Tricare (styled TRICARE ), formerly known as Civil Service and Medical Programs of Uniformed Services ( CHAMPUS ), is health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits to military personnel of the US Army, military retirees, and their dependents, including some members of the Reserve Component. Tricare is a civilian care component of the Military Health System, although historically it also includes health care delivered at military medical care facilities.
The Tricare program is managed by the Defense Health Agency (DHA). Prior to October 1, 2013, it is managed by the Tricare Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). On that date, the TMA was dissolved and Tricare was responsibly transferred to a newly established DHA.
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Histori
Historically, health care for military personnel and their dependents are provided in military medical facilities as promised by the military, and through a referral system, by civilian medical personnel where military doctors are not available in a particular specialty, or when and where the density of a facility military medical takes place.
Active military personnel always have priority for treatment in military medical facilities. After World War II and the Korean War, especially with the growth of US military forces due to the Cold War, access to care at military facilities became increasingly unavailable to retired military and dependents of active duty and retired military personnel due to resource constraints and increased demands on the system. It was at this point that the concept of "space base available" to military retirees and military dependents was first noted. To address this issue, Congress passed the 1956 Deposit Medical Treatment Act and the Military Medical Benefits Amendment of 1966. These actions allowed the Minister of Defense to contract with civilian health care providers. This civilian health care program was known as the Civil Service and Medical Program of Uniformed Services (CHAMPUS) in 1966.
In the late 1980s, due to rising costs, document demands, and general beneficiary dissatisfaction, the DoD embarked on a series of pilot projects. Under a program known as CHAMPUS Reform Initiative (CRI), a contractor provides related health care and administration services, including claims processing. The CRI project is one of the first to introduce managed care features into the CHAMPUS program. Beneficiaries under CRI are offered three options - a health maintenance organization called Tricare (CHAMPUS) Prime that requires registration and offers enhanced benefits and low cost shares, preferred organizational options such as Tricare (CHAMPUS) Extras that require the use of network providers in exchange for a lower cost section, and a standard CHAMPUS option that continues the freedom of choice in choosing a provider but requires a higher cost and deductible section known as Tricare Standard.
Although DOD's initial intention under CRI is to provide three competitive bidding contracts covering six states, only one bid, made by the Health Foundation Corporation (now Health Net) covering California and Hawaii, has been accepted. The Foundation provided services under this contract between August 1988 and January 1994.
At the end of 1993, in response to the requirements of the DOD Elimination Act for Fiscal Year 1994, the Department of Defense announced plans to implement a nationally managed care program for MHS to be fully implemented in May 1997. Under the program, known as the Tricare, United States is divided into 12 areas of health care. An administrative organization, the main agent, is appointed to each region and coordinates the health care needs of all military maintenance facilities in the region. Under Tricare, seven managed care support contracts were awarded covering 12 DOD health care areas.
Since then, Tricare has undergone several restructuring initiatives, including the re-alignment of the contract area, Rearrangement and Basic Closure, and the addition of Tricare for Life benefits in 2001 to those eligible for Medicare, and "Tricare Reserve Select" in 2005.
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Tricare Options
Tricare Standard
Tricare Standard provides benefits similar to the original CHAMPUS program and is available to retirees of Active Components, retired from the Backup Component aged 60 or older, and their eligible family members. Tricare Standard is also available for Reservist and their families under Tricare Reserve Select Component. Under the Tricare Standard, beneficiaries may use any civilian health care provider paid under Tricare regulations. The beneficiary is responsible for annual deductible and coinsurance payments, and may be responsible for certain out-of-pocket costs. There is no registration fee for Tricare Standard.
Tricare Extra
Tricare Standard beneficiaries may choose to use the Tricare Extra option by using a civilian health service provider from within a regional provider network of contractors. In this way, Tricare Extra represents selected provider organizations (PPOs). When using Tricare Extra, the recipient's coinsurance amount is reduced by at least five percentage points. There is no charge for the use of Tricare Extra benefits other than coinsurance.
Tricare Prime
Tricare Prime is a health care organization (HMO) style plan available for active duty personnel, retired from Active Components, retired from the Backup Component aged 60 or over, and their eligible family members. Under Tricare Prime, beneficiaries should choose primary care physicians and obtain referrals and authorizations for special care. In return for these restrictions, beneficiaries are responsible for only small payments for each visit (pensioners and their families only). There is an annual registration fee for Tricare Prime for military retirees and their family members. There is no registration fee for active military duties and their family members. The majority of Tricare PRIME registrants must exclusively use MTF (Military Care Facility) to receive their care, as long as MTF has capacity. If the MTF does not have the capacity, the MTF commander notifies the contractor of the region and the network of the contractor provider used to complete the MTF capacity. If MTF regains capacity, MTF reserves the right to move recipients back to receive their treatment at MTF in a process known as "recapture."
Family Health Plan USA
The US Family Health Plan, Tricare Prime's sponsored health plan option, is provided by non-profit healthcare providers in the Northeast US, Southeast/Southwest Louisiana, and Puget Sound regions of Washington state.
Tricare Reserve Select (TRS)
Tricare Reserve Select is a premium-based health plan whose active status is eligible that National Guard and Reserve members can buy. This classification is sometimes referred to as the Tricare Reserve Component (RC). This requires monthly premiums and offers coverage similar to Tricare Standard and Extra for military members and eligible family members. It has a partial premium cost-sharing arrangement with DoD similar to the plans of private companies or civil government sectors, though usually at a lower cost than a civilian plan. Program coverage is available worldwide for Selected Reserve members (SELRES) of both the 10 Federal Reserve Components of the USC (Reserve of the Army, Navy Reserves, Air Force Reserves, Marine Corps Reserves), Title 14 Federal Reserve Components of USC (Reserve Coast Guard) and Title 32 National Guard (National Guard Army and Air National Guard) in payroll (also known as "paid") status. In February 2008, the staff of the Reserve Components who retired under the age of 60, actively burdening Individual Ready Back (IRR) personnel in unpaid status, or actively charging Volunteer Training Unit personnel (VTU) in nonpayment status are not eligible. for TRS. Members of IRR and VTU eligible for recovery under TRS are back to their SELRES status. Personnel of Reserve Components who are also Federal civil servants (to include Army Reserve Technicians and Air Reservoir Technicians in Army Reserve, National Guard Army, Air Force Reserve and Air Guard) and qualify for the Federal Employee Health Benefit Program (FEHBP )) are also excluded from TRS. Retired personnel of the Reserve Component and eligible family members are eligible to become Tricare Standard, Tricare Extra or Tricare Prime on the 60th anniversary of service members in the same manner as Retired Active Components and their eligible dependents are entitled immediately after retirement from active service. Qualification questions should be referred to Tricare.
Tricare Reserve Retired (TRR)
Tricare Reserve Retired is a premium-based health plan that qualifies retired members of the National Guard and Reserves under the age of 60 can purchase for themselves and eligible family members. Founded in 2008 and opened for registration in 2010, this is similar to Tricare Reserve Select (TRS), but differs in that there is no premium cost sharing with DoD as it exists with TRS. Accordingly, the retired Components of the Reserve member who choose to purchase the TRR must pay the full cost (100%) of the calculated premium plus the additional administrative fee. Payment can reach $ 900.00 a month. While open to all eligible employees of the Eligible Reserve Components under age 60, the program's primary focus is often considered to be focused on retired self-employed or unqualified New Backup Components for provided civilian employers/subsidized health insurance, especially those mobilized for full-time active service after 11 September 2001 to support Operation Enduring Freedom, Enduring Freedom, Iraqi Freedom, New Dawn and/or Noble Eagle. Retired personnel of the Reserve Component who choose to participate in the TRR will exit TRR when service members reach the age of 60 and he and their eligible dependent family members become eligible for the same Tricare Standard, Tricare Extra or Tricare Prime option as retired Active Components and , in the case of Tricare Prime, at the same cost as the Retired Active Component. Qualification questions should be referred to Tricare.
Tricare for Life (TFL)
Tricare for Life was first included as part of a regional Managed Tricare Care Support Contract seven months in May 2001. The benefits are enforced by Congress in response to increased complaints from beneficiaries that Medicare is out of pocket expenses increasing the benefits required to pay these costs in lieu of retired Tricare who is required to purchase Medicare Supplemental Coverage to pay for prescriptions, doctors and medicines distributed in hospitals, stock fees and deductibles. Prior to Tricare for Life, Tricare beneficiaries immediately lost Tricare's coverage after obtaining a Medicare eligibility at age 65, placing them at the same level of coverage as US citizens who have not had a full 20 to 30 year career in the armed forces. This includes being eligible for Medicare due to disability. Tricare for Life is designed to pay the patient's responsibility after Medicare payments. No registration is required for Tricare for Life and to qualify, members must be Tricare and Medicare Eligible and have purchased Medicare Section B coverage. Exceptions to the requirements for Part B coverage when a Medicare qualified beneficiary is a partner of an Active Duty Service Member. In some cases Tricare for Life is the primary payer when service is usually a benefit of Tricare but not covered by Medicare. This includes the cost of drugs, when Medicare meets the limits reached and services performed outside the United States or at the Veterans Affairs facility where Medicare does not pay. TFL does not pay patients liability for services that are not Tricare benefits even though they may be paid by Medicare, such as chiropractic benefits. The policy limits that apply to Tricare also apply to TFL and therefore should be considered necessary medical care and skilled. Therefore custodian care is not covered. In 2004 Tricare for Life benefits were transferred from each of the regional Tricare contractors. Medical claims are processed by the FDI Tricare Double (TDEFIC-Wisconsin Physicians Service Insurance Corporation). Pharmaceutical claims processed by Tricare Pharmacy Contractor (Express Scripts) and Overseas TFL claims are processed by Tricare Overseas Program Contractor (as of September 2010 it will be International SOS using Wisconsin Physicians Service as Fiscal Intermediary partner).
Tricare Young Adults (TYA)
Tricare Young Adult (TYA) is a premium-based health care plan available for purchase by eligible dependents outside of Tricare at age 21, or 23 years old for full-time students. Dependents are eligible if they are not married, do not qualify for Tricare coverage or healthcare coverage sponsored by their own employers, and their sponsors are qualified Tricare.
Eligible dependents have the option to purchase Tricare Standard/Extra health coverage every month. Coverage covered includes medical and pharmaceutical benefits but excludes teeth. Premium Tricare Prime benefits will be available in 2011.
The signing of the National Defense Authorization Act in January 2011 synchronizes Tricare under the terms of the 2010 Patient Protection and Affordable Care Act, and leads to the creation of TYA. Registration begins on May 1, 2011.
Tricare Supplement
In addition to the Tricare option listed above, military retirees may choose the Tricare supplement package. The Tricare supplement is designed to help military retirees and their families save money for unexpected pocket expenses not covered by Tricare. Out of pocket costs that can be reduced by Tricare supplements can include specialists, surgery, and hospitalization. The Tricare supplement plan may benefit Tricare standard beneficiaries covered under the 75/25 plan that does not cover all costs in the event of an unexpected illness or accident.
Program administration
The main organization responsible for the Tricare administration is the US Department of Defense Military Health System, which organizes Tricare Management Activity (TMA). Contracts of Tricare Management Activities with several major health insurance companies to provide claims processing, customer service and other administrative functions to the Tricare program.
Basic structure
Currently, there are three Regional Managed Care Support Contractors (MCSC), Medicare/Tricare Dual Figal Intermediary Contractor (TDEFIC), and Tricare Pharmacy contractor, which manages both Mail Order (TMOP) and Retail Pharmacy (TRRx) pharmacy programs. In addition, some administrative contractors provide quality management, audits, and statistical services.
Dental Insurance
TMA contracts and manages some dental programs.
- United Concordia Dental - as a Tricare Dental Program (TDP)
- Delta Dental - as a Tricare Retiree Dental Program (TRDP)
Health insurance
In 2004, Tricare Management Activity re-aligned the previous twelve territories into three major areas, known as Tricare North, Tricare South, and Tricare West. Services in this region are provided by: North America includes Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin and parts of Iowa (Rock Island Arsenal area), Missouri (area St. Louis) and Tennessee (Ft. Campbell area).
All medical claims are processed ("decided") by subcontractors of the following claims processing:
- North, South and West - PGBA, LLC (BlueCross BlueShield of South Carolina subsidiary)
- Tricare Overseas Claims and Tricare for Life - Insurance Service Company of Wisconsin Underwriters
In 2009, the Tricare Overseas Program contract consolidated the following:
- Overseas registration
- Tricare Overseas claims processing
- Tricare Service Center contracts three areas
- Tricare Global Remote Overseas (TGRO)
- Tricare Puerto Rico Prime
In October 2009 International SOS Assistance, Inc. was awarded a contract to provide comprehensive health care support services to the Department of Defense Tricare Overseas Program.
Effective January 1, 2018 the Tricare area is consolidated into two major areas, Tricare East and Tricare West. Services in this region are provided by:
- East - Humana Military Healthcare Services, Inc. Eastern Region includes Alabama, Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi New Hampshire, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin and parts of Iowa (Rock Island Arsenal area), Missouri (St. Louis) and Texas (excluding El Paso area) li>
- Western - Health Services Clean Federal, LLC Western Region including Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (except St. Louis region), Montana , Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwest corner, including El Paso), Utah, Washington, and Wyoming.
See also
- Health insurance in the United States
References
External links
- Official website
- TRICARE @ Google
Source of the article : Wikipedia
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