Tricare beneficiaries who qualify for Medicare Part A will automatically be enrolled in Medicare Part B at an increased marginal cost unless declined by the beneficiary. However, subject to the exceptions noted below, the consequences for declining Medicare B can be potentially disastrous, as Tricare can pay nothing for care while a beneficiary is eligible for Medicare Part A unless the beneficiary also has Medicare Part B coverage. Tricare will also recoup any benefit payments made to physicians for a disqualified beneficiary for the period that the beneficiary was eligible for Medicare Part A but declined Medicare Part B. The same consequence would apply to Tricare beneficiaries who are awarded two years or more of retroactive Medicare Part A coverage because of a Social Security disability award but decline the option to take Medicare Part B for the period of retroactive Medicare Part A coverage. Any payments made to physicians during a period of retroactive Medicare Part A coverage for which Medicare Part B is declined will be recouped by Tricare.

The mandatory Medicare Part B enrolment rule does not apply if the beneficiary has an active duty sponsor, is enrolled in the US Family Health Plan, or is covered under Tricare Reserve Select. Tricare beneficiaries who are changing Tricare coverage, such as those switching to Tricare for Life and those Tricare beneficiaries with potentially successful Social Security claims should particularly take heed of the Medicare Part B requirement if they want to continue Tricare coverage. The clear message from Tricare Management Activity to Tricare beneficiaries covered by Medicare Part A is that if they decline Medicare Part B coverage, they do so at their peril as this could terminate Tricare payments of claims. It is possible to later enroll in Medicare Part B for those who decline the initial coverage but substantial penalties could apply. Questions on this requirement should be directed to your Tricare contractor. You can also visit the Tricare website for your region or program as follows.

• North Region: www.healthnetfederalservices.com

• West Region: www.triwest.com

• South Region: www.humana-military.com

• Tricare for Life: www.tricare-4u.com

[Source: NGAUS Leg Up 5 Sep 08 ++]

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An upcoming change to Tricare soon could give military retirees living overseas reason to smile. Beginning 1 OCT, those retirees will have access to the Tricare Retiree Dental Program (TRDP) insurance benefits that have been previously unavailable outside the United States, Tricare officials said in an e-mail to Stars and Stripes on 5 SEP. Jeff Album, spokesman for Delta Dental, the California-based contractor that handles Tricare’s dental coverage, said the company expects about 14,000 of the 35,000 eligible retirees to take advantage of the optional program in its first year. While the change is good news for many, it might not be cost-effective for every retiree living overseas, said Ed Chan, the Tricare Pacific director. For instance, out-of-pocket expenses for dental care in the Philippines are generally much less than monthly insurance premiums, he said. “In some cases, they may not get back what they paid into it,” he said. In South Korea and Japan, he said, retirees might have national insurance if they’re married to citizens of those countries, which includes some dental coverage. In some places in Japan and Okinawa, officials say, retirees can receive free space-available care on base. Retirees in South Korea have very limited on-post care. They are authorized emergency care and can get cleanings during special events such as retiree appreciation days and noncombatant evacuation exercises, said Chris Vaia, chairman of the retiree counsel at Yongsan Garrison in Seoul.

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The URFS can verify his/her DEERS information by contacting their regional TRICARE contractor, the local TRICARE Service Center, or the nearest uniformed services personnel office (ID card facility). They can also update their addresses and personal information via the online Real-Time Automated Personnel Identification System (RAPIDS). When updating addresses, you should make sure to specify a mailing address and not just a home address. The URFS must visit his/her uniformed services personnel office or nearest RAPID site in person and present the necessary documentation, e.g., a marriage certificate, divorce decree and/or birth certificate, to add or be removed from the database. To update DEERS eligibility information:

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Since 1 OCT 03, the Defense Enrollment Eligibility Reporting System (DEERS) reflects TRICARE eligibility for URFS (Unremarried Former Spouses) under his/her own name and Social Security Number (SSN), not his/her former sponsor’s. The URFS now use their own name and SSN to schedule medical appointments and to file TRICARE claims. As an URFS of a uniformed service member, you may be eligible for continued benefits if you do not remarry, are not covered by an employer-sponsored health plan and meet certain requirements. If a URFS remarries, the loss of benefits remains applicable even if the remarriage ends in death or divorce. However, if the URFS remarries a uniformed service active duty or retired member, he or she becomes TRICARE-eligible under his/her new sponsor.

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The Tricare military health system’s 9.2 million beneficiaries now have an easy way to receive the latest newsletters and stay informed about changes in coverage, pharmacy updates and other news. Their new electronic delivery system is up and running. Tricare officials said subscribing is fast and secure by clicking on the “little red envelope” on Tricare’s Web site, www.tricare.mil. Subscribers can choose alerts by topics or beneficiary category. Delivery is safe and secure. An e-mail address is the only information collected. Subscribers also have a unique page they can manage any time and they can choose to be notified as soon as news or benefit changes are posted or get updates daily, weekly or monthly. The new subscription service also links users to similar alerts available on other Military Health System Web sites, including www.health.mil, which features MHS news and other information. Partnership subscription options with other health-related federal Web sites include the Centers for Disease Control and Prevention and Disabilityinfo.gov. [Source: NGAUS NOTES 22 Aug 08 ++]

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Families of some active-duty Reserve and National Guard members will get a break on paying annual deductibles associated with the military’s health care system, according to a final rule (http://edocket.access.gpo.gov/2008/E8-18597.htm) published 12 AUG in the Federal Register. The rule, which was proposed in AUG 06 and took effect on 12 AUG makes permanent the Defense Department’s authority to waive the annual TRICARE deductibles for eligible dependents of reservists and Guard members who are called to active duty for more than 30 days. It applies to those who choose to participate in TRICARE Standard or Extra, rather than TRICARE Prime. By law, the TRICARE Standard (or Extra) deductible for active-duty family members is $150 per individual and $300 per family each fiscal year. For those at the E-4 level and below, the deductibles are $50 per individual and $100 per family. Dependents are defined as spouses and children. In addition, the final regulation increases the amount that can be billed to out-of-network health care providers. “This helps reserve and Guard family members to be able to continue to see civilian providers with whom they have established relations and promotes access and clinically appropriate continuity of care,” the notice stated. The rule makes permanent authority exercised by Defense through the extension of a demonstration project. The fiscal 2005 National Defense Authorization Act gave the department that authority and waived certain TRICARE deductibles for active-duty members of reserve components. The Federal Register notice stated that an independent government estimate concluded that the annual cost for implementing the rule would be less than $30 million. [Source: GovExec.com Today 13 Aug 08 ++]

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The new form, available in the link below was developed to ease the claim processing in the Philippines for two different situations:

1. When an itemized bill/receipt/statement is needed to go along with a claim, but the provider cannot provide one.

2. When one of our beneficiaries has Other Health Insurance (OHI), but the OHI company does not, cannot or will not provide a statement of coverage and what was paid by the OHI.

This form has been reviewed, vetted and approved through the required HQ TRICARE departments as well as the contracting partner, WPS. It is the hope of Tricare Area Office – Pacific (TAO-P) that this form will help ease the claims processing when the above two situations occur. The form is available for download on the TAO-P website: http://tpaoweb.oki.med.navy.mil/, by clicking the button titled “TRICARE In The Philippines”. For questions call (81) 6117-43-2031/29 Camp Lester, Okinawa or email Tony.Ingram@med.navy.mil. [Source: Lt Col Tony Ingram, Chief, Program Operations, TAO-P msg. 11 Aug 08 ++]

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On 24 JUL the Beneficiary Advisory Panel (BAP) met to provide comments to the Department of Defense (DoD) Pharmacy and Therapeutics Committee’s (P&T Committee) recommendations on formulary status, pre-authorizations, and the effective date for a drug’s change from formulary to non-formulary status. Moving a drug to non-formulary status means it will still be available to beneficiaries, but usually at a higher price. It may also require medication authorization. Current and new drugs were reviewed during this meeting. BAP recommendations for drugs currently on the DoD Uniform Formulary are as follows:

Hydroxytryptamine (Triptans) drugs:

• sumatriptan (Imitrex), sumatriptan/naproxen (Treximet), eletriptan (Relpax), rizatriptan (Maxalt), zolmitriptan (Zomig) will be classified as formulary, and

• almotriptan (Axert), frovatriptan (Frova) and naratriptan (Amerge) will be non-formulary within a 90-day implementation period.

Osteoporosis Agents:

• alendronate (Fosamax), alendronate/vitamin D (Fosamax plus D), risedronate (Actonel), risedronate with calcium (Actonel with calcium), ibandronate (Boniva), raloxifene (Evista), teriparatide (Forteo), recombinant calcitonin (Fortical) will be maintained on the Uniform Formulary, and

• salmon-calcitonin (Miacalcin) will be placed on the non-formulary status within a 90-day implementation period.

Newly approved drugs by the Federal Drug Administration were considered by the BAP. Those recommended to be classified as non-formulary with a 60-day implementation period were:

• nebivolol (Bystolic) is used to treat hypertension,

• levocetirizine (Xyzal) is used to treat seasonal and perennial allergic rhinitis and chronic idiopathic urticaria,

• zileuton extended release (Zyfol CR) is used to treat asthma, and

• olmesartan/amlodipine (Azor) is used to treat hypertension.

New drugs that were recommended for formulary status were:

• fenofibrate meltdose (Fenoglide) is used for the treatment of hyperlipidemia and mixed dyslipidemia,

• simvastatin/niacin extended release (Simcor) is used for the treatment of hyperlipidemia,

• birmonidine/timolol maleate (Combigan) is used to reduce the increase intraocular pressure; aliskiren/H, and

• aliskiren/hysdrochlorothiazide (Tekturna HCT) is used for the treatment of hypertension.

Axert was placed on non-formulary status. For additional information on the recent BAP meeting, refer to www.tricare.mil/pharmacy/bap. [Source: NMFA e-News 29 Jul 08 ++]

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All Hands [7/1/08]

Edmund Chan, the Director of TMO Pacific has sent the following message to all Philippine Tricare users. Attached is the Tricare Philippine pamphlet for your future reference:

Dear Sirs,

I am writing this email to inform you about the establishment of a TRICARE Satellite Office in the Philippines and also to let you know about the newly established TRICARE rates that will go into effect on October 1, 2008. I know that you work with the Retirees on a frequent basis and may have newsletters, forums and other means to communicate with our Retiree beneficiaries and their families. If possible, kindly help us with reaching out to our Retirees with this information. I am attaching a letter that you can post and also our Philippines Retiree TRICARE brochure. Thank you for serving our Retirees and Happy Fourth of July.

Please let me know if you have any questions and also let us know how we can serve you better. V/R Ed Edmund Chan Director, TRICARE Area Office Pacific

Commercial: 011-81-611-743-2057

Voice Commercial: 011-81-611-743-2056

Fax DSN: 315-643-2057

PSC 482 Box 2749 FPO AP 96362

Dear TRICARE Beneficiaries,

I send you greetings from the TRICARE Area Office – Pacific in Okinawa, Japan. We are delighted to announce that we will be establishing a Philippines Satellite Office (hopefully by the end of the year) in Manila. Lt Col Tony Ingram and I are currently meeting with JUSMAGPHIL and the Department of State to negotiate space for our office. Once the office is set up, you will be able to call or visit the Philippines Satellite Office for help with your TRICARE issues and problems. More importantly, the Satellite Office will be my “boots on the ground” to help with improving the TRICARE program for you and our providers.

In the meantime, we will continue to support you from our Okinawa office. Please send us email at TPAO.CSC@med.navy.mil or call us at the numbers below:

Commercial: 81-611.743.2036

DSN: 315.643.2036 DSN FAX: 315.643.2037

Toll Free: 888-777-8343 Menu Option # 4

In the next few weeks, you will be receiving a letter from Wisconsin Physician Services (WPS) to inform you about the new Philippines rates that have been established to pay for inpatient (hospital) and outpatient care. These new rates will begin on October 1, 2008. The new rates were developed by the TRICARE Management Activity (TMA) office to replace the Puerto Rico caps that are currently used for outpatient services and for the inpatient daily rates in the Philippines. TMA used the World Bank International Comparison Program index for the Philippines to establish more reasonable rates to reflect costs in the Philippines.

Generally the new rate caps will be lower than the current caps, so it is important that you know what these rates are in order to avoid significant out of pocket costs. These rates will be published on the TRICARE

website: http://www.tricare.mil/tma/foreignfee/ – inpatient rates

are already listed (next page) and the outpatient rates will be listed soon.

Finally, I want to wish everyone a Happy Fourth of July and Mabuhay! I also want to thank the Retired Activities Offices (RAOs) and other contacts for your continued support with helping the retirees throughout the Philippines.

Sincerely,

Ed Chan

Director, TRICARE Area Office – Pacific

Philippines Inpatient

Per Diem Rates

Group

Number Description Current Allowed October 1, 2008

Amount Per Day

01 Infectious Disease $1,847 $1,144

02 Cancer $2,136 $1,196

03 Endocrine $2,119 $1,141

04 Mental Health $909 $395

05 Nervous System $1,906 $1,027

06 Circulatory $3,044 $1,769

07 Respiratory $1,828 $916

08 Digestive $1,888 $1,009

09 Genitourinary $1,980 $1,152

10 Pregnancy and birth $1,076 $555

11 Musculoskeletal and Skin $3,079 $1,998

12 Congenital anomalies $2,916 $1,657

13 Perinatal $731 $333

14 Symptoms, signs, etc. $1,950 $1,080

15 Injuries $2,246 $1,249

16 Poisoning $1,801 $1,069

17 Complications $2,333 $1,403

18 V-codes $1,640 $966

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A former health care executive was sentenced 17 JUN to five years in prison for helping his Philippines-based company swindle nearly $100 million from the U.S. military health insurance program. Thomas Lutz, 41, said in federal court he took responsibility for the six-year scheme in which Health Visions Corp. bilked $99.9 million from the military’s Tricare program through inflated and fraudulent claims. U.S. District Judge Barbara Crabb said the five-year sentence was modest given the extent of the fraud, but it was the longest she could impose under Lutz’s plea deal. Health Visions and Lutz were initially charged in a 75-count indictment in 2005. He pleaded guilty in 2006 to a single count of conspiracy to pay kickbacks and agreed to cooperate with prosecutors, a deal Crabb called “a huge break” for Lutz. “It’s just horrifying that you were able to take as much money as you did,” Crabb told Lutz. Prosecutors said the company routinely inflated claims by more than 230%, operated a phony insurance program and billed for medical services never delivered.

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