TRICARE Your Military Health Plan 1 BR426401BET0806W Active Component Medical Benefits June 2007 TRICARE Your Military Health Plan 1 PP411BEC11063W REINTIGRATION

TRICAREYour Military Health Plan

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REINTIGRATIONMedical Benefits

Active Component Medical BenefitsJan 2013

Google Search - Fort Hood Darnallwww.crdamc.amedd.army.mil

TRICARE > TRICARE Briefings > RIT

2Active Component Medical Benefits

Jan 2013

Briefing Topics• TRICARE Regions

• DEERS

• Traveling: Emergent & Routine care

• Behavioral Health Care Services

• POS option

• Pharmacy


Jan 2013

TRICARE Regions

TRICARE Overseas1-888-777-8343

www.tricare.mil/overseas

North RegionHealthNet Federal Services, Inc.

1-877-TRICAREwww.healthnetfederalservices.com

South RegionHumana Military1-800-444-5445

www.humana-military.com

West RegionUnitedHealthcare1-877-988-WEST

www.uhcmilitarywest.com


Jan 2013

DEERS• Defense Enrollment Eligibility Reporting

System

• Active and retired service members (sponsors) are automatically registered in DEERS

• Sponsors must register family members in the DEERS database

• Uniformed Services Identification Cards


Jan 2013

CHANGE IN STATUS• Reenlistment, separation from active duty, or

retirement

• Change of address (yours and/or your family members

• Marriage or divorce

• Birth or adoption of a child

• Full-time student age 21 and older

• Death of spouse or child

• REMEMBER THAT ENROLLING OR UPDATING YOUR DEERS INFORMATION DOES NOT AUTOMATICALLY ENROLL YOUR FAMILY IN TRICARE.


Jan 2013

While Traveling – Active DutyBlock, PCS, or Terminal Leave• Preauthorization Approval for Medical Care

– 1-888-833-2607 (254-553-1846) (CRDAMC Referral Management) – Emergency care:

• ID card validates your eligibility for emergency care• If admitted to civilian facility or you require emergent care (life, limb or

loss of eyesight), call CRDAMC phone number above– Urgent Care: Call CRDAMC phone number above for

preauthorization

• Routine Care: Not covered– Make sure all current medical conditions are addressed

before you leave Fort Hood !!!– The government WILL NOT PAY for any routine care you receive

while traveling on leave unless authorized by CRDAMC.

• You are still enrolled to Fort Hood until you:– (PCS) change your enrollment at your new duty station– (ETS) midnight of your last day of terminal leave– (Block Leave) no change


Jan 2013

While Traveling – Family Members still enrolled in Prime• Preauthorization Approval for Medical Care

– Phone numbers• CRDAMC enrollees (800-305-6421, Option 4)• Network PCM: pre-auth (800-444-5445 Humana Military)

– Emergency Care – go to closest Emergency Room• Conditions involving Life, Limb, or Loss of Eyesight

– Urgent Care: Call CRDAMC phone number above for preauthorization

• Routine Care: Not covered– Make sure all current medical conditions are

addressed before you leave Fort Hood !!!– You will incur additional charges for any routine care you

receive while traveling on leave unless authorized by CRDAMC.

• Point of Service (POS) charges will apply


Jan 2013

Behavioral Health Care Services

• Psychiatrists (M.D., D.O.)• Clinical Psychologists (Ph.D.)• Certified psychiatric nurse specialists (PNS)• Master’s-level clinical social workers (LCSW)

• Certified marriage and family therapists (MFT)

• Licensed Professional Counselors (LPCs), Pastoral Counselors & Mental Health Counselors*

– *with physician referral and supervision


Jan 2013

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• Warriors on Block/PCS/Terminal Leave– Requires PCM referral– Must seek care at a military treatment facility

(MTF)• Contact CRDAMC (800-305-6421, Option 4) if you

are not near an MTF• May receive preauthorization for civilian care

– May be referred to a civilian network provider if MTF availability is limited

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Jan 2013


• Family member Prime benefits– Authorized up to eight (8) outpatient visits

each fiscal year (1 Oct – 30 Sep)• No primary care manager (PCM) referral is

needed

• No prior authorization required

– Must seek care from a TRICARE network provider

– Prior authorization is required after the eighth (8th) visit


Jan 2013

Behavioral Health Care Services• Family Members – Accessing Care and Obtaining

Prior Authorization– TRICARE Regional Contractor

• www.humana-military.com or 1-800-444-5445– TRICARE Regional Offices

• www.tricare.mil

• To find out more information about your benefits• Find a behavioral health care provider in your area• Your behavioral health care provider is responsible

for obtaining prior authorization for additional visits


Jan 2013

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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% cost-share continues to be applied even after the catastrophic cap has been met

POS Cost-shares and Deductibles

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Jan 2013

TRICARE Pharmacy Coverage

*Not available in the MTF unless medical necessity is established.

†Deductibles apply.

Typeof Pharmacy Generic

Brand Name

Non-Formulary

MTF(up to a 90-day supply)

$0 $0 $0*

TMOP(up to a 90-day supply)

$0 $13 $44

Network Retail(up to a 30-day supply)

$5 $17 $44

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

†Non-TRICARE Prime: $9 or 20%

†TRICARE Prime: 50% cost-share

†Non-TRICARE Prime: $9 or 20%

†TRICARE Prime:50% cost-share

†Non-TRICAREPrime: $22 or 20%

†TRICARE Prime:50% cost-share


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TRICARE > TRICARE Briefings > RIT

Documents

TRICARE Your Military Health Plan 1 BR426401BET0806W Active Component Medical Benefits June 2007 TRICARE Your Military Health Plan 1 PP411BEC11063W REINTIGRATION