Transformation Office to Streamline Military Health System

By Samantha L. Quigley
American Forces Press Service

Servicemembers can rest easy that their health care benefits will only improve with the chartering of the Military Health System Office of Transformation, the director of the new office said today.

"It's important that servicemembers and (their) families know that they are meant to be the focus of this patient-oriented system of the future," Rear Adm. John Mateczun, Navy deputy surgeon general, said. "There is no intent to lessen the health care delivery that they would see today."

He said patients of the military health care system should notice a more patient-focused manner of delivering service.

The Defense Department announced Aug. 31 that acting Deputy Defense Secretary Gordon R. England had chartered the new office to reform military health services. Eight people will make up the new office: two each from the Army, Navy and Air Force, and two from the Tricare Management Activity.

Mateczun likened changing the system to building a house. What is to be included in the house as well as the materials to be used must be decided upon, he said.

"(And) you still have to have somebody transform that into a plan so that the contractors and subcontractors will know exactly what to do," he said. "That's what the Office of Transformation's job is going to be. It's kind of like an architect. It's taking the building blocks that have been put together and then drawing the plan."

From that plan, he said, a team that includes the Office of the Secretary of Defense, the services and the Tricare Management Activity will be able to build that new military health system of the future. They will get their raw materials, or building blocks, from the base realignment and closure process, local working group recommendations and medical readiness review initiatives, Mateczun said.

"When all those building blocks come together, you'll have actually four or five different views of how the system needs to transform," he continued. "What (this) office will do will be to take all of those and put them together into a blueprint that the team ... (will evaluate to) make sure that we build the system that we need for the future."

That future, he said, is a military health system that is efficient and can capitalize on the new technologies and drugs that are a result of a constantly changing American health system.

"We want to maintain the very high standard of both battlefield care and the health care systems we have today worldwide," Mateczun said. "But at the same time, make sure that we're doing it as efficiently as we can (by) being good stewards of the money that the American people provide."

Gordon England
Rear Adm. John M. Mateczun, USN

Tricare Begins Enrollment for New Reserve Healthcare Benefit

By Sgt. 1st Class Doug Sample, USA
American Forces Press Service

WASHINGTON, April  2005 Thousands of Reserve and Guard servicemembers can now qualify to purchase more healthcare coverage for themselves and their families under a new Tricare program.

Tricare, the military's health care provider, is now accepting enrollment for its new Tricare Reserve Select health plan, said Steve Lillie, Tricare's deputy chief of operations.

Congress authorized the new healthcare benefit for Reserve Component members under the fiscal 2005 National Defense Authorization Act as a way of providing health coverage to RC members burdened by the current war. Lillie said the premium-based plan will be offered as an option to more than 400,000 eligible servicemembers who may want to purchase healthcare coverage.

"This is pretty attractive for the kind of coverage that's offered under Tricare," he said. "It's an excellent comprehensive health plan with comprehensive pharmacy coverage at a reasonable price. I think this will be attractive for many people compared to what they can get through employment."

Currently, RC members ordered to active duty for a period of more than 30 days are covered under one or more of several Tricare programs. "Health coverage is also provided up to 90 days prior to activation for servicemembers who receive a 'delayed-effective-date' order," he added.

For the most part, TRS helps make providing continuous health coverage a seamless process for servicemembers.

Lillie explained that after a servicemember is released from active duty, the Transitional Assistance Management Program then picks up their health coverage for 180 days, and if purchased, TRS coverage begins immediately afterwards.

"Everything is seamless until you get to TRS because it's an optional program that requires premiums," Lillie said. "We can't make that completely seamless -- there are steps that you have to follow to qualify and purchase coverage."

To be eligible for TRS, servicemembers must have been called or ordered to active duty in support of a contingency operation since Sept. 11, 2001, and they must execute a "Service Agreement" through the Guard and Reserve Web Portal to serve in the Selected Reserves.

In addition, Guard members must have served "under an order from the president, not from their governor," Lillie explained. And they must have served continuously on active duty for 90 days or more under such an order, unless they were injured or became ill while activated.

He said servicemembers may be eligible for one year of health coverage for every year of service commitment in the service agreement, up to a maximum of one year for every 90 days of prior service on active duty in support of a contingency operation.

The Service Agreement through the Guard-Reserve portal is a vital first step in qualifying is to enter into continued service in the Selected Reserve. That is done through the member's Reserve unit. That Service Agreement must be executed between the member and the Reserve component before the member can purchase TRICARE Reserve Select coverage.

Meanwhile, Lillie added, the cost for the plan is $75 for TRS member-only coverage and $233 for TRS member and family member coverage, which is reasonable compared to that of civilian health plans.

The annual cap for catastrophic illnesses is another good benefit. According to the plan, this cap limits out-of-pocket expenses to $1,000 per year. "The typical private insurance program might have a catastrophic cap of $4,000 or $5,000," Lillie said.

In many aspects, TRS may even be better than some civilian health maintenance organization or preferred provider-type insurance plans, he said.

TRS provides access to any provider that treats Tricare patients without referrals required, Lillie explained. "So it's broader; it provides more freedom of choice than an HMO plan," he said.

For Reserve and Guard members, Tricare Reserve Select health coverage will be much the same as the Tricare Standard and Extra their families may have received while on active duty.

In addition to typical inpatient and outpatient care, Tricare Reserve Select covers urgent and emergency care, and ambulance services; family healthcare; obstetrics, gynecology and maternity services; and clinical preventive services, including health screening and immunizations.

The plan also covers behavioral health care, annual eye examinations; ancillary services, such as laboratory and radiology; and prescription drug coverage.

"The principal difference between their coverage while on active duty and their Tricare Reserve Select coverage is there is some cost sharing for the time when they go to the doctor or get hospitalized," Lillie pointed out. "It's comparable to a civilian healthcare plan, and it's identical to Tricare Standard.

"The member and the family will pay a 20-percent cost share when they visit a non-network doctor," he said. "They also have a deductible to satisfy at the start of each federal fiscal year."

Lillie said the deductible for servicemembers in the rank of E-4 and below is $50 per individual or $100 per family. The deductible for servicemembers E-5 and above is $150 per individual or $300 per family.

"Our reservists and guardsmen who are called to duty and their families deserve this great new benefit for their service to their country," said Lillie. "We are glad that we can offer Tricare Reserve Select to qualified members and their families. It is good for them and good for the Reserve and National Guard forces.

Related Sites:
Tricare Reserve Select
Guard and Reserve Web Portal

Requirement Expires for Tricare Standard Nonavailability Statements

American Forces Press Service

WASHINGTON,  2004 People covered by the Tricare Standard military health care plan no longer need approval from their military treatment facility to seek inpatient care at civilian hospitals.

The need to get a nonavailability statement before seeking civilian inpatient care expired Dec. 28 under a provision of the 2002 National Defense Authorization Act. A nonavailability statement indicates that care is not available from the military facility and authorizes care at a civilian facility.

An exception in the law continues the requirement for Tricare Standard beneficiaries to get a nonavailability statement before seeking nonemergency inpatient mental health care services. However, officials said, this applies only to beneficiaries who use Tricare Standard or Extra, who are not Medicare eligible, and who have no other health insurance that is primary to Tricare. DoD does not require preauthorization for Tricare beneficiary inpatient mental health care when Medicare is the primary payer.

"With this change in policy, beneficiaries now have the freedom to choose a military treatment facility or a civilian facility, without any extra paperwork," said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs. "However, I urge Tricare beneficiaries to still look to the military health system as their first choice for health care. because I believe the services we offer are second to none."

A military treatment facility may request a departmental waiver of the new policy in certain specific, but limited, circumstances. But those requests don't apply to maternity services, unless the affected beneficiary began her first prenatal visit before Dec. 28, officials said.

Any military treatment facility granted a waiver must publish a notice in the Federal Register that a nonavailability statement is required for a certain procedure; the treatment facility, the services and the Tricare Management Activity will notify the affected beneficiaries if this occurs, officials said. Maternity patients should check with their local military treatment facility to compare maternity services there with those available in civilian facilities, Military Health System officials said.

A recently implemented "Family-Centered Care" program offers enhanced services and recognizes the unique needs of military families in today's climate of increasing deployments and high operations tempo, officials said. Beneficiaries can review the enhanced military treatment facility maternity services online and with their military medical care provider.

Beneficiaries can check the Tricare Web site if they are seeking an inpatient service and want to know if their nearby military treatment facility applied for a nonavailability statement waiver. They also may contact the beneficiary counseling and assistance coordinator or health benefits adviser at their nearest treatment facility, officials said.

Before seeking care at a civilian facility, military health system officials urge beneficiaries to check with their nearby military treatment facility to compare services and ask questions. Even if the facility could not provide the needed services in the past, the facility's staffing levels or capabilities may have changed, and they might now be available, officials said.

(Compiled from a Tricare news release.)

Dr. William Winkenwerder Jr.

Related Web Site:
Military Health System
Military Treatment Facility Family Care Program