TRICARE BenefitsTRICARE Reserve SelectTRICARE Retired Reserve

TRICARE Retiree Entitlement

Denise BinkleyBeneficiary Service and Education Representative

719-266-7652

Updated January 2011

TRICARE®

Your Military Health Plan

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TRICARE Stateside Regions (50 United States & Washington, DC)What Is TRICARE?

TriWest Healthcare Alliance Corp.

Humana Military Healthcare Services, Inc.

Health Net FederalServices, LLC

TRICARE is available worldwide and managed regionally

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Updating DEERS

• 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

– Visit an ID card-issuing facility: www.dmdc.osd.mil/rsl/owa/home

• More information: www.tricare.mil/DEERS

• Remember to register/update DEERS whenever there is a change in the family (marriage, birth, adoption, divorce, death, etc.) or when you move

TRICARE Eligibility

TRICARE Reserve Select

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TRICARE Reserve Select (TRS): Step 1 – Qualify• Selected Reserve Member may qualify if:

– Not eligible for, or enrolled in, Federal Employees Health Benefits (FEHB) program

– For more information, visit www.tricare.mil/trs • Log onto the “Reserve Component Purchased TRICARE Application”

1. Follow the instructions to qualify

2. If qualified, print-out and sign the completed DD Form 2896-1,Reserve Component Health Coverage Request form

Medical Coverage

If you have any questions regarding your TRICARE Reserve Select eligibility, please contact your Reserve Representative at http://ra.defense.gov

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TRICARE Reserve Select: Step 2 – Purchase

• Mail

1. Signed and completed request form (DD Form 2896-1)

2. To TRICARE contractor address on form

3. Make initial premium payment as indicated on form

Medical Coverage

Note: For continuous TRICARE coverage, purchase TRS up to 60 days before TAMP ends, but no later than 30 days after end

Photo courtesy of the National Guard

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Continuous Open Enrollment

• If you qualify, you may purchase TRS coverage to begin in any month throughout the year.

• Coverage begins on the first day of the first or second month after the postmark date of your TRS Request Form. The member can choose which month he or she wishes to begin coverage.

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TRICARE Reserve Select: Getting Care

• No referrals necessary– Certain services require prior authorization– In the event of an emergency, call 911 or go to the nearest

hospital

• Locate a MTF for space-available care– MTF locator: www.tricare.mil/mtf

• For TRICARE Extra, locate a TRICARE network provider– Contact the TRICARE regional contractor, check their website,

visit a TRICARE Service Center (TSC)

Medical Coverage

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TRICARE Reserve Select: Getting Care

• For TRICARE Standard, locate a non-network TRICARE-authorized provider– Check your phone book or www.tricare.mil/findaprovider – Ask provider’s office, “Do you accept TRICARE?”

• If not, invite the provider to become TRICARE authorized• Give your provider the phone number of your regional

contractor or send them to www.tricare.mil/providers/BecomeANonNetworkProvider.aspx

Medical Coverage

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TRICARE Reserve Select Costs

Monthly Premiums TRS Member-only: $53.16

TRS Member and family:

$197.76

Annual Deductibles

(per fiscal year)

Rank E-4 & below:$50/individual or $100/family

Rank E-5 & above:$150/individual or $300/family

Cost-Shares

(after annual deductible is met)

Network Provider: 15%

Non-network Provider: 20%

Catastrophic Cap

(per fiscal year)

$1000 per enrollment

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Medical Coverage

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New Child Enrollment

To have your newborn or newly adopted child covered under TRICARE Reserve Select (TRS):

•First: Register in DEERS– The sponsor (or parent/guardian with power of attorney) must

register the child in DEERS.

•Second: Submit the TRS Request Form– Go to https://www.dmdc.osd.mil/appj/trs/index.jsp– Select Qualifying Life Event (QLE)– Submit the application to TriWest within 60 days of birth or

adoption to have coverage start at birth or adoption.

NOTE: If not enrolled in TRS within 60 days, the child’s coverage will begin upon enrollment, not at birth or adoption.

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Changes to TRS Coverage

• Change in family composition – Marriage, divorce, newborn, etc.

• Take one of the following actions– Purchase new coverage

– Change type of coverage

(e.g., member-only to member-and-family)

– Terminate coverage

• If change impacts type of coverage (e.g., member-only to member-and-family), premium increase (or decrease) is effective based on date of change

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Disenrollment from TRS

You must submit a TRS Request Form to disenroll from TRS.

Do—Log on to the “Reserve Component Purchased TRICARE Application” to complete the TRS Request Form.

Do—Mail your completed TRS Request Form to your TRICARE regional contractor.

Don’t—Stop paying premiums.

Note: If you are activated for more than 30 days you will automatically be disenrolled from TRICARE Reserve Select – Do Not fill out a disenrollment form.

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Termination of TRS Coverage

• Failure to pay premiums

• Loss of Selected Reserve status

• Gain eligibility for other TRICARE program

• May purchase TRS again if you qualify at time of purchase

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TRICARE Assistance Program

Life is stressful. Help is available.

• Confidential• Non-reportable• 24/7/365

Call, click or chat today.

1-888-TRIWEST

www.triwest.com/OnlineCare

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TRICARE Dental Program (TDP)Other Important Information

• Voluntary, premium-based program

• Premiums depend on sponsor’s status

Service SponsorOne Family

MemberMore Than One Family Member

Sponsor and Family

Active Duty N/A $12.69 $31.72 N/A

National Guard and Reserve

$12.69 $31.72 $79.29 $91.98

Individual Ready Reserve

$31.72 $31.72 $79.29 $111.01

TDP website: www.TRICAREdentalprogram.com

TRICARE Retired Reserves

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TRICARE Retired Reserve (TRR)

• TRICARE Retired Reserve (TRR) is a premium-based healthcare plan available to eligible retired members of the National Guard and Reserves, their families and qualified survivors. Members pay a monthly premium and are responsible for annual deductibles and cost-shares.

• Members of the Retired Reserve of a Reserve Component are eligible for TRR when they are:– Qualified for non-regular retirement under 10 U.S.C., Chapter

1223.

– Not yet age 60.

– Not eligible for, or enrolled in, the Federal Employees Health Benefits (FEHB) program.

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TRR Monthly Premium

• Effective for coverage beginning January 1, 2011, TRR monthly premiums are:– $408.01 for Member-only coverage

– $1,020.60 for Member and family coverage

• The monthly premium amount could change every year on January 1.

• Send in payment for the first two month’s premium with the enrollment form. You can pay the initial premium payment by credit/debit card and sign up for automatic monthly credit/debit card payments on the application.

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TRR Coverage Termination

• Termination Due to Nonpayment– Your premium payment is due no later than the last day of the

month for the next month’s coverage. Failure to pay overdue premium amounts will result in a termination of coverage due to nonpayment. A 12-month TRR purchase lockout will go into effect.

• Your TRR coverage will automatically terminate for the sponsor and family members when:– You (the sponsor) reach age 60 (or for surviving family

members, when the sponsor would have reached age 60).

– You (the sponsor) are recalled to active duty service for more than 30 days. If eligible, you may qualify for and purchase TRR after the loss of any other TRICARE coverage.

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TRICARE Standard and Extra Costs:Retirees, Their Families and All Others

TRICARE Option TRICARE Standard TRICARE Extra

Outpatient DeductibleAmount due each fiscal year before cost-sharing begins.

$150/individual or $300/family

Outpatient Cost-share

25%* 20%

Inpatient CostsCheck with your regional contractor about inpatient behavioral health costs.

Lesser of $535/day or 25% of charges plus 25% of professional fees

Lesser of $250/day or 25% of charges plus 20% of professional fees

Catastrophic Cap $3,000 per family per fiscal year

Get extra cost-savings with TRICARE Extra!

The federal fiscal year is Oct. 1- Sept. 30.* Non-network providers may charge up to 15% above the TRICARE allowable charge.

TRICARE Retired (Entitlement Coverage)

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Decision Process

Where will you live?

Will you accept employment?

How is your health (and family)?

What health plans are available?

Cost of competing health plans?

Insurability?

Do I need supplemental insurance?

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• Fee-for-service option

• No enrollment required

• Seek care from any TRICARE-authorized provider

• Responsible for annual deductibles and cost- shares—highest out-of-pocket expense

• May have to pay provider then file claim for reimbursement

TRICARE Standard

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TRICARE Standard—Costs

• Annual deductible

– $150 individual/$300 for family

• Cost-shares after deductible has been met

– 25% of allowed charges

• May be responsible for up to 15% above the TRICARE allowable charge for services if providers do not participate in TRICARE

• May have to pay provider then file claim for reimbursement

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• Preferred provider option (PPO)

• No enrollment required

• Seek care from any TRICARE network provider

• Responsible for annual deductibles and discounted cost-shares

• Providers will file claims for you

• May seek care in an MTF on a space-available basis

TRICARE Extra

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TRICARE Extra—Costs

• Annual deductible – $150 individual/$300 for family

• Cost-shares after deductible has been met– 20% of negotiated rate

• Providers cannot charge more than the negotiated rate for services rendered

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Standard

• Any TRICARE-authorized provider

• Cost-share: 25% of allowable charge

• May have to file claims

• Nonparticipating providers may charge up to 15% above allowable charge for services

Extra

• Any TRICAREnetwork provider

• Cost-share: 20% of negotiated rate

• Providers will file claims for you

• Not responsible for additional charges for covered benefits

TRICARE Extra vs. Standard

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TRICARE Prime

• Enrollment required– Portable: Easy to transfer when you move

– Split enrollment: Families can enroll together in different regions

• Access standards for care

• Most care received from primary care manager

• Minimal out-of-pocket costs

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TRICARE Prime

• Enrollment fees

– Individual: $230 per year

– Families: $460 per year

• Network provider fees

– Outpatient visit: $12 copayment

– Inpatient visit: $11 per day ($25 minimum)

– Emergency services: $30 copayment

– Behavioral health outpatient visit: • $25/individual• $17/group

– Behavioral health inpatient visit: $40 per day

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Catastrophic Cap• Each fiscal year—$3,000 for all

retirees and family members– TRICARE Prime– TRICARE Extra– TRICARE Standard

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• Freedom to use any TRICARE-authorized provider

• In or out of network—no referrals needed

• Nonavailability statement is not necessary

• Subject to higher deductibles and cost-shares

• Point-of-service option is more costly tothe enrollee

TRICARE Prime Point-of-Service (POS) Option

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• Annual outpatient deductibles are $300 for an individual and $600 for a family

• 50% cost-shares for outpatient and inpatient claims

• Excess charges up to 15% above the TRICARE allowable charge

• The 50 percent cost-share continues to be applied even after the catastrophic cap has been met

POS Cost-shares and Deductibles

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TRICARE Retiree Dental Program

• Voluntary dental insurance program administered by the Federal Services division of Delta Dental Plan

• Available to:

– Retired service members and their eligible family members

– Certain surviving family members of deceased active duty sponsors

– Medal of Honor recipients and their immediate family members and survivors

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TRDP—Enrollment

• Delta Dental handles all enrollments

• There is an initial 12-month commitment for new enrollees after which enrollment may be continued on a month-to-month basis

• 30-day grace period from the coverage effective date during which voluntary termination of enrollment is allowed without further enrollment obligation provided that no benefits have been used

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TRDP—Costs

• Annual deductible – $50 per person– $150 deductible cap per family

• Annual maximum coverage

– $1,200 per person

• Deductible and maximum do not apply to:

– Diagnostic and preventive services – Dental accident procedures or orthodontia

• For more information:

– 1-888-838-8737 – www.trdp.org or www.ddpdelta.org

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• TRICARE serves as the secondary payer.

• If you have other health insurance (OHI):

– Fill out a TRICARE Other Health Insurance Questionnaire (www.tricare.mil/mybenefit/Forms.do)

– Follow the referral and authorization rules for your OHI

– Tell your provider about your OHI and TRICARE

– Show him or her your insurance card

• TRICARE is the sole payer for the Guard/Reserve sponsor when activated (or during early eligibility)

– No payment is sought from OHI for the sponsor’s care

TRICARE and Other Health Insurance Other Important Information

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TRICARE Pharmacy ProgramOther Important Information

Pharmacy OptionFormulary

Non-FormularyGeneric Brand Name

MTF Pharmacy(up to a 90-day supply)

$0 $0 N/A

TRICARE Pharmacy Home Delivery (up to a 90-day supply)

$3 $9 $22

Retail Network Pharmacy(up to a 30-day supply)

$3 $9 $22

Non-Network Retail Pharmacy(up to a 30-day supply)

TRICARE Prime: 50% cost-share after point-of-service deductible is met

Other Programs: $9 or 20% of total cost (whichever is greater) after the annual deductible is met

TRICARE Prime: 50% cost-share after point-of-service deductible is met

Other Programs: $22 or 20% of total cost (whichever is greater) after the annual deductible is met

Express Scripts, Inc. website: www.express-scripts.com/TRICARE

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• Convenient home delivery (FPO or APO for overseas locations)– Low Cost

• Generic medication—$3 for up to a 90-day supply• Brand name medication—$9 for up to a 90-day supply• Non-formulary medication—$22 for up to a 90-day

supply• Note: Up to a 30-day supply for controlled substances

– Free Shipping and Handling– For more information:

• Visit www.express-scripts.com/TRICARE• 1-866-DoD-TMOP (1-866-363-8667)

TRICARE Mail Order Pharmacy (TMOP)

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Guard & Reserve Resource Center

www.triwest.com/ngr

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TRICARE North RegionHealth Net Federal Services1-877-TRICARE (1-877-874-2273)www.hnfs.com

TRICARE South RegionHumana Military Healthcare Services 1-800-444-5445www.humana-military.com

TRICARE West RegionTriWest Healthcare Alliance1-888-TRIWEST (1-888-874-9378)www.triwest.com

Stateside Regional Contractors

For Information and Assistance

General Contact InformationTRICARE Website: www.tricare.mil Contacts: www.tricare.mil/contactsMMSO: www.tricare.mil/tma/mmso

Connect with TRICARE Online!

www.tricare.mil/mediacenter

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Overseas Regional ContractorInternational SOS Assistance, Inc. Eurasia-Africa: +44-20-8762-8384Latin America & Canada:+1-215-942-8393Pacific: Singapore: +65-6339-2676Sydney: +61-2-9273-2710www.tricare-overseas.com

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Conclusion

Comments/Questions?