New Parents Seminar by vivi07

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									TRICARE
Your Military Health Plan New Parents Seminar
<Presenter: Insert your name and/or the date of your presentation here>
PP491BET07084W

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Today’s Agenda
• TRICARE Regional Contractors • Maternity Care • Coverage Choices • Your Child’s Coverage • Other TRICARE Benefits • Staying Covered
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TRICARE Regional Contractors
TriWest

Health Net

Humana Military
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New Parents Seminar Maternity Care

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Maternity Care:

Who’s Covered?
• ADSMs and retired service members • ADFMs and retiree family members
– Spouse – Eligible, expectant dependent daughter

• Newborns and newly adopted children

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Maternity Care:

Who’s Covered? (cont.)
• National Guard and Reserve members and their eligible family members who:
– Activate for more than 30 consecutive days; or – Enroll in TRS; or – Qualify for TAMP coverage

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Maternity Care:

Covered Grandchildren
• A dependent daughter’s baby is TRICAREeligible only if registered in DEERS and if:
– Child’s father is ADSM or retired service member; or – A TRICARE sponsor adopts child

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Maternity Care:

What’s Covered?
• Prenatal, labor and delivery, postpartum care • Medically necessary ultrasounds
– Ultrasounds to determine baby’s sex not covered

• Global maternity benefit
– Covers all routine maternity care visits after the first visit, up to delivery – No copayments after first visit

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New Parents Seminar Coverage Choices

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Coverage Choices:

TRICARE Prime
• TRICARE Prime, TPR and TPRADFM • Enrollment is required to participate • ADSMs and ADFMs
– Pay no annual deductible or enrollment fees

• Retirees and their families
– Pay enrollment fees and low costs – Not eligible for TPR or TPRADFM

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TRICARE Prime:

Getting Care
• Primary care received from PCM • PCM referral or regional contractor authorization required for civilian specialty care
– Otherwise, higher costs apply – Includes maternity care

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TRICARE Prime:

Point of Service (POS) Option*
• Applies when nonemergency care is not authorized by PCM • You pay higher costs
• TRICARE will pay only if provider is TRICARE-authorized
* ADSMs may not use the POS option

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TRICARE Prime:

POS Option* (cont.)
• Annual outpatient deductible applies • Cost-share: 50% after deductible is met • Costs not counted toward catastrophic cap • Non-network providers may charge up to 15% above what TRICARE pays
* ADSMs may not use the POS option

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TRICARE Prime:

Getting Out-of-Area Care
• Routine care: Get it before you travel
– Filling prescriptions: Same options as at home

• Urgent care: Call PCM for assistance
• Emergency care: Call 911 or go to nearest emergency room
– A normal delivery is not an emergency

• Lengthy trips: Transfer your enrollment to lower your costs
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Coverage Choices:

TRICARE Standard and TRICARE Extra
• No enrollment required • Select any TRICARE-authorized provider:
– TRICARE network (TRICARE Extra); or – Non-network (TRICARE Standard)

• No referrals required
• Prior authorization required for some services

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TRICARE Standard and TRICARE Extra:

Cost Considerations
• Annual deductible and cost-shares apply • If you use a non-network provider:
– Your cost-shares will be higher – Provider may charge you up to 15% above what TRICARE pays – You may need to pay for care up front, then file a claim for reimbursement

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TRICARE Standard and TRICARE Extra:

Converting from TRICARE Prime
• Must disenroll from TRICARE Prime • One-year lockout from TRICARE Prime
– Does not apply if sponsor is E-4 or below – Only applies for early voluntary disenrollment prior to annual renewal date

• Annual deductible and cost-shares apply

• Care at MTF on space-available basis only

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Coverage Choices:

TRICARE Reserve Select
• Must qualify for coverage before purchasing • Must pay monthly premiums • Select any TRICARE-authorized provider:
– TRICARE network or non-network

• No referrals required • Prior authorization required for some services

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Coverage Choices:

TRICARE Reserve Select (cont.)
• Care at MTF on space-available basis • Annual deductible and cost-shares apply

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New Parents Seminar Your Child’s Coverage

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Your Child’s Coverage:

When Your Child Arrives
• Sponsor must register child in DEERS
– If sponsor is absent, power of attorney required for DEERS registration

• First 60 days*:
– Child covered by TRICARE Prime if a family member is enrolled
* First 120 days, if residing overseas

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Your Child’s Coverage:

When Your Child Arrives (cont.)
• After 60 days*:
– Unless enrolled in TRICARE Prime, child is covered by TRICARE Standard

• After 365 days:
– If not registered in DEERS, child’s TRICARE eligibility ends
* After 120 days, if residing overseas

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Your Child’s Coverage:

Enrolling a Child in TRICARE Prime
• Register child in DEERS • Fill out a TRICARE Prime enrollment form • Submit form to regional contractor before child is 61 days old*
– Ensures continuous TRICARE Prime coverage – Otherwise, child is covered by TRICARE Standard until TRICARE Prime coverage begins
* 121 days old, if residing overseas

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Your Child’s Coverage:

Well-Baby and Well-Child Care
• For newborns, infants and children up to age 6 • Available under all TRICARE program options • TRICARE Prime offers best value
– No copayments – Priority access to care

• TRICARE Standard, TRICARE Extra and TRS
– Deductible and cost-shares apply

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Your Child’s Coverage:

Well-Baby and Well-Child Care (cont.)
• Coverage includes:
– Routine newborn care and well-baby check – Health promotion and disease prevention exams – Vision and hearing screenings – Height, weight and head circumference – Routine immunizations – Developmental and behavioral appraisal

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New Parents Seminar Other TRICARE Benefits

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Other TRICARE Benefits:

Behavioral Health Care Coverage
• Examples of covered services:
– Outpatient psychotherapy – Inpatient care for behavioral health and substance use disorders – Medication management

• Check with PCM or regional contractor for referral and prior authorization requirements
• No referral or prior authorization needed for first 8 outpatient visits per year (except ADSMs)
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Other TRICARE Benefits:

TRICARE Pharmacy Options
• MTF pharmacy: No cost
– Up to 90-day supply

• Mail-order: Convenient and lowest cost
– Up to 90-day supply (maintenance drugs)

• Retail network: Less costly than non-network
– Up to 30-day supply

• Non-network: Most expensive option
– Up to 30-day supply
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Other TRICARE Benefits:

TRICARE Dental Options
• TRICARE Dental Program
– www.TRICAREdentalprogram.com – 1-800-866-8499 (stateside) – 1-818-418-0466 (overseas)

• TRICARE Retiree Dental Program
– www.trdp.org – 1-888-838-8737 – Available overseas beginning in Oct. 2008
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Other TRICARE Benefits:

Your Child’s Dental Care
• Child’s recommended dental visit schedule:
– First visit by child’s first birthday – Follow-up visits every six months

• Two exams and two cleanings covered per year
– No cost-shares apply

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New Parents Seminar Staying Covered

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Staying Covered:

If Eligibility Ends During Pregnancy
• Maternity coverage continues only if:
– Beneficiary qualifies for and purchases TRS; or – Beneficiary qualifies for TAMP or CHCBP; or – Mother is a separating ADSM*

* May only seek care at an MTF, where available

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Staying Covered:

Maintain DEERS Information
• Verify your DEERS information
– Contact your regional contractor – Visit a TRICARE Service Center

• Make changes or add a family member
– In person: Visit ID card-issuing facility – By mail: Send to Defense Manpower Data Center Support Office

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Staying Covered:

Maintain DEERS Information (cont.)
• Change your contact information
– By phone: 1-800-538-9552 – By fax: 1-831-655-8317 – Online: www.tricare.mil/DEERS – BWE online: https://www.dmdc.osd.mil/appj/bwe/

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Thank You
• For more information
– [insert regional information]

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We Value Your Feedback
Please provide feedback on the slides and other materials used during this briefing at: www.tricare.mil/evaluations/presentations

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Optional Slides

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Today’s Agenda
• TRICARE Regional Contractors • Maternity Care
• Coverage Choices

• Other TRICARE Benefits • Staying Covered
• Overseas Coverage Choices

• Your Child’s Coverage

• New Parents Overseas

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New Parents Seminar Overseas Coverage Choices

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TRICARE Overseas Region
• Three overseas areas
– TRICARE Europe – TRICARE Latin America and Canada (TLAC) – TRICARE Pacific

• Supported by TRICARE Area Offices (TAOs)
– www.tricare.mil/overseas – 1-888-777-8343

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Overseas Coverage Choices:

TRICARE Overseas Program (TOP) Prime
• Similar to stateside TRICARE Prime • Enrollment is required
– No enrollment fees

• No annual deductible • TRICARE Prime Puerto Rico

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TOP Prime:

Getting Care
• Care received from primary care manager • Specialty care requires PCM referral or authorization
– Otherwise, higher out-of-pocket costs apply

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Overseas Coverage Choices:

TRICARE Global Remote Overseas (TGRO)
• For ADSMs and eligible family members in designated areas
– Find TGRO locations at www.tricare.mil/tgro

• TGRO is similar to TOP Prime • Enrollment is required, but no fees apply • Care received from TGRO PCM

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Overseas Coverage Choices:

TOP Standard
• Works like stateside TRICARE Standard plan
– TRICARE Extra is not available overseas

• No enrollment required • Receive care from any host nation provider without referrals
– To locate a provider, contact an MTF, TRICARE Area Office or U.S. Embassy Health Unit

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TOP Standard:

Cost Considerations
• Annual deductible and cost-shares apply • May have to pay first, then file a claim for reimbursement

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New Parents Seminar New Parents Overseas

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New Parents Overseas:

Applying for Child’s U.S. Citizenship
• Prior to birth:
– Visit U.S. Embassy or Consulate for instructions – Find locations at http://usembassy.state.gov

• Soon after child’s birth:
– Contact U.S. Embassy or Consulate to record birth – Consulate can help you obtain child’s passport and Social Security number

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New Parents Overseas:

Obtaining Child’s Social Security Card
• Download, complete, sign application form
– www.socialsecurity.gov/online/ss-5fs.html

• Copy and certify documents at:
– U.S. Post Adjutant; or – Military post’s personnel office

• Submit documents to Social Security Admin.
– For more information: www.ssa.gov/foreign

• Child’s card will be mailed from the U.S.
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