TRICARE Prime Service Area Reductions January, 2013 What is PSA Reduction? • The primary purpose of a PSA is to augment the delivery of health care around military treatment facilities (MTFs) and Base Realignment and Closure (BRAC) sites • The latest generation of TRICARE Managed Care Support Contracts (T-3) request for proposals released in 2007 did not require TRICARE regional contractors to develop PSAs in areas remote from MTFs • The PSAs affected under T-3 are not close to existing military treatment facilities, and have never augmented care around MTF or BRAC locations. • PSA reduction assists DoD in controlling health care costs – will save an estimated $45-$56M a year www.tricare.mil/PSA 2 PSA Reductions No Impact on Active Duty • Of approximately 1.6 million retirees and family members currently in Prime, 171,000 potentially affected across all three U.S. regions • No impact on Active duty service members and their families: Prime benefits maintained • Affected Retirees and their family members living <100 miles from remaining PSA may be able to transfer their Prime enrollment • No impact on Medicare eligible beneficiaries – TRICARE For Life and Pharmacy unaffected 3 TRICARE Standard • Impacted beneficiaries automatically have TRICARE Standard/Extra • TRICARE Standard is similar to “open choice” health plans – You can choose any TRICARE authorized physician – No enrollment fees – No monthly fees – No referrals – Fewer authorizations • Preventive care covered at no out-of-pocket cost includes: – Cancer screenings – Well child care – Immunizations 4 Differences Between Prime and Standard 5 Cost Comparison: Standard/Extra vs Prime Enrollment Fees Prime Standard/ Extra Deductible $269.28/year individual $538.56/year family None E1-E4: $50 individual, $150 family E5 and above: $150 individual, $300 family In-Network Copay/ cost-share Point of Service Fees Annual Catastrophic Cap E.R. visit $30 Outpatient visit - $12 Annual deductible plus 50% cost share $3,000/ year 20% innetwork 25% outof-network None $3,000/year 6 Communication Thank You for Your Patience • TRICARE is committed to keeping beneficiaries informed about changes in PSAs • Multiple communication via US Mail; media, customer service support, web, Mil/Vet Assoc. • Information will be updated at www.tricare.mil/PSA where you may also sign up for email updates 7 Implementation Plan Highlights Action/Tactic Target Date PSA Contract modifications to West/North/South 12/2012 Information Paper for Senior DoD Leadership/ Hill/ Surgeons; PSA Fact Sheet January 8, 2013 Tricare.mil/PSA launch January 10, 2013 Customer Service FAQs/Military Associations Briefed January 10, 2013 Notify Interested Media January 10, 2013 TRICARE Region Communication to Commands January 10, 2013 Military Association Execs Full Briefing January 10, 2013 8 Implementation Plan Highlights Action Target Date HASC/SASC Full briefing January 16, 2013 * February 7, 2013 Early notification letters for affected beneficiaries * Dependent on Contractor Printing/Mailing ZIp Code Locator Tool on TRICARE Web February 7, 2013 MHS Conference 02/11-14/2013 Customer Service Support in place for affected beneficiaries 04/01/2013 Health Matters Newsletter (Prime) to 1.5 M 05/2013 Media Roundtable with details; news articles; outreach to affected communities 05/2013 9 Implementation Plan Highlights Action Target Date Second Notification Letter 06/2013 Beneficiary Prime Health Matters Newsletter Article 08/2013 Disenrollment letters for affected beneficiaries 08/2013 Response to question/reinforce information stream 08/201310/2013 10