On 1 October 2004 TriCare completed a massive management-restructuring program that has had a huge impact on how the entire medical benefit program is being administered for all branches of service.
**Important Note: TriCare policies and benefits are governed by Federal public law. Changes to TriCare programs are continually made as laws are amended or enacted. For the most up to date information visit your TriCare Region web site or the main TriCare links listed in the "US Military" Resource Links..
All Regions of TriCare were restructured with several being deleted and new boundaries being set. The changes have been huge with many changes still forthcoming. Case Managers are no longer available on Bases or Posts to assist in Customer Service and Benefit assurance. Each Region now has a main call center with satellite call centers contracted to provide services in their region. While call response times have improved plan on spending at least part of your call on "hold". If your phone has a "conference call" or "speaker" feature we suggest using those while waiting for assistance. This allows callers to complete other tasks while waiting to talk to a customer service representative.
Tip: Linda uses a cordless handset, which attaches to her waistband with an attached headset while on hold during phone calls. This allows her to move about the house and complete chores and other daily tasks while she waits. Linda has discovered she often completes most of her routine daily chores while she is on hold.
Due to the high volume of calls being received by Regional Call Centers it has become even more important to document your calls and conversations. Linda has had to fax her personal notes to Regional representatives several times to assist in problem solving and obtaining benefits. While the call system is slowly improving it is still important to take notes. Remember: Document, document, document. "If it isn't on paper, it didn't happen"!
**TIP: It is recommended you keep your Explanation of Benefits (EOB) forms and the corresponding medical/dental bills for at LEAST 7 years. A news release from TRICARE Management Activity No.06-23 dated June 22, 2006 reads,
" Extended coverage under TRICARE Prime for surviving children whose sponsor dies while serving on active duty for a period of more than 30 days. Eligible beneficiaries should save their receipts for care received from Oct. 7, 2001, and submit for reimbursement upon full implementation of this benefit."
Obviously, benefit implementation may be retroactive. The burden of proof is on the beneficiary. If you don't have your EOBs you're out of luck! Save your EOBs! We recommend maintaining a file of all EOBs and their corresponding billings in a long-term file. Many individuals find that filing these along yearly income tax returns makes them easier to locate. File by year for ready reference.
Once DEERS enrollment has been completed the next step is enrollment in the TriCare medical program. There are three main TriCare components. TriCare Standard, TriCare Extra, and TriCare Prime. Each program has its Pros and Cons.
The most important thing to remember when choosing a health plan is to READ THE LIST OF BENEFITS and THE MANUAL! Not all health care plans are created equal and not all plans will fit the entire family. ESPECIALLY if one or more dependants has Special Needs over and above routine care.
A copy of the TriCare Handbook of Benefits can be found at www.tricare.osd.mil
Beneficiaries needing more help may also call stateside customer service at 1-800-600-9332 or (210) 767-5250 (direct).
Agents are available 24 hours a day to assist Sponsors and their beneficiaries.
*TIP: Always hand-carry a copy of your most recent medical records with you! This will ensure quick access should medical treatment be needed while in transit or before a PCM can be assigned!