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Frequently Asked Questions

General

Do I have to do anything to prepare for the TRICARE changes coming in 2018?

Here are some important things you should do or know:

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milConnect

Note your regional contractor’s toll free number

Jot it down so you have it when you need it.

  • For enrollment questions or help only, call after November 21, 2017.
  • For general information or help, call after January 1, 2018.
    • East: 1-800-444-5445. Monday thru Friday, 8AM-6PM member time.
    • West: 1-844-866-WEST (9378). Monday thru Friday, 5AM to 9PM Pacific time.

Fee Payment

You must update your payment information with the new regional contractor. This applies if you pay Prime enrollment fees, or TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult premiums by credit card, or electronic funds transfer (EFT) from your checking or savings account. On or after November 21, 2017:

For East Region fee payment information For West Region payment information
Visit: http://www.tricare-east.com Visit: http://www.tricare-west.com
Call: 1-800-444-5445 Call: 1-844-866-WEST (9378)

If you pay by allotment, you don’t need to do anything. The contractors work with Defense Finance and Accounting Services (DFAS) to transfer your payment.

Claims Address

Make note of upcoming changes to claims mailing addresses.

  • Until May 2018, submit claims for care or services you received before January 1, 2018 to the current claims processors at:

    North South West

    Health Net Federal Services, Inc. c/o PGBA, LLC/TRICARE
    P.O. Box 870140
    Surfside Beach, SC 29587-9740

    www.mytricare.com

    Claims Department
    P.O. Box 7031
    Camden, SC 29021-7031

    www.mytricare.com

    Claims Department
    P.O. Box 7064
    Camden, SC 29021-7064

    www.mytricare.com

  • On or after May 1, 2018, submit claims with the new regional contractor:

    East West

    For dates of service before January 1, 2018:

    TRICARE East Region Claims
    ATTN: Correspondence/Corrected Claims
    P.O. Box 8923
    Madison, WI 53707-8923

    TRICARE West Claims PO Box 202112

    Florence, SC 29502-2112

    For date of service on or after January 1, 2018:

    TRICARE East Region Claims
    New Claims
    P.O. Box 7981
    Madison, WI 53707-7981

    Note: You have 1 year from the date of service or inpatient discharge to file a claim with TRICARE (doesn’t apply to active duty service members).

Primary Care Managers (PCMs)/Specialists

Check online to see if your PCM or specialty care providers are in the new region's provider directory:

I'm told I have to go online after January 1, 2018 to see my TRICARE Explanation of Benefits and authorizations. What do I need to do?

You have to register for and use the East or West regional contractor’s secure system for this same information.

Costs

Why were percentages of cost under TRICARE Standard changed to a flat fee in many cases for TRICARE Select?

We are aligning TRICARE Select cost shares with the best practices of commercial insurers to provide consistency and predictability.  TRICARE based the flat fee copays on the national average of what TRICARE Standard beneficiaries are paying now for each type of care. This makes your costs under TRICARE Select more predictable than in the past, when the cost was a percentage of a negotiated feeThe discounted rate network providers agree to accept for covered services. between the provider and the regional contractor. Under TRICARE standard, you would not know how much a standard visit to your doctor would cost until you received the bill several weeks later. With a flat fee, you will know how much you will pay when you use a network provider under TRICARE Select for services like primary or specialty care visits, emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. visits, or urgent care visits. This also helps you make an informed decision about whether TRICARE Prime or TRICARE Select is the best plan for you, since you now know how much the most common type of services will cost.

Why are the costs more for me than for people who come into the Service after January 1, 2018? I thought I was grandfathered.

You are grandfathered if you or your sponsor entered Service before January 1, 2018 (meaning you are in Group AIf you or your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A. Effective January 1, 2018, enrollees in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and Continued Health Care Benefit Plan have Group B cost shares, regardless of when the sponsor first joined the military.). The flat fees you see on the cost charts are based on the national average of what beneficiaries have been paying for TRICARE Standard currently. We wanted to make your costs more predictable by changing to a flat fee (see FAQ about why TRICARE Select will use flat fees for more information). The TRICARE Select fees for sponsors who come into the military after January 1, 2018 (Group BIf you or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, you are in Group B. Effective January 1, 2018, enrollees in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and Continued Health Care Benefit Plan have Group B cost shares, regardless of when the sponsor first joined the military. beneficiaries), were set by law, and in some cases are lower than what you pay today under TRICARE Standard for certain types of care. You should note that the grandfathered patients do not have annual enrollment fees for TRICARE Select in 2018, while some Group B patients do pay an annual enrollment fee, and that will address some of the differences in total out of pocket costs.

Did TRICARE intentionally raise the costs of Group A to build a case for ending the grandfathering protection in the law?

Absolutely not. The transition from cost shares to copays was made to make your care under TRICARE Select more predictable than it has been under TRICARE Standard, but the costs are based on national averages of what you are paying today for care under TRICARE Standard. The fees were not set arbitrarily. They are based on the average out of pocket cost for that service that you pay today. The copayments are cost-neutral to TRICARE beneficiaries, and TRICARE is not saving money by charging flat fees under TRICARE Select versus the percentage of negotiated fee model used under TRICARE Standard.

What if I have two family members in Prime and a family member in Select? Do I have to pay separate enrollment fees?

Yes. Separate plans require separate enrollment fees.  Enrollment fees only apply to retiree enrollees.

Will deductibles or cost shares reset in October or January?

Payments that would normally count toward catastrophic caps and deductibles until October 1, 2017, will continue to count until January 1, 2018. This means that enrollees who reach their fiscal yearOctober 1 - September 30 2017 catastrophic caps will not have additional out-of-pocket costs for authorized TRICARE-covered services for the last three months of calendar year 2017.

Providers and Coverage

Will I be able to keep my doctors and other health care providers?

It depends. If you have:

  • A TRICARE Prime plan and your regional contractor is changing, it will depend on if your doctor and other health care providers are in the new network.
  • Any other plan, you will be able to see your doctors, as long as they are TRICARE authorized. 

Check online to see the new region's network provider directory:

I found a civilian Primary Care Manager (PCM) I like, but mine may not be a network PCM under the new contractor.  Do I have to find a new provider? What’s going to happen?

We fully understand your concerns. All contractors are working together to make PCM assignment go as smoothly as possible. Providers decide if they want to be network PCMs. Some may stay, some may not, and new ones may join.

  • Starting January 1, 2018, you can find out who your PCM is by checking in milConnect
    If you get a notice to check milConnect for important information, log on to see if you have a new PCM. If you don’t get a notice, your PCM probably hasn’t changed.
I’m in the new East Region. I got a notice that my PCM changes on January 1, 2018. I can't find the notice. How can I find out who is my new PCM?

After January 1, 2018, you can:

The East region contractor can also help you find a PCM if you're new to the region or have questions about Prime enrollment and PCM assignment.

I’m in the new West Region. I got a notice that my PCM changes on January 1, 2018. I can't find the notice. How can I find out who is my new PCM?

After January 1, 2018, you can:

The West region contractor can help you find a PCM if you're new to the region or have questions about Prime enrollment and PCM assignment.

I got a notice telling me I have a new primary care manager (PCM). I don’t want that person. What do I do to change my PCM to someone else?

You can request a change in PCM using 1 of the 3 following options:

  1. Search the online network provider directory for a new PCM, then call your new regional contractor:
  2. Use the online Beneficiary Web Enrollment (BWE) tool on or after January 1, 2018.
  3. Search the online network provider directory for a new PCM, then complete and mail in a new Prime Enrollment Application and Primary Care Manager Change form (DD 2876). The form and regional mailing addresses are at https://www.tricare.mil/Resources/Forms/Enrollment/Prime
    • For change requests before November 20, 2017, mail the form to the current North, South or West Region Contractor. Mailing addresses are on the form. Forms are at https://www.tricare.mil/forms/
    • For change requests on or after November 20, 2017, mail the form to the:
      East Region Contractor West Region Contractor

      Humana Military/TRICARE East Region
      Attn: PNC Bank
      PO Box 105838
      Atlanta GA 30348-5838

      Health Net Federal Services, LLC
      PO Box 8458
      Virginia Beach, VA 23450-8458

The new contractor (East/West) didn’t contact my provider about becoming a network provider. What can he or she do?

If your PCM or any other provider you see wants to continue seeing TRICARE beneficiaries, tell him/her to:

East Region West Region

Visit the “Welcome to the East” provider page at

OR

OR

Call 1- 800-444-5445 (Monday thru Friday, 8AM- 6PM, member time)

For more on the new regional contracts, visit https://www.tricare.mil/changes.

My Primary Care Manager (PCM) contacted the new East/West Region contractor about being in the network. How long will it take her to become a network provider?

There is no one answer; it varies from provider to provider. Ask her to reach out to the new regional contractor to check on her network status.

I currently see a specialist I like. Do I have to find a new specialist when TRICARE changes contractors for the new East and West Regions?

We don’t have a specific answer to your question. Contractors are constantly working with specialty providers to become network providers. Talk to your specialist. Ask if he or she plans to see TRICARE enrollees, Prime or Select, under the new contracts, as either a network or authorized provider. For more on the new regional contracts, visit https://www.tricare.mil/about/partners/changes. Before setting up and appointment with your specialist (on or after January 1, 2018) check with him or her or your regional contract to confirm they are still a network provider. If not, contact your regional contractor for help finding a new network specialist.

How often do the East and West Region contractors update their network provider directories?

The regional contractors continuously update their provider directories. Since providers can change their network status at any time, we encourage you to ask providers about their network status before you set up an appointment.

I just separated from the service. I only need temporary coverage for my family until my employer coverage starts. How do I get coverage under the Continued Health Care Benefit Program (CHCBP)?

Go to https://www.tricare.mil/chcbp. Here you can view the online brochure and print out the CHCBP application (DD Form 2837). If you questions or need help, call Humana Military at 1-800-444-5445.

What if I travel south during the winter and come back north during the summer, can I change my coverage plan?

During 2018, open enrollment is available to all beneficiaries. Starting January 1, 2019, you may only change your enrollment during the open enrollment season or a Qualifying Life Event (QLE).

New Regions and Contractors

Is it true that TRICARE is going from 3 regions to 2? Why is this happening?

Yes. 2 new regions stand up January 1, 2018.

  1. The East Region
    • The North and South Regions combine into a single “East” region (with a couple of small border areas moving to the West)
    • Humana Military is the East Region Contractor
  2. The West Region
    • The West Region (gains a couple of border locations from the former North and South regions)
    • Health Net Federal Services is the West Region Contractor

The goal is to improve continuity of care, reduce administrative costs, and promote easier transitions when moving within and between regions.

New contractor information is online at https://www.tricare.mil/changes.

For general TRICARE information, visit https://www.tricare.mil.

Before November 20, 2017

For North Region enrollment help and region-specific help before November 20, 2017

On or after November 20, 2017

For East Region enrollment help and information on or after November 20, 2017, and region specific support and information on and after January 1, 2018:

New contractor information is online at https://www.tricare.mil/changes.

For general TRICARE information, visit https://www.tricare.mil.

Before November 20, 2017

For South Region enrollment help and region-specific help before November 20, 2017

On or after November 20, 2017

For East Region enrollment help and information on or after November 20, 2017, and region specific support and information on and after January 1, 2018

I live in the West Region. I will still be there when the new regional contract starts on January 1, 2018. How will I get answers to my TRICARE questions?

New contractor information is online at https://www.tricare.mil/changes.

For general TRICARE information, visit https://www.tricare.mil.

Before November 20, 2017

For West Region enrollment help and region-specific help before November 20, 2017 and region-specific support and information before January 1, 2018

On or after November 20, 2017

For West Region enrollment assistance and information on or after November 20, 2017, and region specific support and information on and after January 1, 2018

How do I transfer enrollment/ premium payments to the new East or West Region Contractor?

You must update your payment information with the new regional contractor. This applies if you pay Prime enrollment fees, or TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Young Adult premiums by credit card, or electronic funds transfer (EFT) from your checking or savings account on or after November 21, 2017:

For East Region fee payment information For West Region payment information

Visit: https://www.tricare-east.com

Visit: https://www.tricare-west.com

Call: 1-800-444-5445

Call: 1-844-866-WEST (9378)

If you pay by allotment, you don’t need to do anything. The contractor will work with Defense Finance and Accounting Services (DFAS) to transfer your payment.

I live in the current TRICARE regions (North/South/West Region). My child has special needs and a case manager. What happens when the new East and West Region contracts start?

All of the regional contractors are working together toward a smooth transfer for those receiving case management or special services. As the time nears for the contractor change, your child’s assigned case manager will contact you about any changes to your child’s current program and to work with you to support continuity of care whenever possible.

I understand there are going to be 2 TRICARE regions starting January 1, 2018. How do I get copies of the new East or West Region handbook?

There are no separate East or West Region Handbooks.

For downloadable TRICARE publications, visit https://tricare.mil/Publications on or after January 1, 2018.

For TRICARE and basic regional information, visit https://www.tricare.mil/changes.

Claims, Authorizations, Referrals, and Appeals

I have an authorization from the current regional contractor to see a specialist. What happens when the TRICARE regions change to East and West? Do I need a new authorization?

The old and new contractors are sharing authorization-related information.

  • Your authorization is still good until its end date.
    • The current contractors (North/South/West) process referrals and authorizations through midnight December 31, 2017.
    • The East and West Region contractors process referrals and authorizations written on or after January 1, 2018.

If your current provider(s) becomes non-network during your authorized episode of care, the new contractor covers your care until the authorization ends. If the non-network provider asks for additional visits, the regional contractor will review the non-network provider’s request and ask for certain paperwork before making a decision.

I’m TRICARE Standard, soon to be TRICARE Select. Where do I send my TRICARE claims after the regions change on or after January 1, 2018?

Until May 1, 2018, submit claims for dates of service before January 1, 2018 to:

North Region Claims South Region Claims West Region Claims:

Health Net Federal Services, Inc.
c/o PGBA, LLC/TRICARE
P.O. Box 870140
Surfside Beach, SC 29587-9740
https://www.mytricare.com

Claims Department
P.O. Box 7031
Camden, SC 29021-7031
https://www.mytricare.com

Claims Department
P.O. Box 7064
Camden, SC 29021-7064
https://www.mytricare.com

On or after May 1, 2018, submit all claims with the new regional contractor:

East West

For dates of service before January 1, 2018:

TRICARE East Region Claims
ATTN: Correspondence/Corrected Claims
P.O. Box 8923
Madison, WI 53707-8923

TRICARE West Claims
PO Box 202112
Florence, SC 29502-2112

For dates of service on or after January 1, 2018:

TRICARE East Region Claims
New Claims
P.O. Box 7981
Madison, WI 53707-7981

Note: You have 1 year from the date of service or inpatient discharge to file a claim with TRICARE (doesn’t apply to active duty service members).

What if I'm in the middle of an AppealThe action you take if you don’t agree with a decision made about your benefit. with the current contractor (North/South/West)? Who finishes my appeal when the new East and West Region contracts start?

Your appeal stays with your current regional contractor to finish its review and make a decision. Be sure to read and follow any instructions in any written responses.

Are authorization rules changing with TRICARE changes starting January 1, 2018?

The following captures some of changes in preauthorization requirements. On or after January 1, 2018, call your regional contractor for questions about referrals and preauthorization. (https://www.tricare.mil/contactus). Always check to make sure you have an authorization before you set up an appointment.

  • TRICARE has certain services that require preauthorization, regardless of what program you are in (Prime/Prime Remote, Select, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, CHCBP)
  • The contractor may identify other services that require preauthorization. These may differ between regions. Contact the regional contractor or visit their website starting January 1, 2018 to get a listing of regional authorization requirements. (For contact and web site information go to https://www.tricare.mil/contactus)
  • Your authorization tells you the provider’s name, the types of service, the number of visits, and the start and end dates. If you want to change your provider, you have to contact your regional contractor.
  • As of January 1, 2018, you have to go online to check on the status of your authorization determination. You won’t be getting authorization notices in the mail. You have to register for a secure account through your regional contractor.

TRICARE services requiring preauthorization include:

Inpatient Services Outpatient Services Any setting

Adjunctive dental careDental care you need to treat a covered medical condition, injury, or disease.

Adjunctive dental care

Dental anesthesia and institutional benefits (e.g. surgical center, hospital)

Organ and stem cell transplants

 

Extended Care Health Option (ECHO) and Autism Care Demonstration services

INPATIENT Mental Health and Substance Use Disorder (SUD). This includes non-emergency inpatient mental health services (acute hospitalization psychiatric care, Residential Treatment Center (RTC) care, and SUD inpatient/ residential detoxification and rehabilitation).

 

Hospice

Skilled Nursing Facility (SNF) care stateside and in U.S. Territories for TRICARE For Life beneficiaries (Medicare- TRICARE dual eligible).

 

Provisional Coverage for Emerging Service and Supplies

Outpatient Mental Health and Substance Use Disorder (SUD) services

  • You need preauthorization for psychoanalysis.
  • You don’t need to get a referral or preauthorization for outpatient mental health and substance use disorder (SUD) services, to include:
    • Partial Hospitalization Programs (PHPs),
    • Intensive Outpatient  Programs (IOPs),
    • Opioid Treatment Programs (OTPs),
    • Office-Based Opioid Treatment (OBOT)
  • Note:  TRICARE no longer requires authorization before the 9th outpatient mental health visit.
  • If you have “other insurance”, TRICARE’s preauthorization requirements don’t apply until TRICARE becomes primary payer. When TRICARE’s primary payer, you have to get preauthorization, when necessary, and use TRICARE-authorized providers.

Through midnight of December 31, 2017, the current (North/South/West) regional contractors authorize care.  Starting January 1, 2018, the East and West Region Contractors authorize care.

TRICARE and Other Health InsuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."

I have other health insurance (OHI) through my employer and use TRICARE Standard as a second payer. What changes for me?

In 2018, you will be automatically enrolled in TRICARE Select. Beginning in 2019, you will need to enroll in TRICARE Select and pay enrollment fees and new cost-shares that apply to your group. If you choose to disenroll, you will no longer be able to file claims with TRICARE as a second payer to your OHI and will lose access to the TRICARE pharmacy benefit.

I have a TRICARE supplemental insurance through a commercial insurance company. How will these changes affect me?

These aren’t government plans, and changes are entirely dependent on the commercial insurance company offering the plan. You should research the costs and benefits of these plans in light of changes in enrollment fees and cost shares beginning January 1, 2018.

 

Last Updated 11/3/2017

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