Dental Purchase

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Dental Purchase Powered By Docstoc
					             TRICARE
       Your Military Health Plan

  Health Care and Dental Benefits
       for Family Members of
National Guard and Reserve Members

         Version 2 (Insert date)




                                       PP471BET04073W
                                   1
Your Eligibility Depends on
Your Sponsor’s Military Status
   Sponsor’s Status           What You’re Eligible For
Military Duty Less          • TRICARE Dental Program
Than 30 Days                • Not eligible for TRICARE health
                              benefits
Activated: Called to        • TRICARE health care options
Active Duty for More than   • TRICARE pharmacy benefit
30 Consecutive Days         • TRICARE Dental Program
Deactivated: Upon           • Transitional health care options for
Separation from Active        which your sponsor is qualified
Duty                        • TRICARE pharmacy benefit
                            • TRICARE Dental Program
            You are considered an active duty family member
            for TRICARE when your sponsor is activated
                                                                 2
TRICARE Regions & Overseas Areas

                          • TRICARE North
                          • TRICARE South
                          • TRICARE West


• TRICARE Europe
• TRICARE Pacific
• TRICARE Latin America
  and Canada

                                            3
TRICARE Regions & Overseas Areas

                          • TRICARE North
                          • TRICARE South
                          • TRICARE West


• TRICARE Europe
• TRICARE Pacific
• TRICARE Latin America
  and Canada

                                            4
Regional Contractors
                                        North Region
• Provide health care
                                       Health Net Federal
  services and support for               Services, Inc.
  the TRICARE program                   1-800-555-2605
                               www.healthnetfederalservices.com
• Establish TRICARE
                                        South Region
  provider networks
                                  Humana Military Healthcare
• Customer service                     Services, Inc.
                                      1-800-444-5445
   – Web sites                    www.humana-military.com
   – Toll-free numbers
                                         West Region
   – TRICARE Service Centers
                                TriWest Healthcare Alliance Corp.
                                        1-888-TRIWEST
                                       www.triwest.com

                                                                5
TRICARE Area Offices
• Administer the TRICARE           Europe
  program overseas             1-888-777-8343
                           www.europe.tricare.mil
• Most health care
  provided at overseas     Latin America & Canada
  MTFs                         1-888-777-8343
                             www.tricare.mil/tlac
• International SOS:
  health care in remote            Pacific
  overseas locations           1-888-777-8343
                            www.tricare.mil/pacific



                                                      6
Defense Enrollment Eligibility
Reporting System (DEERS)
• Visit an ID card-issuing facility
   – Find one near you at www.dmdc.osd.mil/rsl

• Call 1-800-538-9552
• Mail proof of Medicare-eligibility to:
   Defense Manpower Data Center Support Office
   Attn: COA
   400 Gigling Road
   Seaside, CA 93955-6771
                       Registration in DEERS is
                       key to TRICARE eligibility
                                                    7
TRICARE Dental Program
• Voluntary, comprehensive dental plan you
  may purchase at any time
• Offers continuous coverage while sponsor’s
  status changes
  – Monthly premium amounts based on sponsor’s
    military status (activated vs. not activated)

• Administered by United Concordia
  Companies, Inc.
               Contact United Concordia for information:
               www.TRICAREdentalprogram.com or
               1-800-866-8499
                                                           8
Health Care Options When
Sponsor is Activated
• TRICARE Standard and TRICARE Extra
• TRICARE pharmacy benefit
• TRICARE Prime
• TRICARE Prime Remote for Active Duty Family
  Members (TPRADFM)
• May qualify for pre-activation benefit (if sponsor
  was activated in support of a contingency)
           Contact your TAO for information about
           health care options if you accompany your
           sponsor overseas when they are activated
                                                       9
Health Care Options When
Sponsor is Activated (cont.)
• TRICARE Standard and TRICARE Extra
• TRICARE pharmacy benefit
• TRICARE Prime
• TRICARE Prime Remote for Active Duty Family
  Members (TPRADFM)
• May qualify for pre-activation benefit (if sponsor
  was activated in support of a contingency)
            Contact your TAO for information about
            health care options if you accompany your
            sponsor overseas when they are activated
                                                        10
TRICARE Standard
• Enrollment not required
• Care from non-network TRICARE-
  authorized providers
  – Provider may charge up to 15% above TRICARE
    allowable charge
  – May have to submit your own health care claims

• Referrals not required for specialty care
  – Some services may require prior authorization

• MTF care on a space-available basis only


                                                     11
TRICARE Extra
• Enrollment not required
• Care from TRICARE network providers
  – Providers agree to accept negotiated rate as
    TRICARE allowable charge
  – Lower cost-shares than TRICARE Standard
  – No claims to file (in most cases)

• Referrals not required for specialty care
  – Some services may require prior authorization

• MTF care on a space-available basis only

                                                    12
TRICARE Standard and Extra Costs
TRICARE Option                TRICARE Standard              TRICARE Extra
Deductible                    Sponsor rank E1-E4:           Same
Amount due each fiscal year    $50/single or $100/family
before cost-sharing begins.   Sponsor rank E5 & above:
                               $150/single or $300/family
Outpatient Cost-share         20%*                     15%
Inpatient Costs               $14.80/day ($25 minimum) Same
Inpatient Behavioral          $20/day ($25 minimum)    Same
Health Care
Catastrophic Cap              $1,000 per family per fiscal year
The federal fiscal year is Oct. 1- Sept. 30.
* Non-network providers may charge up to 15% above the TRICARE allowable charge.


                 Get extra cost-savings with TRICARE Extra!
                                                                           13
Reserve Family Demonstration Project
• Sponsor activated in support of a contingency
  operation
   – Operation Noble Eagle, Enduring Freedom, etc.

• If you qualify, the following are waived when
  using TRICARE Standard and TRICARE Extra:
   – Annual outpatient deductible
   – Amounts up to 15 percent above the TRICARE
     allowable charge (minus your cost share)

• Demonstration project runs through Oct. 31, 2007


                                                     14
TRICARE Prime & TPRADFM
• Enrollment required
• Access standards for health care
• Most care received from your assigned
  primary care manager (PCM)
  – TRICARE-authorized provider (TPRADFM)

• Minimal out-of-pocket costs
• No claims to file (in most cases)


                                            15
TRICARE Prime & TPRADFM (cont.)
• Enrollment required
• Access standards for health care
• Most care received from your assigned
  primary care manager (PCM)
  – TRICARE-authorized provider (TPRADFM)

• Minimal out-of-pocket costs
• No claims to file (in most cases)


                                            16
TRICARE Prime/TPRADFM Costs
 Enrollment Fees              $0
 Deductible*                  $0
 Outpatient Costs* $0
 Inpatient Costs*             $0
 Emergency Care               $0
 Catastrophic Cap             $1,000 per family per fiscal year
The federal fiscal year is Oct. 1- Sept. 30.

                   *You’ll pay higher out-of-pocket costs if
                   you use the point of service option (POS).

                                                                  17
Point of Service Option
• Seek nonemergency/specialty care without a
  referral or prior authorization
• Higher out-of-pocket costs
  – Annual Deductible: $300/individual or $600/family
  – Cost-Shares: 50% after POS deductible is met

• POS fees not reimbursed by TRICARE
• POS fees do not apply to the annual
  catastrophic cap       Avoid POS fees!
                             Follow TRICARE Prime/
                             TPRADFM referral and
                             authorization guidelines   18
Enrolling in TRICARE Prime/TPRADFM
• Submit completed enrollment application to
  your regional contractor
  – If received by 20th of month, coverage begins
    1st of next month
  – If received after 20th of month, coverage begins
    1st of following month

• Select a PCM
  – From military treatment facility (MTF) or TRICARE
    network
  – For TPRADFM, select any TRICARE-authorized
    provider if a network PCM is not available


                                                        19
TDP When Sponsor is Activated
• If enrolled before activation:
   – Coverage continues
   – Premiums reduced to active duty family member
     rates if sponsor is activated for more than 30 days

• If not enrolled, may enroll now
   – Reduced monthly premium rates

• If activation is in support of a contingency
   – 12-month “lock-in” period waived if you enroll
     within 30 days of activation
                Contact United Concordia for information:
                www.TRICAREdentalprogram.com or
                1-800-866-8499
                                                            20
Options When Sponsor Deactivates
• TRICARE Dental Program
• If sponsor was activated in support of a
  contingency:
  – Transitional Assistance Management Program

• If sponsor continues in the Selected Reserve
  – TRICARE Reserve Select

• If sponsor is not in the Selected Reserve
  – Continued Health Care Benefit Program


                                                 21
TDP When Your Sponsor Deactivates
• Coverage will continue at applicable premium
  rates* for the following family members:
  – Those enrolled prior to activation
  – Those who enrolled more than 30 days after
    sponsor activation
  – Those whose sponsors are not activated for
    specific contingency operations.
    *Family members must complete the remainder of the 12-month
     minimum enrollment requirement.



               Contact United Concordia for information:
               www.TRICAREdentalprogram.com or
               1-800-866-8499
                                                                  22
TDP When Your Sponsor Deactivates
(cont.)

• If enrolled within 30 days after your sponsor
  was activated in support of specific
  contingency operations family members:
    – Are automatically disenrolled
    – Must notify United Concordia if family member
      enrollment is desired



              Contact United Concordia for information:
              www.TRICAREdentalprogram.com or
              1-800-866-8499
                                                          23
Transitional Assistance Management
Program
• Available when sponsor was activated in
  support of a contingency operation and
  served more than 30 consecutive days
• Begins on 1st day after separation
• 180 days transitional TRICARE coverage:
  –   TRICARE   Prime: Must re-enroll
  –   TRICARE   Standard and TRICARE Extra
  –   TRICARE   pharmacy benefit
  –   TRICARE   Prime Remote not available


                                             24
TRICARE Reserve Select
•   Premium-based health care plan your
    sponsor may purchase if he or she qualifies
•   Provides coverage similar to TRICARE
    Standard and TRICARE Extra
•   Administered by regional contractors


           Visit the TRICARE Web site for information:
           www.tricare.mil/reserve/reserveselect



                                                         25
Continued Health Care Benefit Program
• Premium-based health care plan your sponsor
  may purchase after loss of TRICARE eligibility
• Must purchase within 60 days of loss of
  TRICARE coverage
• 18 months of coverage similar to TRICARE
  Standard, includes TRICARE pharmacy benefit


            Contact Humana Military for information:
            www.humana-military.com or
            1-800-444-5445

                                                       26
Need More Information?
• To verify eligibility
   – Guard-Reserve Portal:
     https://www.dmdc.osd.mil/GuardReservePortal

• To learn about benefits
   – Regional contractors
   – TDP contractor: United Concordia
   – TRICARE Web site: www.tricare.mil/reserve

• National Guard and Reserve beneficiary
  counseling and assistance coordinators (BCACs)
   – www.tricare.mil/bcacdcao

                                                   27
In Conclusion…
• Questions?
• Comments or feedback?
  – Visit www.tricare.mil/evaluations/feedback




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