RAO Davao City » Tricare

MEDICARE PART B NON-ENROLLMENT September 14, 2008

Service Officer — Sun, 14 Sep 2008 19:55:48 +0000

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.

â€¢ North Region: www.healthnetfederalservices.com

â€¢ West Region: www.triwest.com

â€¢ South Region: www.humana-military.com

â€¢ Tricare for Life: www.tricare-4u.com

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

Bookmark TO:

TRDP UPDATE September 14, 2008

Service Officer — Sun, 14 Sep 2008 19:53:35 +0000

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 Tricareâ€™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 theyâ€™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.

Under the new Tricare contract, beneficiaries will be able to use off-post dentists on Tricareâ€™s approved list of providers, which can be found at www.tricaredentalprogram.com. For orthodontic care or implants, however, special approval must be granted in advance of the work. Providers will work with local patient care representatives to obtain approval. Patients must pay their co-pay at the time of care, and Tricare will settle the rest of the bill. To enroll you will need to make a prepayment of two month’s premiums to ensure that you will be able to participate as soon as your coverage is effective. Once a payment process is established for you, either through mandated automatic deduction from your retired pay or other applicable billing method, the unused portion of the premium will be refunded. Premium rates vary by region. For example monthly premiums for retirees living in the Philippines (Region D) are $41.73 for single, $81.01 for two people, and $135.40 for a family of 3 or more. These ates for the Enhanced TRICARE Retiree Dental Program are effective 1 OCT 08 through 30 SEP 09. Monthly premiums are scheduled to change each year, on 1OCT. Department of Defense directed implementation of further program enhancements could result in the contractual establishment of monthly premium rate changes. If you move or change your enrollment option, your monthly premium rate may also change. Album said retirees living overseas can enroll in the Tricare dental program at www.trdp.org or by calling 1-866-721-8737. [Source: Stars and Stripes Pacific edition Jimmy Norris & Vince Little article 6 Sep 08 ++]

Bookmark TO:

TRICARE URFS UPDATE 2 September 14, 2008

Service Officer — Sun, 14 Sep 2008 19:42:06 +0000

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:

â€¢ Visit your local uniformed services personnel office or contact the Defense Manpower Data Center Support Office (DSO) at 1-800-538-9552. You can find the nearest uniformed services personnel office at: www.dmdc.osd.mil/rsl/.

â€¢ Go online at www.tricare.osd.mil/DEERSAddress to update your information.

To update your personal information:

â€¢ Fax address, phone numbers and email changes to DEERS at 1-831-655-8317.

â€¢ Mail the address change to the Defense Manpower Data Center Support Office, ATTN: COA, 400 Gigling Road, Seaside, CA 93955-6771.

â€¢ Go online at www.tricare.osd.mil/DEERSAddress to update your information.

The current Uniformed Services Identification and Privilege Card, DD Form 1173, held by the URFS is still valid until it expires. Upon renewal, the URFS will be issued a replacement Department of Defense/Uniformed Services Identification and Privilege Card, DD Form 2765 with their own SSN information. The URFS should always keep his/her DEERS information current and up-to-date. For questions regarding medical records, contact the MTF medical records department where your DoD medical records are stored. [Source: The URFS Tricare Fact Sheet Sep 08 ++]

SBP DIC OFFSET UPDATE 11: The Senate, by a vote of 94-2, added an amendment to the National Defense Authorization Act (S. 3001) that would totally eliminate the SBP/DIC offset that some 57,000 widows now suffer from. Thanks to the efforts of Sen. Bill Nelson (D-FL) and the support of numerous veteran and military associations, this is the fourth year in a row the Senate has taken this action. Unfortunately, every previous year this legislation has been removed in conference with the House. Last year, in an attempt to give the widows something, a new benefit for those affected by the SBP/DIC offset was passed. This token payment of $50 per month starts 1 OCT this year and will increase by $10 yearly increments until it reaches $100 per month. [Source: NAUS Weekly Update 12 Sep 08 ++]

Bookmark TO:

TRICARE URFS 1 September 14, 2008

Service Officer — Sun, 14 Sep 2008 19:41:01 +0000

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.

There are eligibility requirements that URFS must meet.

1. Situation 1â€“20/20/20 Rule: Medical benefits are extended, and continue as long as requirements continue to be met, to an URFS when:

Â§ The parties had been married for at least 20 years

Â§ The member performed at least 20 years of service creditable for retired pay

Â§ There was at least a 20-year overlap of the marriage and service

2. Situation 2â€“20/20/15 Rule: Medical benefits are extended to an URFS, if divorce occurred before 1 APR 85, when:

Â§ The parties had been married for at least 20 years

Â§ The member performed at least 20 years of service creditable for retired pay

Â§ There was at least a 15-year overlap of the marriage and service

Note: If the divorce occurred on or after 29 SEP 88, these 20/20/15 former spouses qualify for medical benefits for one year from the date of the divorce decree.

Benefits are:

- TRICARE Prime: This is a managed care option similar to a civilian health maintenance organization and is offered only in certain geographical locations. TRICARE Prime offers fewer out-of-pocket costs than any other TRICARE option. TRICARE Prime enrollees receive most of their care from a military treatment facility (MTF), augmented by the TRICARE contractor’s provider network. TRICARE Prime enrollees are assigned a primary care manager (PCM). It is important to note that the URFS are no longer covered by the family plan status, since he/she is now a sponsor in his/her own right, under his/her own social security number. Therefore, he/she becomes responsible for his/her enrollment fees at the retirees rate, even though the former spouse may still be on active duty.

- TRICARE Standard: Under this plan, you can see the TRICARE authorized provider of your choice. (People who are happy with coverage from a current civilian provider often opt for this plan.) But having this flexibility means that care generally costs more than Prime (Standard requires a 25% cost share of the TRICARE allowed amount and has a $150 individual fiscal year deductible). Treatment may also be available at a MTF, if space allows and after TRICARE Prime beneficiaries have been served. Furthermore, TRICARE Standard may be the only coverage available in some areas.

- TRICARE Extra: Under this option, you will choose a doctor, hospital, or other medical provider listed in the TRICARE Prime provider directory. The advantages of TRICARE Extra include the fact that cost-shares are five percent less than TRICARE Standard (Extra requires a 20% cost share of the TRICARE allowed amount and consists of a $150 individual fiscal year deductible); there is no balance billing or enrollment fee; and there are no claims forms to file. The disadvantages of TRICARE Extra are you have no PCM; your provider choice is limited; you pay the deductible and the cost shares; and the option is not universally available.

- TRICARE for Life (TFL): This is Medicare-wraparound coverage. A single, nationwide contract provides claims processing, customer service and administrative services for individuals who are eligible for both TRICARE and Medicare, regardless of whether they are over or under age 65. Under TFL, TRICARE becomes second payer to Medicare: you must be eligible for Medicare Part A, and enrolled in Part B. For more TFL information refer to http://www.tricare.osd.mil/tfl/default.cfm.

- Pharmacyâ€“ under this benefit, you are eligible for the basic MTF Pharmacy services, TRICARE Mail Order Pharmacy, TRICARE Retail Pharmacy, and Non-network Pharmacy option. For more information on pharmacy benefits refer to http://www.tricare.osd.mil/pharmacy/default.cfm.

- Dental – URFS are not eligible for TRICARE dental coverage.

[Source: The URFS Tricare Fact Sheet Sep 08 ++]

Bookmark TO:

TRICARE NEWS VIA EMAIL August 29, 2008

Service Officer — Fri, 29 Aug 2008 20:06:27 +0000

The Tricare military health systemâ€™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 â€œlittle red envelopeâ€ on Tricareâ€™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 ++]

Bookmark TO:

TRICARE DEDUCTIBLE UPDATE August 15 2008

Service Officer — Thu, 14 Aug 2008 20:26:54 +0000

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 ++]

Bookmark TO:

Tricare Philippine OHI Form 12 August 2008

Service Officer — Tue, 12 Aug 2008 15:34:30 +0000

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 â€“ 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 ++]

Bookmark TO:

TRICARE UNIFORM FORMULARY UPDATE 1 August 2008

Service Officer — Thu, 31 Jul 2008 18:40:21 +0000

On 24 JUL the Beneficiary Advisory Panel (BAP) met to provide comments to the Department of Defense (DoD) Pharmacy and Therapeutics Committeeâ€™s (P&T Committee) recommendations on formulary status, pre-authorizations, and the effective date for a drugâ€™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:

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

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

Osteoporosis Agents:

â€¢ 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

â€¢ 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:

â€¢ nebivolol (Bystolic) is used to treat hypertension,

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

â€¢ zileuton extended release (Zyfol CR) is used to treat asthma, and

â€¢ olmesartan/amlodipine (Azor) is used to treat hypertension.

New drugs that were recommended for formulary status were:

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

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

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

â€¢ 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 ++]

Bookmark TO:

New Tricare Philippine Office Manila – 1 July 2008

Service Officer — Tue, 01 Jul 2008 20:14:10 +0000

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 â€œboots on the groundâ€ 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 â€“ 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

Bookmark TO:

TRICARE/CHAMPUS FRAUD UPDATE 19 June 2008

Service Officer — Thu, 19 Jun 2008 12:22:07 +0000

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 militaryâ€™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 Lutzâ€™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 â€œa huge breakâ€ for Lutz. â€œItâ€™s just horrifying that you were able to take as much money as you did,â€ 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.

In April, Crabb ordered Health Visions to pay $99.9 million in restitution. Under her order, the company must sell all of its assets, including land, hospitals and office buildings, within 10 months. She said Lutz would be responsible for paying the remainder, including at least 25% of his income once he is released from prison. Crabb gave Lutz until 18 MAR to report to prison. Prosecutors asked for the nine-month delay so Lutz could help the government recover as much money as possible from the company. Formed in 1997, Health Visions owned and operated hospitals and clinics in the Philippines and billed Tricare on behalf of other health care providers. The company served thousands of U.S. military retirees living in the Philippines, where bases were located until the early 1990s. The company was reimbursed $163 million by Tricare between 1998 and 2004, and prosecutors believe at least $99.9 million of that was fraudulent. Lutz, an American citizen, read a brief statement in which he took full responsibility for his companyâ€™s actions. â€œI would like to apologize to the Department of Defense,â€ he said. â€œI am truly sorry for all those who have been affected.

Editors Note: This magnitude of this fraud was allowed in part because of the failure of the U.S. government to provide sufficient transportation funds to DCIS over six years to investigate repeated reports by Tricare users of what was going on since 1997. After 3 to 4 years many retirees in the Philippines just gave up on their attempts to report this fraud in the belief that Tricare officials and WPS for whatever reasons did not want to pursue stopping it. Now, in part as a result of these losses, TMA has initiated actions that will result in all Philippine Tricare users having to effectively pay higher Tricare fees than those in CONUS. This they are allowed to do by lowering the allowed amounts that can be reimbursed to Philippine providers. The net result of this is that in addition to the 25% copay, retirees will also have to pay their providers the difference between what Tricare allows and what is charged to Philippine citizens.

[Source: Air Force Times Ryan J. Foley AP article 18 Jun 08 ++]

Bookmark TO: