Post on 02-Jan-2016
This Briefing is:UNCLASSIFIED
49th Fighter Wing
TRICARE BRIEFING
MSgt Donna WilliamsFlight Chief, TOPA
7 Nov 06
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What We Will Cover
• Important Terms• TRIWEST vs. TOPA• DEERS FIRST• Healthcare Options Provided/Explained• Dental/Pharmacy• Important Changes/Information• Questions
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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
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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
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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
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Healthcare Options Provided and Explained
Three Options
1. TRICARE Prime (and TRICARE Prime Remote)
2. TRICARE Extra
3. TRICARE Standard or CHAMPUS
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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
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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
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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
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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
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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
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Pharmacy Benefit1. MTF: No Cost
2. TRICARE Mail Order Pharmacy (TMOP)• $3/$9/$22 for prescriptions• Convenience• Can get a 90-day supply/30-day for controlled substances
3. TRICARE Network Retail Pharmacy• Max 30-day supply
4. 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)
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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)
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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)
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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
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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
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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
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DD FORM 2870
DD2870 49 MDG OverprintEnter “Spouse’s name” in block 6aCheck block 7 “SPOUSE”
The staff mustWitness the patient’s signature, i.e., sign your name in block 11a orThe form may be notarizedFile original in record (Part 3)Provide copy to patient/spouse
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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)
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Who Ya Gonna Call?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
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Thanks For Having Us
QUESTIONS?QUESTIONS?