TRICARE and Cadets

TRICAREand Cadets Keller Army Community Hospital April 20, 2007

DEERSDefense Eligibility Enrollment Reporting System • All service members and their families are registered in DEERS • System used to determine military benefits, including medical care

DEERSDefense Eligibility Enrollment Reporting System • Cadet Personnel DEERS office Phone: 845-938-2114 • DEERS Support Office: 800-538-9552 www.dmdc.osd.mil

DEERS OHIDefense Eligibility Enrollment Other Health Reporting System Insurance Eligibility for medical care ends at midnight of the last day of duty Our recommendation: Keep your cadet’s private coverage - To preclude preexisting condition clause

OHIOther Health Insurance Things to consider before Cadet uses your family coverage: • Most plans consider a cadet to be Active Duty and will not pay claims • Cadet graduates: now Active Duty and no longer your dependent

Three TRICARE Options • TRICARE Prime – Only option available to Cadets and all Active Duty • TRICARE Standard • TRICARE Extra

TRICARE PrimeHealth Maintenance Organization (HMO) • Mandatory enrollment for Cadets – (Forms completed after R-Day) • Assigned to Cadet Health Clinic • Primary Care Manager (PCM) directs care via referrals

TRICARE Prime No cost to the Cadet for routine civilian health care if: 1) There is a referral 2) There is an authorization 3) Uses TRICARE Network Provider

Health Net Federal Services, Inc 1-877-874-2273 TriWest Healthcare Alliance 1-888-TRIWEST Humana Military Healthcare Services 1-800-444-5445

Keller Army Community Hospital and Health Net Federal Services TRICARE Partners

TRICARE Partner Health Net Federal Services www.HealthNetFederalServices.com 1-877-874-2273 (1-877-TRICARE)

Health Net Federal Services • Keller TRICARE Service Center • Civilian Provider Network • Palmetto Government Benefits Administrators (PGBA)

Care at West Point • Mologne Cadet Health Clinic • Primary Care, pharmacy • Keller Army Community Hospital • Specialty Care • Lab • Pharmacy • Radiology including CT Scan and MRI • Saunders Dental Clinic

Appointment System 845-938-7992 or 800-552-2907 Mon-Fri: 6 am to 7 pm www.tricareonline.com

Emergency CareJust do it! On Post Mon-Fri, 6:30 am to 3:15 pm: Report to Cadet Health Clinic or call 845-938-3003/3806 After clinic hours: Report to Keller ER or call 938-3333

Emergency CareJust do it! Off Post Call 911 or go to nearest civilian ER Report inpatient admission to Health Net within 24 hours at 877-874-2273 Follow USCC reporting instructions

TRICAREon the RoadLeave, collegiate sports, etc. Emergency care – covered Urgent care – covered care is authorized before it’s received Call: 877-874-2273 Network Pharmacy: 866-363-8779

TRICAREon the RoadLeave, collegiate sports, etc. Routine care - not covered Causes cadets the most problems! Without proper referral and authorization, the bill belongs to the cadet.

Referrals to Civilian Network • Provider requests services • Health Net verifies payable benefit • Cadet system for making appointments with network providers and arranging transport • Note: sign the information release form so a report can come back!

Civilian ClaimsWhere to send…. Send all TRICARE North medical claims TRICARE North Claims P.O. Box 870140 Surfside Beach, SC 29587-9740

Follow Up onCivilian Claims Check claim status in PGBA’s system: www.mytricare.com

Explanation of Benefits(EOB) When the explanation needs explaining… 877-874-2273 Health Net 845-938-4838 Keller’s Health Benefits Advisors*

TRICARE Information and HelpKeller Health Benefits Advisors & Debt Collection Assistance Officers 845-938-4838

TRICARE Information and HelpHealth Net Federal Services Local TRICARE Service Center 273 Main Street, Highland Falls 877-874-2273

TRICARE Information and HelpInternet DoD: www.tricare.osd.mil* PGBA: www.mytricare.com www.HealthNetFederalServices.com *best source of TRICARE information

Patient Representative 845-938-5874 Health Benefits Advisors 845-938-4838 Administrative Help at Keller

TRICARE and Cadets

TRICARE and Cadets

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