One of the major benefits of joining the military as an active duty soldier is the family medical coverage through Tricare and access to zero cost prescriptions at any Military Treatment Facility (MTF).  In addition, any time a National Guard or Reserve soldier is on orders for thirty days or more, he or she is also eligible for these benefits.

Great Resource for National Guard Families

As an Army National Guard wife of ten years, my husband has spent almost a third of his time on active duty status due to deployments, schools and time spent in recruiting.  But in all the time he’s been on active duty, we have not lived anywhere near an Army post and therefore have not had access to a Military Treatment Facility.  Tricare members may use a traditional drugstore pharmacy to fill prescriptions but depending on the types of prescriptions a family needs, the prices can really add up.  Over time, I’ve heard the common complaint of military families saying that prescriptions cost way too much if you are not able to fill them on post.

What is Express Scripts?

A great way to save money on prescriptions if you are covered through Tricare but do not live near a MTF is to use Tricare’s mail order pharmacy: Express Scripts.   Basically, it costs 1/3 of the price to get prescriptions filled. You can order a 90 day supply of a prescription for the same cost as you would pay for a 30 day supply at a drugstore pharmacy.   Even more exciting news is that as of October 1, Express Scripts is offering generics at no cost!

How Do I Sign Up?

Using Express Scripts is very easy to do.  Simply go to www.express-scripts.com to set up a family account.  Once an account is set up all you have to do is print a form and take it with you to the doctor.  The doctor can fill out the prescription section and fax it directly to Express Scripts to fill your order.  If you go to an appointment without the pre-printed form, you can also send a traditional doctor prescription note to Express Scripts in the mail. The company works very quickly to get orders sent out in just a few days.  Another benefit is that you will get email reminders sent to you when it is time to refill a prescription every 90 days.

My family has used the mail order pharmacy program whenever my husband has been on active duty orders.  We have saved a lot of money over the years by using this service.  The only downside is that you have to wait a few days to get your order in the mail so it is not always convenient when someone is sick and needs their medication right away.  But, for anything that is taken on a regular basis I would absolutely recommend Express Scripts!

by Rebecca

Infertility is hard enough to deal with; add in the Army and it can become even more stressful.  My husband and I have been dealing with infertility for a total of 25 months-13 of them have been in the Army.  Here are some helpful hints and an idea of what to expect based on my personal experience.

Always keep the contact information of all of your previous doctors.  You never know when records will get lost so it is helpful to keep a list of your doctors’ names, addresses, phone numbers and fax numbers.  As soon as you get to your new (or first) duty station, be sure that you have all of your records transferred to your new hospital.  Having them there before your first appointment can make things much easier

As soon as you get to your new (or first) duty station, call the on post hospital appointment line and make an appointment with your PCM.  Be sure to tell the appointment scheduler that you have infertility issues and that is the reason that you need to be seen.  Here at our current duty station, there is only one PCM who does infertility workups-it could be the same at other duty stations.   Also, don’t assume that you won’t receive help if you’ve been TTC (trying to conceive) for less than a year.  Due to my history of whacky and painful cycles, we received help in under a year.

When you see your PCM, be clear about what you need and what testing (if any) you’ve had done.  In our case, I’d received Clomid and Pregnyl and had previously completed blood work.  What we had not had was an HSG for me and a SA (sperm analysis) for my husband.  Those tests were ordered before I could receive a referral to an OB/GYN.

In my case, our referral was for an OB/GYN on post and he is wonderful.  Others have not been as fortunate.  If you have a bad/rude/uncaring doctor, try to change doctors.  Infertility sucks and it will suck more with a doctor who is less than good.

After testing, speak with your doctor about options.  Be open with him about what you and your partner want to do.  You need to lose all inhibitions about discussing sex and bodily fluids, trust me on that one.  Expect to travel for IUI and IVF.  A few MTFs do them but not nearly enough.  In our case we are looking at travelling across 5 or 6 states to get treatment.

Be realistic about your expectations but also try to be positive.  This is a difficult journey but remember that you are not alone.  Many couples out there face infertility and many become pregnant.  Remember that sex should be fun, even is you have to schedule it around your ovulation.  I want to punch people when they tell me to relax and not stress-hello, this is stressful people-but they are right.  Infertility puts a tremendous amount of stress on a couple and you need to find ways to relax and enjoy each other like you did before infertility.  For us it’s eating out, going to movies, hanging out with friends at the local watering hole-anything that is not baby related.

I’d hoped to be able to close this article with our happy ending but I can’t do that just yet.  We are still on this journey.  Hopefully one day soon we will have our happy ending and you’ll be able to read it at http://liberalgranolagirl.wordpress.com.Until then, we will have fun practicing.

TIP:
Submit all claims separately; do not bundle multiple claims. Processors manage claims separately, if you send multiple claims in together, a problem with one claim will delay payment on all claims. Choosing the right TRICARE coverage plan for your family is difficult. Each of the three TRICARE options are designed to fit the needs of the individual beneficiary. Understanding the following factors will assist you in determining if TRICARE Standard is your best choice.

Why TRICARE Standard?
TRICARE Standard Features
The Cost – Copays and Deductibles
Getting Help and Hints
TRICARE Standard is the TRICARE option that provides the most flexibility to TRICARE-eligible beneficiaries. It is the fee-for-service option that gives beneficiaries the opportunities to see any TRICARE-authorized provider. TRICARE Standard is not available to active duty service members. Standard shares most of the costs of medically necessary care from civilian providers when military treatment facility (MTF) care is unavailable.

Reasons for Choosing TRICARE Standard:
Beneficiaries who are happy with the treatment they currently receive from a specific civilian provider that may not be in the TRICARE provider network often choose to use TRICARE Standard. Some beneficiaries, especially retirees under age 65 and their families, may live in areas where the TRICARE Prime network is not available, and TRICARE Standard may be their only option. Additionally, retired service members may have employer-sponsored health insurance. TRICARE Standard may be used as secondary coverage for these beneficiaries.

Standard’s Pros – Advantages
Broadest choice of providers
Widely available
No enrollment fee
You may also use TRICARE Extra

Standard’s Cons – Disadvantages
No Primary Care Manager
Patient pays Deductible and Co-payment
Patient pays balance if bill exceeds allowable charge and provider is non-participating (up to 15% additional)
Nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs
Beneficiaries may have to do their own paperwork and file their own claims
Important Note: The Point of Service annual deductible and cost-share amounts do not count toward your enrollment-year maximum out-ofpocket expense, but instead are credited to your fiscal year maximum. There is no limit to the amount of a patient’s responsibility under the POS option.

TRICARE Standard Features:
TRICARE Standard offers greater provider choice. Beneficiaries may choose any TRICARE-authorized provider. TRICARE-authorized providers are not required to participate in the TRICARE network; however, they must be certified as an authorized provider by the managed care support contractor (MCSC) in that region. Beneficiaries should contact their regional MCSC to find a TRICARE authorized provider.

TRICARE Standard allows beneficiaries to self-refer for specialty care. Beneficiaries who choose TRICARE Standard are not assigned a primary care manager, so, in most cases, they are able to see specialists without prior authorization. There are some outpatient procedures that require prior authorization. Beneficiaries should contact their regional contractor for authorization assistance before seeking care.

For inpatient mental health care, pre-authorization and continued stay authorization requirements apply to Residential Treatment Center care, partial hospitalization program care, and alcoholism detoxification and rehabilitation. All beneficiaries should contact TRICARE regional contractors regarding potential limits on length-of-stay at these facilities. TRICARE Standard beneficiaries living in an MTF catchment area must obtain a non-availability statement from their local MTF before being admitted as an inpatient for mental health services.

Costs for TRICARE Standard:
Beneficiaries are responsible for cost shares and deductibles for care that is covered under TRICARE Standard. Providers who participate in TRICARE will accept the TRICARE allowable charge (TAC) as the full fee for services they render. However, non-participating providers may charge up to 15 percent above the TAC for their services, and TRICARE Standard beneficiaries are financially responsible for these additional charges.

A “catastrophic cap” is the annual upper limit a family will have to pay for TRICARE Standard-covered services in any fiscal year. The catastrophic cap for families of active duty service members is $1,000. All others have a catastrophic cap of $3,000. The catastrophic cap applies only to allowable charges for covered services. The catastrophic cap does not apply to services that are not covered, or to the total amount of what nonparticipating providers may charge above the TAC.

Getting Help With TRICARE:
TRICARE Standard has specific rules, and beneficiaries choosing to use TRICARE Standard may need to contact the regional contractor call centers toll free number or a beneficiary counseling and assistance coordinator (BCAC) in their area for assistance. Customer service staff can answer specific questions about health care benefits, billing or claims as well as provide help navigating through the Military Health System. TRICARE Beneficiaries may locate a BCAC online.

Helpful Hints on TRICARE Standard:
Sponsors should ensure their family members have up-to-date uniformed services identification cards, and that they are properly enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).* Note: This form can be found in the Important Forms Section

Beneficiaries may be required to file their own claims when using TRICARE Standard. Beneficiaries may find more information about filing claims and download claims forms on the TRICARE Web site at www.tricare.osd.mil/claims/default.htm.

Although TRICARE Standard beneficiaries have a lower priority for access to care in MTFs than TRICARE Prime enrollees, Standard beneficiaries may attempt to receive their care from an MTF. This will save them money and paperwork.

Beneficiaries will save money by seeking care from a TRICARE network provider. For more information see TRICARE Extra.

TRICARE suggests conducting business online whenever possible, calling during non-peak hours, and visiting TRICARE service centers for face-to-face assistance as ways to beat phone congestion.

TRICARE Prime Remote (TPR) provides healthcare coverage through civilian providers for those U.S. Uniformed Service Members and their families who are on remote assignment. It applies to members of the Army, Navy, Marine Corps, Air Force, Coast Guard, U.S. Public Health Service, and National Oceanic and Atmospheric Administration. You must live AND work more than 50 miles or approximately one hour’s drive time from the nearest Military Treatment Facility. TPR is offered in the 50 United States only.

Permanently assigned active duty members and their families Reserve Component (RC) members and their families

Permanently assigned active duty members and their families:

Members must live AND work more than 50 miles or approximately one hour’s drive time from the nearest MTF.

Active duty family members are eligible to enroll in TPRADFM if they reside with their sponsor in a TPR location and the sponsor is eligible for TPR. The Service member must be eligible for TPR for family members to be eligible for TPRADFM.

Reserve Component (RC) members and their families:

RC members are eligible for TPR if activated for more than 30 consecutive days. Members must live AND work more than 50 miles or approximately one hour’s drive time from the nearest MTF. It is key that you properly register your residence address in DEERS!

RC family members’ eligibility in TPRADFM requires that they and the Service member “reside with” one another in a TPR ZIP code. “Reside with” means that eligible family members resided with the Service member on the effective date of the Reservist’s orders and remain living at the residence. The RC member is not required to be enrolled in TPR for his or her family to enroll in TPRADFM.

TPR provides no-cost healthcare for Active Duty members. A new interim Waived Charges benefit for family members dispenses with out-of-pocket expenses.

http://www.tricare.mil/mybenefit/ProfileFi…s%2FPrimeRemote

Choosing the right TRICARE Plan is a difficult and daunting task. The following information will explain the key factors you need to know to choose the best program for your family. These factors include:

Primary Care Manager
The Point of Service Option
Prime Pros and Cons
TRICARE Cost Comparison
Helpful Hints
TRICARE Prime Enrollment Forms

Note: According to TRICARE all active duty servicemembers are eligible in TRICARE Prime. However they must fill out an enrollment form and submit it to the regional contractor by either filling out the enrollment form. In addition servicemembers receive most of their care from military medical personnel. *Note: These forms can be found in the Important Forms Section.

For active duty families, there is no enrollment fee for TRICARE Prime, however they must complete an enrollment form to select Prime as their coverage plan.

With TRICARE Prime, most health care will come from a military treatment facility (MTF), along with the TRICARE contracted Civilian Medical Providers called Preferred Provider Network (PPN).

Primary Care Manager
Your Primary Care Manager (or team of providers) will see you first for your health care needs. The Primary Care Manager:

Provides and/or coordinates your care
Maintains your health records
Refers you to specialists, if necessary (To be covered, specialty care must be arranged and approved by your Primary Care Manager)
Care is usually provided in a military treatment facility, but civilian clinics may be used in some cases.

TIP: TRICARE Prime members should always seek the advice of their Primary Care Manager (or local MTF) before seeking medical attention from any specialists or other medical facilities.

Point of Service (POS) Option
The POS Option under TRICARE Prime allows enrollees the freedom to seek and receive non-emergency health care services from any TRICARE authorized civilian provider, in or out of the TRICARE network, without requesting a referral from their Primary Care Manager (PCM) or the Health Care Finder (HCF). When Prime enrollees choose to use the POS option, all requirements applicable to TRICARE Standard apply except the requirement for a Nonavailability Statement(NAS).

However POS claims are subject to outpatient deductibles ($300 individual and $600 family), 50% cost-shares for outpatient and inpatient claims, and excess charges up 15% over the allowed amount. The 50% cost-share continues to be applied even after the Enrollment Year catastrophic cap has been met.

TRICARE Prime – Advantages
No enrollment fee for active duty and families
Small fee per visit to civilian providers, and no fee for active duty members
No balance billing
Guaranteed appointments (access standards)
Primary care manager supervises and coordinates care
Away-from-home emergency coverage
Point-of-Service option
Reduced catastrophic cap for retirees ($7,500 now decreased to $3,000)

TRICARE Prime – Disadvantages
Enrollment fee for retirees and their families
Provider choice limited
Specialty care by referral only
Not universally available

TRICARE Prime Summary
Guaranteed access to timely medical care
Priority for care at military hospitals and clinics
Primary Care Manager provides and guides health care delivery
Lowest cost for treatment among three options
Requires enrollment for one year
Retirees pay enrollment fee
Very expensive to receive care outside TRICARE Prime (Point-of-Service Option)
Not available everywhere

Helpful Hints:
Sponsors should ensure their family members have up-to-date uniformed services identification cards, and that they are properly enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).* Note: This form can be found in the Important Forms Section.

Beneficiaries may find that the closest MTF is outside their area. In that case they will be enrolled in TRICARE Prime Remote.

Beneficiaries may be required to file their own claims when using TRICARE Standard.

Beneficiaries may find more information about filing claims and download claims forms on the TRICARE Website.

Although TRICARE Standard beneficiaries have a lower priority for access to care in MTFs than TRICARE Prime enrollees, Standard beneficiaries may attempt to receive their care from an MTF. This will save money and paperwork.

TRICARE Plus is a military treatment facility primary care enrollment program that is offered at selected local military treatment facilities. All beneficiaries eligible for care in military treatment facilities (except those enrolled in TRICARE Prime, a civilian HMO, or Medicare HMO) can seek enrollment for primary care at military treatment facilities where enrollment capacity exists. Non-enrollment in TRICARE Plus does not affect TRICARE For Life benefits or other existing programs.

TRICARE Plus Benefits:

Your primary care manager at the military treatment facility is your principal health care provider.

You may still get care from civilian and/or Medicare providers. TRICARE Standard/Extra or Medicare rules apply. TRICARE will be second payer to Medicare for TRICARE-covered services for beneficiaries who are entitled to Medicare Part A and who have Medicare Part B coverage.

You are not locked into an HMO-like program.

There are no enrollment fees.

You get primary care appointments with the same access standards as TRICARE Prime enrollees.

TRICARE Plus enrollment is noted on your records in the Defense Enrollment Eligibility Reporting System.

TRICARE Plus Limitations:

TRICARE Plus is not available at all military treatment facilities. Local commanders may continue or discontinue TRICARE Plus at their military treatment facilities depending on their capacities, capabilities and missions.

TRICARE Plus is a military treatment facility primary care access program, not a health plan, so it has no effect on civilian provider care, and TRICARE Standard/Extra rules will apply for most enrollees.

TRICARE Plus does not guarantee access to specialty care at the military treatment facility where you are enrolled.

TRICARE Plus is not a portable benefit. Your enrollment at one facility does not guarantee access at another facility.
We encourage TRICARE Plus enrollees to get all their nonemergency primary care at the military treatment facility where they are enrolled.

The local military treatment facility reviews enrollment in TRICARE Plus annually. You may be disenrolled if capacity is no longer available.

For more information about TRICARE Plus, call 1-888-DOD-LIFE (1-888-363-5433), or check the TRICARE Website.

The following link is a printable companion that thoroughly explains the benefits and allowances for National Guard and Reserve Service Members and their Families.

It is an excellent source of information and I recommend printing off a copy and storing in a file where other health information is available.

TRICARE for National Guard and Reserve: Your Passport to Quality Health Care

http://www.tricare.mil/mybenefit/Download/…passport_07.pdf

With this Extra, you don’t have to enroll or pay an annual fee. You do have to satisfy an annual deductible for outpatient care, just as you do under TRICARE Standard. The deductible and cost sharing work the same way for TRICARE Extra. In the TRICARE Extra program, when you receive care from a TRICARE Extra network provider, you get a discount on cost sharing, and you don’t have to file your own claims. You don’t enroll and may use TRICARE Extra on a case-by-case basis just by using the network providers. TRICARE Extra is not available overseas or to active duty service members.

Advantages
Co-payment 5% less than TRICARE Standard
No balance billing
No enrollment fee
No deductible when using retail pharmacy network
No forms to file
You may use also TRICARE Standard

Disadvantages
No Primary Care Manager
Provider choice is limited
Patient pays Deductible and Co-payment
Non availability statement may be required for civilian inpatient care for areas surrounding MTF’s
Not universally available
TRICARE Cost Comparison at a Glance
The following tables provide examples of cost-shares or co-payments for families who use civilian providers and facilities under each of the three TRICARE options. The listed fees are subject to change.

SUMMARY — TRICARE Extra
Choose any doctor in TRICARE Extra network
Less expensive than TRICARE Standard
Still may be expensive
Enrollment not required
Can still seek space-available care in military hospital, but at low priority

Helpful Hint:
Sponsors should ensure their family members have up-to-date uniformed services identification cards, and that they are properly enrolled in the Defense Enrollment Eligibility Reporting System (DEERS).

First, congratulations on the addition to your family. This is an exciting and, as I’m sure I will soon find out, exhausting time in your lives! In order to ensure that the baby is covered under Tricare, there are a few steps that you need to take.

Enroll the baby in DEERS by visiting the closest RAPIDS site (you can search for the closest office by clicking the link). You will need an original birth certificate or hospital proof of live birth as well as a completed Form DD 1172. This will allow the baby to be entered into the system as your newest Army dependent. This will automatically ensure the baby is covered under Tricare Standard at the end of 60 days if you do not do anything else. If you do not register the baby in DEERS within 365 days, the system will show a “loss of eligibility” for the baby.

The baby is covered under Tricare for the first 60 days after birth, regardless of if you enroll him. If you would like for the baby to be enrolled in Tricare Prime, you need to complete a Prime enrollment form and submit it before the first 60 days of the baby’s life pass by. This form can be faxed or mailed. It MUST be done within the first 60 days in order to avoid a lapse in coverage.

If your soldier has a CAC card or a DFAS pin number (for MyPay), the form can be completed online at Tricare’s website. Again, be sure this is done within the first 60 days of the baby’s birth.

Children do not need an ID until they reach age 10. At that time, you can proceed to the nearest office to have their ID made. In the meantime, you will have a separate Tricare insurance card for them since they won’t have an ID to serve in this purpose.

It is helpful to also bring in the newborn’s social security card when you enroll him in DEERS. If you have not received it yet when he is enrolled, he will be assigned a temporary identification number which is valid for 90 days. The parents must supply a social security number before the 90 day window expires or the child will lose coverage until it is provided.

Picture courtesy of Serena Huskey

When your soldier goes to basic training, he will fill out the paperwork for his dependents (wife and children) to enroll in DEERS. This puts you into the Army system and provides healthcare coverage through Tricare. When he enrolls you, you will automatically be enrolled in Tricare Standard. This plan allows you to use physicians off post but you will pay a portion of the costs associated with any visits or procedures.

If you live near a post, Tricare Prime is generally the best deal as your healthcare will be provided at no cost to you. With Prime coverage, you will use the Military Treatment Facility at the closest post. In some cases, this is a hospital and in some cases, it is a clinic. You will be assigned to a Primary Care Manager (PCM) and you will use this doctor for any routine visits. You can still see specialists (civilian, off post) when you are enrolled in Prime but you must obtain a referral from your PCM first. Referrals are not hard to get but sometimes can be time consuming through making the appointment with the PCM and waiting for the referral approval in the mail.

To enroll in Prime, you will need to visit the Tricare office. They will give you a short set of forms to fill out. At the completion of that, you will be given a copy and your paperwork will be processed. Within a week or so, you will receive cards in the mail indicating your Prime enrollment. I’ve never personally had to use these cards – the only one anyone is interested in is your military ID.

You will need to update your enrollment with every move that you make. We only moved 130 miles on our first PCS but I still had to change my enrollment. Do not forget to do this!

For more information on Tricare and the different insurance plans offered, please the Tricare website.