Download - TRICARE Prime Service Area Reductions
TRICARE Prime Service Area Reductions
January, 2013
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• The primary purpose of a PSA is to augment the delivery of health care around military treatment facilities (MTFs) and Base Realignment and Closure (BRAC) sites
• The latest generation of TRICARE Managed Care Support Contracts (T-3) request for proposals released in 2007 did not require TRICARE regional contractors to develop PSAs in areas remote from MTFs
• The PSAs affected under T-3 are not close to existing military treatment facilities, and have never augmented care around MTF or BRAC locations.
• PSA reduction assists DoD in controlling health care costs – will save an estimated $45-$56M a year
What is PSA Reduction?
www.tricare.mil/PSA
PSA Reductions
• Of approximately 1.6 million retirees and family members currently in Prime, 171,000 potentially affected across all three U.S. regions
• No impact on Active duty service members and their families: Prime benefits maintained
• Affected Retirees and their family members living <100 miles from remaining PSA may be able to transfer their Prime enrollment
• No impact on Medicare eligible beneficiaries
– TRICARE For Life and Pharmacy unaffected
No Impact on Active Duty
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• Impacted beneficiaries automatically have TRICARE Standard/Extra
• TRICARE Standard is similar to “open choice” health plans – You can choose any TRICARE authorized physician
– No enrollment fees
– No monthly fees
– No referrals
– Fewer authorizations
• Preventive care covered at no out-of-pocket cost includes:– Cancer screenings
– Well child care
– Immunizations
TRICARE Standard
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Differences Between Prime and Standard
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Cost Comparison: Standard/Extra vs Prime
Enrollment FeesDeductible In-Network
Copay/cost-share
Point of Service
Fees
Annual Catastrophic
Cap
Prime
$269.28/year individual
$538.56/year family
E.R. visit - $30
Outpatient visit - $12
Annual deductible plus 50% cost share
$3,000/ year
Standard/Extra
None
E1-E4: $50 individual,
$150 familyE5 and above:
$150 individual,
$300 family
20% in-network
25% out-of-network
None $3,000/year
Communication
• TRICARE is committed to keeping beneficiaries informed about changes in PSAs
• Multiple communication via US Mail; media, customer service support, web, Mil/Vet Assoc.
• Information will be updated at www.tricare.mil/PSA where you may also sign up for e-mail updates
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Thank You for Your Patience
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Implementation Plan Highlights
Action/Tactic Target Date
PSA Contract modifications to West/North/South 12/2012
Information Paper for Senior DoD Leadership/ Hill/ Surgeons; PSA Fact Sheet January 8, 2013
Tricare.mil/PSA launch January 10, 2013
Customer Service FAQs/Military Associations Briefed January 10, 2013
Notify Interested Media January 10, 2013
TRICARE Region Communication to Commands January 10, 2013
Military Association Execs Full Briefing January 10, 2013
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Implementation Plan Highlights
Action Target Date
HASC/SASC Full briefing January 16, 2013
Early notification letters for affected beneficiaries
* February 7, 2013 * Dependent on Contractor Printing/Mailing
ZIp Code Locator Tool on TRICARE WebFebruary 7, 2013
MHS Conference 02/11-14/2013
Customer Service Support in place for affected beneficiaries 04/01/2013
Health Matters Newsletter (Prime) to 1.5 M 05/2013
Media Roundtable with details; news articles; outreach to affected communities
05/2013
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Implementation Plan Highlights
Action Target Date
Second Notification Letter 06/2013
Beneficiary Prime Health Matters Newsletter Article 08/2013
Disenrollment letters for affected beneficiaries 08/2013
Response to question/reinforce information stream08/2013-10/2013