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Tricare Point Of Service - TRICARE: Your Military Health Plan: Transitioning from Active Duty to Retirement ATTENTION SPEAKER: To ensure that TRICARE beneficiaries receive

Presentation on theme: "TRICARE: Your Military Health Plan: Transitioning from Active Duty to Retirement ATTENTION PRESENTER: Ensuring TRICARE Beneficiaries Receive."— Presentation Transcript:

Tricare Point Of Service

ATTENTION PRESENTERS: To ensure that TRICARE beneficiaries receive the most up-to-date information about their health benefits, please visit prior to each presentation for the most updated version of all briefings. Notifications are constantly updated as benefit changes occur. Presenter Tips: Review all slides before the meeting. Provide the "slide show" setting. Delete any slides that don't apply to your audience. Target audience: Active duty service members approaching military retirement based on length of service and their family members. Estimated familiarization time: 30 minutes TRICARE Resources: Visit to view, print, or download copies of TRICARE educational materials. Outreach Objectives: Increase understanding of TRICARE benefits and educate beneficiaries about their program options as they transition to retirement. Optional Presenter Comment: Welcome to TRICARE's Active Duty to Retirement Transition Presentation. As you approach retirement from active duty, you and your family members have some important health care decisions to make. TRICARE will still be there for you when you retire, but there are different options to consider and certain actions to take.

Understanding Military Medical Care And Tricare

2 Today's Agenda During today's information session, we will discuss retirement preparation, TRICARE program options, and information about TRICARE benefits. Finally, we will provide important resources to help and answer any additional questions. To learn more about TRICARE options, visit To receive TRICARE news and publications by , sign up at To sign up for benefit correspondence by , visit

The Defense Enrollment Eligibility Reporting System, or DEERS, is a database of service members and dependents worldwide who are eligible for military benefits, including TRICARE. Sponsors can register family members in DEERS in person with Uniformed Services ID or ID units. To check eligibility and update information, log on to the milConnect website at MilConnect is the Defense Manpower Data Center's online portal that provides access to DEERS information. The data can also be updated by telephone, fax or by visiting the office for issuing identity cards of the uniform services. Changes require appropriate documentation, such as a marriage certificate, divorce decree, birth certificate and/or adoption documents. Note: Only sponsors or individuals designated by sponsors with valid authorization can add a family member. Family members 18 years of age or older can update their contact information. Remember that providers are allowed by law to copy military IDs and dependents' IDs to verify TRICARE eligibility. For more information visit

An individual may be eligible for Medicare Part A benefits because of age, disability, or illness. If you are nearing retirement and you or a family member is currently eligible for Medicare Part A: Apply for Medicare Part B before your sponsor's retirement date to avoid termination of TRICARE coverage. Medicare Part B starts the next month after you enroll. Note: If you or a family member is eligible for Social Security disability benefits or is diagnosed with end-stage renal disease and you decline Medicare Part B coverage, you will lose your eligibility for TRICARE. Beneficiaries under 65 who are eligible for Medicare Part A and Part B have: Can continue to enroll in TRICARE Prime. In this case, the annual TRICARE Prime enrollment fee is waived. You can use TRICARE For Life or TFL. We will discuss TFL later in this briefing. For more information about Medicare Part B coverage, visit the Social Security Administration's website at Additional information about Medicare can be found at

If you take terminal leave before retirement, you and your family will remain enrolled in your current TRICARE program until your retirement date. If you are enrolled in TRICARE Prime, you are considered part of your current unit until your retirement date. Active duty service members or ADSMs cannot change their military hospital or clinic or primary care manager or PCM. If you go on leave and move to another area: You must coordinate all care with your current PCM. Your family members may be able to transfer to a military hospital or clinic or civilian PCM network in your new area before your retirement date if your new location is in a large service area or PSA. To check if you live in a PSA, use the PSA Postcode Lookup Tool available at Remember to update your information in DEERS.

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Your entitlement to a retired member starts on the day you retire. Your spouse also remains eligible for TRICARE benefits. Surviving spouses and eligible former spouses who have not remarried also remain eligible for TRICARE. Former spouses who have not remarried should check with their personnel office to determine eligibility. Unmarried dependent children, including stepchildren of retired service members, are eligible for TRICARE benefits. Certain admission requirements apply. Dependent parents or in-laws are not eligible for TRICARE civilian benefits; however, they may be eligible for care at designated military hospitals and clinics on a space-available basis.

When you retire and are younger than 65, you can re-enroll in TRICARE Prime or be covered by TRICARE Standard and TRICARE Extra. You can re-enroll in TRICARE Prime if you live in a PSA in the United States or, if you waive your driving access standards, within 100 miles of an available PCM. You must re-enroll in TRICARE Prime to continue coverage. If you are eligible for Medicare Part A and have Part B, you are covered by TRICARE for Life, which we will discuss later in this presentation. If you decide to re-enroll in TRICARE Prime, you must re-enroll before your retirement date or within 30 days of your retirement date to have continued TRICARE Prime coverage. The effective date of coverage will be your retirement date. If you enroll more than 30 days after your retirement, your claim will be considered the first TRICARE Prime enrollment and the 20th of the month rule applies. For the first TRICARE Prime enrollment received on or before the 20th of the month, your coverage will begin on the first day of the following month. For the first enrollment received after the 20th of the month, your coverage will begin on the first day of the month following the following month. There are three ways to re-enroll in TRICARE Prime: Online: Use the Online Beneficiary Enrollment website at Telephone: Call your regional provider (when your retiree status is reflected in DEERS). Mail: Download the TRICARE Prime Enrollment, Disenrollment and Primary Care Manager Change of Primary Care Manager (PCM) form, which is DD Form 2876, and mail it to your regional provider. With TRICARE Prime, retirees pay the enrollment fee and copayments. For enrollment or cost questions, visit Retirees and their family members who opt out of TRICARE Prime before the annual enrollment renewal deadline are subject to a 12-month lockout. Note: TRICARE Prime Remote options and TRICARE Overseas Program Prime options are not available after retirement.

With TRICARE Prime, your PCM handles routine care and referrals. PCM can treat you at a military hospital or clinic when space permits (ADSMs and their families have priority at military hospitals and clinics). If space is not available at a military hospital or clinic and you live in a PSA, you can receive care from a civilian TRICARE provider. Beneficiaries are also eligible to enroll with a primary care physician in the American Family Health Plan, which will be discussed later. For civilian specialty care, get a referral from your primary care manager, or PCM, before seeking care to avoid higher out-of-pocket costs. You may be referred to a military hospital or specialty care clinic based on the military hospital or clinic's "right of first refusal" to provide non-emergency care under the PSA. When a TRICARE Prime beneficiary seeks special care or treatment, a military hospital or clinic should be considered first if services are available there. This means that if a military hospital or clinic has the capacity to provide specialty care, it may decide to treat you instead of referring you to a civilian provider. If you are traveling or moving, coordinate care before you leave. Take care of routine care before your trip. Contact your PCM or regional provider for help before receiving emergency care. If care is not coordinated with your PCM or regional provider, it will be covered through the point-of-service or POS option, resulting in higher out-of-pocket costs. In an emergency, call 911 or go to the nearest emergency room. Referrals are not required, but if received, your regional provider must be notified within 24 hours or the next business day to coordinate follow-up care. If you expect to be away for more than 60 days, consider transferring your enrollment to maintain routine care and keep costs down.

With TRICARE Prime, the POS option is used to receive non-emergency care from any TRICARE-authorized provider without a PCM referral. Using the POS option does not require you to opt out of TRICARE Prime, but it does result in higher out-of-pocket costs. When you use POS

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