Thursday, December 16, 2010
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:
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: tricare.mil⁄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 information:tricare.mil⁄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: www.tricare.mil⁄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: www.tricare.mil⁄trs.