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  • Tricare provider

     

    Some Tricare beneficiaries still have problems trying to get medical care, and officials have taken actions to try to improve the performance of contractors, said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency.

    Officials are closely monitoring the performance of the two U.S. Tricare contractors, Humana Military in the East region, and Health Net Federal Services in the West region, said Bono, speaking at a family forum Monday at the 2018 AUSA annual meeting.

    She said she recently was impressing upon some senior spouses that “it’s extremely important to me that we get the type of performance we need” from the contractors.

    And, she told them, “While I may not look like it, I can be a bad ass.”

    Defense health officials have issued several corrective action plans to the contractors, among other things. Through August, the contractors were meeting contract requirements at a level of about 80 percent.

    She said there are still challenges with the accuracy of the contractors' provider directories. Defense health officials have issued corrective action plans to both contractors regarding these issues. Families have had trouble finding area doctors and other medical providers who are in the Tricare network.

    Officials also issued a corrective action plan to Health Net regarding its customer call centers. Humana has corrective action plans regarding claims processing, correspondence, autism care/Applied Behavior Analysis therapy.

    Tricare underwent massive changes in January, as three regions were reduced to two, and Tricare Select replaced Tricare Standard and Extra. There have also been increases in some co-pays and some pharmacy costs.

    Help spread the word

    Bono asked for the help of those in the audience – which included many military spouses – in getting the word out about important changes coming up.

    There are new requirements for those who are retiring. To keep Tricare with no break in coverage, the service member must re-enroll within 90 days of retirement.

    There are new open enrollment seasons affecting three benefits, all of which will be held Nov. 12 to Dec. 10:

    • Those in Tricare Prime or Select who like their plan don’t need to do anything. But anyone wishing to switch from Prime to Select, or vice versa, must do so during that open season. Until now, families could switch at any time. But once the open season is over, a switch can be made only for a qualifying life event. A few examples of those are moving, retiring, separating from active duty, getting married, having children, and getting divorced. (Tricare.mil/openseason)
    • The Tricare Retiree Dental Program ends Dec. 31. To have dental coverage for themselves and their family members through the government in 2019, retirees must enroll in the FEDVIP plan during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)
    • Retirees and their family members and active duty family members (not active duty) will also have access to new vision coverage under the FEDVIP, during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)

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  • 5 Things Tricare

     

    For the first time ever, Tricare will host an open enrollment period for military families and retirees who want to change their coverage plans.

    Currently, changing between Tricare Prime and Tricare Select, previously known as Tricare Standard, is easy and typically not time sensitive for active-duty families and retirees. If you want to change and your military status or location qualifies you to do so, you can simply call your Tricare regional contract and ask to be swapped. Sometimes, there is a waiting period before you can switch from Tricare Select to Tricare Prime, but it is often waived.

    Starting Jan. 1, however, the ability to switch back and forth at will is going away. Here's what you need to know:

    1. To change plans, you must have a "qualifying life event." Along with the change to Tricare Select from Tricare Standard, the Defense Health Agency did away with the ability to switch back and forth. Starting Jan. 1, you'll need to experience a "qualifying life event" (QLE). What does that mean? Tricare officials created a list based off industry standards. It includes things like a move, job loss and being recaptured from a civilian doctor into the Military Treatment Facility system. You can see a complete QLE list on Tricare's website.

    2. Tricare's QLE list does not include pregnancy. While giving birth is a qualifying event that would let you switch between plans, pregnancy is not. That means military spouses who think they might get pregnant and who do not want to be seen for their pregnancy within the military treatment facility system should register for Tricare Select during the annual open enrollment period.

    3. Open enrollment happens only one time each year. Once a year, all Tricare users will have the chance to switch plans without first having one of those QLEs. That window will run from mid-November to mid-December. Starting Jan. 1, 2019, if you missed that window, you will not be able to change plans.

    4. Other Tricare users can switch at any time. Tricare users on Tricare Reserve Select, Tricare Retired Reserve and Tricare Young Adult don't have to worry about QLEs. Instead, they can enroll or un-enroll at any time. That's because those programs, known as "purchased plans," are based on other eligibility factors such as age and Guard or Reserve status.

    5. The newly available vision plans also have enrollment rules. Looking to take advantage of the vision plan now available for military families through the Federal Employees Dental and Vision Insurance Program (FEDVIP)? That program has its own open enrollment rules. You will also need to enroll or make changes to your coverage during the annual open enrollment or during a qualifying life event.

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  • 65M

     

    CATHEDRALCITY,Calif. – Bill Schneid stood in his home office, holding a package of skin cream worth more than gold. He didn't know exactly what he had stumbled on, but he was pretty sure it was illegal.

    It was March 2015. A few weeks before, Schneid, 72, a curmudgeonly private investigator, had been snooping aroundSouthern California military bases when a Marine he knew mentioned he had a strange source of side income.

    The Marine was being paid to get medicine he didn’t need. ATennessee doctor he had never met wrote him a medicinal cream prescription, which was being filled by a pharmacy inUtah. The military covered the bill and the Marine got a cash kickback from somebody. When the creams arrived in the mail, the Marine didn't actually use them.

    He was in it for the money, not the medicine, after all.

    Suspicious, Schneid launched a ruse to investigate, persuading the Marine to reroute the shipments to his house. Soon, Schneid received a shoebox-sized parcel that held several tubes of cream about the same size and consistency as sunscreen that was supposedly used to treat pain and scars.

    This medicine had been prescribed, supplied and delivered seemingly for no reason at all. Nobody needed it. Nobody wanted it. So what was the point?

    “After the second delivery, I realized this was some kind of fraud,” Schneid said in an interview. “I believed there were about a dozen Marines involved, and they were being actively recruited to be prescribed this cream.

    “It was a conspiracy, and it was growing, but I just didn’t know how huge.”

    Today, court records make clear the enormity of the conspiracy. The scheme that Schneid stumbled upon in 2015 stretched fromCalifornia toTennessee, involving people and companies from at least four states. InTennessee, two doctors and a nurse practitioner have pleaded guilty to defrauding a military insurance program, called Tricare, out of $65 million. At least two more suspects are still facing charges. Federal prosecutors also are attempting to seize swaths ofEast Tennessee farmland, a strip mall, and a large estate they argue was purchased with health care fraud profits.

    OutsideTennessee, an ex-Marine inSan Diego has confessed to recruiting Marines for the scheme and aUtah pharmacy company is under indictment. That company is also linked to an even larger scheme inMississippi, where seven people have pleaded guilty to using similar medicinal creams to defraud the federal government out of an additional $400 million.

    “It was just a setup to pay cash to patients and then turn around and prescribe them this expensive cream,” said Jerry Martin, a formerU.S. attorney who specializes in health care fraud.

    Martin reviewed the pain cream case at the request of The Tennessean, calling the conspiracy "extraordinarily brazen."

    “If these allegations are true, that is just a criminal enterprise," he added. "There is just nothing legitimate about it.”

    Pain creams cost $14,500 – each

    InTennessee, the crux of the cream conspiracy was Choice MD, a small, now-shuttered clinic in Cleveland, a manufacturing town near theGeorgia border.

    A Choice MD nurse practitioner, Candace Michelle Craven, has admitted she conducted fake telemedicine evaluations with Marines inCalifornia so that two Choice MD doctors, Susan Vergot and Carl Lindblad, could write nearly 4,500 cream prescriptions to Marines they had never met or diagnosed.

    Each prescription cost about $14,500. American taxpayers covered the cost.

    Vergot and Lindblad pleaded guilty to conspiracy to commit health care fraud in April, and Craven pleaded guilty in November. But all three are still licensed to practice medicine inTennessee. Their sentencing hearings have been delayed until March, likely to provide time for them to testify against other suspects in the case.

    Steven Moore, an attorney who represents Vergot and Lindblad, said the doctors knew the prescriptions “weren’t right,” but were unaware of the larger conspiracy.

    “It wasn’t their scam,”Moore said. “They just kind of buried their heads in the sand, and that’s why they’ve taken responsibility by entering a plea. … But it’s important to know they aren’t the big fish here.”

    The big fish – or at least a bigger fish – are the owners of Choice MD, Jimmy and Ashley Collins, ofBirchwood,Tennessee. Federal prosecutors have indicted the couple and are attempting to seize four of their properties that authorities say were bought with profits from the prescription scam.

    One of those – a 4,500-square-foot mansion on a 60-acre estate with an ornate iron gate emblazoned with a large "C" – was bought by Ashley Collins for $843,000 with money directly traced to fraud earnings, federal court documents state.

    The Collinses, who have pleaded not guilty, are accused of using kickbacks to create a fake customer base for their prescriptions. Court documents say they led a network of prescription recruiters who targeted Marines aroundCampPendleton, often by convincing the Marines they were joining a drug trial for the pain and scar creams. Marines were paid about $300 in illegal kickbacks each month, court records state.

    The leader of these recruiters was Joshua Morgan, a former San Diego Marine who pleaded guilty to his role in the conspiracy in February. Morgan was at one time roommates with the Marine at the beginning of this story, who is not being named because he has not been charged with any crime.

    Prosecutors have filed charges againstCFK Inc., the parent company of The Medicine Shoppe, a pharmacy inBountiful,Utah, that made millions from the Choice MD prescriptions. Prosecutors say the pharmacy was bought byCFK in December 2014, then the business model changed overnight.

    The pharmacy's billings to Tricare, which once amounted to about $40 apiece, rose to an average of more than $13,000. During the first five months of 2015, The Medicine Shoppe billed Tricare for $67 million.

    Court documents identify the owners of the pharmacy by only their initials – W.W. and T.S. – but business records appear to reveal the full names of at least one.CFK is owned by another company, Walters Holdings LLC, which in turn is owned byMississippi businessman Wade Walters.

    Walters is the subject of a criminal investigation in a separate but similar case inMississippi where authorities have raided at least three of his pharmacies and arrested 12 people, including four pharmacists, a doctor, an oral surgeon and two nurse practitioners. Seven of the accused conspirators have confessed, another was convicted at trial, and at least three more are expected to go to trial this year.

    Walters has not been indicted in either case, but prosecutors have frozen his assets.

    “To maximize profits from the fraud scheme, the pharmacies created their own demand for compounded medications,” prosecutors say in court records. “The pharmacies illegally engaged a series of marketers to provide incentives to doctors to write prescriptions for compounded medications and divert patients to the pharmacies.”

    To understand the details of this Tricare fraud, The Tennessean reviewed and cross-referenced hundreds of pages of court documents from 15 separate federal court cases, including criminal prosecutions, search warrants, forfeiture proceedings and a whistleblower lawsuit that Schneid filed in an effort to collect a reward for his discovery.

    Schneid's attorneys would not permit him to comment for this story, but a Tennessean reporter previously interviewed Schneid and inspected the medicinal creams at his home in 2015.

    Court records unsealed last year reveal that the federal investigation into Choice MD officially began three weeks after Schneid discovered and reported the suspicious prescriptions, showing he may have kicked off the entire criminal investigation.

    A Tricare investigation begins

    Not long after Schneid began receiving the cream packages in the mail in 2015, he decided to warn the government about what he had found.

    Sitting in his messy home office, surrounded by paperwork from his long career as a private investigator, Schneid tapped out an email to Tricare’s fraud department, saying he had uncovered a “fraudulent multi-level marketing scheme.”

    A Tricare representative responded a few hours later, believing that Schneid had found a routine “phishing” scam designed to steal his private information, according to email records obtained by The Tennessean. Schneid wrote back, insisting Tricare was missing the point.

    “It’s deeper than that,” Schneid wrote. “(The Marine) makes a percentage of the commission as do the others that signed him up.”

    Suddenly, the government started listening.

    In a matter of days, Schneid had guests on his doorstep. Eleanor Gailey, an inspector from the Department of Defense’s Office of the Inspector General, flew toCalifornia to inspect the creams, emails show. She was accompanied by officers from the Naval Criminal Investigative Service, which investigate crimes in the Marine Corps.

    In an interview, Schneid said authorities would not reveal exactly what he had stumbled upon, but he agreed to help anyway. They made a plan: Schneid would continue to play dumb, receiving the Marine's cream prescriptions in the mail, then he would wrap the packages in evidence tape and hand them over to the NCIS. He did this for a few months until the prescription ran out and the cream stopped coming.

    Then, in May 2015, it became clear what was going on.

    That was when CBS News published an investigation revealing a Tricare loophole that appeared to be costing taxpayers millions, if not billions, of dollars. The CBS investigation said military troops across the country were being prescribed “cure-all” medicinal creams that did next to nothing but cost taxpayers a fortune every month.

    The creams were marketed as “compounded” medication. Compounding is a practice in which a pharmacist mixes several medicines into one to create a treatment tailored for a specific patient. Because every mix is unique, compounded medicines are not reviewed by the Food and Drug Administration and often cost much more than standard medicine. As of 2015, Tricare covered the full cost of compounded medicine for active-duty troops.

    "We're on track this year to spend over $2 billion unless we get our hands around this," said Maj. Gen. Richard Thomas, then-head of Tricare, in the 2015 CBS report. "It's just been astronomical, an explosion of the charges in a relatively short period of time."

    Schneid's jaw dropped as he watched the CBS report.

    He thought over all the clues he had seen in the last three months – the unnecessary creams, the cash kickbacks, theTennessee doctors, theUtah pharmacy and the abrupt interest from federal inspectors.

    Suddenly it all made sense.

    “I had thought it was just this very localized fraud,” Schneid said. “It wasn’t until then I understood the enormity of this thing.”

    The Choice MD conspiracy is far from the only cream scheme to take advantage of Tricare’s compounded medical loophole. In June, the U.S. Department of Justice announced it had charged 601 suspects in a nationwide health care fraud investigation into dozens of similar but unconnected fraud schemes, many of which used compounded medications and kickbacks to swindle Medicare, Medicaid or Tricare. The investigation was called the largest health care fraud investigation in American history.

    The U.S. Attorney’s Office declined to comment for this story, citing ongoing investigations inTennessee,California andMississippi. Attorneys for Walters, Craven, Ashley Collins andCFK either declined to comment or did not respond to calls and emails requesting comment. Jimmy Collins currently does not have an attorney and could not be reached for comment.

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  • Tricare Fees

     

    With the federal deficit expected to top $1 trillion this year, the Congressional Budget Office in December published a list of options for reducing the imbalance over the next 10 years, including three suggestions on Tricare and six that address Veterans benefits.

    In its Options for Reducing the Deficit: 2019 to 2028, the CBO laid out 121 opportunities for curtailing spending and raising revenue. These include raising Tricare enrollment fees for military retirees, instituting enrollment fees for Tricare for Life and reducing Veterans benefits.

    The publication marks the fourth time in five years that the CBO has suggested raising Tricare enrollment fees for working-age retirees and introducing minimum out-of-pocket expenses for those using Tricare for Life.

    The CBO suggested that increasing Tricare enrollment fees for working-age retirees -- those under age 65 -- could help slash the deficit by $12.6 billion. To obtain this, it said, the Defense Department should more than double annual enrollment fees for individuals and families enrolled in Tricare Prime and institute annual fees of $485 for an individual and $970 for a family for Tricare Select. Most working-age retirees currently pay no enrollment fees for Tricare Select.

    The CBO also suggested instituting enrollment fees for Tricare for Life, the program that serves as supplemental coverage for military retirees on Medicare. Analysts estimated that the Defense Department could save $12 billion between 2021 and 2028 if it adopted annual enrollment fees of $485 for an individual or $970 for a family for Tricare for Life, in addition to the Medicare premiums most military retirees 65 and older pay.

    According to CBO analysts, these options would reduce the financial burden of Tricare for Life to the DoD in two ways: It would cut the government's share by the amount of fees collected and indirectly would save money by causing some patients to forgo Tricare for Life altogether, either by buying a private Medicare supplement or simply going without one.

    Another option would be to introduce minimum out-of-pocket requirements for those using Tricare for Life. In this proposal, TFL would not cover any of the $750 of cost-sharing payments under Medicare and would cover just 50 percent of the next nearly $7,000.

    Retired Navy Capt. Kathryn Beasley, director of government relations for health issues at the Military Officers Association of America, said her organization is concerned that the CBO continues to include health care rate hikes for military retirees in its list of options, which it publishes every few years or so. The CBO also ignored the fact that rate increases went into effect last year, she added.

    "CBO does this every year. Our biggest concern is that some of these options would make their way into the president's budget," Beasley said. "With all the changes to the military health care system in the past year, we think we simply need to stabilize Tricare. It's been a lot to absorb."

    According to the CBO, the Department of Veterans Affairs also presents several opportunities for cost-savings measures. Some suggestions in the CBO assessment include:

    • Narrowing eligibility for disability compensation for seven diseases the Government Accountability Office has said are not caused or aggravated by military service, including arteriosclerotic heart disease, chronic obstructive pulmonary disease, Crohn's disease, hemorrhoids, multiple sclerosis, osteoarthritis, and uterine fibroids. This option would save $33 billion over 10 years.
    • Ending the VA's individual unemployability payments to disabled Veterans when they turn 67, the retirement age for receiving full Social Security benefits, which would save an estimated $48 billion.
    • Reducing disability benefits to Veterans older than 67 who are receiving Social Security payments. This could save the government $11 billion.
    • Eliminating disability compensation for 1.3 million Veterans with disability rates below 30 percent, saving $38 billion over an eight-year period.

    The VA option with some of the largest savings potential, according to CBO, would be to end enrollment for the two million Veterans in Priority Groups 7 and 8 -- those who do not have service-connected disabilities and have income above the VA national threshold and below a geographically adjusted threshold (Group 7) or above both thresholds (Group 8). This could save the government up to $57 billion, CBO analysts said.

    Finally, the CBO said the federal government could raise revenue by including VA disability payments as taxable income. According to the CBO, if all disability payments were to be taxed, federal revenues during the time frame would increase by $93 billion.

    If just Veterans rated 20 percent or less paid taxes on their disability compensation, federal revenues would increase by $4 billion, it said.

    CBO analysts say their options only "reflect a range of possibilities" and are not recommendations or a ranking of priorities. "The inclusion or exclusion of any particular option does not imply that CBO endorses it or opposes it," they wrote.

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  • DVA Logo 009

     

    Do you have a family member who gets supplemental services through the TRICARE Extended Care Health Option (ECHO) program? If so, you need to know that beginning on Jan. 1, 2019, the ECHO benefit cap will apply to covered costs during a calendar year and not a fiscal year October 1 - September 30. The calendar year runs from Jan. 1 to Dec. 31. Due to the shift to calendar year, TRICARE adjusted the benefit cap by $9,000 to cover the remaining quarter of this year. The $36,000 limit for the costs of all ECHO benefits combined will reset on Jan. 1, 2019. For more information, visit the TRICARE ECHO webpage.

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  • Monitor Tricare

     

    Pentagon officials need to do more to make sure civilian health care providers are giving military families good care, according to a new report from the Government Accountability Office (GAO).

    The report, released Sept. 17, found that while military health care officials have created a way to monitor whether families and troops are getting quality care from military treatment facilities, those same benchmarks aren't applied to community-based providers.

    "As a result, DoD's senior leadership has limited information on the extent to which Military Health System (MHS) beneficiaries receive consistently high-quality care across the MHS," the report states.

    To keep track of health care performance, the Defense Department has two sets of measurements -- one for military treatment facilities and one for civilian care.

    But for community-based care, rather than the providers and hospitals themselves, the Pentagon instead reviews the performance of Tricare's two civilian health care contractors, Health Net and Humana, using what's known as the Purchased Care Dashboard. The Pentagon expects those contractors, in turn, to monitor individual doctors and hospitals.

    But the providers' performance isn't based off the metrics created by the Pentagon, and details on whether the contracted doctors are providing good care aren't shared with military officials, the report found.

    "According to MHS officials, the MHS does not require the contractors to ensure that each individual hospital, physician or other provider in these networks meets the performance standards related to the Purchased Care Dashboard measures," the report states.

    And while the contractors are expected to make sure military families are receiving quality care, they aren't required to push out providers who don't perform, it adds.

    "In practice, however, MHS officials said, and documents we reviewed show, that providers are rarely removed from the network," the report says. "For example, MHS officials reported that one contractor estimated that one provider was removed from its network over quality issues every one to two years."

    Pentagon officials told GAO investigators that they don't require performance reports from individual doctors because they don't want to increase provider workloads. Instead, they said they are creating a series of "value-based" pilot programs that give extra incentives and rewards to providers who have good outcomes.

    The GAO found fault with that plan, however, because even when completely in place in 2020, those incentive programs would affect only about 25 percent of care. That means the bulk of patient experiences would be left without DoD oversight.

    "Without consistent performance standards and corrective action requirements, DoD is limited in its ability to address variation in the quality of care delivered and help ensure that its beneficiaries receive consistent high-quality care across the MHS," the report states.

    Instead, the auditors recommend that the Pentagon fix the Tricare East and West contracts to require action against providers who don't meet the standards.

    Defense officials countered that when it comes to the contracts, their hands are tied -- at least for now.

    "The Defense Health Agency will hold the contractor to the contractual performance standards, but currently cannot take action against individual providers based solely on performance," Pentagon officials said in a response included with the report.

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  • Tricare 002

     

    If you’re new to TRICARE in 2019, welcome! You’ve joined 9.4 million beneficiaries who receive comprehensive health and dental coverage. You can now connect to a network of military and civilian providers worldwide. Learning about your benefit will help you make the most of your coverage and take command of your health this year.

    Choose or Change TRICARE Plans

    For TRICARE Prime (including the US Family Health Plan) and TRICARE Select, you may only choose or change your enrollment when you or a family member experiences a Qualifying Life Event (QLE) or during the annual TRICARE Open Season. Other TRICARE plans offer continuous open enrollment.

    When making an enrollment decision, how do you know which TRICARE plans are best for you and your family? Visit the TRICARE Plan Finder to determine which plan best meets your family’s needs. Remember that different family members may be eligible for different plans. You can also use the Compare Plans Tool to compare health plans side-by-side.

    Find a Provider

    TRICARE covers care offered by two types of TRICARE-authorized providers: network and non-network. To locate a provider, visit the TRICARE Find a Doctor Tool. Do you already know the type of provider you’re looking for? You can view provider directories for each of the TRICARE regions.

    Know Your Costs for Care

    Depending on who you are and the plan you have, you may pay out-of-pocket costs. Use the TRICARE Compare Cost Tool to view your costs and compare them with other plans. The TRICARE Costs and Fees Sheet also provides an overview of TRICARE plan costs.

    Keep DEERS Updated

    It’s important that you keep your contact information up-to-date in the Defense Enrollment Eligibility Reporting System (DEERS). Anytime you experience a change or QLE, update DEERS You have several options for updating your information in DEERS (online, phone, mail). You must keep your information updated in DEERS to remain eligible for TRICARE coverage.

    Learn more about TRICARE by exploring the information and resources on its website. And stay informed by signing up to get updates from TRICARE via email.

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  • TRICARE Logo

    By law, the TRICARE Retiree Dental Program (TRDP) will end on Dec. 31, 2018. New dental plan options for those enrolled in TRDP will be available through the Federal Employees Dental and Vision Insurance Program (FEDVIP). FEDVIP vision coverage will also be available for the first time.

    In case you missed the September webinar, join the TRICARE webinar on Oct. 11, from 2 to 3 p.m. ET, to learn about new dental and vision coverage under FEDVIP. The “New Dental and Vision Coverage Options for TRICARE Beneficiaries” webinar will discuss who is eligible for FEDVIP, as well as how and when to enroll.

    There’s no automatic enrollment into a new dental plan once TRDP ends. For 2019 dental coverage, retirees and their family members must take action to enroll in a FEDVIP plan. All beneficiaries eligible for TRDP are eligible for FEDVIP dental coverage. Visit the FEDVIP website for dental plan options.

    If you’re eligible, your first chance to enroll in FEDVIP is during the 2018 Federal Benefits Open Season. This runs from Nov. 12 through Dec. 10, 2018. Your coverage will then start Jan. 1, 2019.

    Retirees, retiree families, and active duty families are eligible for FEDVIP vision coverage. This year’s FEDVIP open season is also your first chance to enroll in a FEDVIP vision plan. If you enroll during open season, your coverage will start Jan. 1, 2019. Visit the FEDVIP website for vision plan options.

    Register to join us on Oct. 11 to learn more about the TRDP transition to FEDVIP and what the change means for you. A Q&A led by the presenters will follow the presentation.

    Keep updated on all of the TRICARE changes. For the latest on changes to TRICARE, visit TRICARE News and TRICARE Changes.

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  • Master Sgt Robin Gift

     

    First, Tricare approved the surgery that a retired and disabled Air Force master sergeant needed to correct a debilitating back disease and reimbursed his costs.

    Then, the Defense Department’s health insurance program said they had made a mistake — and sent him a bill for nearly $46,000.

    Retired Master Sgt. Robin Gift, 56, has now been fighting Tricare on this for roughly seven years, and he’s almost out of moves — and money. Tricare at one point agreed to cut the $45,956 debt in half, to $22,978, his attorney Stephen Jewell said — but he would have to declare the forgiven debt as income and pay taxes on it.

    Gift now lives in Seminole, Florida, on his disability payments from his time in the Air Force, with a roommate to make ends meet. If Tricare forces him to repay this debt, Jewell said, it will make his already-dire financial situation even worse.

    Defense Health Agency spokesman Kevin Dwyer said the agency could not comment specifically on Gift’s case.

    “Tricare is committed to providing safe, quality, accessible and patient-centered care for those in our charge and their families,” Dwyer said in an email Tuesday. “Though we do not discuss specifics regarding any particular case, Tricare continually reviews claims to ensure they have been properly paid. Tricare works with patients to secure repayment.”

    Gift medically retired in 2006, after serving more than 22 years in passenger service operations for aircraft — hauling cargo and baggage, as well as cooking and serving food and working as a flight attendant.

    He pulled a back muscle during physical training one day, sought treatment, and in 2002 was diagnosed with a pre-degenerative disc disease in his back, Jewell said. In 2003, he was diagnosed with full-blown degenerative disc disease, and the military found he had become injured as a result of his job.

    “It was kind of a wear-and-tear type of thing,” Jewell said of Gift’s injury. “He’s 100 percent disabled, he pretty much can’t work. He’s really in some rough shape.”

    In 2009, he underwent a lumbar disc replacement surgery in Germany, the cost of which he paid up front. Tricare approved the surgery and in early 2010, reimbursed him for $45,956.

    But by 2012, Tricare’s opinion had changed, according to a release from Jewell’s law firm, Tully Rinckey. Tricare told Gift that it had made a mistake; the procedure was not covered and he would have to repay the full amount.

    Gift refused to pay, Jewell said, and asked them to reconsider. He had a letter from his doctor at the time of the surgery, which said that without the procedure, he might not have been able to walk within a year.

    “When he started [fighting] this back in 2012, he thought cooler heads would prevail,” Jewell said.

    Gift asked for help from his representatives, including Sen. Marco Rubio, R-Florida. Jewell said congressional assistance helped convince Tricare to offer some relief, such as by offering to cut his debt in half.

    But Jewell said Gift doesn’t think he should have to pay, since Tricare agreed to cover the costs nearly a decade ago. What’s more, Jewell said, Tricare now officially covers the surgery Gift received, and has since at least 2017.

    Gift is almost out of moves, Jewell said. He’s exhausted his appellant options and doesn’t have any more money to further pursue a lawsuit. He’s hoping someone in Congress steps in to relieve him of the financial burden. If he has to pay, Jewell said, “he does not know what will happen to him.”

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  • Tricare After Retirement

     

    Retiring service members now have up to a year to decide whether to stay with Tricare Prime or choose Tricare Select for their family's health coverage after they leave military service.

    Effective immediately, the health care selection period for retirement -- one of eight lifetime events considered by Tricare to be significant enough to warrant reconsideration of a beneficiary's health plan -- is now 365 days rather than the 90-day window for any other qualifying circumstance.

    The change does not impact currently enrolled retirees, active-duty families, Tricare for Life users or other categories of beneficiaries.

    The change was made, Defense Health Agency spokesman Kevin Dwyer explained, to ensure that a service member's retirement status has been recorded in the Defense Enrollment Eligibility Reporting System before they select their health coverage.

    "We extended it to 365 days to account for the gap in time it sometimes takes for the services to update sponsors' statuses in DEERS," Dwyer said in an email to Military.com on Monday.

    As retirement approaches, retirees can't enroll in a new health program until their actual retirement date, when their active-duty Tricare Prime coverage expires. After retirement, they can choose to remain in Tricare Prime or Tricare Select. Retirees and family members on Tricare Prime pay enrollment fees; most using Tricare Select do not.

    Coverage is backdated to the retirement date, according to Tricare. They pay back their enrollment fees to the date of retirement.

    While the new retiree or family member is deciding which program to choose, they are eligible to be seen at a military treatment facility. This eligibility lasts the full 365 days. After that, they will not be able to enroll in Tricare until a life qualifying event or open season.

    "The Defense Health Agency recognizes that it sometimes takes time for the services to update sponsors' statuses from active duty to retired in DEERS," Dwyer said.

    In addition to retirement, changes in family makeup, such as divorce, retirement, death or childbirth; a move; loss of eligibility or change in eligibility status; or a Defense Department-directed change or change in overseas command sponsorship are considered qualifying life events, or QLE. Pregnancy is not considered a QLE.

    Tricare beneficiaries who want to change health programs outside a QLE must wait until open enrollment season, which will be Nov. 11 to Dec. 9 this year.

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  • Tricare Pmnt Glitch Snags

     

    More than 4,000 retired Tricare Prime users in the northern U.S. may not have paid their January enrollment fees due to a glitch caused during a contractor change this month.

  • TRICARE Logo

     

    If you’re eligible for TRICARE, you can choose from a variety of plans. This gives you options for where and how you seek medical care. But how do you decide which plan or plans are best for you and your family members? The TRICARE website can help you learn what health plans you may be eligible for and compare plan features and costs. This will help you choose the right TRICARE plan for you and your family.

    Find a TRICARE Plan

    If you aren’t sure what health plans you may be eligible for, start by using the TRICARE Plan Finder. Answer a few simple questions, and the tool will display the choices of plans you may be eligible for based on who you are and where you live. You can do this for yourself or for family members. Remember that different family members may be eligible for different plans.

    Compare Plans

    If you want to compare several health plans, you can compare their features side-by-side using the Compare Plans tool. Simply select the plans you’re interested in learning more about. The results will display in a table, allowing you to compare the main features and costs of each plan, including:

    • Cost for a primary or specialty care visit
    • Annual deductible
    • Maximum out-of-pocket costs
    • Enrollment requirements
    • Annual fee
    • Locations where the plan is available

    Take command of your health by making informed decisions about your TRICARE benefit. The TRICARE Plan Finder and Compare Plans are just two helpful tools that make it easier to determine the right health plan for you and your family.

    Source

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  • TRICARE Logo

     

    On July 13, 2018, the Food and Drug Administration (FDA) issued a voluntary recall of valsartan. Valsartan is used to treat high blood pressure and heart failure.

    The FDA announced the voluntary recall after finding an impurity linked to cancer in drug products containing valsartan.

    Not all valsartan-containing drugs are affected and have been recalled.

    Express Scripts identified 31,120 TRICARE beneficiaries who potentially received contaminated products through the mail order network or from retail pharmacies. The Department of Defense (DoD) sent notification letters to all beneficiaries who potentially received currently affected products.

    The FDA notes that because this is an ongoing investigation, more manufacturers may voluntarily recall their valsartan products. If additional valsartan products are added to the recall list, the DoD will continue to send letters to TRICARE beneficiaries who received contaminated products.

    Patients and prescribers are also encouraged to check the FDA website often for potential changes in the recall status of their valsartan medicine.

    If you take valsartan, the FDA recommends:

    • Continue taking your current medicine until your doctor or pharmacist gives you a replacement or a different treatment option.
    • If you are taking any medication containing valsartan, compare the information on your prescription bottle with the information in the recall list (company, National Drug Code, lot number) to determine if your current medicine has been recalled. If you are not certain, contact your pharmacist.
    • If you have medicine included in the recall, contact your pharmacist. The pharmacist may be able to provide you with valsartan made by another company. If not, contact your doctor immediately to discuss other treatment options.

    You can find the latest information about the recall and affected products on the FDA website.

    If you have more questions about the recall, contact the FDA or the Defense Health Agency (DHA) Pharmacy Operations:

    FDA: 855-543-3784 (toll-free) or This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

    DHA: 866-275-4732, option 1 (toll-free) or This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.

    Source

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