TRICARE

TRICARE NEWS

What’s a TRICARE Qualifying Life Event?

July 13, 2020

A Qualifying Life Event (QLE) is a certain change in your life, such as moving, marriage, birth of a child, or retirement from active duty. This means TRICARE health plan options for you and your family may change. Learn how certain life events may change your TRICARE health plan options. 

Download the new TRICARE Qualifying Life Events Fact Sheet.

The new fact sheet includes:

  • A list of TRICARE QLEs
  • What your options may be following a QLE
  • Information on automatic enrollment

Download the TRICARE Qualifying Life Events Fact Sheet and browse our other TRICARE publications at www.tricare.mil/publications.

Retiring from the National Guard or Reserve?

July 1, 2020

Are you a National Guard or Reserve member who has retired or is about to retire? When you retire from the National Guard or Reserve, your TRICARE coverage changes. Learn how TRICARE options may change for you and your family and what you must do.

Download the new TRICARE Retiring from the National Guard or Reserve brochure.

The brochure covers what your TRICARE options are when you are::

  • Under age 60
  • Ages 60 through 64
  • Age 65 and older

You’ll also learn about pharmacy coverage and voluntary dental and vision coverage.

Download the TRICARE Retiring from the National Guard or Reserve brochure and browse our other TRICARE publications at www.tricare.mil/publications.

Packing Up and Moving with TRICARE

July 1, 2020

Does your family have permanent change of station, or PCS, orders to move to a new location this summer? According to the Department of Defense (DoD) website Move.mil, the DoD moves more families than any other organization in the U.S. Whether you’re moving on government orders or on your own, you may have a lot of questions, including what will happen to your health care. 

To learn more, read the article

TRICARE FAQs: COVID-19 and Quarantine

June 29, 2020

As you continue to do your part to slow the spread of the coronavirus, you may have questions about your TRICARE benefit. You can find answers to your frequently asked questions (FAQs) and more on the TRICARE Coronavirus FAQs page. The following are some of the most frequently asked questions about quarantine and COVID-19. 

To learn more, read the article.

Here’s another article that you may be interested in:

The Role of Data in the War Against COVID-19 

In the war on COVID-19, the Department of Defense will rely on future development of vaccines and treatments as weapons in its arsenal. Data sets that inform decisions and improve care serve as a key component toward this effort. The staff at the Joint Trauma System at Joint Base San Antonio-Fort Sam Houston, Texas, lead that effort. 

To learn more, read the article

TRICARE BENEFITS

1. Understanding Your TRICARE Explanation of Benefits  
2. What You Need to Know about Filing a TRICARE Medical Claim
3. What is a TRICARE Qualifying Life Event?
4. Get to Know Your TRICARE Prime Plan
5. TRICARE For Life

6. TRICARE Provider Types
7. Continuing TRICARE Health Coverage after Retirement

8. Now Enroll Your Family in a TRICARE Plan Online Using milConnect
9. Moving with TRICARE

10. Updating other health insurance (OHI)
11. Retiring from active duty status retro enrollment
12. TRICARE Young Adult for young adults
13. TRICARE Catastrophic Cap Reimbursement

14. On Vacation with the Military Health System (MHS)
15. Be Disaster Prepared With TRICARE
16. TRICARE and Your Vision Options
17. Filling Prescriptions With TRICARE: You’ve Got Options
18. DHA Begins to Exclude Some Drugs from Coverage
​19. TRICARE Expands Coverage for Breast Cancer Screenings
20. Your TRICARE Payment Options​
21. Telehealth Benefits in Medicare/TRICARE
22. Catastrophic Cap Credit for Some TRICARE Households

1. TRICARE Explanation of Benefits 

If you’ve ever visited the doctor or hospital and used your health benefits, you’ve probably received an explanation of benefits (EOB). An EOB is sent after the claim for your visit is processed. It’s an itemized statement that breaks down the cost-shares and deductibles. While an EOB isn’t a bill, it’s still an important document to read through and understand.

​Medical

Your EOB will include the date you received the medical treatment or service, along with several amounts. This includes the amount billed, the amount covered, and the amount paid by TRICARE, Medicare, or other health insurance. It will show any balance you owe your provider. It will also let you know how much has been credited toward your annual deductible and catastrophic cap.
Each time you receive an EOB, compare it to the receipt or statement from the health care provider. Contact your primary insurance claims processor if you see charges for services you didn’t get. And keep your EOB statements with your health insurance records for reference. After reviewing your EOB, you can:


• Appeal certain decisions about your claims.  If you don’t agree with a decision made about your benefit.

• File an appeal within 90 days of the date of the EOB notice.

TRICARE regional and overseas contractors don’t mail EOBs to you. EOB statements are available online on your TRICARE regional or overseas contractor website. You must first log in or register on their secure portal to get access to your EOB statements online. After you log in, you can then view and print your TRICARE EOB. This gives you access to your information anytime. To get to your regional or overseas contractor website, select a link below:


• TRICARE West; https://www.tricare-west.com/content/hnfs/home/tw/bene/claims.html 

• TRICARE Overseas Program; http://www.tricare-overseas.com/beneficiaries/claims 

• TRICARE For Life  

https://www.tricare4u.com/wps/portal/tdb/tricare4u/home/!ut/p/z1/04_Sj9CPykssy0xPLMnMz0vMAfIjo8ziAzw8zDwMLQx8LAJdDQwczSwMvQINnY0tDMz0w8EKDHAARwP9KGL041EQhd_4cP0osBIjdwNPDwMDQ28Dd5CEkbOrWUigr7GLhRFUAR4zCnJDIwwyHRUB-da56A!!/dz/d5/L2dBISEvZ0FBIS9nQSEh/ 
TRICARE contractors don’t issue an EOB to you when claims involve services related to certain sensitive diagnoses. To learn more about this, contact your TRICARE regional or overseas contractor.

Pharmacy

Your pharmacy EOB statement is a summary of your prescription claims history when you use your TRICARE pharmacy benefit. Express Scripts, the TRICARE Pharmacy Program contractor, will send you an EOB only if there’s claim activity from a retail pharmacy or TRICARE Pharmacy Home Delivery. If you only fill your prescription at a military pharmacy, you won’t receive an EOB.
Pharmacy EOB statements are printed and mailed quarterly. However, if you sign up to receive your EOB online, you’ll get a monthly notification when it’s ready. You’ll also be able to view your statements online anytime. To register online, follow the instructions on the Express Scripts website.

Dental

​If you’re enrolled in the TRICARE Dental Program (TDP), you’ll receive a Dental Explanation of Benefits (DEOB) from United Concordia Companies, Inc. that explains what was covered for your dental services. The DEOB breaks down the costs for the procedures and helps you understand how much you have to pay in cost-shares if any. You can view your DEOB on the TDP website. Find more about a DEOB in the TRICARE Dental Program Handbook.

Remember, an EOB and a DEOB are not bills. These statements simply show you what action TRICARE has taken on your claims. For more information related to an explanation of benefits, visit the Filing Claims section. To learn more about your health care costs, visit Costs on the TRICARE website.

2. What You Need to Know about Filing a TRICARE Medical Claim

Did you visit your doctor recently? If you visited a TRICARE network provider, in most cases, your provider will file a claim for you after the visit. In some cases, you may have to pay for health care services upfront and file your own claim to get money back. It’s important to know when you need to file a claim and how to do so.

A claim is a request for payment from TRICARE that goes to your regional contractor after you get a covered health care service. If you also have Medicare, the claim will go to a Medicare contractor.

When Do I Need to File My Own Claims?:
If you’re enrolled in TRICARE Prime or TRICARE Prime Remote, you usually don’t need to file claims for health care services. In most cases, your provider will file claims for you. If you’re enrolled in TRICARE Select, network providers will file claims for you. But if you get care from a non-network provider, you may have to file your own claims. You should also expect to file your own claims to get money back if you have TRICARE Overseas Program (TOP) Select. If you’re unsure about how your claims will be filed, check with your provider to find out if you need to submit a claim after receiving care. You don’t need to file claims when using the US Family Health Plan.

Typically, you must file your own claim if: 
*  You receive services from a non-network provider or pharmacy or use a civilian pharmacy overseas.
*  You get care outside of the U.S. or overseas. (There are exceptions overseas depending on your health plan and the type of provider you see.)
*  You use TRICARE For Life (TFL) and get care from a Medicare non-participating provider. 
*  You have other health insurance in addition to TRICARE, such as Medicare or employer-sponsored health insurance. 
*  TRICARE supplements don’t qualify as “other health insurance.” (OHI) in addition to Medicare and TFL.           
*  Your claim must include all the required information when you file it.

How do I File a Medical Claim?:
For all stateside claims, download and submit your completed medical claim form (DD Form 2642) and supporting information (for example, a copy of the provider’s bill) to your TRICARE regional contractor. Do this as soon as possible after you receive care.

For overseas claims, submit the claim form and proof of payment to the TOP claims processor in the region where you received care. You may file overseas claims online through the secure claims portal on the TOP website. Video tutorials are also available to help guide you through the overseas claims process.

If you have TRICARE For Life, TRICARE pays last after Medicare and other health insurance. If you do have OHI in addition to Medicare and TFL, submit DD Form 2642, a copy of your provider’s bill, Medicare Summary Notice, and OHI explanation of benefits to the TFL contractor, Wisconsin Physicians Service – Military and Veterans Health (WPS). If you get care overseas, TFL is the primary payer, unless you have OHI. You should also file claims in the overseas area where you received care. Visit the claims section in the TRICARE For Life Handbook for more details about filing health care claims stateside and overseas. Claims filing instructions for TFL are also available on the WPS website.

When Should I Submit Claims?:
File claims as soon as possible to help avoid delays in payment. In the U.S. and U.S. territories, you must file your claim within one year of the date that you received medical services. Overseas, you need to file your claim within three years. Remember, you’ll need to submit a proof of payment with all overseas claims.

Avoid Delays in Processing Your Claim:
To avoid delays, follow these claim filing tips to help you fill out the claim form correctly and attach all required documents. Remember, you can always contact your claims processor or regional contractor for help with filing a claim, to check a claim status, or to get more information about denied claims.

In most cases, you don’t have to file your own health care claims; your provider will file the claim for you and you’ll be able to view your explanation of benefits online. Learn more about how to file medical claims and check the status of claims on the TRICARE website. You can also review the claims process for pharmacy claims and dental claims.

3. What is a TRICARE Qualifying Life Event?
 
Every year during TRICARE Open Season, you can enroll in or change your TRICARE Prime or TRICARE Select health plan. But did you know that outside of TRICARE Open Season, you can only enroll in or make changes to your TRICARE Prime (including the US Family Health Plan) or TRICARE Select plan following a Qualifying Life Event(QLE)? A QLE is a certain change in your life, such as marriage, birth of a child, change of address, or retirement from active duty. Different TRICARE health plan options may be available to you and your family members after a QLE.

Options Following a QLE:
Following a QLE, you and your family members have three options depending on your situation: 

       
If you wish to continue your current coverage following a QLE and remain eligible for your current health plan, you don’t need to take action. Your coverage will continue uninterrupted.

If you want to make a change to your health plan enrollment, you have 90 days following the QLE to make any eligible changes.

If you’re eligible for TRICARE but not enrolled in a TRICARE plan, you have 90 days following the QLE to enroll in a health plan. If you or your family members aren’t enrolled in a health plan and don’t enroll in one within 90 days of a QLE, you’ll only be eligible for care at a military hospital or clinic if space is available.


Remember, a QLE for one family member creates a QLE for all family members.

Examples of QLEs:
What counts as a QLE? There are different types of TRICARE QLEs, including military changes, family changes, and government-directed changes. Many of them revolve around changes in job, location, or family status. Some common examples of TRICARE QLEs include:

  • Change in sponsor status that results in ineligibility to continue existing coverage. This includes retiring from active duty, separating from active duty, activating, or deactivating.
  • Change in family composition. This includes getting married or divorced, giving birth, adopting a child, placement of a child by a court in a member’s home, and more.
  • Moving. This includes moving to a new state, a new Zip code (plus four), a child moving away to college, and more.
  • Losing sponsor or family member eligibility. This includes when a Retired Reserve member turns 60 or when the sponsor or any dependent turns age 65, and become eligible for Medicare.           


What to Do Following a QLE:
With any QLE, the first step is to update your or your family member’s information in the Defense Enrollment Eligibility Reporting System (DEERS). You must update DEERS before you contact TRICARE to make the change. Depending on your QLE, you may need to provide official documents, like a birth or marriage certificate, to update DEERS. Find your nearest ID card office and call ahead to make an appointment or to verify which documents you need to bring. 

Once your change shows in DEERS, you can then enroll or change your TRICARE coverage. You may make eligible health plan enrollment changes online, by mail, or by phone. Enrollment must be within 90 calendar days of the date of the QLE. Coverage starts on the QLE date. Enrollment fees, if required, begin on the QLE date, not the date the enrollment request is submitted. Once you enroll, your TRICARE regional contractor can confirm your enrollment.

Making Enrollment Changes When You Don’t Have a QLE:
If you and your family don’t experience a QLE, you can only enroll in or make changes to your TRICARE Prime or TRICARE Select health plan during the annual TRICARE Open Season. QLE and open season enrollment rules apply only to TRICARE Prime and TRICARE Select. Premium-based plans (TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program) offer continuous open enrollment throughout the year. However, keep in mind that certain QLEs may mean you or your family members may become eligible for TRICARE Prime or TRICARE Select (for example, when a Selected Reserve member is called to active duty for more than 30 days).           

Life changes are inevitable. When they occur, your TRICARE health options may change too. Knowing how to navigate QLEs with TRICARE can help you take command of your health and the health of your family this year. For more information about QLEs and the impact they may have on you or your family, visit Qualifying Life Events; <https://tricare.mil/lifeevents 

4. Get to Know Your TRICARE Prime Plan

TRICARE Prime is similar to a health maintenance organization, or HMO, plan. This means you get most of your care from an assigned or selected primary care manager(PCM). This PCM refers you to specialists for care that he or she can’t provide and works with your TRICARE regional contractor (Health Net/1-844-866-9378/www.tricare-west.com) for referrals and authorizations. Depending on where you live and your sponsor’s status, other TRICARE Prime options include:
* TRICARE Prime Remote
* TRICARE Overseas Program (TOP) Prime
* TOP Prime Remote
* US Family Health Plan

TRICARE Prime differs from TRICARE Select, the other TRICARE enrollment health plan. In general, TRICARE Prime offers lower out-of-pocket costs than TRICARE Select, but fewer personal choices for providers.

Who can enroll in TRICARE Prime?
If you’re on active duty, you’re automatically enrolled in TRICARE Prime. Active duty family members (ADFMs), retirees, and retiree family members may also enroll in TRICARE Prime. In overseas locations, TOP Prime is available to active duty service members (ADSMs) and their command-sponsored family members.

How do you get care with TRICARE Prime?
Under a TRICARE Prime option, you’ll get most of your routine care from your PCM. If you need specialty care, you’ll generally need to coordinate this with your PCM. Certain services require a referral and prior authorization.

If you see a specialist without a referral from your PCM, you’re using the point-of-service option. With the point-of-service option, non-ADSMs can see any TRICARE-authorized provider An authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. without a referral. This means that you’ll pay more money to get non-emergency health care from any TRICARE-authorized provider without a referral. ADSMs can’t use the point-of-service option.

What are the costs with TRICARE Prime?
TRICARE Prime generally has the lowest out-of-pocket costs of all the TRICARE health plans. ADSMs and ADFMs pay no deductible and generally have no costs for TRICARE covered services.

Enrollment Costs:
ADSMs, ADFMs, and transitional survivors have no enrollment fees. Retirees, their families, and others pay annual enrollment fees.

Costs for Covered Care:
ADSMs pay no out-of-pocket costs for covered health care services from a PCM, or with the appropriate referral and prior authorization. ADFMs pay no out-of-pocket costs for covered health care services from a TRICARE network provider in their enrolled TRICARE region, or with the appropriate referral and prior authorization.

Retirees pay copayments or cost-shares for covered health care services from network providers in their enrolled TRICARE region. Out-of-pocket costs are limited to the catastrophic cap amount for that calendar year. For more cost details, check out the TRICARE Costs and Fees Sheet and TRICARE Prime costs. You can also use the TRICARE Compare Cost Tool to compare current plan costs.

Getting to know your TRICARE Prime plan will help you make informed choices and take command of your health this year. To learn more about your health plan and key features, visit TRICARE Prime and download the TRICARE Plans Overviewhttps://tricare.mil/Publications .

5. TRICARE For Life

TRICARE For Life is Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B. 

*   Enrollment not required.
* Coverage is automatic if you have Medicare Part A and B.
* You must pay Medicare Part B premiums.

Available worldwide:
* TRICARE pays after Medicare in the U.S. and U.S. Territories
* TRICARE is the first payer in all other overseas areas

Who Can Participate?
TRICARE-eligible beneficiaries who have both Medicare Part A and B can use TRICARE For Life.

Not sure if you’re eligible? Check out the Eligibility Page for details; <https://tricare.mil/Plans/Eligibility

How it Works:
* You may visit any authorized providerhttps://tricare.mil/FindDoctor/AllProviderDirectories/Medicare  
* Your provider files your claims with Medicare. 
* Medicare pays its portion and sends the claim to the TRICARE For Life claims processor. 
* TRICARE For Life then pays the provider directly for TRICARE-covered services. 
* You won’t receive a TRICARE wallet card, all you need is your Medicare card and military ID as proof of coverage.
* You can get care at military hospitals and clinics, but only if space is available. Find a Military Hospital or Clinichttps://tricare.mil/FindDoctor/mtf 

What You Pay:
You don’t pay any enrollment fees, but you must pay Medicare Part B monthly premiums. Your Part B premium is based on your income.

For more information about Part B premiums:
Visit the Medicare websitehttps://www.medicare.gov/   
* Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)

If you’re looking for what Medicare pays for services covered by Medicare and TRICARE, check out the TRICARE For Life Cost Matrix. You’ll pay nothing out of pocket for services covered by both Medicare and TRICARE. View TRICARE For Life Costshttps://tricare.mil/Costs/HealthPlanCosts/TFL

TRICARE For Life Contractors:
The TRICARE For Life contractors assist with claims and provide customer service to all beneficiaries using TRICARE For Life.
* In the U.S. and U.S. Territories: Wisconsin Physicians Service (WPS)
* All other overseas areas: International SOS

Is TRICARE For Life Right for You?

TRICARE For Life is the plan for you if:
* You’re eligible for TRICARE
* You have both Medicare Part A and B
* Coverage is available worldwide and you can see any provider you want. However, you’ll pay more if you get care from Veteran’s Administration providers or providers who opt-out of Medicare, because they’re not allowed to bill Medicare. 

When retired service members and their families become eligible for TRICARE For Life, typically at 65, they are no longer able to enroll in TRICARE Prime.

6. TRICARE Provider Types

When you need care, you can visit several types of providers. Depending on where your provider is located, you may seek care at a military hospital or clinic or from your TRICARE-authorized provider.

When seeking care outside a military hospital or clinic, your ability to choose a provider may depend on your TRICARE plan, whether you need a referral, and the type of careyou need. Seeing TRICARE-authorized providers saves you money and ensures quality treatment. There are different types of TRICARE-authorized providers. The type you see can affect how much you pay and how you file claims.

TRICARE-authorized Providers:
A provider must be TRICARE-authorized for TRICARE to pay any part of your claim. If you see a provider who isn’t TRICARE-authorized, you’re responsible for the full cost of care. The TRICARE regional contractors have established networks of providers. If stateside or overseas, use the Find a Doctor tool to find a TRICARE-authorized providerClick to closeAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network.. The overseas provider search tool is another way to find a provider abroad. Search the preferred-provider network if you live in the Philippines. There are two types of TRICARE-authorized providers. They include network and non-network.

Network Providers:
Network providers have signed an agreement with your regional contractor to provide you care. They file claims for you and accept TRICARE payment as the full payment for covered health care services.

Sponsor status and location plays a role in determining what overseas options you may have. If overseas, TRICARE network providers have an agreement with the overseas contractor. They agree to provide cashless and claimless services to those in TRICARE Overseas Program (TOP) Prime and TOP Prime Remote. But these providers don’t have to file claims for those in TOP Select. Check with your TOP Regional Call Center before visiting a civilian provider.

Non-network Providers:      
Non-network providers don’t have a signed agreement with your regional contractor. This makes them out of network, also known as non-network. There are two types of non-network providers. They include participating and nonparticipating.

Participating Providers:
Among non-network providers, using a participating provider is your best option. These providers file claims for you and accept TRICARE payment as the full payment for any covered health care services.

Outside the U.S. and U.S. territories, participating non-network providers don’t have an agreement with the overseas contractor. They may provide cashless and claimless services to TOP Prime and TOP Remote beneficiaries. But they don’t have to submit claims on behalf of TOP Select beneficiaries.

Nonparticipating Providers:           
Nonparticipating providers don’t file claims for you. They also don’t accept TRICARE payment as the full payment for covered services. Because of these reasons, you should expect to pay the provider first and file a claim with TRICARE to get money back. If stateside, these providers may charge you up to 15 percent above the TRICARE-allowable charge Click to close the maximum amount TRICARE pays for each procedure or service.  This is tied by law to Medicare’s allowable charges. for services. You’re responsible for paying this amount as well as applicable patient costs.

If you visit a nonparticipating non-network provider overseas, there may be no limit to the amount that a provider may bill you. You’re responsible for paying any amount that exceeds the TRICARE-allowable charge.

Understanding TRICARE provider types will help you get quality health care, save money, and take command of your health. To learn more about your provider options outside of your military hospital or clinic, visit Provider Types. 

To visit a provider in your area, search the provider directorieshttps://tricare.mil/FindDoctor/AllProviderDirectories 

7. Continuing TRICARE Health Coverage after Retirement
 
When you retire from active duty or turn age 60 as a retired reserve member, your TRICARE coverage changes. After either of these Qualifying Life Events (QLEs), you must take action and enroll in a TRICARE retiree health plan so that you and your family members don’t have a gap in your TRICARE coverage after retirement. Typically, you have up to 90 days after your retirement date to enroll in a TRICARE plan as a retiree. If you don’t, you and your family members will only be able to get care at a military hospital or clinic if space is available.

Each service is responsible for updating the Defense Enrollment Eligibility Reporting System (DEERS) with your retirement date. Until that date is posted to DEERS, you can’t enroll in a retiree TRICARE plan. In some cases, the retirement date doesn’t show up in DEERS until days or even months after you’ve retired. For the time being, the Defense Health Agency (DHA) is allowing retiring members and their eligible family members up to 12 months from their retirement date or turning age 60 (for retired reserve members).

“This 12-month period is longer than the standard QLE period of 90 days,” said Mark Ellis, TRICARE Select Program Manager, DHA. “This allows plenty of time to update DEERS and enroll in a TRICARE health plan as our new retirees adjust to civilian life.”

Coverage must begin effective the day after you ended your previous TRICARE coverage, and any TRICARE enrollment fees must be paid retroactively to that date.

Continuing TRICARE health care coverage isn’t automatic following these QLEs. If you don’t enroll in a plan after retiring from active duty or turning age 60, you’ll lose TRICARE coverage and only be able to receive care at military hospitals and clinics if space is available. After the 12-month period, you may only enroll in or make changes to your health plan during the annual TRICARE Open Season or following another QLE.

You’ll need to make sure you update your and your family’s information in DEERS. You and your family members will also need new identification cards upon the sponsor’s status change. No matter when you enroll within the 12-month period, coverage begins on the first day of your retirement and you must pay all enrollment fees back to that date.

Retiring from Active Duty
If you’re retiring from active duty, you previously paid nothing out of pocket and your family’s costs were minimal (if covered under TRICARE Select). As a retiree, you’ll now pay retiree costs for care. Depending on the retiree TRICARE health plan you choose, you may see an increase in your enrollment fees, deductibles, copayments, cost-shares, and other fees.

Retired Reservists Turning Age 60
If you’re a retired reserve member who turns age 60 and was enrolled in TRICARE Retired Reserve (TRR), your TRR coverage ends the day you turn age 60 and become eligible for TRICARE Prime or TRICARE Select coverage. You must have your retirement fully completed with your service personnel office or command. This means your retirement pay is processed and activated with the Defense Finance and Accounting Services.

To confirm your retired status is properly reflected in DEERS, visit; https://www.dmdc.osd.mil/milconnect  or call the DEERS Support Office (1-800-538-9552). Once DEERS is accurate, enroll in a TRICARE health plan based on your residence within 12 months from your 60th birthday. As a retiree, you’ll pay retiree costs such as enrollment fees, deductibles, copayments, and cost-shares.

Learn more about retiring with TRICARE by downloading the Retiring from Active Duty Brochure and Costs and Fees Sheethttps://www.tricare.mil/publications  

Take command of your health and understand your benefits before you retire.  

8. Now Enroll Your Family in a TRICARE Plan Online Using milConnect
 
Staying current on how to enroll in TRICARE health and dental programs will help you and your family get the most out of your TRICARE coverage. Online enrollment through Beneficiary Web Enrollment now takes place through milConnect at https://milconnect.dmdc.osd.mil 

You can enroll or change enrollment online.

To enroll online, follow these steps:

  • Sign into milConnect.
  • Click on the “Benefits” tab at the top of the page.
  • Select “Beneficiary Web Enrollment (BWE)” from the menu.


And remember, you can only enroll in or change enrollment in TRICARE Prime or TRICARE Select options following a Qualifying Life Event or during TRICARE Open Season.

Visit the TRICARE website for more information on milConnect features.   

9. Moving with TRICARE

Are you and your family moving? 

Moving doesn’t change your TRICARE eligibility. But it may change the TRICARE health care options available to you and your family. A change of address, such as moving to a new country, city, region, or ZIP+4 code is a TRICARE Qualifying Life Event (QLE). This QLE means you have 90 days from the date of your address change to enroll in or change your TRICARE Prime or TRICARE Select health plan based on your eligibility or plan availability in the new location.

A QLE lets you enroll in or change your TRICARE health plan outside of the annual TRICARE Open Season. When a QLE happens for one family member, it creates a QLE for the entire family. This means all family members may be able to switch TRICARE health plans when one person in the family has a QLE.

Before you move:

  • Don’t disenroll from your current health plan. Your current coverage will continue until your enrollment transfer is completed after you arrive at your new location.
  • Contact your current regional contractor about your upcoming move, so they can begin transferring your enrollment.
  • Learn about TRICARE options in your new location. Use the TRICARE Plan Finder to see what plans are available and what you and family members may qualify for.


After you move:

  • Update your address and other new information in the Defense Enrollment Eligibility Reporting System (DEERS).
  • If you want to make changes and you’re eligible to do so, you may change the TRICARE health plan for you or your family members.
  • If you make changes to your health plan, the effective date will be the date your address change is effective in DEERS.
  • Tell your regional contractor and doctors if you have other health insurance (OHI) besides TRICARE. TRICARE pays after most other health insurance
  • Health insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as “other health insurance.”. OHI doesn’t apply to active duty service members (ADSMs).


For a Stateside Move:
If you’re enrolled in TRICARE Prime and moving to another Prime Service Area within the U.S., you can transfer your TRICARE Prime enrollment. Depending on how far you move from your current home, you’ll likely need to change your primary care manager.

TRICARE Prime isn’t available everywhere. You can use the TRICARE Plan Finder to see if TRICARE Prime is available in your area. If you’re moving to an area where TRICARE Prime isn’t available, the QLE will allow you to change your enrollment. (ADSMs may only use TRICARE Prime.)

If you’re enrolled in TRICARE Select or a premium-based plan (TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult Select, and the Continued Health Care Benefit Program), update your personal information in DEERS. Then find a new TRICARE-authorized network or non-network provider in your new location. Using a TRICARE network provider will help keep your out-of-pocket costs lower.

For an Overseas Move:
Before you move, call the TRICARE Overseas Program (TOP) Regional Call Center for your new area. Although retirees and their family members aren’t eligible for TOP Prime options, they may be eligible for TOP Select. Only active duty family members who are command-sponsored may enroll in TOP Prime or TOP Prime Remote.

10. Updating other health insurance (OHI)

Keeping your OHI up-to-date with HNFS will help to avoid delays in claims payments. Simply log in to your secure portal at www.tricare-west.com to update your OHI in a few simple steps. If you do not have a login, you can also complete the TRICARE Other Health Insurance Questionnaire and send it into HNFS. Updates submitted online are processed within three business days, while updates using the form are processed within 30 business days. Losing or gaining OHI is a QLE. Learn more at www.tricare.mil/LifeEvents/Losing-or-Gaining-OHI.
 
11. Retiring from active duty status retro enrollment

When you retire from active duty service or turn 60 as a retired reserve member, you must enroll in a TRICARE plan as a retiree to avoid a gap in coverage. DHA is allowing retiring members and their eligible family members up to 12 months from their retirement date or turning age 60 (for retired reserve members), to enroll in a TRICARE plan.
 
12. TRICARE Young Adult for young adults

Dependents of an eligible sponsor will age out of TRICARE at age 21 (age 23 for full-time college students). As this is considered a QLE, the young adult and/or sponsor will have 90 days to change or select a new TRICARE plan. Qualifying young adults can purchase TRICARE Young Adult, which is an option for unmarried, young adult dependents under age 26 who are not eligible for other TRICARE coverage.

13. TRICARE Catastrophic Cap Reimbursement 

The Defense Health Agency (DHA) Director, Vice Adm. Raquel Bono and senior military medical personnel are working to correct an error with the implementation of recent TRICARE changes which resulted in retiree enrollment fees not being credited to the family catastrophic cap. To rectify the overpayment, DHA has sent out letters to affected beneficiaries that indicates they can be refunded or credited to future enrollment fees. 

14. On Vacation with the Military Health System (MHS)

Instead of waiting or worrying, use the Military Health System (MHS) Nurse Advice Line and get advice from a registered nurse anytime.

A registered nurse is available 24/7 to:

  • Answer your health care questions
  • Assess your symptoms and provide recommendations for the most appropriate level of care
  • Provide evidence-based instructions to treat minor ailments at home
  • Help locate an urgent care or emergency care facility
  • Help you schedule an appointment within 24 hours at a military hospital or clinic, when recommended by the nurse, and if enrolled at a military hospital or clinic


To reach a nurse, visit the MHS Nurse Advice Line website to begin a secure web chat or video chat. You can also call and speak to a nurse. If you’re in the U.S., Guam, or Puerto Rico, call 1-800-TRICARE (1-800-874-2273) and choose option 1. For all other country-specific phone numbers, visit the website.

The MHS Nurse Advice Line is only available to TRICARE beneficiaries living or traveling in the U.S. or a country with an established military hospital or clinic. There’s no cost to you. If you’re enrolled in the US Family Health Plan; however, there’s a different resource for you to use for 24/7 assistance.

Remember, the MHS Nurse Advice Line isn’t for emergencies that threaten life, limb, eyesight, or safety, or that requires immediate medical assistance. If you reasonably think that you have an emergency, call 911 or your local emergency service center immediately. Or, go to the nearest emergency room. 

15. Be Disaster Prepared With TRICARE

Weather events and natural disasters are, by nature, unpredictable. But you can predict what you should do before, during, and after an emergency. Being prepared for events like wildfires, floods, and hurricanes can help keep you and your family safe. A disaster may change access to your TRICARE benefit, prescriptions, and medical resources.

Get Prepared:
The Federal Emergency Management Agency (FEMA) encourages you to plan ahead for a disaster. You can do this by establishing a meeting place and evacuation route with your family. According to FEMA, the family meeting place should be familiar and easy to find. The FEMA website lists helpful tips on how to start an emergency plan. You can download and fill out emergency plans for families, pets, property, and more.
Make sure you and your family can access TRICARE in an emergency by following these steps before a disaster strikes:
• Sign up for disaster alerts. If emergency TRICARE policies apply to your enrollment area, TRICARE will let you know. First, you must sign up to get disaster alerts. You can receive disaster alerts by email. You can also view disaster alerts any time on the TRICARE website.
• Keep key medical information safe and easy to find. Before a disaster, safeguard critical documents. This includes medical records, prescription information, and your uniformed services ID card. It’s also a good idea to make a list of illnesses, allergies, and prescription bottles for all family members.
• Get your prescriptions and medical devices ready. If you suspect you may need to evacuate, fill any prescription refills that are due before you leave. Think about medications you take that may need refrigeration. Or, you may have medical devices that you use, like breathing aids or eyeglasses.

Getting Routine Care During a Disaster:
TRICARE will let you know of any emergency procedures in effect in a disaster alert. Keep in mind you may not be able to visit your regular doctor during a natural disaster. In a state of emergency, TRICARE may authorize referral waivers in certain affected counties. This means you may not need a referral to get care during the referral waiver period. Be sure to keep your receipts and file any claims with TRICARE as soon as possible.

As described in the TRICARE Pharmacy Program Handbook; https://tricare.mil/publications , TRICARE may authorize early refills for prescriptions in a disaster emergency in certain affected counties. This means you can refill your prescription before your current supply is finished during the early refill period. To get an emergency refill, take your prescription to any TRICARE retail network pharmacy. You can search online for a network pharmacy. You can also call Express Scripts, Inc. at 1-877-363-1303 to help you find a pharmacy near you.

Remember that you and your family’s access to care may change during a weather-related emergency. Sign up for email updates from TRICARE, and make a disaster plan today. While you can’t prevent all disasters, you and your family can prepare for them. Visit Disaster Information to learn more.

16. TRICARE and Your Vision Options; Make Vision Coverage Choices to Fit Your Needs
 
If you aren’t an active duty service member (ADSM) or activated, Called or ordered to active duty service for more than 30 days in a row. National Guard and Reserve member, TRICARE only covers prescription glasses and contacts to treat certain conditions. If you or your family members wear glasses or contacts, did you know you might be eligible to purchase vision insurance through the Federal Employees Dental and Vision Insurance Program (FEDVIP)? https://www.benefeds.com/ 
 
TRICARE Select retirees and their family members don’t have coverage for eye exams. If you have TRICARE For Life (TFL), you also don’t have eye exam coverage.
 
FEDVIP Vision Coverage:​
With FEDVIP, you can choose from multiple vision plans and eye care providers. The plans vary in coverage and cost. But most plans include routine eye exams, vision correction, glasses, and contact lenses.
 
FEDVIP Eligibility:
You can check to see if you can enroll in a FEDVIP vision plan online. ADFMs, retirees, retiree family members, and National Guard and Reserve members enrolled in TRICARE Reserve Select or TRICARE Retired Reserve may qualify to purchase FEDVIP vision coverage. You must be enrolled in a TRICARE health plan or have TFL coverage to enroll in FEDVIP.
You can use the plan comparison tool to learn about and compare FEDVIP plans. The tool lets you view rates, benefits, and coverage information for multiple plans at a time.
 
Enroll in FEDVIP During Federal Benefits Open Season:
During Federal Benefits Open Season, you can enroll in or change FEDVIP vision plans. Open season begins on Nov. 11 and ends on Dec. 9. Your enrollment choices will take effect on Jan. 1, 2020. You can only make plan changes during open season, or when you experience a FEDVIP qualifying life event (QLE). Examples of FEDVIP QLEs include events, like getting married or moving.
 
Remember that as long as you’re enrolled in a TRICARE health plan, your TRICARE vision coverage continues. To learn more about your vision benefit, contact your regional contractor. To learn more about FEDVIP vision plans, check out the FEDVIP enrollment website.

17. Filling Prescriptions With TRICARE: You’ve Got Options

The TRICARE Pharmacy Program provides prescription drug coverage for all TRICARE beneficiaries. There are several options for filling your prescriptions. They include military pharmacies, TRICARE Pharmacy Home Delivery, TRICARE retail network pharmacies, and non-network pharmacies. Some options are available worldwide. And there are some limits for filling prescriptions overseas. As described in the TRICARE Pharmacy Program Handbook, how you fill your prescription depends on your beneficiary category and the type of drug you’re prescribed.

Here’s a breakdown on where you can fill your prescriptions:

Military pharmacies:
Do you want to keep your costs low? You can consider filling your prescriptions for free at military pharmacies. You can receive a 90-day supply of most covered generic and brand-name drugs at a military pharmacy at no charge. Most military pharmacies accept electronic prescriptions for covered generic and brand-name drugs from your medical provider, regardless of whether or not you’re enrolled at the military hospital or clinic. Military pharmacies usually don’t carry non-formulary drugs. You should call your pharmacy before going to check if your drugs are available.

TRICARE Pharmacy Home Delivery:
Are you looking for in-home convenience and savings? TRICARE Pharmacy Home Delivery is a great option for you. You may order your covered drugs through Express Scripts, Inc. (Express Scripts). Your order from Express Scripts should arrive within 14 days or less after you place your order. Remember to order your refills at least 14 days before your current supply runs out. Home delivery also provides you with:

  • Convenient notifications about your order status.
  • Refill reminders.
  • Assistance in renewing expired prescriptions.

The chance to enroll in the Express Scripts Automatic Refill Program.
With home delivery, you can get up to a 90-day supply of drugs. Keep in mind that you may have to fill certain prescription drugs through home delivery. And some limits on home delivery may apply overseas. There’s no cost for home delivery for active duty service members. For all other beneficiaries, there are copayments. Check out the TRICARE Costs and Fees Sheet to view your copayments.

TRICARE retail network pharmacies:
Do you need a prescription filled quickly, and a military pharmacy isn’t an option? You can find a TRICARE retail network pharmacy. There are more than 58,000 locations in the U.S. and certain U.S. territories (Guam, Puerto Rico, U.S. Virgin Islands, and the Northern Mariana Islands). You don’t have to file a claim if you fill your prescriptions at retail network pharmacies throughout the U.S. But you do have to pay a copayment A fixed dollar amount you may pay for a covered health care service or drug. for each 30-day supply of a covered drug.

When filling your prescription, you’ll have to show your uniformed services ID card. It’s easy to find a retail network pharmacy close to you. You can search online; https://militaryrx.express-scripts.com/find-pharmacy . 
You can also use the Express Scripts mobile app or call 1-877-363-1303.

Non-network pharmacies:
Do you want to fill a prescription at a non-network pharmacy in the U.S. or certain U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands)? You’ll have to pay full price for your prescription drugs and file a claim for reimbursement. Overseas pharmacies are non-network. You’ll also have to pay the full cost upfront and file a claim for reimbursement. For covered drugs, repayments are subject to deductibles, out-of-network cost-shares, and copayments. You must meet all the deductibles before reimbursement. You can find details about filing claims in the U.S., U.S. territories, and overseas in the “Claims” section in the TRICARE Pharmacy Program Handbook; https://www.tricare.mil/publications 

To refill specialty drugs, learn about the Specialty Medication Care Management Program.

For non-covered drugs, you’ll have to pay the full cost of the drug. These are prescription drugs and other products that TRICARE doesn’t cover. To see if your drug is covered or not, check the TRICARE Formulary; https://www.express-scripts.com/static/formularySearch/2.9.5/#/formularySearch/drugSearch 

Take command of your health and learn more about your pharmacy coverage and options for filling your prescriptions. Check out TRICARE resources like the TRICARE Pharmacy Program Handbook and TRICARE Pharmacy Program Overview.

18. DHA Begins to Exclude Some Drugs from Coverage

The FY2018 National Defense Authorization Act (P.L.115-91, H.R.2810) that was signed into law Dec. 12, 2017, allows for the Defense Health Agency to identify drugs that provide little or no clinical effectiveness relative to available alternatives. The drugs can be partially or fully excluded from being covered by the TRICARE Pharmacy Benefits Program. Drugs excluded from coverage are referred to as Tier 4 on the prescription drug formulary list. 

The DHA believes that this will align the TRICARE Pharmacy Benefits Program with industry standards among commercial healthcare plans. The exclusion has the potential to save the Department of Defense $30 million per fiscal year. Previously, all prescriptions were categorized in one of three tiers – generic, brand name and non-formulary. Each having varying copay costs for beneficiaries.

The prescription drugs that DHA categorizes as Tier 4/non-covered and are excluded from coverage. These Tier 4 drugs are not available in pharmacies at military treatment facilities. They also are not available through the TRICARE Pharmacy Home Delivery Program.
 
Tier 4 drugs are only available at retail pharmacies and beneficiaries will have to pay the full price out-of-pocket. The costs for Tier 4 drugs do not apply to the annual TRICARE catastrophic cap. The FRA is working with other military organizations to ask the DHA to create an appeals process for drugs placed on the Tier 4/non-covered list. 

19. TRICARE Expands Coverage for Breast Cancer Screenings

To improve preventive health care services for women, on Jan. 1, 2020, TRICARE expanded coverage for breast cancer screenings to include 3-D mammography (also known as digital breast tomosynthesis). TRICARE will cover 3-D mammography as a population-based, preventive health care service through the provisional coverage program, which requires pre-authorization. TRICARE covers annual screenings for all female beneficiaries age 40, and older and those age 30–39 who are high-risk and have either a 15 percent or greater lifetime risk of breast cancer as determined by a screening instrument or who meet a risk factor. In a 3-D mammogram, an X-ray source moves over the breast to obtain cross-sectional images of the tissue and this has the potential to improve accuracy in detecting abnormalities and reduce imaging problems due to overlapping tissue and dense breast tissue.

3-D mammography falls under the provisional coverage program. This means you need pre-authorization. Your provider must first get pre-authorization from your regional contractor.

20. Your TRICARE Payment Options:   
When it comes to TRICARE payments, you have options. You can pay your enrollment fees annually or quarterly by credit card. You can pay monthly enrollment fees by an electric funds transfer (EFT) or an allotment from retirement pay. No administrative fees are charged if you choose to pay monthly or quarterly. Payment may take many forms and depends on your plan.

Again, your options include:
• Setting up an EFT
• Setting up an allotment from retirement pay
• Paying online with your credit or debit card
• Calling your regional contractor to pay with your credit or debit card

You can also get your bill in the mail and return it each quarter to your regional
contractor with your debit or credit card information on the bill. Setting up an
automatic payment may help you avoid missed payments.
It’s important to keep your payment information up to date. If your credit card or
payment information changes and your payment doesn’t go through, you may be
disenrolled from TRICARE (See “TRICARE Rules for Enrolling and Disenrolling” on
page 1).

Visit your regional contractor’s website to learn more about payment options. Select
the “Beneficiary” tab at www.tricare-west.com. Then select “Enrollment” and then
“Make a Payment.” 

21. Telehealth Benefits in Medicare/TRICARE
The Military Health System has established a microsite to be the primary information resource for Military Health System beneficiaries.  

The administration has authorized the Centers for Medicare & Medicaid Services to broaden access to telehealth for Medicare so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility. For more information on Medicare telehealth go online:

Medicare Telemedicine Health Care Provider Program; https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet   

22. Catastrophic Cap Credit for Some TRICARE Households
 
Since Jan. 1, 2018, enrollment fees for TRICARE Prime, TRICARE Select, and the US Family Health Plan (USFHP) haven’t been applied to the annual TRICARE family catastrophic cap for certain households. The Defense Health Agency is working to fix this issue. This issue only affects those TRICARE-eligible households who exceeded or came close to exceeding their catastrophic cap in 2018, 2019, and 2020.

What is the catastrophic cap?
The catastrophic cap is the maximum you and your family pay for covered TRICARE health care services each calendar year. This protects you because it limits the amount of out-of-pocket expenses you pay for TRICARE covered medical services. Out-of-pocket costs that apply to the catastrophic cap include:
• Enrollment fees
• Deductibles
• Copayments
• Cost-shares

How do I know if this affects me?
This may affect your household if you exceeded or came close to exceeding your family’s annual catastrophic cap in 2018, 2019, or 2020, and you paid enrollment fees in any of those years as either a:
• TRICARE Prime Group A enrollee or TRICARE Prime Group B enrollee.
• TRICARE Select Group B Click to close If you or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B. enrollee.
If this affects your household, you’ll get a letter from your TRICARE regional contractor, USFHP provider, or TRICARE Overseas Program (TOP) contractor. The Department of Defense estimates this may affect about 35,000 retiree households.

What do I do if I get a letter?
If a catastrophic cap overpayment occurred, you have two options:
• Automatically get a credit toward future enrollment fee payments.
If you choose this option, you don’t need to do anything. You’ll be credited up to two years’ worth of enrollment fees. You’ll get a refund for any amount over two years’ worth.
• Request a refund of the amount overage.
You may also request a refund for the overage amount. Make this refund request by calling your regional contractor, USFHP provider, or TOP contractor.

Going forward, future enrollment fees will be credited towards your family’s yearly catastrophic cap. To learn more about your catastrophic cap or TRICARE costs, visit Cost Terms and Costs on the TRICARE website.

Take command of your health and learn more about your pharmacy coverage and options for filling your prescriptions. Check out TRICARE resources like the TRICARE Pharmacy Program Handbook and TRICARE Pharmacy Program Overview.