TRICARE Top-6 Issues December 2011 Q1.

I missed a payment for TRICARE Reserve Select and now Im locked out for a year. How do I get a waiver so that I can reenroll?
(TRICARE Regional Office North)

A1. TRICARE Reserve Select (TRS) is a premium-based health plan available world-wide to Selected Reserve members and their family members of the Ready Reserve who are NOT eligible for or enrolled in the Federal employee Health Benefits (FEHB) program (as defined in Chapter 89 of Title 5 U.S.C.) or currently covered under FEHB, either under their own eligibility or through a family member. For more information on TRS, please visit this website: http://www.tricare.mil/mybenefit/home/overview/Plans/LearnAboutP lansAndCosts/TRICAREReserveSelect It is the responsibility of the TRS beneficiary to keep their payments up-to-date for this purchased care program. Under the contractual rules, once a member has failed to pay the premium within the 30 day window, they and their families must be disenrolled and locked out for reenrollment of a period of 12 months. Waivers can only be granted by the TRICARE Regional Office (TRO) of the region where the member resides. Understanding that there are special circumstances which can result in a missed payment the TRO representative reviews these requests on a caseby-case basis and if it is determined to be warranted, can grant either a: 1) retroactive reenrollment provided the member remits all back payments for the period of time covered; 2) waiver of the lockout, allowing the member to reapply for enrollment. Requests for TRS waivers should be directed to the appropriate Regional contractor via telephone or e-mail. Q2. When does TRICARE cover newborn and adopted children?

(TRICARE Regional Office South)

A2. As long as another family member is enrolled in TRICARE Prime, the following are covered: Newborns for 60 days beginning from the date of birth

Adopted children for 60 days beginning from the effective date of the adoption Children with pending adoptions for 60 days beginning on the date of placement of the court or approved adoption agency

Note: Overseas parents have 120 days to enroll a newborn child in TRICARE Overseas Program (TOP) Prime or TOP Prime Remote. To continue TRICARE Prime coverage past the first 60 days, you must enroll your newborn or adopted child in either TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members (TPRADFM) within the initial 60-day period. http://www.tricare.mil/tricaresmartfiles/Prod_824/Newborn_and_Ad opted_Children_Fact_Sheet_508.pdf Q3. My childs father is in the military, my child needs medical care and the father will not help us get it. What can I do?
(TRICARE Regional Office West)

A3. You must understand that TRICARE benefits are based on eligibility which is determined by the uniformed services. Paternity must be established and the child entered into DEERS. If that is not done, the child will not be eligible for benefits. Once paternity has been formally established, it is the sponsors responsibility to update their page 2/DEERS to add dependents. If the sponsor does not do this, is being difficult or refuses then the custodial parent can go to the command (Executive Officer for officers or the Senior Enlisted Leader for enlisted) with the proof of paternity and ask for assistance. Without the proof of paternity, the command will not be able to help with any of this. Due to Health Insurance Portability and Accountability (HIPAA) restrictions all military and civilian health care plans, including the TRICARE managed care contractors, TRICARE Service Centers (TSC), and the Defense Manpower Data Center (DMDC) cannot provide specific information as to the status of children unless the sponsor completes an Authorization for Disclosure of Medical or Dental Information form DD-2870. As noted above, if the sponsor is not working with the custodial parent, they can go to the sponsors command for assistance. 2

Special note concerning TRICARE eligibility and Medicaid: In some cases the sponsor or parent may request TRICARE eligibility be removed for their dependent child because it interferes with the provision of care by state Medicaid programs. Once the sponsor adds a child to his/her record and the child has been deemed eligible and entitled to DoD health care benefits, that entitlement CANNOT be removed to allow the child to receive care under Medicaid. Sponsors and biological parents should have a clear understanding of this entitlement rule before taking the step to add a child as a dependent. Contact your local DEERS office for eligibility determinations. Once eligibility has been established, contact your local TSC for assistance with TRICARE benefits and enrollment. For a list of TSCs, visit your Regional Contractor at their respective website: Region North Contractor HealthNet Federal Services Humana Military Healthcare Services TriWest Healthcare Alliance Contact Info 1-877-874-2279 https://www.hnfs.com/apps/tsclocator/default.aspx 1-888-777-8343 http://hmd.humanamilitary.com/ProvLocator/TSCLocator.aspx 7-888-874-9378 http://www.tricare.mil/westtsc/

South

West

Overseas International 1-888-777-8343 SOS http://www.tricare.mil/overseastsc/ Q4. I am assigned here in CONUS and plan to travel to Asia for vacation with my wife and children (Prime Beneficiaries), what do I need to know?
(TRICARE Area Office Pacific)

A4. First thing to do is get a TRICARE Travel Card which provides all pertinent overseas contact information. The card can be accessed at the following website:

http://www.tricare.mil/tricaresmart/product.aspx? id=568&CID=0&RID=1 Emergency Care In an emergency, go to the nearest emergency care facility. Before you leave the facility, contact International SOS Medical Assistance. If you are admitted, International SOS will coordinate with the facility for payment, as well as determine whether you should be transferred to another facility and coordinate emergency transport, if needed. Urgent & Routine Care If traveling overseas and you need urgent care, contact International SOS in the area where you are traveling for assistance finding a host nation provider. Be sure to contact your primary care manager and/or regional contractor as soon as possible after care is received overseas. Remember, routine care is not normally authorized, so try to obtain all routine care before you travel or after you get home. ISOS Pacific: Singapore: +65-6338-9277 or visit: http://www.tricare-overseas.com/Beneficiaries.htm Q5. Who should I contact if my provider / hospital say that I need to pay them upfront but they were listed as a network provider/ hospital?
(TRICARE Area Office Latin America/Canada)

A5. This pertains only to Prime beneficiaries, Active Duty and Active Duty Family Members; they should contact ISOS for either clarification on the providers status in the network or for a guarantee of payment. This can be done through the ISOS Regional Call Center: 1-215-942-8393 Q6. How should I submit a compliment or grievance about service received by the TRICARE Overseas Contactor (TOP), International SOS?
(TRICARE Area Office Europe/Asia)

A6. If you have a compliment, complaint, or grievance you would like to share with the TOP Contractor, International SOS, you may use the TRICARE Overseas Program-Universal Grievance and Complaint Form. This form can be found at www.tricare4

overseas.com/PDF/UniversalComplaintGrievanceForm.pdf. Use of this form allows International SOS to conduct an official investigation with feedback to the involved beneficiary as well as the TRICARE Area Offices and TRICARE Management Activity. The use of this form and reporting process is highly encouraged and provides a clear level of visibility for compliments as well as grievances. The mailing address for form submission is at the top of the form itself.