Beneficiaries should know about big TRICARE changes

| January 19, 2018 | 0 Comments

Military Health System
News Release
HONOLULU — On Jan. 1, TRICARE made many changes to benefits. These changes will provide more benefit choices, improve access to care, simplify cost shares and allow patients to take command of their health.

The best way for patients to take action now is to update their information in DEERS, sign up for TRICARE benefit updates and visit TRICARE Changes online to learn more.

Here are changes that patients need to know about:

Region Consolidation
Previously, there were three TRICARE regions in the United States: North, South and West. The North and South regions combined on Jan. 1 to form TRICARE East, and TRICARE West remains mostly unchanged.

The West region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner, including El Paso), Utah, Washington and Wyoming.

New Regional Contractor
The new contractor now administering for the West region is Health Net Federal Services. This change will allow for better coordination between the military hospitals and civilian health care providers.

Patients should update their payment information and option to guarantee continued payment of their TRICARE enrollment fees and monthly premiums if paying through bank electronic fund transfer, debit or credit card. If patients currently pay by allotment through the Defense Finance Accounting System, DFAS, they will not need to take any action.

“As we embark on a new era in TRICARE, we want to help ensure a smooth transition for beneficiaries,” said Ken Canestrini, director, TRICARE Health Plans. “One of the first things they should do is make sure their payments are going to the right place.”

See below information in the yellowed web box to update payment information and confirm primary care manager, or PCM, information.

TRICARE Select and TRICARE Prime Health Plans
On Jan. 1, TRICARE Select replaced TRICARE Standard and TRICARE Extra both stateside and overseas. Stateside, which includes the states of Hawaii and Alaska, TRICARE Select will be a self-managed, preferred provider network option. Patients will not be required to have a PCM without a referral.

For patients who live overseas, TRICARE Overseas Program Select will be a preferred provider organization-styled plan that provides access to both network and non-network TRICARE-authorized providers for medically necessary TRICARE covered services.

TRICARE Prime is a managed care program option; an assigned PCM provides most of the patient’s care. When patient’s need specialty care, their PCM will refer them to a specialist. Active duty service members and their family members do not pay anything when referred to a network provider by their PCM; all others pay annual enrollment fees and network copayments.

Preventive Services
TRICARE Select adopts a number of improvements, including additional preventive care services previously only offered to TRICARE Prime beneficiaries. Preventive care helps patients take command of their health and manage potential issues before they experience symptoms. This type of health care allows patients to address health problems before they become life threatening.

Examples of TRICARE-covered preventive services include cancer screenings and vaccines, in addition to well-woman and well-child exams.

TRICARE beneficiaries using Standard or Extra, didn’t pay anything for some preventive services, but for all other preventive services, beneficiaries paid between 15-25 percent of the cost after their yearly deductible was met, depending on the plan and beneficiary category.

“With TRICARE Select, beneficiaries don’t pay anything out-of-pocket for covered preventive services if they are provided by a network provider,” said Valerie Palmer, a TRICARE health care policy analyst with the Defense Health Agency. “However, if they use a non-network provider, fewer preventive services are paid by TRICARE. This is why it is important to see a network provider for your preventive care if you want to save money.”

Additional Coverage
The additional, no-cost preventive services beneficiaries can receive under TRICARE Prime that TRICARE Select now covers, as of Jan. 1, include the following:

  • One Health Promotion and Disease Prevention (HP&DP) exam. This is covered annually for beneficiaries age 6 and older. In 2018, this exam will no longer require the inclusion of a covered cancer screening or immunization if you see a network provider.
  • Lung cancer screening (low-dose computed tomography). This is covered annually for persons ages 55-80 with a 30 pack-per-year history of smoking who are currently smoking or have quit within the past 15 years. Screening should be discontinued once the individual has not smoked for 15 years or develops a health problem significantly limiting life expectancy or ability or willingness to undergo curative lung surgery.
  • A new preventive service added for both TRICARE Prime and TRICARE Select is aimed at adults with a body mass index (BMI) of 30 kg/m2 or higher and children or adolescents with a BMI value greater than the 95th percentile.

Intensive, multi-component behavioral interventions to promote sustained weight loss (12 to 26 sessions per year) are covered when rendered by a TRICARE-authorized provider. Types of behavioral management interventions include diet and physical activity guidance, strategies to promote and maintain lifestyle changes and more. This addition is a covered benefit regardless of whether the beneficiary uses a network or non-network provider, though costs are typically lower with a network provider.

Enrollment
Automatic enrollment occurred for all TRICARE beneficiaries into plans on Jan. 1, as long as they were eligible. TRICARE Prime enrollees remained in TRICARE Prime. TRICARE Standard and TRICARE Extra beneficiaries were enrolled in TRICARE Select. During 2018, you can continue to choose to enroll in or change coverage plans.

In the fall of 2018, TRICARE will introduce an annual open enrollment period. During this period, you can choose whether to continue or change your coverage for the following year. Each year, the open enrollment period will begin on the Monday of the second full week in November and run through the Monday of the second full week in December.

Upcoming Changes
New Pharmacy Copays. Starting Feb. 1, TRICARE pharmacy copayments will change.

Dental and Vision Coverage: Certain enrollees will become eligible for Federal Employees Dental and Vision Insurance Program F.E.D.V.O.P beginning in 2019.

In the coming months, more information will be available at www.tricare.mil.changes. To stay informed, sign up for email alerts at www.tricare.mil/subscriptions.

Patients can also get alerts by signing up for e-correspondence in milConnect at https://tricare.mil/Plans/Eligibility/DEERS/milConnect/eCorrespondence.

By staying informed, patients will be ready for a smooth transition with TRICARE.

(Editors Note: Contributions provided by Spc. Peter Sky, Leanne Thomas and Jim “Goose” Guzior of Tripler Army Medical Center Public Affairs.)

 

West Regional Contact
To confirm your primary care manager is in-network with the new region, visit your region’s provider directory. The West region provider directory is available at Tricare-west.com/content/hnfs/home/tw/bene/provider-directory.html, or visit the TRICARE all provider directories resource at www.tricare.mil/FindDoctor/AllProviderDirectories.

For dates of service on or before Dec. 31, 2017, claims information will be available at www.myTRICARE.com through April 30, 2018.

Pharmacy Updates
Sign up for email alerts at www.tricare.mil/subscriptions. Patients can also get alerts by signing up for e-correspondence in milConnect at https://tricare.mil/Plans/Eligibility/DEERS/milConnect/eCorrespondence.

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Category: Health

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