Tricare for Life TFL When Life Happens, Do A Tricare Checkup

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When Life Happens, Do A Tricare Checkup
March 05, 2008
No. 08-14

Falls Church, Va. - Few would argue that one of the most valuable benefits
of military service is free or low-cost health care. However, life events
mean that beneficiaries must stay on top of eligibility, co-payments, and
deductibles to make the most of the health benefit, and to avoid unexpected
charges and denied claims.

When 69-year-old retired Navy Chief Warrant Officer Smith* learned of a new
vaccine covered as TRICARE medical benefit, he immediately took advantage of
it. A few weeks later, the chief warrant officer was a little surprised to
see a bill for more than $100. Now faced with paying an unexpected medical
expense, he learned that a covered benefit does not always mean free.

Just like the TRICARE benefit, Medicare has medical and prescription
coverage. As a TRICARE for Life (TFL) beneficiary, it's important to know
what Medicare covers and what TRICARE covers.

Many vaccines are a service that may be covered by Medicare only as part of
its prescription drug program (Medicare Part D), while being covered only as
a TRICARE medical benefit. One such example is the Zostavax vaccine for
shingles. TRICARE will reimburse a medical provider for administering the
Zostavax vaccine in their office as a part of the TRICARE medical benefit.
Vaccines are NOT a part of the TRICARE pharmacy benefit because it can not
be self-administered by the patient. In these cases where it is not a
medical benefit under Medicare, the only way to avoid paying the TRICARE
deductible and cost shares is to have both Medicare Part D and TRICARE.
Since many TFL members do not have Medicare Part D because of their TRICARE
pharmacy benefit, they are responsible for a cost share.

For more information on TFL benefits, co-payments, and claims, visit
http://www.tricare4 u.com or contact WPS TRICARE for Life at 1-866-773-0404.

After his wife gave birth to their first son, Air Force Senior Airman Jones*
was so excited about his new namesake that he told everyone-his section
leader, the squadron first sergeant, even the group commander. He told
everyone except DEERS.

It's important to enroll newborns and adopted children in the Defense
Enrollment Eligibility Reporting System (DEERS) to establish TRICARE
eligibility for well-baby and pediatric health care. By enrolling a newborn
or adopted child in DEERS, sponsors may avoid potential claims problems.
Enrollment in DEERS is a separate step required before sponsors can enroll
the child in any of the TRICARE program options such as TRICARE Prime,
TRICARE Prime Remote for Active Duty family members, or TRICARE Reserve
Select. If a child is not registered in DEERS within one year (365 days) of
his or her birth or adoption, DEERS will show "loss of eligibility" on day
366, and the child will no longer be able to receive TRICARE benefits until
he or she is registered in DEERS.

To establish a newly-born, adopted or pre-adoptive child's TRICARE
eligibility in DEERS, submit the following to the local ID card office:

- An original or certified copy of a birth certificate or certificate of
live birth (signed by the attending physician or other responsible person
from a U.S. hospital or military treatment facility), or consular report of
birth (FS-240) for children overseas;

- A record of adoption or a letter of placement of the child into the home
by a recognized placement/adoption agency or the court before the final
adoption; and

- An application for Department of Defense Common Access Card and DEERS
Enrollment (DD Form 1172).

To learn more about DEERS enrollment, visit
http://www.tricare. mil/mybenefit/ home/LifeEvents.

*A fictitious person

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SOURCE: TRICARE News Release, TRICARE Web Site at http://www.tricare. mil

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TRICARE For Life Toll-Free Help Desks:

TRICARE Pharmacy: 1-877-DOD-MEDS (1-877-363-6337)

TRICARE For Life: 1-888-DOD-LIFE (1-888-363-5433)

Help desk operating hours are: Monday through Friday, 8:00 a.m. to 8:00 p.m. (ET) (excluding federal holidays).

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Answers to TRICARE questions and requests for assistance may be obtained by sending E-Mail messages to QUESTIONS@tma. osd.mil or online at http://www.tricare. mil/mybenefit/ jsp/questions/ feedback. jsp