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Show Dec 7, 1995 13 Hilltop Times Confused about medical coverage? CHAMPUS eligibility? Available options? TriCare by TSgt. David P. Masko Air Force News Service Features - LACKLAND AFB, Texas As many TriCare regions begin operations, Air Force surgeon general officials say the response to the new health care option is positive. At Wilford Hall Medical Center at Lackland, for example, the TriCare Regional operations begin; what's bottom line? o o Tnaxrs Enrol REGION Mar qr grjMte 11 1995 REGION 8 Nov 1996 service center has been busy signing and retiree famiup both active-dut- y lies for the new health care option. Wilford Hall is the lead agent for the TriCare southwest region. ' TriCare services are active in five of 12 health service regions, where hundreds of thousands have enrolled and are discovering for themselves why TriCare is affordable and easy to REGION 1 May 1997 use, officials said. From its genesis to its ongoing role in changing military medicine, TriCare has been praised as a fresh approach to managed care. TriCare is a nondiscriminatory program for CHAM-PUeligibles, and is offered without regard to beneficiary age, race, sex, rank, sponsor status, family size or personal income or health status. Still, the Defense Department's move to TriCare is not pleasing everyone. For instance, it has received a certain amount of backlash from both active-dut- y and retirees concerned about an erosion of benefits. On the heels of its debut came a stream of briefings by medical officials at bases throughout the United States. At issue was the controversy of charging some beneficiaries money REGION 2 May 1997 S for medical services. While medical care at military hospitals will continue to be free, each of the TriCare pro- g re-grams has different quirements. f Also, there are many facets to Tri- Care. A recent TriCare briefing at Kelly AFB, Texas, for example, lasted nearly three hours and included book-- i lets with dozens of pages devoted to f the differences between TriCare's i three options. People at the Kelly briefing said it is no wonder that amid all this information, military people and their families became confused about TriCare Prime, Extra and Standard. Officials said critics added to misunderstandings about TriCare by focusing on the most controversial aspect of the program, and failed to include information about the many benefits. Aside from the fact that medical spending threatens to bankrupt the system, officials also noted that critics didn't recognize why military medicine is changing. ' "People need to recognize the impact of cost on the health care system, and why reforms need to be made," said a beneficiary services representative at Kelly. "The bottom line is TriCare gives people access to a network of quality doctors, hospitals and other health care providers," the representative said. "The stark reality, which some people may not want to face, is TriCare's real purpose is to improve access to medical care, and to lower costs." Given the prognoses that retirees and their family members must pay an annual enrollment fee, "the bottom line" for DOD is, TriCare will reduce overall costs for beneficiaries while supporting the cost-sharin- REGION 10 Oct 1995 Oct 1995 REGION 12 Oct 1995 VV,. Vl Q REGION 3 May 1996 REGION Mar 1995 Now Operational ifVWS TRICARE Enrollment Option And Cost Annual deductibles: Families of 4 and below E-- $0 Other active duty families Retirees and others SO $0 et Shares Point of service Option for 5505100 $150S300 51505300 $50$100 51505300 51505300 TRICARE Prime enrol lecs only Applies to all Annual Enrollment Fees: Families of 4 and below E-- SO 50 SO Other active duty families Retirees and others SO SO SO S 2305460 $0 SO ! out-of-pock- S v A Civilian provider copays: Families of 4 and below E-- Other active duty families Retirees and others Civilian inpatient cost shares: and below Families of 56 1 3 $12 512 1 5 SI 1 per day E-- 4 S1 Other active duty families Retirees and others 1 per day $11 per day 20 of negotiated fees 20 of allowed charges of negotiated fees 20 of allowed charges of negotiated fees 20 of allowed charges $9.50 per day $9.50 per day $250 per day plus 20 of negotiated prof fees 59.50 per day 5930 per day $323 per day plus 25 of negotiated prof fees $100-524- 0 based on beneficiary category Estimated annual savings per enroDed family d, non- emergency inpatient and out patient service by enrol Ices (active duty families and retirees and family). Deductibles: $300 per individual $600 per family Cost shares: 50 of allowed charges Source: Aa Fore Sorgcoa GeneraTi Office medical corps wartime mission. Officials said if you are now covered by another comprehensive health care insurance plan, that plan is your primary health care coverage, and TriCare Prime and Standard will pay only after your other health insurance pays. Also, if you don't have health insurance and use either TriCare Standard or Extra, the daily amount active-dutfamily members pay for inpatient care y in civilian hospitals is the same rate paid under the CllAMPUS Officials said this means program. that an active-dut- y family member who is admitted to a civilian hospital for care except for mental health care under TriCare Standard or Extra will pay the daily rate of $9.70 times the number of days spent in the hospital, or a flat fee of $25, whichever g is greater. The flat $25 beneficiaries cost-sharin- rate also applies to same-da- y surgery. Officials said signing up for TriCare Prime is voluntary, and that "free" medical care is still available in mile itary hospitals on a space-availabl- basis. For more information, contact the 75th Medical Group CHAMPUS health benefits advisor, Ext BSee benefits and coverage charts, page 14. |