Thursday, February 7, 2002

TRICARE catastrophic cap reduced

The TRICARE fiscal year "catastrophic cap" has been reduced from $7,500 to $3,000 for uniformed services retirees, their family members and survivors. The cap is the maximum amount of out-of-pocket costs these beneficiaries are required to pay for medical care during a fiscal year (Oct. 1 through Sept. 30). For active duty family members, the catastrophic cap remains $1,000 per fiscal year.

The catastrophic cap reduction is retroactive to Oct. 1, 2000. Retirees, their family members and survivors who have paid more than $3,000 out-of-pocket for TRICARE-covered services are eligible for reimbursement. The managed care support contractors (MCSC's) will search their files and identify beneficiaries due refunds.

Beneficiaries who have saved their receipts and choose to initiate a request for reimbursement, may do so by contacting their regional claims processor for guidance on where to submit their receipts and claims.

It is not necessary for beneficiaries to resubmit claims already paid by TRICARE to qualify for reimbursement of the amount paid over the catastrophic cap. For retirees, their family members and survivors enrolled in TRICARE Prime, there is an enrollment year cap. The enrollment year cap begins on the anniversary date of enrollment in TRICARE Prime, and applies to all enrollees.

Catastrophic caps, both fiscal year and enrollment year combined, will not exceed $3,000 in a given 12-month period for retirees, their family members and survivors, and $1,000 for family members of active duty members. Once the catastrophic cap and enrollment year cap (combined) are met by TRICARE Prime enrollees, TRICARE will pay up to the TRICARE allowable amount for all covered services (excluding point-of-service charges which do not count toward the catastrophic cap).

For beneficiaries who are not enrolled in TRICARE Prime, TRICARE will pay up to the TRICARE allowable amount for all covered services for the remainder of the fiscal year after the fiscal year cap is met.

Retirees, family members, and survivors remain responsible for the cost of all services and treatments received which are not TRICARE covered benefits.

Some beneficiaries mistakenly believe that the $3,000 catastrophic cap is the ceiling on the amount that TRICARE will cover for a family during any given year, however the opposite is true. The cap will protect retirees, their family members and survivors from paying more than $3,000 out-of-pocket for medical care.

For additional information on catastrophic cap reduction, beneficiaries are encouraged to contact the nearest TRICARE service center or military treatment facility beneficiary counseling and assistance coordinators for assistance. TRICARE benefit information is also available on the Military Health System/TRICARE Web site at , or by calling 1-888-DoD-LIFE (1-888-363-5433).

2. For telephone number, E-mail address, etc., of the TRICARE Beneficiary Counseling and Assistance Coordinator (BCAC) assigned to your area, please go to