Thursday, December 16, 2010

TRICARE’s top five issues

Q1. With the National Healthcare Reform, how do I ensure continued coverage for my dependent child?
A1. TRICARE already meets or exceeds most of the new health care provisions which took effect Sept. 23, under the Patient Protection and Affordable Care Act. The PPACA provides new or expanded options and consumer protections for those with private health insurance coverage.

One provision under PPACA that is not already addressed in the TRICARE entitlement is coverage for dependents up to the age of 26. TRICARE’s current age limit for dependent children is 21 or age 23, if the dependent child is a full-time college student or has been determined to be incapable of self-support.

The recent PPACA required civilian health plans that provide medical coverage to children to make that coverage available until the child turns 26 years of age. While the Act does not give the Department of Defense the authority to offer this benefit through TRICARE, there are provisions in the U.S. Senate and U.S. House of Representatives versions of the National Defense Authorization Act for FY11 that would extend dependent medical coverage up to age 26. It is not known yet whether there will be a charge or premium until the law is enacted. If enacted into law, DOD will make every effort to implement this provision as soon as possible.

Q2. What is the benefit and how can I enroll in TRICARE for Life?
TRICARE for Life is TRICARE’s Medicare-wraparound coverage available to all Medicare-eligible TRICARE beneficiaries. Under this program, Medicare is the primary insurance and TRICARE acts as the secondary payer.

A quick overview:

  • If using a Medicare participating or non-participating provider, they will file your claims with Medicare. Medicare pays their portion and electronically forwards the claim to the TFL claims processor.

  • For services covered by both Medicare and TRICARE, Medicare pays first and TFL pays the remaining coinsurance.

  • For services covered by TRICARE but not by Medicare, TFL pays first and Medicare pays nothing. The member must pay the TRICARE fiscal year deductible and cost shares.

  • For services covered by Medicare but not by TRICARE, Medicare pays first and TFL pays nothing. The member must pay the Medicare deductible and coinsurance.

  • For services not covered by Medicare or TRICARE, Medicare and TRICARE pay nothing and the member must pay the entire bill.

    There is no actual enrollment in TFL. You must be enrolled in Medicare Part B via the Social Security Administration. Once you have Medicare Part A and Medicare Part B coverage and it is confirmed in the Defense Enrollment Eligibility Reporting System, your DEERS record should show you as ‘‘TRICARE For Life-eligible.” To confirm TFL eligibility, visit the nearest ID card-issuing facility or contact DEERS at 1-800-538-9552.

    For information, visit:⁄mybenefit⁄home⁄overview⁄Plans⁄LearnAboutPlansAndCosts⁄TRICAREForLife.

    Q3. I just moved to a new region, how do I enroll my family?
    It is very important to keep your DEERS information up-to-date to ensure uninterrupted health care coverage. Contact DEERS at 1-800-538-9552 to update your DEERS information with your new address. If you would like to continue Prime enrollment you may visit a TRICARE Service Center, contact the Regional contractor for information on possible online enrollment options or complete a TRICARE Prime Enrollment and PCM Change form and mail your enrollment application to the Regional contractor at the new region.

    Visit the following website for more⁄mybenefit⁄home⁄overview⁄Plans⁄LearnAboutPlansAndCosts⁄TRICAREPrime.

    Q4. How do I submit a claim and where do I send it?
    Claims filing information is different depending on who you are, where live and which health plan you are using. Here are 5 basic steps to file a claim:

    1. Update personal information in DEERS.

    2. Complete and sign the Beneficiary Claim form.

    3. Attach a Third Party Liability form (if needed).

    4. Attach a copy of your provider’s bill to the claim form.

    5. Submit the claim to the appropriate address:
    a. Applicable Regional Managed Care Support Contractor
    North: Health Net Federal Services
    South: Humana Military Healthcare Services
    West: TriWest Healthcare Alliance
    OCONUS: International SOS

    b. TRICARE For Life Claims
    WPS TRICARE For Life
    P.O. Box 7890
    Madison, Wis. 53707-1028

    c. Pharmacy Claims
    Express Scripts, Inc.
    P.O. Box 66518
    St. Louis, Mo. 63166-6518

    See the website for region specific information:⁄mybenefit⁄home⁄Medical⁄Claims?status=Active+Duty+Family+Member&country=Belgium&country=Belgium&plan=TRICARE+Reserve+Select+(TRS).

    Q5. I am a Guard and Reservist and I was told I have TRICARE coverage but DEERS says I am not eligible.
    TRICARE Reserve Select is a premium-based health plan available worldwide to Selected Reserve members of the Ready Reserve (and their families) who are not eligible for or enrolled in the Federal Employee health Benefits program or currently covered under FEHB, either under their own eligibility or through a family member.

    Members must qualify and enroll to receive the benefit. First, you must fill out and submit the DMDC Reserve Component Purchased TRICARE Application to your regional contractor. You may purchase the plan at any time throughout the year beginning the following month after the application has been postmarked⁄received by the Regional Contractor. When you send the application, you must also send the first month’s premium payment.

    For information on the TRICARE Reserve Select program, visit:⁄trs.