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TRICARE BRIEFING

TRICARE BRIEFING. MSgt Donna Williams Flight Chief, TOPA 7 Nov 06. What We Will Cover. Important Terms TRIWEST vs. TOPA DEERS FIRST Healthcare Options Provided/Explained Dental/Pharmacy Important Changes/Information Questions. Terms You Should Know. TRICARE: Health care plan

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TRICARE BRIEFING

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  1. TRICARE BRIEFING MSgt Donna Williams Flight Chief, TOPA 7 Nov 06

  2. What We Will Cover • Important Terms • TRIWEST vs. TOPA • DEERS FIRST • Healthcare Options Provided/Explained • Dental/Pharmacy • Important Changes/Information • Questions

  3. Terms You Should Know • TRICARE: Health care plan • TRIWEST: Health care contractor • WPS: Wisconsin Physician Services The Subcontractor for TRIWEST who pays claims for western region • DEERS: Defense Enrollment Eligibility Reporting System • PCM: Primary Care Manager • CHCS/AHLTA: Composite Health Care System The DoD’s master medical computer program • HIPAA: Health Ins Portability/Accountability Act • NOPP: Notice of Privacy Practices

  4. TRIWEST vs. TOPA • TRIWEST: Claims Assistance, Billing Issues, Referrals, and Enrollment Issues • What is available in your area? • Peterson AFB: TRICARE Service Center with walk-in service only • Buckley AFB: TRICARE Service Center • USAF Academy: TRICARE Service Center with walk-in service only • TOPA (TRICARE Operations and Patient Administration): Medical TDY Orders

  5. DEERS FIRST! • DoD-wide personnel tracking system • You must be enrolled in DEERS for care • DEERS information must be correct • Medical computer systems (CHCS/AHLTA) pull info from DEERS • How Can I Update This Information? • Email: addrinfo@osd.pentagon.mil • Telephone: (800) 538-9552 • Mail: DSO, ATTN: COA • 400 Gigling Road • Seaside, CA 93955-6771 • Fax: (831) 655-8317 • In person – Locate the nearest MPF • (www.dmdc.osd.mil/rsl/) • Online – www.tricare.osd.mil/DEERS/default.cfm

  6. Healthcare Options Provided and Explained Three Options • TRICARE Prime (and TRICARE Prime Remote) • TRICARE Extra • TRICARE Standard or CHAMPUS

  7. TRICARE PRIME • Advantages • Lowest cost (and no cost to AD member) • Priority access to the MTF • Portability: Travels with you • No claims to file • Requires Enrollment • Cost • $230 (single) $460 (family) - RETIREES • Co-pays and catastrophic cap ($1K/$3K) • Payments made annually, quarterly, or monthly

  8. TRICARE PRIME REMOTE • Gives AD and family members in remote areas access to care (available only in certain locations) • No out of pocket expenses • Exception: prescriptions $3 or $9 • AD can file claim for reimbursement thru Express Scripts • Requires enrollment • TPR website – www.tricare.osd.mil/tpr • Based on residence and work address • Eligibility Requirements: • AD must be on full time orders w/permanent duty assignment who lives and works more than 50 mi./1 hr. drive time from MTF • Family member must live with sponsor • May request a waiver from unit CC to TRICARE Regional Ofc

  9. TRICARE EXTRA • TRICARE providers who agree to accept 5% less than non-network providers average rate • Advantages • No claims to file • No enrollment fees • Discounted cost shares • Access to the MTF (Space Available) • Costs • Deductibles (E1-E4 - $50/$100) (E5 and up $150/$300) • Catastrophic cap (AD - $1K/Ret - $3K) • 15% Cost share and co-pay for AD families and 20% for retired members and their families

  10. TRICARE STANDARD • Fee for Service: See the TRICARE provider of your choice • Advantages • No enrollment fees • Can seek care at the MTF (Space Available) • Freedom to seek care from ANY TRICARE-authorized provider • Disadvantage: Most costly of the three TRICARE options • Costs • Deductibles (E1-E4 - $50/$100) (E5 and up $150/$300) • Catastrophic cap (AD - $1K/Ret - $3K) • 20% Cost share and co-pay for AD families and 25% for retired members and their families

  11. Dental Benefit Active Duty: Contact the Military Medical Support Office (MMSO) at 888-647-6676 Family Members: United Concordia • Sponsor must have 12 months service remaining for eligibility • United Concordia - www.ucci.com or (888) 418-0466 • To enroll/make changes online - www.tricaredentalprogram.com • Telephone - (888) 622-2256 • For Retirees – TRICARE Retiree Dental (Delta Dental) • www.trdp.org or (888) 838-8737 • Costs Include (monthly): Single - $10.51 Family - $26.27

  12. Pharmacy Benefit • MTF: No Cost • TRICARE Mail Order Pharmacy (TMOP) • $3/$9/$22 for prescriptions • Convenience • Can get a 90-day supply/30-day for controlled substances • TRICARE Network Retail Pharmacy • Max 30-day supply • Non-network Retail Pharmacy • $9 or 20% (whichever is greater) of full retail cost once annual deductible is met • Max 30-day supply • Drawbacks • Takes 10 – 14 days to process, fill, and ship • If AD and asked to pay – seek reimbursement thru Express Scripts Register at Express Scripts, Inc. (www.express-scripts.com)

  13. How to Make An Appointment • Find a civilian provider who accepts TRICARE Prime • https://www.triwest.com • Call and confirm that they accept TRICARE Prime & that they are accepting new patients • Contact provider to set up appointment • You can self-refer for: • Annual Pap Smears • Annual Eye Exams – every 2 years for dependents/AD every year • Annual Mammograms – annually for women over 40; if under 40, it requires a referral (unless special circumstances exist)

  14. Other Information • Pregnancy • PCM gives global authorization: See your PCM • Covers entire pregnancy in addition to 4 to 6 weeks post partum • Newborns • You have 5 business days to enroll newborns in DEERS! • Newborns are covered as TRICARE Prime for 60 days following birth, AS LONG AS 1 member in the family is TRICARE Prime • After 60 day period, TRICARE Standard • TRICARE Standard coverage ends 365 days following the birth, if not enrolled in DEERS • Adoptions • AD: if you have an active adoption case, you can enroll the child in DEERS w/adoption paperwork (even if the child is warded to you)

  15. Other Information, CONT. • Advance Directives • Ensure your desired medical instructions are followed when you are incapacitated (i.e., if suffering from an irreversible coma & you request life-sustaining treatment not be rendered to prolong life). • Must be filed in the medical record • It is your responsibility to ensure civilian providers have your Advance Directives. • For questions, see your local Legal Office • TRICARE on Line • Electronic version of “Taking Care of Yourself/Child” Handbook(s) • Includes: Personal health journal, 18M pages of medical, health, drug interaction, and fitness information • TRICARE benefit information • Website: www.tricareonline.com

  16. Notice Of Privacy Practices • Describes what information the Medical Group may share and with whom we may share it • All MDG Staff are trained on this issue. • Patients should read it to be knowledgeable and confident about the safety of their personal information

  17. Spouses do NOT Automatically HaveAccess to Another Spouse’s Record • The patient must “authorize” their spouse access to their health information • Fill out authorization form when you check into your appointment or see TOPA

  18. DD FORM 2870 DD2870 49 MDG Overprint Enter “Spouse’s name” in block 6a Check block 7 “SPOUSE” The staff must Witness the patient’s signature, i.e., sign your name in block 11a or The form may be notarized File original in record (Part 3) Provide copy to patient/spouse

  19. Legal Authority of Children • JOINT CUSTODY: Court has awarded “custody designation” to both parents • STEP PARENTS: No legal authority. However, a step parent who has adopted the child or acting in loco parentis has legal authority • OUT-OF-HOME PROVIDER (OHP): Similar to “foster parent” – may or may not have legal authority • BIOLOGICAL PARENT: You must ensure that the court has awarded “custody designation” to biological parent • NOTE: A step parent (without any legal authority) may bring a child to the MTF for an appointment, however, the guardian has no legal authority to participate in medical decision-making events Parents can access their child’s medical record or request a copy (17 years or less); however, exceptions may apply for children seeking care without parental consent as permitted by NM Statute (i.e., treatment of STD)

  20. Who Ya Gonna Call? - Toll-free number: 1-888-TRIWEST - Website: www.triwest.com - Claims mailing address: West Region Claims P.O. Box 77028 Madison, WI 53707-7028 - Toll-free claims number: 888-874-9378 - Claims website: www.tricare4u.com - TRICARE Regional Office website: www.tricare.osd.mil/west/default.cfm

  21. Thanks For Having Us QUESTIONS?

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