TRICARE Prime Service Area Reductions

January, 2013

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• The primary purpose of a PSA is to augment the delivery of health care around military treatment facilities (MTFs) and Base Realignment and Closure (BRAC) sites

• The latest generation of TRICARE Managed Care Support Contracts (T-3) request for proposals released in 2007 did not require TRICARE regional contractors to develop PSAs in areas remote from MTFs

• The PSAs affected under T-3 are not close to existing military treatment facilities, and have never augmented care around MTF or BRAC locations.

• PSA reduction assists DoD in controlling health care costs – will save an estimated $45-$56M a year

What is PSA Reduction?

www.tricare.mil/PSA

PSA Reductions

• Of approximately 1.6 million retirees and family members currently in Prime, 171,000 potentially affected across all three U.S. regions

• No impact on Active duty service members and their families: Prime benefits maintained

• Affected Retirees and their family members living <100 miles from remaining PSA may be able to transfer their Prime enrollment

• No impact on Medicare eligible beneficiaries

– TRICARE For Life and Pharmacy unaffected

No Impact on Active Duty

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• Impacted beneficiaries automatically have TRICARE Standard/Extra

• TRICARE Standard is similar to “open choice” health plans – You can choose any TRICARE authorized physician

– No enrollment fees

– No monthly fees

– No referrals

– Fewer authorizations

• Preventive care covered at no out-of-pocket cost includes:– Cancer screenings

– Well child care

– Immunizations

TRICARE Standard

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Differences Between Prime and Standard

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Cost Comparison: Standard/Extra vs Prime

Enrollment FeesDeductible In-Network

Copay/cost-share

Point of Service

Fees

Annual Catastrophic

Cap

Prime

$269.28/year individual

$538.56/year family

E.R. visit - $30

Outpatient visit - $12

Annual deductible plus 50% cost share

$3,000/ year

Standard/Extra

None

E1-E4: $50 individual,

$150 familyE5 and above:

$150 individual,

$300 family

20% in-network

25% out-of-network

None $3,000/year

Communication

• TRICARE is committed to keeping beneficiaries informed about changes in PSAs

• Multiple communication via US Mail; media, customer service support, web, Mil/Vet Assoc.

• Information will be updated at www.tricare.mil/PSA where you may also sign up for e-mail updates

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Thank You for Your Patience

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Implementation Plan Highlights

Action/Tactic Target Date

PSA Contract modifications to West/North/South 12/2012

Information Paper for Senior DoD Leadership/ Hill/ Surgeons; PSA Fact Sheet January 8, 2013

Tricare.mil/PSA launch January 10, 2013

Customer Service FAQs/Military Associations Briefed January 10, 2013

Notify Interested Media January 10, 2013

TRICARE Region Communication to Commands January 10, 2013

Military Association Execs Full Briefing January 10, 2013

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Implementation Plan Highlights

Action Target Date

HASC/SASC Full briefing January 16, 2013

Early notification letters for affected beneficiaries

* February 7, 2013 * Dependent on Contractor Printing/Mailing

ZIp Code Locator Tool on TRICARE WebFebruary 7, 2013

MHS Conference 02/11-14/2013

Customer Service Support in place for affected beneficiaries 04/01/2013

Health Matters Newsletter (Prime) to 1.5 M 05/2013

Media Roundtable with details; news articles; outreach to affected communities

05/2013

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Implementation Plan Highlights

Action Target Date

Second Notification Letter 06/2013

Beneficiary Prime Health Matters Newsletter Article 08/2013

Disenrollment letters for affected beneficiaries 08/2013

Response to question/reinforce information stream08/2013-10/2013