An updated list of the TRICARE reimbursement

Transcription

1 Volume 3 Number 1 January - February 2007 TRICARE Announces Updated Reimbursement Rates An updated list of the TRICARE reimbursement rates is now available to beneficiaries. The changes for fiscal year 2007 include updated rates for inpatient mental health, residential treatment centers, partial hospitalization, hospice, and inpatient cost-shares for civilian hospitals. We take very seriously the President s initiative toward transparency in health care costs, said Army Major General Elder Granger, deputy director, TRICARE Management Activity. This is just one way we make the cost of medical services available to our beneficiaries. TRICARE reimbursement rates are aligned with Medicare rates as set by Congress. However, TRICARE does have some dispensations that may not be available to Medicare to ensure that beneficiaries continue to have health care available. It is important for our service members and their families to know that we will take care of them, Granger said. Medicare premiums also change annually and now the Medicare Part B premium is linked to income. In 2007, individual incomes will trigger premium increases at $80,000, $100,000, $150,000 and $200,000. For married couples the premium rises when the income is double those amounts. However, this change will have no effect on TRICARE costs or benefits for those who are also Medicare beneficiaries. The updated reimbursement rates are printed in the continued on page 4 Report from the Hill As you know, military active duty, Reserve, National Guard and retired veterans had a lot of issues pending in With action by the 109 th Congress and the President finally completed on the National Defense Authorization Act for fiscal year 2007, we can review the results and get our first look at what we need to do for the 110 th Congress. Some of the actions taken on key issues affecting AFTEA members are covered in the paragraphs below. The President and the Congress provided a 2.2 percent across-the-board pay raise and a targeted increase for senior non-commissioned officers and warrant officers. Early in 2006, Department of Defense civilians and military leaders testified in favor of significant TRICARE Standard, Extra, and Prime fee increases for military retirees. AFTEA was proud to have been part of the effort that beat it back and as a result, Congress refused to impose the increases this year. However, the Congressional prohibition is in place only until 30 September 2007, and the law requires the Government Accountability Office (GAO) to do a study and also calls for a task force review for the TRICARE program. These actions set the stage for a continuing fight next year over TRICARE fee increases. AFTEA position last year and in the future is that it is wrong to enact fee increases during war time and wrong to saddle retirees and veterans with the cost of fighting wars. The nation commits us to war and the nation should pay for it. Further, by slashing the size of the services medical departments and reducing the numbers of doctors, nurses and other medical professionals, more TRICARE-eligible patients are barred from obtaining care in military treatment facilities and must obtain higher-cost civilian health care. So it is clear that DOD helped create the problem and now is trying to solve it on the backs of military retired veterans, their families and widow(er)s. DOD proposed to eliminate TRICARE mail order pharmacy copayments on most generic drugs and increase fees at local retail drug stores continued on page 3

2 P r e s i d e n t s C o l u m n Albert G. Ybanez Let me begin this first column of 2007 by wishing you a very happy and prosperous New Year! I hope this will be a very good year for you, your family and others who are important to you. Looking back at the 2006 mid-term Congressional elections, it is clear the electorate has voted for change, change at home, change in Washington and change in Iraq. Democrats gained control of both the House and Senate and a large majority of the governorships and state legislatures. Democrats in Congress now have the ability to put their issues on the agenda, and agenda control is key to being in charge on Capitol Hill. What does this mean for military men and women, retirees and survivors? This means that AFTEA must introduce a new leadership and Congress to issues that impact the military and veteran community. All of these changes mean there are many issues concerning military personnel and veterans on which we must educate new members of Congress and their staffs. It is critical that we take the first months of the new Congress to educate them about issues important to the military and veteran community - issues of military pay, the disabled veterans tax, health care, illegal immigration and national security, among others. Voters in the 2006 elections show they prefer a politically divided government, with more checks and balances on presidential leadership. Sometimes good things come out of divided government, where there is opportunity for our leaders to show the country that Republicans and Democrats are equally as patriotic and equally concerned about the future, and that they can work together. Democrats now have the stage with the opportunity to show the direction they will take the country. The starting points are the lessons of the election of 2006, with voters looking for Democrats to act for the people and the public interest. AFTEA urges the new Congressional leadership to listen to the people and to work in a bipartisan manner, face reality and tell Americans some hard truths. As President Bush has noted since the election, both parties want America to succeed and both want our military to succeed. We take at face value recent statements on both sides that they intend to work together to achieve bipartisan progress. One thing is for sure this is going to be a very interesting year in Washington, D.C. The one thing you can be sure of is that AFTEA will continue to be on the frontlines fighting for you. New Tricare Website Announced by DoD Everything you ever wanted to know about Tricare has now been put under one virtual roof. Late last year the Pentagon unveiled the new health care information resource, The new Web site combines the information now available at and It also serves as a portal to five user-specific content areas for information, whether someone is a Tricare beneficiary or not. The My Benefit section houses the kind of content that was available at Beneficiaries can now browse their insurance plans, locate providers, find out what s covered and what s not and stay up-to-date on regional Tricare news. Those enrolled in Tricare Prime can go to the My Heath section of the new site to make doctor s appointments on line, check on their personal health information and use the same interactive pharmacy tools now found at Beneficiaries are not the only ones who will benefit from this new military health Web portal. Military health professionals now have their own section on the new site, along with information about the military health system. Information for health care providers who accept Tricare is also housed on the Web site. AFTEA Website Members are invited 8to use the AFTEA web-site at: Read the latest Alliance newsletter or research the archive of past issues. Review AFTEA s legislative agenda, check the status of key legislation, or communicate with your elected officials, all through the dynamic features on the website.

3 Report from the Hill continued from page 1 and pharmacies. Again, because of the efforts of AFTEA and other military associations this proposal did not pass. Instead, Congress barred any changes in local retail drug prices and called for a GAO review. One of the major changes enacted affected Reserve and National Guard personnel and their families. The TRICARE Reserve Select program would bring all drilling Reserve and National Guard personnel under the same medical premium plan that previously applied only to Reserve/National Guard personnel mobilized for combat service. This is a well deserved, much needed provision and will significantly increase the cost of the TRICARE program. These costs should be paid for by necessary increases in the Defense budget not by robbing Peter to pay Paul or by imposing the cost on military retirees through premium and co-pay increases. The law also prohibits employers from helping pay the TRICARE co-pays, deductibles or supplemental premiums for military retired employees who choose to use TRICARE as their primary insurance. This is an outrageous limitation on retirees use of their earned health care benefit and was opposed by AFTEA and other Associations. Although the provision is scheduled to take place on January 1, 2008, DOD did require a study to determine how the restriction will affect companies who offer employees an array of options for their health care. The study is due to Congress on 1 April AFTEA and other Associations have long had as an objective a proposal that individual retirees 70 years old or older who have paid into SBP for 30 years will no longer have to pay premiums. Currently the proposal is scheduled to go into effect 1 October AFTEA and other military Associations attempted to have the date moved up to 1 October This effort failed. Full concurrent receipt of military retired pay and veterans disability compensation has been another long time goal of AFTEA, the National Military and Veterans Alliance and the Military Coalition. Once again the proposal did not pass. A related objective over the years has been ending the survivor benefit plan offset from the surviving spouse of a retired veteran who also draws VA dependency and indemnity compensation. That effort was killed in the House of Representatives. Failure to act on these proposals is a disgrace and we urge the President and Congress to give them priority next year. VETERANS AFFAIRS The Senate passed a funding bill for VA operations that provides nearly $78 billion for the Department of Veterans Affairs, which is $8.88 billion above the amount VA received last year. The legislation includes an amendment offered by outgoing Senate Veterans Affairs Committee Chairman Larry Craig which will enable the Department of Veterans Affairs to spend up to $10 million on individual projects without having to seek specific Congressional authorization. The prior limit was $7 million. Also under this bill, the US Court of Appeals for Veterans Claims would receive nearly $20 million for fiscal year 2007, a 6.4 percent increase over its 2006 appropriations. This level of funding would allow the Court to increase its staff, continue an electronic case-filing initiative, and continue studying the feasibility of constructing or obtaining a dedicated Veterans Courthouse and Justice Center. Compensation and Pensions: Provides $38.01 billion for compensation and pensions, which is $4.11 billion above the FY06 enacted level. Medical Services: Provides $28.69 billion for Medical Services, which is equal to the Administration s request and $4.51 billion above the FY06 enacted level. Readjustment Benefits: Provides $3.26 billion for readjustment benefits which fully funds the Administration s request. This benefits the education and training of veterans and service personnel who entered service on or after 1 July Veterans Housing: Provided $196.7 million for the Veterans Housing Benefit Program. This is $132.1 million above the FY06 enacted level. As we went to press, the House had not acted on the bill but was expected to complete work on it and forward it to the President for his signature. As you can see, military and veterans organizations won some and lost some this past year. We are only as effective as our members and in those cases where our voices were heard, members of Congress were also hearing from their constituents you. Our retired AFTEA members, in fact, all military retirees, have a responsibility to speak out, particularly for active duty personnel who are not as free to speak out as retirees and other veterans. If we don t let our members of Congress and Department of Defense officials know our position on issues, not only will benefits of current retirees and veterans be reduced but the benefits of those currently fighting in Iraq, Afghanistan and elsewhere will be eroded or eliminated. To allow this to happen in time of war is a disgrace. All of us must do our share to see that it does not happen. AFTEA and other associations are now working on the issues that we know will face us in the 110 th Congress and we will keep you informed so you can speak out. We heard from many of you in 2006 and very much appreciate your support. Chuck Partridge Government Relations

4 TRICARE Announces Updated Reimbursement Rates continued from page 1 tables below, or they may be viewed on the TRICARE web site at Tricare Costs The charts, below, explain the cost shares for families using TRICARE programs: Prime is an HMO-type program; Standard is a fee-for-service plan; and Extra is a preferred provider option (when the Standard beneficiary sees an innetwork provider, he/she is exercising the Extra option.). For assistance in obtaining medical care or in understanding your benefits-plan choices, please contact a customer service representative at the regional contractor; visit a TRICARE Service Center to talk with a health benefits advisor; or talk with a Beneficiary Counseling and Assistance Coordinator (BCACs) at the military treatment facility (the hospital or clinic on base or on post). For information about how costs are applied to a catastrophic cap, see the CAT CAP explanation-its message is particularly timely for any person who is a newto-prime enrollee, such as a service member who retires, changes status, and then must re-enroll in Prime. For information about costs associated with TRICARE For Life (TFL), the program for Medicareeligible beneficiaries (due to age, disability, or disease), please view the TFL website at tflcostmatrix_b.html. Retirees, Their Family Members, and Others TRICARE Prime TRICARE Extra TRICARE Standard Annual Deductible None $150/individual or $300/family $150/individual or $300/family Annual Enrollment Fee $230/individual $460/family Civilian Cost Shares 20% of negotiated fee 25% of allowable charges for covered service Outpatient Emergency Care Mental Health Visit Civilian Inpatient Cost Share Civilian Inpatient Skilled Nursing Facility Care Civilian Inpatient Behavioral Health $12 $30 $25 $17 (group visit) $11/day (minimum $25 charge per admission); no separate copayment for separately billed professional charges. $11/day (minimum $25 charge per admission) $40 per day; no charge for separately billed professional None Lesser of $250/day or 25% of negotiated charges plus 20% of negotiated professional fees $250 per diem cost share or 20% cost share of total charges, whichever is less, institutional services, plus 20% cost share of separately billed professional charges None Lesser of $535/day or 25% of billed charges plus 25% of allowable professional fees 25% cost share of allowable charges for institutional services, plus 25% cost share of allowable for separately billed professional charges.

5 Reporting the Death of a Military Retiree or Annuitant The Defense Finance and Accounting Service (DFAS) has prepared this contact sheet to assist you in reporting the death of a military retiree or annuitant. The information provided is meant to serve as a general guide. Notify DFAS at either (800) or (800) Please have the decedent s Social Security Number (SSN) and the date of death when you call. We ask that you send one photocopy of a death certificate which indicates the cause of death. Please send it to: For Retirees Address: DFAS U.S. Military Retirement Pay P.O. Box 7130 London, KY Fax: (800) For Annuitants Address: DFAS, U.S. Military Annuitant Pay P.O. Box 7131 London, KY Fax: (800) We will take steps to close out the pay account to prevent any overpayments. If the decedent was a retiree enrolled in the Survivor Benefit Plan (SBP) and/or the Retired Serviceman s Family Protection Plan (RSFPP), we will take additional steps to initiate pay accounts for eligible survivors. Designated beneficiaries of retirees should expect a Standard Form 1174 (SF-1174) and, if applicable, SBP/ RSFPP-related forms in the mail within seven to ten business days of reporting the death. If you need assistance please call us at either of the numbers listed above. Notify the Social Security Administration (SSA) at (800) Notify the Defense Enrollment Eligibility Reporting System (DEERS) at (800) If the member was receiving disability compensation or Dependency Indemnity Compensation (DIC), notify the Department of Veterans Affairs (DVA) at (800) If the member was a civil servant or retired civil servant, notify the Office of Personnel Management (OPM) toll-free at (888) If the member enrolled in DVA-sponsored insurance such as National Service Life Insurance (NSLI) or Servicemembers Group Life Insurance (SGLI), notify them at (800) If you live near a military installation you may be able to receive help with administrative matters from a Casualty Assistance Officer (CAO) or Retired Activities/Affairs Office (RAO). Please note that these services are not available at all military installations. NOTICE The AFTEA Board of Directors (BOD) is planned to transition so that each branch of service is represented on the board. The AFTEA National President will initially appoint one member from each of the Marine Corp., Navy and Coast Guard since those services are not presently represented on the board. Any member from these services willing to serve on AFTEA s BOD should submit a short resume to: Armed Forces Top Enlisted Association Attn: National President P.O. Box Washington, D.C Unified Military Medical Command May Be On Its Way According to an article in the Stars and Stripes, the Army s top medical officer in the U.S. Pacific Command told a medical conference the Pentagon is considering a unified medical command that would combine health care staff from all branches of the military services. According to Maj. Gen. Carla G. Hawley-Bowland, commander of Pacific Regional Medical Command at Tripler Army Medical Center in Hawaii, the joint command would put a four-star general in charge of all military doctors, nurses and health-care facilities. The move would standardize roles, equipment and manpower for the military s medical missions. Interestingly, Hawley-Bowland said those military missions include not only providing care on battlefields and on installations during peacetime, but also providing medical personnel to be sent to help other nations during natural disasters. AFTEA has no problem with the U.S. providing medical assistance to other nation s when natural disasters occur. But we find it curious, at least, that military retirees have been excluded from treatment at most military medical facilities, and yet the mission of military medical personnel has now been expanded to go to other countries to help. Something doesn t seem right to us. If you have thoughts on this subject, please let us know. We d be happy to pass them along to members of Congress.

6 Send Care Packages to Troops Online Operation Homefront has announced the start of a new online service that allows caring citizens to send care packages to deployed troops and their families. The service is known as ecarepackage. Operation Homefront is part of CinCHouse.com, a community for military wives, and is a team member of America Supports You, a Department of Defense program connecting U.S. citizens with members of the military. Servicemembers and families can register on which protects their identity and location, and visitors can adopt them based on common interests. Then visitors select individual items to create a customized care package for their chosen service member or family and include a personal message. Operation Homefront s team of volunteers takes the order, boxes the selected items and ships them directly to the service member or family always protecting their identity and physical location. There s nothing like a care package to cheer a deployed soldier or a lonely military family, said Amy Palmer, executive vice president of operations for Operation Homefront. With operational security for the troops so Veterans Court on Record Pace Cutting Down the Backlog of Cases The U.S. Court of Appeals for Veterans Claims is deciding more cases than ever, after recalling two judges to the bench last year, and is now on track to issue 30 percent more decisions than any year in the Court s history. That feat is earning praise from the outgoing chairman of the U.S. Senate Committee on Veterans Affairs. At a hearing this past July, I cautioned that if trends continued without action, such as bringing back retired judges, the number of pending cases could reach 10,000 in the next five years. Since then, two retired judges have been brought back to work and the Court is getting back on track. This is wonderful news for veterans, said former Chairman Larry Craig (R- Idaho). According to numbers released to the Senate Committee on Veterans Affairs, with 7 full time judges and 2 There s nothing like a care package to cheer a deployed soldier or a lonely military family, recalled judges now deciding cases, the Court is on track to handle over 4400 cases in fiscal year 2007, which is almost 800 more cases than the Court is expected to take in. Other federal courts regularly recall judges, including the U.S. Tax Court and U.S. Court of Appeals for the Armed Forces. Then in 2006, Chief Judge William Greene of the U.S. Court of Appeals for Veterans Claims became the first chief judge of that court to recall retired judges. I was very pleased that the Court decided to use this valuable resource to bring back recall-eligible judges tight, we were concerned that care packages weren t getting through. So we built ecarepackage to ensure our troops and families continue to feel the love from Americans. Items available in the ecarepackage store range from toiletries and necessities to games, books and candy. Most items were donated from sponsors, particularly The Dollar Tree, which runs its Operation Appreciation program in most stores nationwide. Donated items are not marked up, so ecarepackage visitors often pay only the cost of handling and shipping making ecarepackage less expensive than doing it yourself. Moreover, Operation Homefront has partnered with DHL, which provides postal service to overseas troops, to ensure direct and timely delivery of all care packages to deployed troops. The ecarepackage program is an extension of Operation Homefront s mission to provide emergency support and morale to our troops, the families they leave behind during deployments, and wounded warriors when they return home. Operation Homefront recently signed a Memorandum of Understanding with the Defense Department to ensure greater collaboration. to help them deal with the huge number of cases the Court has been receiving. It s clear that Chief Judge Greene, all of the judges and the entire Court staff have been working very hard to make sure that veterans receive timely decisions, Craig said. In July of 2006 the Senate Committee on Veterans Affairs conducted a hearing on the backlog issue, at which Craig and other committee members pushed the Court to recall its eligible retired judges. Under current federal guidelines, the retired judges receive the same pay as active judges currently $165,200 a year so they can be called back to work if the Court needs additional help to deal with its workload. The U.S. Court of Appeals for Veterans Claims reviews decisions rendered by VA s Board of Veterans Appeals. Most of the Court s decisions deal with veterans claims for disability compensation.

7 Officers & Directors Albert G. Ybanez, CSM USA (Ret) President Michael L. Myers, CMSgt USAF (Ret) 1st Vice President Roger J. Ehrke, CSM USA (Ret) 2nd Vice President Albert N. Garrett III, SGM USA (Ret) Secretary Oscar R. Hinson, SGM USA (Ret) Treasurer Oliver W. Estes, SGM USA (Ret) Director Daniel J. O Connell, CMSgt USAF (Ret) Director Larry L. Thomas, CMSgt USAF (Ret) Director Ernest J. Walker, CMSgt USAF (Ret) Director The AFTEA Alliance is published bi-monthly by the Armed Forces Top Enlisted Association Publisher Albert G. Ybanez, CSM USA (Ret) Executive Editor Catherine Tavarozzo Managing Editor/Designer Sue Boyles Front AFTEA Wear and Accessories Order Form and Price List Back Mail with check or money order to: AFTEA Wear and Accessories P.O. Box Colorado Springs, CO Item Qty. Cost Total Baseball Cap (Black only) $22 Jacket (Red only) $50 Polo Shirt (White) $30 Polo Shirt (Blue) $31 Polo Shirt (Yellow) $31 AFTEA Patch $10 Coin $10 Indicate Size S M L XL (circle choice) XXL (Add $2) XXXL (Add $3 Subtotal Add Shipping and Processing Amount Enclosed Allow 6-8 weeks for delivery SHIPPING AND PROCESSING Subtotal: Add: $0 - $25.00 $5.00 $ $50.00 $7.00 $ $ $10.00 $ $ $13.00 $ $ $15.00 $ $17.00 Name: Address: City: State: Zip: Armed Forces Top Enlisted Association Charter Membership Acceptance Form Name: q 1 Year ($30) q 2 Year ($53) q 3 Year ($75) Rank: Branch of Service: q Lifetime Membership Lifetime Membership dues based on age Address: (May be paid quarterly) City: State: Zip: Under 51 q $255 (one payment) q $63.75 (qrtrly) Make your check payable to: AFTEA q $230 (one payment) q $57.50 (qrtrly) q $180 (one payment) q $45.00 (qrtrly) q Check Enclosed q Visa q Mastercard Over 70 q $155 (one payment) q $38.75 (qrtrly) Card No. Exp. Date / Name on Card: Signature: Membership: Armed Forces Top Enlisted Association P.O. Box Washington, DC

8 Armed Forces Top Enlisted Association P.O. Box Washington, D.C Address Service Requested Presorted Standard US Postage PAID Roanoke, VA Permit No. 495 President s Column page 2 New Tricare Website Announced by DoD page 2 Reporting the Death of a Military Retiree or Annuitant page 5 Unified Military Medical Command May Be On Its Way page 5 Send Care Packages to Troops Online page 6 Veterans Court on Record Pace Cutting Down the Backlog of Cases page 6