2006 Patient Administration Training Symposium July 17, 2006

1. 2006 Patient Administration Training Symposium July 17, 2006 Mr. Mike Talisnik, TMA

2. Introduction • TRICARE Global Remote Healthcare Contract (TGRO): • Healthcare benefits for active duty and family members • TGRO Provider Network • Case Management • Cashless/Claimless Service • Beneficiary Satisfaction • Additional Issues • International SOS Contact Numbers

3. TRICARE Global Remote OverseasOverall Objective Provide TGRO Beneficiaries access to a Western Standard Level of Care by utilizing an SOS TRICARE Credentialed Network of providers and Specialty Services with No Out of Pocket Expenses CONUS TGRO OCONUS

4. TGRO Beneficiary Services • Cashless / Claimless Services to TGRO Beneficiaries • Case Management – Quality of Care • Global Consistency of Approach in Delivering Healthcare Services for enrolled members • SOS TRICARE Credentialed Network • Outpatient, Inpatient, and Specialist Care • 24 x 7 Urgent Care Capacities • Urgent Medical Transports • Governed by TRICARE Policies

5. TRICARE Global Remote Overseas • Coverage under TGRO • Routine, Urgent and Emergent Medical Care for Active Duty (AD) and Active Duty Family Members (ADFM) permanently stationed in a TGRO Location. • Urgent and Emergent Care for Active Duty TDY/TAD, Reservist, On Leave, Liberty, Navy/Marine/Coast Guard Deployed. • TRICARE Beneficiaries Excluded from TGRO • TRICARE Retirees / TRICARE For Life • TRICARE Standard • Direct Care

6. TRICARE Global Remote Overseas • Beneficiaries • Cashless/Claimless Services • Enrolled and TDY/TAD • Routine, Urgent & Emergent • Credentialed Network • SOS TRICARE Credentialed Network • Availability of Primary and Specialist Care • Monitoring and Quality Control • Local Currency Capacities ` International SOS TRICARE Mgmt / TRICARE Area Office Coordination • Globalized and Standard Services • Europe • Asia Pacific • Latin America Case and Network Mgmt • Case Management / Medical Oversight • Management of Routine and Urgent Care • Access to over 1100 Medical Staff worldwide • Support of TRICARE Healthcare Policies Globally • Cost Containment Capacities • Case History: Longitudinal Reporting • Claims Processing • ICD and CPT Standard Coding • HIPAA Compliance • Electronic 837 Submissions to WPS

7. Engaging Providers • All providers are credentialed under the TRICARE Quality Plan • CV, Education, License, Site Audit, Malpractice, Agreement • Provider Education • Cashless/Claimless Services • TRICARE ID Cards • Beneficiaries can Self-Refer to a Primary Care Provider through SOS/TRICARE Website

8. TRICARE/SOS Websites (Self Referral-Primary Care ONLY) • SOS has developed 3 Regional Websites • Used by Beneficiaries to find a provider • Each Region has a set of Published Primary Care Providers

9. Types of Providers • Hospitals • Specialists • Dentists • Primary Care Providers • General Practitioners • OB/GYN • Pediatricians • Internists • Specialty Transport Services • Ground Ambulance • Air Ambulance

10. Case Management Services • Based in International SOS Alarm Centers with a dedicated TGRO team • First contact Coordinators and Nurses • Supported by other SOS Medical staff and International SOS Centers • 24/7 service including verification of eligibility • Direct access to services in over 70 languages

11. Emergency evacuation/repatriation • Over 10,000 medical transports in 2004 8,500 on commercial carriers • Best practice decision-making protocolfor medical transportation • Auditable medical transport standards • In-house commercial travel desks • Excellent relationships with majorcommercial carriers for medicalclearance • 10 dedicated air ambulances • Patient Medical Isolation Unit • Mass casualty transport experience

12. GIQD Beneficiary Eligibility • PCP Self-Referral from Web Site • SOS provides Guarantee of Payment • Provider Education (Cashless/Claimless) • TRICARE Identification Cards International SOS WPS 837 835 Local $ USD $ Cashless/Claimless Case Management Workflow

13. Beneficiary Survey Tools • Driven by International SOS Case Data • Pushed to the Beneficiary through the WEB • Surveys Results Collected by Third Party • Beneficiary Survey Reports are deliverable every (6) months to TMA

14. Point of Service Option (POS) • Health Affairs (HA) Policy: 04-021 • All TOP Prime AD/ADFM enrolled in a remote overseas location under the TGRO or Puerto Rico contracts (PRC) will be required to coordinate their non-emergency host nation/civilian healthcare through the TGRO or PRC contractor or pay deductible and POS charges • Policy memo allows one waiver not to pay the POS charge. EOB message will inform the beneficiary of the waiver • Second claim will process as POS

15. Transitional Survivor Benefit • HA Policy: 05-004 • Transitional survivors who accompanied their AD sponsor on orders in his/her assignment OCONUS and are residing overseas at the time of their sponsor’s death will be eligible for three year transitional healthcare benefits under TOP Prime • Policy is based on the transitional benefit in CONUS

16. Enrollment • 11 Apr 05 HA Policy memo • Reserve Members reporting for active duty with a final assignment to a duty station overseas for more than 179 days are permitted to enroll into the Prime options overseas • TMA proposing a revision to the 11 Apr 05 HA Policy memo to permit RC members ordered overseas to be eligible to enroll into the Prime option overseas if on orders for more than 30 days

17. Enrollment • 4 Apr 05 HA Policy memo • ADFMs who meet the Joint Federal Travel Regulation (JFTR) definition of Command Sponsored shall be eligible for enrollment into the Prime options overseas with the exception of those who meet one of the four critieria: • ADFMs who are enrolled and the sponsor is reassigned on unaccompanied orders to a location that does not permit Command Sponsored family members, the family member can remained enrolled • ADFMs who are allowed to relocate under the sponsor’s PCS orders or Noncombatant Evacuation Orders • ADFMs who are currently enrolled in the Prime option overseas and the family has an newborn or adopts a child • ADFMs who are a transitional survivor

18. Enrollment • 21 Jun 05 Policy memo • No later than 1 Oct 05, ADFM who choose to reside overseas but are not Command Sponsored and do not meet certain exceptions will not be eligible for enrollment into TRICARE Prime • ADFMs who do not meet the new requirements but are enrolled prior to 1 Oct 05 will remain enrolled for the duration of their sponsor’s overseas assignment

19. Other Issues • TMA working on modifying the TGRO contract to eliminate the MTF country restriction. This modification would permit I SOS to facilitate urgent/emergent care for AD and RC members requiring medical assistance within a country that has existing MTF capabilities. • TMA also working to require that the Military Medical Support Office (MMSO) be the authorizing agent for the healthcare required by RC members on orders for less than 30 days and requiring care overseas. Healthcare claims would be processed and paid by WPS vs. the member’s unit.

20. Help Contacts – Global Remote • I SOS-Europe 44 20 8762 8133 • I SOS-Latin America 800-834-5514 • I SOS- Pacific 65-6338-9277 (Singapore) 61-2-9273-2760 (Sydney) http://tricare.osd.mil

21. Questions