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?