With the start of new Tricare contracts, beneficiaries can expect some changes to their military health care, including the expansion of some benefits, according to military advocates and officials.
Defense Health Agency officials said the new contracts, which went into effect Jan. 1, will provide more efficient referral transfers between the East and West Tricare regions; greater access to highly specialized medical and surgical care; better access to telehealth appointments; and improved choices for beneficiaries, including tools that will help them quickly identify providers with the best outcomes.
The new generation of Tricare contracts is designed to improve care for the 9.6 million beneficiaries in the military health system, officials said.
“It’s my understanding most of the Tricare contract changes will happen behind the scenes,” said Karen Ruedisueli, director for health affairs in government relations for Military Officers Association of America, a military advocacy nonprofit. “Once we get past the transition phase, we hope networks will be robust so most military families can maintain continuity of care with their civilian providers.”
The new contracts will help streamline the process for military families to access specialty care when they move, a long-standing goal for MOAA, Ruedisueli said. The contracts reportedly allow Tricare to start providing Tricare Prime beneficiaries with referrals for specialty care at the new duty station before they leave their current location during a permanent change of station move.
The new contracts don’t affect those with Tricare for Life, the U.S. Family Health Plan or a Tricare health plan overseas.
Also part of the new contracts are a referral transition period and a waiver policy update.
TriWest will accept unexpired referrals and preauthorizations from the previous West Region contractor, Health Net Federal Services, that were issued before Jan. 1. Those will be valid through June 30 or when they expire, whichever comes first.
For those who live in states that have moved to the West Region — Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin — TriWest will also accept valid referrals and preauthorizations from Humana Military. They will be valid until they expire or until June 30, whichever comes first.
As always, Tricare Prime beneficiaries must have referrals from their primary care manager for necessary medical treatment that their primary care manager, or PCM, can’t provide. Preauthorizations are more comprehensive reviews before certain services are covered.
The new contracts have also changed the drive-time waiver policy for Tricare Prime beneficiaries in both regions. Those who move to a location that’s more than a 30-minute drive — but less than 100 miles — away from their military hospital or clinic can seamlessly continue to receive care from their current primary care manager. No action is required on the part of the beneficiary who wants to continue with the current PCM, unlike previous requirements.
Those beneficiaries will get a letter notifying them that they are outside the 30-minute drive window. Those who don’t respond can keep their current PCM, while those who want to change can follow the letter’s instructions.
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While Humana Military remains the East Region contractor, TriWest Healthcare Alliance is the contractor for the West Region, which now includes beneficiaries living in certain ZIP codes in addition to the six states that moved from the East Region.
As part of the West Region contract change, beneficiaries who make recurring payments are required to update their payment information with TriWest. Officials have extended the original Dec. 31 deadline to Jan. 15 for beneficiaries enrolled in Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve plans, while those enrolled in Tricare Prime or Tricare Select have until Jan. 30. The requirement applies to those who pay enrollment fees or premiums by credit card, debit card or electronic funds transfer.
Some West Region beneficiaries, however, have reported glitches when trying to set up payments with TriWest, Military Times previously reported. TriWest officials have said they are working on website issues and adding staff to their call center to handle increases in call volume.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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