mil/appj/address/
– By phone: 1-800-538-9552
– By fax: 1-831-655-8317
– By visiting an ID card-issuing facility: www.dmdc.osd.mil/rsl
– More information: www.tricare.mil/deers
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Medical Coverage
TRICARE Retired Reserve (TRR): Qualifying Members
• A member may qualify to purchase TRR coverage if he or she is:
– A member of the Retired
Reserve who is qualified for
non-regular retirement
– Under age 60
– Not eligible for or enrolled in
the Federal Employees Health
Benefits (FEHB) program
Photo courtesy of the National Guard
99
Medical Coverage
TRR: Qualifying Survivors
Survivors may qualify to purchase TRR coverage if all of the
following apply:
• The deceased sponsor was covered by TRR on the date of
his or her death
• Survivors are immediate family members of the deceased
sponsor (spouses cannot have remarried)
• TRR coverage would begin before the date the deceased
sponsor would have reached age 60
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10
Medical Coverage
TRR: Changes in Family Composition
• Adding a family member: Newborns and newly adopted children
must be registered in DEERS and TRR within 60 days for TRICARE
to provide coverage retroactive to the date of birth or the date of
adoption.
• Removing a member: Log on to the DMDC Reserve Component
Purchase TRICARE Application at
https://dmdc.osd.mil/appj/reservetricare and follow instructions
to disenroll.
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11
Medical Coverage
TRR: Purchasing
• Log on to the Defense Manpower Data Center (DMDC)
Reserve Component Purchase TRICARE Application at
https://www.dmdc.osd.mil/appj/reservetricare
• To access the Web site, you will need to use a Department of
Defense (DoD) Self Service Logon (DS Logon) premium account
or Common Access Card (CAC)
• Complete, print, and sign the Reserve Component Health
Coverage Request form (DD Form 2896-1)
• Mail the completed form with the first two months’ premium
payment to your regional or overseas contractor
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Medical Coverage
TRR: Getting Care
• See any TRICARE-authorized provider for care
– Network provider = lower costs
– Non-network provider = higher costs
• Find a network provider: www.tricare.mil/findaprovider
• No referrals are necessary for care, but certain services require
prior authorization
• In the event of an emergency, call 911 or go to the nearest
emergency room
• Care is available at military treatment facilities (MTFs) on a
space-available basis only
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Other Important Information
Priority for Access to Military Treatment Facility Care
1
Active duty service members, including National Guard and
Reserve members on active duty status
2
Active duty family members enrolled in a TRICARE Prime
option
3
Retired service members, their dependents, and all others
enrolled in a TRICARE Prime option
4
Active duty family members not enrolled in a TRICARE Prime
option, and TRICARE Reserve Select beneficiaries
5
Retired service members and their dependents not enrolled in a
TRICARE Prime option, TRICARE Retired Reserve
beneficiaries, and all other eligible beneficiaries not enrolled in
a TRICARE Prime option
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Other Important Information
TRICARE Pharmacy Program
Express Scripts, Inc. Web site: www.express-scripts.com/TRICARE
Phone number: 1-877-363-1303
15
15
Medical Coverage
TRR: Costs
Monthly Premiums
Annual Deductibles
(per fiscal year, Oct. 1-Sept. 30)
Cost-Shares (after annual
deductible is met)
Catastrophic Cap
(per fiscal year)
TRR Member-Only:
TRR Member-and-Family:
$408.01
$1,020.05
$150
$300
Network Provider: 20%
Non-Network Provider: 25%
$3,000 per fiscal year
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Other Important Information
TRICARE Retiree Dental Program (TRDP)
• Voluntary, premium-based program
• Premiums depend on sponsor’s location and number of family
members enrolled
• Enroll in three ways:
– Online at TRDP Web site: www.TRDP.org
– By toll-free telephone: 1-888-838-8738
– By mail:
Delta Dental of California
Federal Government Programs
PO Box 537008
Sacramento, CA 95853-7008
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Other Important Information
TRICARE and Other Health Insurance
• TRICARE serves as the secondary payer, if you have other health
insurance (OHI).
• If you have OHI:
– Fill out a TRICARE Other Health Insurance Questionnaire
(www.tricare.mil/mybenefit/Forms.do)
– If you have OHI, you must follow your OHI’s rules
– Tell your provider about your OHI and TRICARE coverage
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TRICARE Health Benefit
Social Security Number Removal from ID Cards
In an effort to protect the privacy of TRICARE beneficiaries, the
Department of Defense (DoD) is removing Social Security numbers
(SSNs) from military ID cards, including the Common Access Card.
• Your new ID card will have one or both of the following:
– A 10-digit DoD ID Number
– A DoD Benefits Number (DBN), if you are eligible for
DoD benefits
• You will not need a new ID card until your old card expires.
• For more information, visit www.tricare.mil/ssn
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For Information and Assistance
Stateside Regional Contractors
Overseas Regional Contractor
TRICARE North Region
Health Net Federal Services, LLC
1-877-TRICARE (1-877-874-2273)
www.hnfs.com
International SOS Assistance, Inc.
Eurasia-Africa:
+44-20-8762-8384 (overseas)
1-877-678-1207 (stateside)
Latin America and Canada:
+1-215-942-8393 (overseas)
1-877-451-8659 (stateside)
Pacific:
Singapore: +65-6339-2676 (overseas)
1-877-678-1208 (stateside)
Sydney: +61-2-9273-2710 (overseas)
1-877-678-1209 (stateside)
TRICARE West Region
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
General Contact Information
TRICARE Web site: www.tricare.mil
Contacts: www.tricare.mil/contacts
Military Medical Support Office:
www.tricare.mil/tma/mmso
Web site: www.tricare-overseas.com
Connect with TRICARE Online!
PP4372BET09112W
TRICARE South Region
Humana Military Healthcare Services, Inc.
1-800-444-5445
www.humana-military.com
www.tricare.mil/mediacenter
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