TRICARE

TRICARE
Active-duty military families who live overseas have two options for receiving health care: TRICARE Europe Prime and TRICARE Standard. There are important differences between the two.

TRICARE Europe Prime
Active Duty Members. All active duty members will be enrolled in TRICARE Europe Prime upon assignment to the theater. Active duty members will see military physicians primarily and most referrals will be made to military medical facilities.

Active Duty Family Members. Family members must make a choice between the two TRICARE options (Prime and Standard). If they choose TRICARE Standard, no action is necessary. To obtain coverage under TRICARE Europe Prime they must take action to enroll by completing an enrollment form at the local TRICARE Service Center.

Normally, the enrollment for both active duty members and their families is done during inprocessing.

There are several reasons why a family member should enroll in TRICARE Europe Prime:

Primary Care Manager. Beneficiaries who enroll in TRICARE Europe Prime will know their Primary Care Manager (PCM) by name. A PCM is a provider who will take care of the enrollee on a regular basis and manage their care even when referred to a specialist.

Priority for care. Beneficiaries who choose to enroll in TRICARE Europe Prime are provided the highest priority for care in military medical facilities.

Enhanced Preventive Medicine Benefits. Enrollees will enjoy access to specific preventive medicine benefits. The philosophy and focus behind TRICARE Prime is to keep enrollees healthy and encourage them to live a healthy lifestyle, not simply treat diseases and conditions when they occur.

Preferred Provider Networks (PPN). Prime enrollees will have access to both military medical facilities and networks of local civilian providers put together by the commanders of military medical facilities. Wherever possible or available, most of their care will be provided by the PCM to whom they are assigned, and, when necessary, will have access to specialized care recommended by the PCM. Members of the PPN are quality providers who agree to see beneficiaries and to file TRICARE claims for Prime patients. In most cases, these providers will speak English, but when they don't, bilingual patient liaisons will serve as interpreters.

Access to Care Standards. The Department of Defense has published access standards for enrollees: one day for urgent care, whether primary or specialty; one week for a routine primary visit; four weeks for a health prevention visit (e.g., pap smear), and four weeks for routine specialty care. Military medical facilities in Europe either meet these access standards at their facilities or send enrollees to a preferred provider.

TRICARE Europe Standard
Family members who choose not to enroll in TRICARE Europe Prime will be automatically eligible for TRICARE Standard. Under TRICARE Standard, the beneficiary is responsible for deductibles and cost-shares for care obtained from civilian facilities and providers. Individuals who make this choice will have no primary care manager, will have reduced priority for access to care in a military treatment facility, and will not receive the preventive medicine benefits that come along with Prime.

Yet even with its increased costs and reduced benefits, TRICARE Standard may be the right choice for some beneficiaries who prefer to get their care directly from host-nation providers. By choosing TRICARE Standard, they retain the full freedom to choose from any provider they wish for outpatient care. A reminder though, beneficiaries who live near an inpatient military medical facility must check with that facility for a non-availability statement before obtaining inpatient care in a host-nation hospital.

What Do You Need To Do? Persons needing more information or wishing to enroll in TRICARE Europe Prime, should simply contact the closest TRICARE Service Center. After enrolling they will receive an enrollment confirmation package with the TRICARE Europe Health Care Passport and the name of their Primary Care Manager.

Persons seeking medical care in Europe may well have many healthcare related questions. For this reason, TRICARE Service Centers have been established at military treatment facilities. These are the first places to turn to turn for answers.

Traveling With TRICARE
Family Members. When you are covered by TRICARE Standard or enrolled in TRICARE Europe Prime, your TRICARE benefit is always available to you - whether you are traveling or on vacation, whether you stay in Europe, travel to another overseas area or head back to the states. However, your Prime enrollment protects you even further by ensuring priority care at all military medical facilities and prevents you from incurring high-cost medical bills when you're away from home.

Traveling In Europe or Other Overseas Locations. As a TRICARE Europe Prime family member, your medical benefit covers you whenever you travel overseas. If you require emergency medical care while on vacation, seek care at the nearest military medical facility. If you aren't certain where to go, contact the nearest TRICARE Service Center for referral to a local national civilian doctor or seek care at the nearest emergency room, hospital or clinic (the TRICARE Europe Health Care Passport lists all service centers and their phone numbers). In all cases, you must contact your servicing TRICARE Service Center, preferably before care is rendered but at least immediately afterward, in order to have your claims processed correctly.

Preauthorization is required for any non-emergency civilian care received overseas. Claims submitted without an authorization will be paid at the point-of-service rate, which includes a high cost share and deductible. If you incur a charge for civilian medical care, retain the itemized statement and any medical documentation and submit the claim to Wisconsin Physician Services (WPS). The address is listed below. If you are referred to a member of the preferred provider network, the physician may submit your medical bills to WPS. Claims for authorized civilian care will be paid 100%, with no cost-shares, co-pays or deductibles for covered, authorized services.

Traveling In the USA. If you need emergency or urgent medical care when traveling in the USA, you are not required to seek authorization for care. However, if you are near a military medical facility with emergency facilities, go there first for care; otherwise, take the following steps:

o Call the applicable toll-free number for the region in which you are seeking care to find out if there is a TRICARE network provider located near you (the TRICARE Europe Health Care Passport has a list of all US regional toll free numbers);

o If there is no network provider, make sure the civilian provider accepts the TRICARE/CHAMPUS allowable charges as payment in full. Otherwise, you may be responsible for some additional charges above the CHAMPUS allowable;

o The provider may file the claim for you, or you may be expected to pay first and then file the claim for yourself. In either event, all claims for family member care in the US should be mailed to:
TRICARE Europe
WPS -- Foreign Claims
P.O. Box 8976
Madison WI 53708-8976

Traveling Outside the Region for Over 30 Days. If you will be traveling to the states for an extended visit that exceeds 30 days, you should contact your servicing European TRICARE Service Center to request a transfer of your Prime enrollment to the region in which you will be staying. When you arrive at your destination, you must contact the gaining TRICARE Service Center to ensure your enrollment is transferred. The TRICARE representative will provide you with an information packet, which will include where to send your claims and information on the local civilian network of providers. If you return to Europe, you will again contact your TSC to ensure your Prime enrollment is transferred.

Children Attending School In The USA. Children of active duty members assigned overseas who attend school or college in the USA must transfer their Prime enrollment to the region that services the area in which they are attending school, if Prime is available. If TRICARE Prime is not available in their area, they must disenroll from Prime, but will be covered by TRICARE Standard. Students or other family members may enroll in TRICARE Europe Prime if they live with their active duty sponsor assigned overseas during periods that exceed 30 days. When they return to school in the US, they will process out with their servicing European TRICARE Service Center and return to the coverage they had in the states, whether Prime or Standard. Note: Children of retirees who are enrolled in TRICARE Prime in the states but spend their summers (over 90 days) in Europe with their retired sponsor should have their sponsor notify their region TRICARE Office.

CONUS Prime Family Members Visiting in Europe. If a family member is enrolled in TRICARE Prime in a CONUS region and will be staying in Europe for less than 30 days, they may remain enrolled in Prime in their current region. However, they must have authorization from their PCM for anything other than emergency care or face a point-of-service charge for any civilian medical care.

Active Duty. Active duty members needing emergency medical care, while traveling, should obtain care from the nearest medical facility and follow parent service reporting procedures. Active duty members must obtain routine civilian and host-nation medical care according to policies established by their parent service. Medical bills should be submitted according to parent service policy.

Retiree Benefits
Significant changes occurred to the TRICARE Benefit over the past several months, especially for the 65 and over retirees. The FY 2001 National Defense Authorization Act, signed into law on October 30, 2000 included a number of health care provisions that collectively represented the most significant change to military health care benefits since the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) was established by Congress in 1966. Here are some of the key features and how they affected the TRICARE Europe Program:

TRICARE for Life. Medicare-eligible military beneficiaries became eligible for TRICARE medical benefits effective October 1, 2001. The law requires that all Medicare-eligible beneficiaries, regardless of age, must be enrolled in Medicare Part B to receive TRICARE benefits.

In the past, 65 and over military retirees living in overseas locations had only two options for medical coverage: seek space available medical care from the nearest US military medical facility or sign up for civilian insurance coverage. If these same individuals lived in the US, they would also be able to seek medical coverage under Medicare Parts A & B. However Medicare will not pay for services received outside the US and this had not been an option in the past for retirees in Europe.

In overseas locations, under-65 retirees are covered by TRICARE Standard; on 1 October 2001, the Standard benefit was extended to 65 and over eligibles, continuing their current under-65 coverage indefinitely. The only requirement is that they enroll in Medicare Part B, which, although it does not cover care received in overseas locations, does cover medical care sought in the US. Since enrollment in Medicare Part B is a requirement for coverage in the states, where TRICARE is the second payer after Medicare on any medical claims, Medicare Part B is also a requirement for the overseas beneficiaries, where TRICARE will be the prime payer on any claims.

TRICARE Senior Pharmacy Program. As of 1 April 2001, 65 and over TRICARE-eligible beneficiaries became eligible to receive pharmacy benefits for the first time, a benefit not available under Medicare. This benefit also applies to overseas retirees, who will be able to submit claims to TRICARE for their prescription drugs. Beneficiaries may also use the National Mail Order Pharmacy if they have an APO/FPO address. The pharmacy benefit is a substantial one and will mean drastically reduced out-of-pocket costs for all 65 and over retirees.

Beneficiaries who turned 65 prior to April 1, 2001, automatically qualify for the benefit whether or not they have purchased Medicare Part B. (However, they still must have Medicare Part B to be eligible for the TRICARE for Life Benefit.)

All beneficiaries who turn 65 after April 1, 2001, must be enrolled in Medicare Part B to receive the Senior Pharmacy Benefit.

Reduction in Retiree Catastrophic Cap. Another significant benefit for the retiree population is the reduction of the TRICARE Standard Catastrophic Cap from $7,500 to $3,000. A "catastrophic cap" is the upper limit on what must be paid for health care. This applies to the family's annual deductibles and cost-shares for covered medical care received in any one fiscal year. Once this "cap" has been reached, TRICARE Standard will pay the full-billed charges for covered care provided during the rest of the fiscal year. This can drastically reduce the out-of-pocket medical care costs for the retiree.

TRICARE Plus
TRICARE Plus is a program that provides Prime-like access to primary care services at certain military medical facilities. All beneficiaries, except active duty, are eligible to enroll in TRICARE Plus. Availability, however, is not guaranteed; it is based on local capacity and is determined by military medical facility commanders. Further, because availability is locally determined, enrollment cannot be transferred from one military medical facility to another.

TRICARE Plus provides the enrollee guaranteed access to primary care services only. Access to specialty care in military medical facilities is not guaranteed and if an enrollee obtains specialty care in a civilian facility, the applicable TRICARE Standard deductibles and cost shares apply.