TRICARE 101 TRICARE Management Activity

1. TRICARE 101TRICARE Management Activity

2. What is TRICARE? A Healthcare Program Using Military Healthcare as the Main Delivery System - Prior to TRICARE, there was no integration between care in military facilities and that purchased under CHAMPUS - By statute, care is space available in military facilities, which led to inequitable system of obtaining care on any kind of assured basis- Prior to TRICARE, there was no integration between care in military facilities and that purchased under CHAMPUS - By statute, care is space available in military facilities, which led to inequitable system of obtaining care on any kind of assured basis

4. TRICARE isthe same as before(CHAMPUS = TRICARE Standard)Plus More(TRICARE Prime, Extra, TRICARE For Life and TRICARE Plus)TRICARE isa Better Benefit

5. TRICARE Options TRIPLE OPTION TRICARE Prime HMO-type Option-Enhanced Preventative Benefits (Requires Enrollment and Copayments) TRICARE Extra PPO-type (Deductibles and Cost Shares) TRICARE Standard Fee For Service type (Deductibles and Cost Shares) - TRICARE adds options to previous space available care in military facilities plus standard CHAMPUS - TRICARE adds options to previous space available care in military facilities plus standard CHAMPUS

7. While our beneficiaries represent less than 5 percent of the U.S. population, they’re covered by a network of U.S. physicians that has grown from 20 percent (114,000) in 1999 to 26 percent (184,100) in 2001. The network of U.S. hospitals has grown from 40 percent (1,975) in 1999 to 47 percent (2,382) in 2001. Updated by Mike Talisnik, July 2001While our beneficiaries represent less than 5 percent of the U.S. population, they’re covered by a network of U.S. physicians that has grown from 20 percent (114,000) in 1999 to 26 percent (184,100) in 2001. The network of U.S. hospitals has grown from 40 percent (1,975) in 1999 to 47 percent (2,382) in 2001. Updated by Mike Talisnik, July 2001

8. MHS Beneficiary Populationby Beneficiary Category Because of our readiness mission and the unique needs of military medicine, we must consider "health promotion" and "prevention" in a much broader context than what we normally think about for the general population. The Department of Defense (DoD) focuses on three areas that contribute to its strategy for population health improvement: Force Health Protection, Worksite and Community-Based Programs, and TRICARE. Because of our readiness mission and the unique needs of military medicine, we must consider "health promotion" and "prevention" in a much broader context than what we normally think about for the general population. The Department of Defense (DoD) focuses on three areas that contribute to its strategy for population health improvement: Force Health Protection, Worksite and Community-Based Programs, and TRICARE.

10. - Difficult challenge to make care more accessible yet contain costs to taxpayer - Have added choices to previous system of military care and CHAMPUS- Difficult challenge to make care more accessible yet contain costs to taxpayer - Have added choices to previous system of military care and CHAMPUS

13. TRICARE Pharmacy Program Eligibility AD, Retirees and their families and RC members and their families when ordered to active duty for more than 30 consecutive days Four options for filling prescriptions Military treatment facility pharmacy National Mail Order Pharmacy Retail Network Pharmacy Retail Non-network Pharmacy **

14. TRICARE Dental Coverage The TDP covers a wide range of diagnostic, preventive and restorative services—dental X-rays, examinations, cleaning, fluoride applications, sealants, fillings, root canals, crowns, etc. Benefit package includes general anesthesia coverage when provided in connection with a covered benefit. Dentists or other professional providers must be licensed and approved to provide anesthesia in the state where the service is rendered. Maximum annual benefit coverage is $1,200 for all routine dental care. The maximum lifetime orthodontic benefit coverage is $1,500. Enlisted members in pay grades E-1 to E-4 have reduced cost-shares for certain procedures. Eligibility is determined based on the service member’s military personnel information residing in the Defense Enrollment Eligibility Reporting System (DEERS). The uniformed services personnel office reports the information to DEERS. Active duty personnel are not eligible for the TRICARE Dental Program. They receive dental care from military dental treatment facilities. Reservists who are ordered to active duty for a period of more than 30 consecutive days have the same benefits as active-duty service members. *Eligibility is determined based on the service member’s military personnel information residing in the Defense Enrollment Eligibility Reporting System (DEERS). The uniformed services personnel office reports the information to DEERS. Active duty personnel are not eligible for the TRICARE Dental Program. They receive dental care from military dental treatment facilities. Reservists who are ordered to active duty for a period of more than 30 consecutive days have the same benefits as active-duty service members. *

18. Improvements in TRICARE claims processing TRICARE claims over 60 days old went from 30,535 in December 1999 to 8 in June 2001. TRICARE claims over 120 days old went from 1,493 in December 1999 to 0 in June 2001. TRICARE's Returned Claims percentage is about the best in the industry - 4.2% in June 2001 compared to over 25% for the managed care industry as a whole. Also, average turnaround time for claims has been dropped by 2.5 days since 1999 - to 12.0 compared to 14 to 15 for industry. Improvements in TRICARE claims processing TRICARE claims over 60 days old went from 30,535 in December 1999 to 8 in June 2001. TRICARE claims over 120 days old went from 1,493 in December 1999 to 0 in June 2001. TRICARE's Returned Claims percentage is about the best in the industry - 4.2% in June 2001 compared to over 25% for the managed care industry as a whole. Also, average turnaround time for claims has been dropped by 2.5 days since 1999 - to 12.0 compared to 14 to 15 for industry.

21. TRICARE Costs Active Duty Members No Cost for Care to Active Duty Members (except POS) Care Typically Provided in Military Facilities Supplemental and/or Emergency Care in Civilian Facilities Paid for 100% Active Duty Covered by Prime Benefit

24. TRICARE Medical Costs for RC Family Members Fee For Service Options TRICARE Extra – 15% cost share TRICARE Standard – 20% cost share $ 50-100 deductible (E4 and below) $150-300 deductible (E5 and above) HMO Option - TRICARE Prime No cost shares or deductibles No enrollment fees TRICARE offers Two Fee For Service Options with an annual deductible of $50-300 depending on the rank of the sponsor. TRICARE Extra Requires the use of TRICARE network providers and has a $50-300 deductible based upon rank. It has a lower cost share (15%) than TRICARE Standard TRICARE Standard Allows you to use any Tricare authorized provider. It has a $50-300 deductible that is based upon rank. There is a 20% cost share with this option. TRICARE Prime Is the HMO option and requires no deductibles or enrollment fees. However, it is the only TRICARE option that requires enrollment and the selection of a primary care manager. If your family members enroll on or before the 20th of the month, it provides coverage on the first day of the following month. For example, if your family enrolled on the 15th of January they would be eligible for TRICARE Prime benefits on February 1st. If they did not enroll until the 21st of January, they would be eligible for care until March 1st. In the interim, your family would still be eligible for the fee for service options, TRICARE Extra or Standard. TRICARE offers Two Fee For Service Options with an annual deductible of $50-300 depending on the rank of the sponsor. TRICARE Extra Requires the use of TRICARE network providers and has a $50-300 deductible based upon rank. It has a lower cost share (15%) than TRICARE Standard TRICARE Standard Allows you to use any Tricare authorized provider. It has a $50-300 deductible that is based upon rank. There is a 20% cost share with this option. TRICARE Prime Is the HMO option and requires no deductibles or enrollment fees. However, it is the only TRICARE option that requires enrollment and the selection of a primary care manager. If your family members enroll on or before the 20th of the month, it provides coverage on the first day of the following month. For example, if your family enrolled on the 15th of January they would be eligible for TRICARE Prime benefits on February 1st. If they did not enroll until the 21st of January, they would be eligible for care until March 1st. In the interim, your family would still be eligible for the fee for service options, TRICARE Extra or Standard.

25. Uniform Formulary Pharmacy Copay Structure

26. TRICARE Dental Program Monthly Premiums Change January 2003 -- by United Concordia Rate Changes for TRICARE Subscribers Harrisburg, PA (Dec 5, 2002) - TRICARE Dental Program (TDP) enrollees will notice a small increase in their monthly premiums beginning January 2003. The new rates are effective on February 1, 2003; however, since premiums are collected one month in advance, TDP enrollees will notice the change in their January 2003 billing statement, payroll allotment or deduction. The new monthly premium rate for active duty family members, members of the Selected Reserve, Individual Ready Reserve (Special Mobilization Category), and family members of Reservists who are on active duty for more than 30 consecutive days will be $8.14 for a single enrollment and $20.35 for a family enrollment. Members of the Individual Ready Reserve (Other than Special Mobilization Category) and their family members, and the family members of the Selected Reserve (not on active duty) will pay a new monthly rate of $20.35 for a single enrollment and $50.88 for a family enrollment. (See chart below for monthly premiums applicable to each category of enrollee).Tom Harbold, United Concordia’s TDP Senior Vice President said "The 2003 TDP premium increase of about 3% is less than the annual increase in the dental services component of the Consumer Price Index. The TDP continues to provide excellent value for members of the military community.”  United Concordia Companies, Inc. has administered the TRICARE Family Member Dental Plan (TFMDP) and the follow-on TRICARE Dental Program for the Department of Defense since 1996. Headquartered in Harrisburg, Pa., United Concordia is the fifth largest dental insurer in the country with more than six million members worldwide. In 2001, the company processed more than 10 million claims and paid more than $700 million in dental benefits.TRICARE Dental Program Monthly Premiums Change January 2003 -- by United Concordia Rate Changes for TRICARE Subscribers Harrisburg, PA (Dec 5, 2002) - TRICARE Dental Program (TDP) enrollees will notice a small increase in their monthly premiums beginning January 2003. The new rates are effective on February 1, 2003; however, since premiums are collected one month in advance, TDP enrollees will notice the change in their January 2003 billing statement, payroll allotment or deduction. The new monthly premium rate for active duty family members, members of the Selected Reserve, Individual Ready Reserve (Special Mobilization Category), and family members of Reservists who are on active duty for more than 30 consecutive days will be $8.14 for a single enrollment and $20.35 for a family enrollment. Members of the Individual Ready Reserve (Other than Special Mobilization Category) and their family members, and the family members of the Selected Reserve (not on active duty) will pay a new monthly rate of $20.35 for a single enrollment and $50.88 for a family enrollment. (See chart below for monthly premiums applicable to each category of enrollee).

27. TRICARE vs HMO’s

30. Not a Stagnant Benefit TRICARE Initiatives National Defense Authorization Act Improvements Strategic Planning—Best Business Practices Customer Service a priority – BCACs/DCAOs T-NEX

32. National Defense Authorization Act (NDAA) 01 Accomplishments Medal of Honor (MOH) Survivor Ext. Senior Pharm Active Duty Dependent (ADD) Copays TRICARE Prime Remote for Family Members (TPR-FM)-Waived Charges School Physicals Catastrophic Cap Travel Entitlement TPR-FM TRICARE For Life (TFL) * School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.* School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.

33. National Defense Authorization Act (NDAA) 02 Accomplishments Skilled Nursing Facility--Prospective Payment System (PPS) Benefit Aug 03* Payment Aug 03* Home Health Care-PPS Benefit with T-Nex Payment with T-Nex Custodial Care Definition Not at Risk (NAR) Custodial Care Definition At Risk (AR) Aug 03* and with T-Nex Extended Care Health System (ECHO)— Modified Program For Persons with Disabilities (FPWD) with T-Nex Prosthetics, Hearing Aids, Augmentative Communication Devices with T-Nex Travel Expense Reimbursements Payment Rates for Institutions and Balance Billing Nonavailability Statement (NAS) TBD * School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.* School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.

34. Transitional Assistance Management Program Demonstration NA per 03 language Enhanced Benefit National Defense Authorization Act (NDAA) 03 Accomplishments * School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.* School Physicals: Glitch: Waiting on designation of phone line for these individuals to call. **Cat Cap Glitch: Beneficiaries should have checks by May 2002. ***Travel Entitlement Glitch: Waiting on definition of travel members. Currently being staffed by OPS and HA.

35. MHS Strategic Planning

36.  Customer Service a Primary Focus

37. BCAC & DCAO Roles & Responsibilities Overview Responsible for casework and resolution for all cases presented Assist beneficiary in resolving issues Obtain Privacy Act Notice from beneficiary if necessary Assign case number and maintain tracking sheet Notify beneficiary of case resolution Adhere to reporting requirements of TMA as outlined

38. TRICARE Next Generation of Contracts (T-NEX) Current Regional Contracts Expiring 3 Regions versus 11 3 Contracts versus 7 TMA to adopt industry best practices Will improve the TRICARE program while leaving the basic benefit structure (TRICARE Prime, Extra, Standard, and Plus) unchanged.

43. The TRICARE health plan is one of the best in the world! Coca-cola conducted 200,000 taste tests and proved that New Coke tastes better than Pepsi. Pepsi tastes better than their original Coke formula (Coca-Cola Classic) Coca-Cola Classic tastes the worst. But in 1993 Classic was in first place and New Coke was in third. Soft-drink marketing is a battle of perceptions, not a battle of taste. In November 1986, “60 Minutes” had a segment about how there were a number of complaints about Audi’s “unintended acceleration”. Sales fell from 60,000 in 1986 to 12,000 in 1991. Automobile experts have failed to duplicate the complaint, yet the perception lingers. Coca-cola conducted 200,000 taste tests and proved that New Coke tastes better than Pepsi. Pepsi tastes better than their original Coke formula (Coca-Cola Classic) Coca-Cola Classic tastes the worst. But in 1993 Classic was in first place and New Coke was in third. Soft-drink marketing is a battle of perceptions, not a battle of taste. In November 1986, “60 Minutes” had a segment about how there were a number of complaints about Audi’s “unintended acceleration”. Sales fell from 60,000 in 1986 to 12,000 in 1991. Automobile experts have failed to duplicate the complaint, yet the perception lingers.