LVMAC News — TRICARE in the Lehigh Valley
MR. TERRY GOODYEAR EXPLAINS THE TRICARE PROGRAM
Mr. Terry Goodyear, Educational Specialist for HealthNet Federal Services LLC, which manages the TRICARE North contract serving our region, spoke to the Council on 15 February at its business meeting on the subject of TRICARE and the options available.
TRICARE brings together the health care resources of the Military Health System—such as military treatment facilities (MTFs) —with a network of civilian health care professionals, institutions, pharmacies, and suppliers. It is a worldwide system managed regionally.
Eligibility to the program begins with registration in DEERS (which results possessing a military ID card). Service members are automatically registered, but family members are not and are the service member’s responsibility to register. The actual beneficiary categories are: 1) Active Duty service members; 2) Active Duty family members; 3) Retired service members and their family members (in dependent status) [including medically retired and receiving retired pay]; 4) National Guard and reserve members and their families not on active duty orders or ordered to active duty up to 30 days; 5) Survivors, certain former spouses, and others, such as Medal of Honor winners [This does not include 100% service-connected disabled veterans and their dependents unless also medically retired and receiving retired pay].
The TRICARE program options are almost mind boggling. Excluding the overseas programs, they are: 1) TRICARE Prime, 2) TRICARE Prime Remote [when more than 50 miles or an hour’s drive from a Military Treatment Facility, 3) TRICARE Prime Remote for Active Duty Family Members, 4) The U.S. Family Health Plan (USFHP, a civilian provider HMO option in a few locations in the country), 5) the individual choice TRICARE Standard [when dealing with network providers] and Extra [when dealing with non-network providers] program (and the automatic default option for those on active duty or retired), 6) TRICARE Young Adult (a purchased special, purchased program allowing continued benefits for dependent children while in college to the age of 26 instead of 23, as a result of recent legislation), 7) the purchased TRICARE Reserve Select (TRS), 8) the purchased TRICARE Retired Reserve, and 9) TRICARE For Life. The weighting of program options is telling. TRICARE was originally and chiefly designed for active duty personnel, military retirees, and their families.
Unless enrolled in approved institution of higher learning children fulltime are eligible for TRICARE until they reach age 21 if the sponsor (the service member) provides over 50% of the child’s financial support. Unmarried biological and adopted children are eligible for benefits even if their parents divorce or remarry. Stepchildren must be adopted to retain benefits following divorce.
Dependent parents and parents-in-law are not eligible for most civilian TRICARE benefits. However, dependent parents may receive care in a military hospital or clinic a space-available basis. Eligibility for former spouses depends on the number of years of marriage during which the sponsor was on active.
Some form of modest premium or copayment may be involved … or not. This is a part that often lends itself to confusion. For example, Active Duty families pay no TRICARE Prime fees at all while those who are retired would pay about $260 for an individual and $520 for a family per annum but with no copayments. TRICARE Standard and Extra, which is used by most retirees in our area, involves a $150 deductible for the individual and a $300 deductible for the family and generally a 25% copayment after the deductible is met (20% when TRICARE Extra applies). For those on Active Duty, the copayments are 5% less and the deductible is divided into two levels based upon rank.
Mr. Goodyear also explained the pharmacy program. Other than when using the USFHP, the co-pays are small or non-existent, a significant benefit to those who have placed themselves in harm’s way.
He mentioned the Transitional Assistance Management Program (TAMP) which applies to all Reservists for the first six months after separation. Excluding service members on Active Duty, the Annual Catastrophic Cap is either $1,000 or $3,000 per family [not an Active Duty Family member, on TRS or TAMP] depending on one’s beneficiary status.
TRICARE has a dental program under a separate, premium-based contract. Currently the contractor is United Concordia, but Humana Military has won the new contract. It does not include routine audiology and eye care. In essence, TRICARE, other than allowing for the use of Military Treatment Facilities [service is affected by beneficiary category and program option], acts like a private insurance program in most ways.
The discussion revealed that the options under TRICARE Prime/Prime Remote in our region still are limited and many times require travel to the vicinity of the Quakertown area and further. This is an unsatisfactory state of affairs, has not improved significantly in the past seven years, and Department of Defense seemingly needs to apply more attention to “remote areas.” Seems the VA has a partner here in this deficiency.
For more details (note pages of the briefing), click here. Miliary.com contains a good run recap for this enormously complex and often confusing system with “in’s and out’s.” The official site for information, which allows tailoring to one’s circumstances is found by clicking here.
Editors Note: While the VA gets the press locally, TRICARE is the important healthcae system to military service members and retirees and especially their dependents. It serves more than 9.4 million beneficiaries currently. In the Lehigh Valley alone, it is estimated that about 2000 veterans plus their families are beneficiaries, a not insignificant figure amongst the 45,000 or so veterans in the valley. Notably, only about 20% of beneficiaries were active-duty members of the armed forces or activated members of the National Guard or Reserves (TRICARE, 2009). About 26% were family members (including children) of active-duty or activated personnel, and the balance, or 54%, were retirees and their families. Unlike in the VA system, almost half the beneficiaries are female (48.5%) and TRICARE, since it acts as an insurance program, gives its beneficiaries generally more flexibility in receiving care that the VA system cannot and serves. Finally, it serves almost twice as many beneficiaries than the VA system, for about the same cost.
SCHOLARSHIP PROGRAM RESUMES
In the past we have reported to you about changes in the Scholarship program and most recently on the need for someone to step up to be its chairman. Mr. Robert Rothenberger, a former Whitehall Middle School Principal, has stepped up. Mr. Phil Hublitz is working with him and has prepared the letters needed to send out. I am in the process of reviewing the business plan. Startup for this fiscal year will be 2 March and the application deadline will be 15 May.
MILITARY SUPPORT COMMITTEE FORMING
If you know of someone interested in becoming a chairman or a member of the new Military Support Committee, please contact us.
AN UPDATE ON HOMELESSNESS ACTIONS
Pat diLuzio is reviewing our homelessness program for improvements.
There has been increased interest among the social work nonprofits in the VA’s Supportive Services for Veterans Families program which emphasizes homeless prevention measures and is a new program. LVMAC has helped spread word of this new VA program started last year. Some of this has to do with the fact that HUD’s Homeless Prevention and Rapid Re-Housing Program is ending. It is to the advantage of the Lehigh Valley if an organization here obtains a grant. We have been collaborating to help in that effort, when asked.
Meanwhile, Steve Costas, the VA’s local homelessness person, has managed to increase the number of permanent housing vouchers available. As a result of a meeting last Friday with LVMAC, the VFW is looking at whether or not it can provide veterans service officer support directly to Veterans Sanctuary and Victory House.
OPERATION JOVE GEARS UP
Dave Newton tells us our job hunting skills workshops will start on 7 March. Since about 20% of younger veterans are unemployed and the Department of Labor and Industries veteran specific efforts are in need of help, we are certain there is a market for the product.
If you know of someone interested in the program, go to our website or blogsite to find out how to enroll. Application will soon be available on line. A brochure explaining the program is both the web and blog sites. This is the hard part in our area, for both us and those in the job training professions, getting the veterans to come in. Full-bore start up will depend on the number of clients.
LOCAL HEALTHCARE COMMUNITY MEETS WITH THE VA
Eric Johnson conducted the second military-veteran healthcare focus group meeting on 20 January. This initiative is all about improving access, quality, and safety in healthcare for veterans using the both the community and the VA working in together. It will take time to achieve the vision.
This last meeting, which occurred at the Allentown VA Outpatient Clinic, was a first for our community. It brought together executives from all the major medical establishments (hospitals) in the Lehigh Valley together with Wilkes-Barre VA hospital staff. The need for designated VA Liaison Officers, creation of in-processing questions to ascertain if a patient is a veteran (useful for a number of reasons to include patient safety and improved diagnosis), and the need to prepare to react to a “yes” response were all discussed as first items of business. We have asked the VA to help us train our medical community to be more responsive.
The next working group meeting will occur 23 February at St. Lukes Hospital as all agreed to meet on a monthly basis. As previously implied, this meeting will focus on the status of VALO appointments, continued discussion on veteran/military patient pre-identification/screening, and the identification of existing tools found helpful in providing or coordinating care for this population. Also an executive level steering committee meeting to review progress will occur in July.
To be this far along, so soon, with the VA willing to meet, speaks volumes. It is also timely since the disability rate among military personnel has increased 80% since the war on terror began.
FAMILY PTSD BOOKLET IS CONTINUES TO BE DISTRIBUTED
If you know of a family or an organization interested in the new family PTSD Booklet with a local resource guide to help and services and entitled Veterans and Families’ Guide to Recovering from PTSD, let Dick Moore or the Chairman of the Veterans Affairs Committee f know. To date, we have distributed about 250 copies. We need to do better and push this product out to where it is most needed. This requires your help as member organizations. Contact us at email@example.com.
PROJECT HEALING WATERS FLY FISHING CASTS A NEW YEAR OF ACTIVITIES
The fly tying courses, free to veterans, continue. The next major event by Trout Unlimited – Hokendauqua, our partner, is a Fly Fishing Outing is scheduled for May 5th 2012 at Bob Saks’ Pond. For a report on what is happening for the coming year, click here.
A GOVERNMENT AFFAIRS UPDATE
District 8 of the VFW has once again resolved we need a Department of Veterans Affairs not stuck under the National Guard. We have heard District 30 of the American Legion recently passed a similar resolution and other districts like Districts 14 and 19 are also interested in the subject. Perhaps they will change the American Legion thinking at state level. The state VFW has been an advocate for a separate department for a while. The time has certainly come.
DoD/VA NEWS BRIEFS
VA Budget Submission: With more than 1 million active-duty personnel scheduled to join the ranks of America’s 22 million Veterans during the next five years, the President has proposed a $140.3 billion budget for the Department of Veterans Affairs for the fiscal year beginning Oct. 1. In the areas of healthcare and disability and pension it involves a 4% increase in funding. The new request includes provision for creating a Veterans Job Corps and a separate funding increase to expand the “VetSuccess on Campus” program from 28 campuses to 80, serving approximately 80,000 Veterans. The program provides outreach and supportive services during their transition from the military to college.
Women Veterans Care: In a sign of the times and as we induct more women into the military, the VA has to react accordingly. The Department of Veterans Affairs has published a regulation officially amending VA’s medical benefits package to include up to seven days of medical care for newborns delivered by women Veterans who are receiving VA maternity care benefits. While typically it provided maternity benefits from the confirmation of pregnancy to about six weeks after delivery, previously it could not provide services to the infant itself. That has changed. What has not changed is that one needs to contact the Women’s Program Manager as soon as one becomes pregnant because this service is provided out of house.
FOR MORE INFORMATION, GO TO THE BLOGSITE AND CALENDAR.
15 February 2012 (Revised 21 February 2012)