Healthcare for Active Duty Military Families… “Keeping it Safe Here”

1. Healthcare for Active Duty Military Families…“Keeping it Safe Here” Martin McCaffrey, MD, CAPT USN (Ret)

2. Military Ranking • http://www.defenselink.mil/specials/insignias

3. What is TRICARE? • Health care program for 9.2 million beneficiaries • 120,000 births per year • Integrated health care delivery system • Military treatment facilities (MTFs) • Civilian health care facilities • Range of program options • Comprehensive coverage • Available worldwide

4. TRICARE Eligibility • Beneficiary categories • Sponsors (active duty, National Guard, Reserve or retired service members) • Family members (spouses and unmarried children) • Survivors, certain former spouses and others • Requirements • Registration in the Defense Enrollment Eligibility Reporting System (DEERS) • Valid Uniformed Services ID Card

5. Tricare • Standard • Basic, comprehensive coverage • No enrollment required • Fee for service flexibility • Deductible • Extra • Standard plus (access to Prime Network providers at TMA rates or Other Providers) • Prime • Required for AD members • Must actively enroll • Assumption is all primary care at MTF • Referral/approval required for specialty care • http://www.tricare.mil

6. Tricare North Contacts

7. TRICARE Standard • Enrollment not required • Care from non-network TRICARE-authorized providers • Provider may charge up to 15% above TRICARE allowable charge • May have to submit your own health care claims • Referrals not required for specialty care • Some services may require prior authorization • MTF care on a space-available basis only

8. TRICARE Standard and Extra:Active Duty Families

9. TRICARE Prime • Enrollment required • Portable: Easy to transfer when you move • Split enrollment:Families can enroll together in different regions • Access standards for care • Most care received from primary care manager • Minimal out-of-pocket costs • No claims to file (inmost cases)

10. TRICARE Prime Costs:Active Duty Families

11. Pharmacy Options and Costs

12. Other Tricare Notes • Transports • Authorization to non-MTF usually required • Reimbursement for Travel • Beyond 100 mile radius eligible for travel support (Non-medical attendant: NMA) • Distance and allowances determined by TMA • Tricare Support Center (TSC) at every base • TMA website (www.tricare.mil)

13. Command Contacts • Every military member belongs to a unit or command • Multiple commands or units on a given base • Every service member has an immediate NCO (E-5 above) or Officer • Rank dependent • Supervisor name/contact critical for all military families we care for • Some proactive, some not, weekly contact helpful for the family

14. Conversations With Commands • Command has a mission • AD member’s deploy • In the perfect world, full family present for a difficult prenatal course, birth or NICU stay • Most families understand this may not always be the case • Is AD member required back from a deployment? • When can the AD member deploy next? • AD Members generally want to deploy when it is medically reasonable

15. Notification of Deployed Family Member • Service member's Command • Red Cross • Messages to service members 24/7/365 • Service member’s full name, rank/rating, branch, social security number, military address and information about the deployed unit and the home base unit (for deployed service members only) • Drs. name, diagnosis, prognosis, current condition, life expectancy • Recommend service member presence? • 1-800-696-3873 • Command Family Support Groups • Ombudsman (Navy, Army) • Key Volunteers (USMC) • Family Support Services (all services) • http://deploymentlink.osd.mil/deploy/family

16. Preparing Families for Discharge • Compassionate reassignment • May get bills after hospitalization • Don’t panic • Call Tricare Service Directory (TSC) • TSCs throughout regions • Staffed with customer service reps • TSC locator on Tricare website • www.tricare.osd.mil • Information • http://www.militaryonesource.com • http://www.tricare.mil/specialneeds • http://www.stompproject.org/ • Consider contacting STOMP for inservice

17. Must Do’s for Families as Discharge Approaches • DEERS (Defense Enrollment Eligibility Reporting System) • Tricare Coverage (must enroll for Prime) • Exceptional Family Member Program • ECHO Program

18. Exceptional Family Member Program (EFMP) • Identifies family members with special medical and/or educational needs • EFMP enrollment is mandatory and required immediately upon identification of a family member with special needs. • Start this paperwork pre-discharge from NICU • Documents the services they require • Considers those needs during the personnel assignment process (especially when approving family members for accompanied travel to overseas locations) • Involves the personnel and medical commands and the educational system

19. ECHO Program • A supplemental program to the TRICARE Basic Program • Provides eligible active duty family members with additional financial resources • Focuses on integrated sets of services and supplies designed to assist in the reduction of the disabling effects of the beneficiary’s condition. • Pays up to $2500/month after co-pay met • Use public resources first

20. ECHO Deductibles

21. ECHO Program • Qualifying conditions include: • Moderate to severe mental retardation • Serious disability • An extraordinary physical or psychological condition of such complexity that the beneficiary is homebound • Families must apply through the EFMP office

22. ECHO Program • Durable medical equipment • Training for assistive technology • Assistive communication devices • 16 hours of respite care per month if receiving another ECHO benefit • Training to give home meds • Transportation • Institutional care when required • Medical and rehab services, prosthesis, orthopedic braces and appliances

23. ECHO Program • Institutional care when required • Medical and rehab services, prosthesis, orthopedic braces and appliances • ECHO Home Health Care • In home health service needs not met under ECHO

24. Maternity (Prenatal) Benefit • In 2002, NDAA approved maternity benefit for Tricare standard female enrollees • Only non-AD eligible • One time cost of $25 for ALL prenatal and maternity costs • If father AD, infant eligible for Tricare Prime at birth • Mother not able to enroll (re) in Prime for 1 year • Potentially risky if non-OB health issues develop

25. Maternity Leave • AD mothers receive six weeks maternity leave • Not counted as regular leave • Discuss with Command plan to allow time at home, especially if infant admitted to the NICU • Don’t consume all maternity leave during NICU stay • May need to consider returning to work during a long NICU stay • Variable approach by Command’s re extended leave and TAD/TDY of AD Member to hospital

26. Supporting the Family • Occasionally Command not supportive • Failure to generate Command support • Service member has not informed us of full chain of command and other contact options • We have not contacted the proper people • The Command has significant problems with the service member • Absolutely cannot spare the service person • Letter writing has great value • Rarely are commands unwilling to support reasonable medical requests

27. Who We Are Healthcare for Active Duty Military Families…“Keeping it Safe Here”

30. Family Readiness = Force Readiness