TRICARE

2. TRICARE Regions

3. TRICARE Regional Contractors TRICARE North (Health Net) 1-877-TRICARE (1-877-874-2273) TRICARE South (Humana) 1-800-444-5445 TRICARE West (TriWest) 1-888-TRIWEST (1-888-874-9378)

4. TRICARE Options Triple Options TRICARE Prime TRICARE Extra TRICARE Standard Other Programs TRICARE Prime Remote TRICARE Plus TRICARE For Life

5. TRICARE Eligibility DEERS Active duty & retirees Medal of Honor recipients Family members Unmarried children to age 21; 23 if full-time student Certain survivors Certain former spouses TRICARE For Life eligibility requires Medicare Part B

6. DEERS Defense Enrollment Eligibility Reporting System Defense Manpower Data Center Support Office (DSO) Phone: 1-800-538-9552 Fax: 1-831-655-8317 Mail: DSO (Attn: COA or TFL), 400 Gigling Road, Seaside, CA 93955-6771 Web: www.tricare.osd.mil/DEERS DEERS information must be current to ensure continued eligibility.DEERS information must be current to ensure continued eligibility.

7. Making Changes in DEERS Demographic changes (address, phone) Can be done in person; by phone, fax or mail; or online To add or remove a family member Sponsor responsibility Personnel / ID Card Office Birth, death, adoption, marriage, divorce Documentation required Certificates Decrees 1. Demographic information should be kept current to ensure that claims are processed properly, and to allow for contacting or notifying beneficiary if necessary.1. Demographic information should be kept current to ensure that claims are processed properly, and to allow for contacting or notifying beneficiary if necessary.

8. DEERS (Continued) Unremarried Former Spouses Former spouse’s SSN used to verify eligibility (20/20/20 rule) Not eligible if covered by an employer-sponsored health plan Personnel / ID Card Office Stepchildren eligibility URFS not eligible for TRICARE if covered under an employer sponsored health plan. Stepchildren lose eligibility after a divorce unless they had been adopted by the sponsor.URFS not eligible for TRICARE if covered under an employer sponsored health plan. Stepchildren lose eligibility after a divorce unless they had been adopted by the sponsor.

9. Military Treatment Facility – Priorities for Care Active duty Active duty family members in Prime Retirees, family members & survivors in Prime TRICARE Plus enrollees (where available) Active duty family members not in Prime Retirees, family members & survivors not in Prime Other eligible beneficiaries Non-enrollees on a space-available basis.Non-enrollees on a space-available basis.

10. TRICARE & Medicare –Dual Eligibility Medicare Part A entitlement Under age 65 – disability or end-stage renal disease Age 65 TRICARE eligibility Must purchase Medicare Part B Except active duty family members TRICARE is second payer to Medicare Dual eligibility = TFL 1. Beneficiaries who are eligible for Medicare and TRICARE are considered dual-eligible.by law, dual-eligible beneficiaries, with the exception of active duty service members must have Medicare Part A and B to retain TRICARE benefits. 2. Dual-eligible TRICARE beneficiaries under age 65 who are also entitled to Medicare Part A due to a disability or end-stage renal disease (ESRD) are considered dual-eligible. For these individuals, TRICARE coverage may continue as a secondary payer to Medicare. 3. Non-active duty and their family members who are eligible for Medicare Part A and Part B, must enroll in order to maintain TRICARE eligibility. Failure to enroll in Medicare Part B and pay the monthly Part B premiums will result in disenrollment from TRICARE. 4. All other dual-eligible beneficiaries must enroll in Medicare Part B or they will not be eligible for coverage under TRICARE. When TRICARE beneficiaries become entitled to Medicare Part A upon attaining the age 65 and purchase Medicare Part B, they become eligible for TRICARE’s Medicare-wraparound coverage known as TRICARE For Life (TFL). 1. Beneficiaries who are eligible for Medicare and TRICARE are considered dual-eligible.by law, dual-eligible beneficiaries, with the exception of active duty service members must have Medicare Part A and B to retain TRICARE benefits. 2. Dual-eligible TRICARE beneficiaries under age 65 who are also entitled to Medicare Part A due to a disability or end-stage renal disease (ESRD) are considered dual-eligible. For these individuals, TRICARE coverage may continue as a secondary payer to Medicare. 3. Non-active duty and their family members who are eligible for Medicare Part A and Part B, must enroll in order to maintain TRICARE eligibility. Failure to enroll in Medicare Part B and pay the monthly Part B premiums will result in disenrollment from TRICARE. 4. All other dual-eligible beneficiaries must enroll in Medicare Part B or they will not be eligible for coverage under TRICARE. When TRICARE beneficiaries become entitled to Medicare Part A upon attaining the age 65 and purchase Medicare Part B, they become eligible for TRICARE’s Medicare-wraparound coverage known as TRICARE For Life (TFL).

11. Medicare & Social Security – When do They Begin? Medicare For most people at age 65 Before age 65 for people with certain disabilities or end-stage renal disease Social Security Full retirement age is 65 to 67, depending on year of birth Can start receiving reduced benefits at age 62 Disability benefits for total disability

12. TRICARE For Life Became law October 1st, 2001 Eligibility Medicare-eligible beneficiaries age 65 and over; disability; end-stage renal disease Sponsors, family members, widows, widowers, certain former spouses Eligible for Medicare Part A, and enrolled in Medicare Part B Eligibility current in DEERS

13. TRICARE For Life - Costs No enrollment fees for TFL Medicare Part B premiums $93.50/month for 2007 Income-based Increase annually 2007 monthly premium $93.50 – a $5 increase over the 2006 premium of $88.50. Part B Premiums for 2007 are based on income. For individuals who earn $80k or less ($160k or less for a couple), the premium is $93.50. Incremental increases based on income.2007 monthly premium $93.50 – a $5 increase over the 2006 premium of $88.50. Part B Premiums for 2007 are based on income. For individuals who earn $80k or less ($160k or less for a couple), the premium is $93.50. Incremental increases based on income.

14. Health Care for SeniorsBefore & Since TFL Began

15. TRICARE For Life –Who Pays for What

16. TFL - Enrollment in Medicare Part B Required to receive TRICARE For Life benefits Initial 7-month enrollment period Annual general enrollment period January 1st – March 31st Special enrollment situations Premium & surcharge/penalty 1. The initial enrollment period covers a 7-month period - 3 months before you reach age 65, your birthday month, and 3 months after your birthday month. If eligibility is based on disability or kidney failure, the initial enrollment period depends on the date the disability or treatment began. 2. If you enroll in Part B during the 3 months before your birthday month, you become eligible on the first day of your birthday month; if you enroll during your birthday month, you become eligible on the first day of the month following your birthday month; if you enroll during the first month after your birthday month, you become eligible on the first day of two months after enrollment; and if you enroll during the second or third month after your birthday month, you become eligible three months after enrollment. 3. For people who do not sign up during the initial enrollment period when they first became eligible for Medicare Part B, there is a General Enrollment period each year from January 1st through March 31st, with coverage beginning on July 1st. However, the monthly premium increases 10% for each 12-month period the person was eligible but did not enroll. 4. There are Special Enrollment Situations for certain categories of beneficiaries, and there is a Special Enrollment Period for people covered under an employer group health plan. Contact Medicare or the Social Security Administration for information. 5. Dual-eligible active duty family members are not required to purchase Medicare Part B until their active duty sponsor retires. 6. The monthly Medicare Part B premium for 2006 is $88.50. As noted above, however, the surcharge will increase the monthly premium by 10% for each 12-month period the person was eligible but did not enroll. 7. Patients who are eligible for, but elect not to enroll in, Medicare Part B will not be eligible for most TRICARE benefits (except for space-available direct care within an MTF, and certain pharmacy benefits depending on age).1. The initial enrollment period covers a 7-month period - 3 months before you reach age 65, your birthday month, and 3 months after your birthday month. If eligibility is based on disability or kidney failure, the initial enrollment period depends on the date the disability or treatment began. 2. If you enroll in Part B during the 3 months before your birthday month, you become eligible on the first day of your birthday month; if you enroll during your birthday month, you become eligible on the first day of the month following your birthday month; if you enroll during the first month after your birthday month, you become eligible on the first day of two months after enrollment; and if you enroll during the second or third month after your birthday month, you become eligible three months after enrollment. 3. For people who do not sign up during the initial enrollment period when they first became eligible for Medicare Part B, there is a General Enrollment period each year from January 1st through March 31st, with coverage beginning on July 1st. However, the monthly premium increases 10% for each 12-month period the person was eligible but did not enroll. 4. There are Special Enrollment Situations for certain categories of beneficiaries, and there is a Special Enrollment Period for people covered under an employer group health plan. Contact Medicare or the Social Security Administration for information. 5. Dual-eligible active duty family members are not required to purchase Medicare Part B until their active duty sponsor retires. 6. The monthly Medicare Part B premium for 2006 is $88.50. As noted above, however, the surcharge will increase the monthly premium by 10% for each 12-month period the person was eligible but did not enroll. 7. Patients who are eligible for, but elect not to enroll in, Medicare Part B will not be eligible for most TRICARE benefits (except for space-available direct care within an MTF, and certain pharmacy benefits depending on age).

17. Claims Processing for TFL & Dual-Eligible Beneficiaries Claims processor – Wisconsin Physician Services (WPS) www.tricare4u.com Providers file claims with Medicare Medicare forwards claims to WPS Explanations of Benefit (EOB) from both Medicare & TRICARE

18. Using TFL with Other Health Insurance (OHI) Examples of OHI: Employer-sponsored health insurance Medigap & other supplemental health insurance policies TRICARE does not pay second to Medicare if there is OHI Medicare pays first, OHI second, & TRICARE last May have to file paper claims with TRICARE for payment/reimbursement

19. Catastrophic Cap Annual (fiscal year) out-of-pocket expenses for covered services Active duty families - $1000/family Retirees & families - $3000/family Includes TFL beneficiaries Covered services - Annual deductibles; inpatient, outpatient & pharmacy co-pays; TRICARE Prime enrollment fees. Retirees include TFL. Covered services - Annual deductibles; inpatient, outpatient & pharmacy co-pays; TRICARE Prime enrollment fees. Retirees include TFL.

20. Catastrophic Cap (continued) Exclusions: Does not apply to active duty personnel Out-of-pocket expenses under TRICARE Prime point-of-service option Any amount charged by non-participating providers above the TRICARE allowable charge Medicare premiums

21. TRICARE Plus Primary care enrollment program at select MTFs NMCP – Internal Medicine Clinic Enrollment by invitation only No enrollment fees or co-pays Same primary care access-to-care standards as TRICARE Prime Limitations Continued availability not guaranteed Specialty care not included nor guaranteed

22. Pharmacy Eligibility Options: MTF Pharmacy TRICARE Mail Order Pharmacy TRICARE Retail Network Pharmacy Non-network Retail Pharmacy TFL beneficiaries who turned 65 before 1 April 2001 may participate in the program without being enrolled in Medicare Part B; beneficiaries who turn 65 on or after 1 April 2001 must be enrolled in Medicare Part B and must ensure their DEERS profile is updated to participate. Express Scripts is the contractor for both the Mail Order and Retail Network pharmacy programs. TFL beneficiaries who turned 65 before 1 April 2001 may participate in the program without being enrolled in Medicare Part B; beneficiaries who turn 65 on or after 1 April 2001 must be enrolled in Medicare Part B and must ensure their DEERS profile is updated to participate. Express Scripts is the contractor for both the Mail Order and Retail Network pharmacy programs.

23. Pharmacy Costs 1. Note: patients using non-network retail pharmacies may have to pay the total amount of their prescription first, then file a claim for partial reimbursement.1. Note: patients using non-network retail pharmacies may have to pay the total amount of their prescription first, then file a claim for partial reimbursement.

24. TRICARE For Life and Medicare Part D Most TFL/Medicare beneficiaries will not need Medicare Part D Exception may be those with limited income and assets, such as people also eligible for Medicaid Things to consider: Monthly premiums Deductibles and co-payments Drug coverage Annual open enrollment Nov 15 – Dec 31 Monthly premiums do not apply towards the catastrophic cap.Monthly premiums do not apply towards the catastrophic cap.

25. Physical Exams & Preventive Services Clinical Preventive Services - Limited TRICARE & Medicare Benefit Cancer screening exams & tests Disease prevention exams & tests Immunizations/vaccinations Smoking cessation & healthy living education One-time “Welcome to Medicare” Physical Exam Within the first 6 months of having Medicare Part B

26. Hearing Aids Not a covered benefit under TRICARE or TFL for retirees Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP) At select MTFs NMCP ENT Clinic (Audiology) Referral required Retiree only Retiree family members do not qualify Does TRICARE cover hearing aids? No. TRICARE does not cover hearing aids for retirees or their family members. However, some military treatment facilities (MTFs) support the Retiree At Cost Hearing Aid Purchase Program (RACHAPP) for retired uniformed service members in need of hearing aids. The RACHAPP program allows retired service members the opportunity to purchase hearing aids at government cost.Contact a RACHAPP participating MTF to learn more about the RACHAPP program. The web site listing the RACHAPP facilities is http://www.militaryaudiology.org/rachap/state.html What happens if my military treatment facility offers the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP)?If the RACHAPP is available, the MTF instructs you on how to obtain an appointment at the Audiology Clinic. The MTF Audiologist then performs a complete diagnostic evaluation, and any necessary medical referrals will be addressed at the audiology appointment. If it is determined that you may benefit from the use of amplification, the Audiologist will recommend a specific hearing aid(s), inform you of the cost of the hearing aid, and provides you with a prescription. The military treatment facility then assists with ordering your hearing aid. Under the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP), when will I pay for my hearing aid?Most Military Treatment Facilities (MTFs) will ask you to provide payment at the time the hearing aid(s) is ordered. Once the MTF receives the hearing aid, the MTF contacts you and schedules you for a Hearing Aid Fitting appointment. Does TRICARE For Life (TFL) pay for hearing aids?No, hearing aids are not covered. However, retired sponsors may be eligible for the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP). Retired service members should call a RACHAPP participating military treatment facility to learn more about the RACHAPP program. Please visit the RACHAPP web site (http://www.militaryaudiology.org/rachap/state.html) for contact information.Does TRICARE cover hearing aids? No. TRICARE does not cover hearing aids for retirees or their family members. However, some military treatment facilities (MTFs) support the Retiree At Cost Hearing Aid Purchase Program (RACHAPP) for retired uniformed service members in need of hearing aids. The RACHAPP program allows retired service members the opportunity to purchase hearing aids at government cost.Contact a RACHAPP participating MTF to learn more about the RACHAPP program. The web site listing the RACHAPP facilities is http://www.militaryaudiology.org/rachap/state.html What happens if my military treatment facility offers the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP)?If the RACHAPP is available, the MTF instructs you on how to obtain an appointment at the Audiology Clinic. The MTF Audiologist then performs a complete diagnostic evaluation, and any necessary medical referrals will be addressed at the audiology appointment. If it is determined that you may benefit from the use of amplification, the Audiologist will recommend a specific hearing aid(s), inform you of the cost of the hearing aid, and provides you with a prescription. The military treatment facility then assists with ordering your hearing aid. Under the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP), when will I pay for my hearing aid?Most Military Treatment Facilities (MTFs) will ask you to provide payment at the time the hearing aid(s) is ordered. Once the MTF receives the hearing aid, the MTF contacts you and schedules you for a Hearing Aid Fitting appointment. Does TRICARE For Life (TFL) pay for hearing aids?No, hearing aids are not covered. However, retired sponsors may be eligible for the Retiree-At-Cost Hearing Aid Purchase Program (RACHAPP). Retired service members should call a RACHAPP participating military treatment facility to learn more about the RACHAPP program. Please visit the RACHAPP web site (http://www.militaryaudiology.org/rachap/state.html) for contact information.

27. TRICARE Online Current Features Online MTF appointing Rx checker TRICARE information Personal health journal Medical library Health & wellness links Healthy life style tools MTF facility & clinic pages Provider pages Secure access

28. Future Features Pharmacy refills Routine pharmacy renewal requests Routine lab requests Online enrollments Patient/provider messaging Appointment reminders Health assessments Access to electronic health record TRICARE Online

29. Dental TRICARE Dental Program (TDP) For active duty family members, & National Guard & Reserve members & their families United Concordia is the contractor TRICARE Retiree Dental Program (TRDP) For retirees & their families, Medal of Honor recipients & their families, & certain survivors & former spouses Delta Dental Plan of California is the contractor

30. Long Term Care &Skilled Nursing Care Long Term (Custodial) Care Comfort, personal, wellness needs – activities of daily living Can be received in the home, assisted living facility, adult day care, or nursing home Not covered by TRICARE or Medicare Commercial insurance plans available Skilled Nursing Care Medically necessary nursing & rehabilitation (physical, occupational & speech therapy) services Delivered in a skilled nursing facility Covered by TRICARE & Medicare (restrictions apply)

31. TRICARE – Sustaining the Benefit Major expansions in the TRICARE benefit Proposed changes to the TRICARE benefit – phase-in Increase TRICARE Prime enrollment fees (applies only to eligible retirees under the age of 65) Create TRICARE Standard enrollment fees & increase deductibles (applies only to eligible retirees under the age of 65) Change some pharmacy co-payments Major Expansions 1. Active Duty & Their Families Introduced TRICARE Prime Remote for service members and their families Eliminated all Prime cost-sharing for care delivered by civilian providers…virtually no out-of-pocket costs Added TRICARE Reserve Select, offering a DoD-subsidized, “buy-in” provision for Guard and Reserve 2. Retirees & Their Families Introduced a civilian network prescription drug benefit for Medicare-eligible beneficiaries in 2000 Introduced TRICARE For Life, which established TRICARE as a second payer to Medicare for dual-eligible beneficiaries Reduced catastrophic cap for retirees under age 65 in TRICARE Standard from $7,500 to $3,000 3. Expansions in Customer Service Expanded network and participating hospitals, providers and pharmacies every year; more than 200,000 physicians, 55,000 pharmacies, and 6,000 hospitals nationwide Dramatically improved claims processing, becoming an industry leader in timeliness and accuracy of claims payment Co-located TRICARE Service Centers in more military facilities over the years Eliminated the requirement for Non Availability Statements for TRICARE Standard beneficiaries, greatly expanding customer choice for inpatient care Introduced 1-800-TRICARE, toll-free customer service, linking beneficiaries to the right support system easily and quickly Major Expansions 1. Active Duty & Their Families Introduced TRICARE Prime Remote for service members and their families Eliminated all Prime cost-sharing for care delivered by civilian providers…virtually no out-of-pocket costs Added TRICARE Reserve Select, offering a DoD-subsidized, “buy-in” provision for Guard and Reserve 2. Retirees & Their Families Introduced a civilian network prescription drug benefit for Medicare-eligible beneficiaries in 2000 Introduced TRICARE For Life, which established TRICARE as a second payer to Medicare for dual-eligible beneficiaries Reduced catastrophic cap for retirees under age 65 in TRICARE Standard from $7,500 to $3,000 3. Expansions in Customer Service Expanded network and participating hospitals, providers and pharmacies every year; more than 200,000 physicians, 55,000 pharmacies, and 6,000 hospitals nationwide Dramatically improved claims processing, becoming an industry leader in timeliness and accuracy of claims payment Co-located TRICARE Service Centers in more military facilities over the years Eliminated the requirement for Non Availability Statements for TRICARE Standard beneficiaries, greatly expanding customer choice for inpatient care Introduced 1-800-TRICARE, toll-free customer service, linking beneficiaries to the right support system easily and quickly

32. TRICARE Assistance & Information Beneficiary Counseling & Assistance Coordinators (BCACs/HBAs) Located at most MTFs TRICARE Service Centers (TSCs) Health Net Federal Services Located at major MTFs Telephone resources Internet resources

33. TRICARE Assistance & Information - BCACs Boone Branch Health Clinic, NAB Little Creek (757) 314-7347 Kenner Army Health Clinic, Fort Lee (804) 734-9447 Langley 1st Medical Group, Langley AFB (757) 225-5111 McDonald Army Community Health Clinic, Fort Eustis (757) 314-7939 Naval Medical Center Portsmouth (757) 953-2610 Northwest Branch Health Clinic, NavComSta NW (757) 421-8220 Oceana Branch Health Clinic, NAS Oceana (757) 314-7129 Sewells Point Branch Health Clinic, Norfolk Naval Base (757) 953-8708 TRICARE Prime Clinic Chesapeake (757) 314-8958 TRICARE Prime Clinic Virginia Beach (757) 314-8939 Yorktown Branch Health Clinic, Naval Weapons Station (757) 314-6107 Yorktown Coast Guard Health Clinic (757) 856-2147

34. TRICARE Service Centers Health Net Federal Services 1 (877) TRICARE (874-2273) Locations Naval Medical Center Portsmouth Kenner Army Health Clinic Langley 1st Medical Group McDonald Army Community Health Clinic TRICARE Assistance & Information - TSCs

35. TRICARE Service Center (Health Net Federal Services) 1-877-TRICARE (1-877-874-2273) TRICARE Mail Order Pharmacy (Express Scripts) 1-866-DoD-TMOP (1-866-363-8667) TRICARE Retail Pharmacy (Express Scripts) 1-866-DoD-TRRx (1-866-363-8779) Hampton Roads Appointment Center 1-866-MIL-HLTH (1-866-645-4584) TRICARE Online 1-800-600-9332 or 1-210-767-5250 TRICARE Dental Program (United Concordia) 1-800-866-8499 TRICARE Retiree Dental Program (Delta Dental) 1-888-838-8737 TRICARE For Life 1-866-773-0404 (or TTY/TDD callers use 1-866-773-0405) TRICARE Assistance & Information – Telephone #s

36. TRICARE Assistance & Information – Internet TRICARE Management Activity – www.tricare.mil Health Net Federal Services – www.healthnetfederalservices.com TRICARE Dental Program – www.TRICAREdentalprogram.com TRICARE Retiree Dental Program – www.trdp.org TRICARE Mail Order Pharmacy Program – www.express-scripts.com/TRICARE TRICARE Retail Pharmacy Program – www.tricare.osd.mil/pharmacy Reserve Affairs – www.defenselink.mil/ra Naval Medical Center Portsmouth – www-nmcp.mar.med.navy.mil DEERS – www.tricare.osd.mil/DEERS TRICARE For Life – www.tricare4u.com Medicare & Social Security – www.ssa.gov TRICARE Online Appointments – www.tricare.mil TRICARE Claims (PGBA) – www.mytricare.com TRICARE For Life Claims (Wisconsin Physician Services) – www.wps.com

37. Health Net Web Site www.healthnetfederalservices.com Features: TRICARE Prime enrollment, benefit, policy and cost-share information Information about referrals and authorizations for specialty care Claims information AudioHealth Library featuring hundreds of recorded health topics which can help you stay healthy “Online TRICARE Service Center” TRICARE Service Center Directory Health Net Provider Network Directory

38. Thank You!