*** Important Notes! ***
1. "Enrollment" is not required for TRICARE Standard or TRICARE for Life (TFL) (see note #4 below)--it's automatic and there's no enrollment fee. However, there is an occasional misperception that TRICARE Prime is available in Thailand. TRICARE Prime is not available in Thailand. Prime is not available overseas to Retirees and their family members. Moreover, there are no Military Treatment Facilities (MTF) in Thailand.
2. Annual Deductible = $150 Individual / $300 Family. Once you meet the Annual Deductible, Patient Cost Share = 25% of Covered Services (allowable charges) up to the Catastrophic Cap of $3,000 (see #3 below). Reminder: Patient always pays 100% of non-allowable charges.
3. Catastrophic Cap = $3,000 per Family per Fiscal Year (1 Oct xx - 30 Sep xx). The catastrophic cap limits your out-of-pocket liability on cost-shares and annual deductibles. It is the maximum amount you are required to pay annually for covered services. Once the beneficiary's deductible and 25% cost-shares reach $3,000 each fiscal year, TRICARE will begin to reimburse you 100% for TRICARE covered services (allowable charges) for the remainder of that fiscal year, as opposed to only 75% (less deductible) before the catastrophic cap is reached. Reminder: Patient always pays 100% of non-allowable charges.
4. Medicare and TRICARE. In order to keep your TRICARE benefits (TRICARE for Life) when you turn 65, you must be eligible for Medicare Part A and join/purchase Medicare Part B. There are also certain conditions when a beneficiary under the age of 65 must join Medicare Part B in order to retain TRICARE benefits. Since the TRICARE-Medicare link can be somewhat confusing, TRICARE has some easy to understand information here. Click here for information on Medicare Part B from the Social Security Administration.
5. Patient Confidentiality. In order to safeguard patient confidentiality, when someone (family member, legal guardian, advocate, etc.) contacts our office inquiring about a patient's condition or wanting to help the patient file a claim, we first need legal proof that the inquiring person is authorized to do so (Federal Regulations, Title 42, CFR Part 2). A signed Authorization to Disclose Information form by the patient to our staff is required; else, a legal Power of Attorney is required (photocopy not accepted). Please also carefully read DD Form 2642, Block 12 instructions regarding claim reimbursement checks.
6. Your Address in DEERS (Defense Enrollment Eligibility Reporting System) must be in the Overseas Region and must be kept updated!
7. DEERS Verification. We are very stringent about a patient’s TRICARE eligibility being verified in DEERS. The JUSMAG-THAI Personnel Section performs DEERS verification only during normal duty hours. Therefore, if you seek medical care during non-duty hours, you must wait until the next duty day to have your eligibility confirmed. Actual Case: Patient visited the E.R. on a Saturday and was subsequently admitted. The patient [mistakenly] expected an automatic 25%-75% Partial Payment Arrangement between TRICARE and the hospital (arrangements are NOT automatic). Since DEERS eligibility could not be verified until Monday, the patient was required to give the hospital a 40,000 Baht deposit.
8. Partial Payment Arrangement (PPA). (25%-75% PPAs are NOT automatic--see PPA letter for full details.) This local initiative is entering its eighth year in Thailand. However, numerous dishonest persons have tried to illegally benefit from this arrangement. For example, a major healthcare provider in Pattaya opted out of any future PPAs due to dishonest individuals not paying their invoices. Fortunately however, that provider usually still accepts full payment up front. (Non-payment of cost-shares is not limited to Pattaya). Bottom line: If this negative trend continues, a few dishonest individuals risk losing this helpful initiative for everyone. Do the right thing. Pay your bills!
Note: After patient discharge (under a PPA) do NOT file a DD-2642 claim with TRICARE! JUSMAG-TRICARE staff will file the PPA claim using Form HCFA-1500 completed by the patient and caregiver during the discharge process. Wrongfully filing a DD-2642 impedes the claims process and results in future PPA non-availability for the sponsor and their family until this [financial and legal] matter is sorted. Not to confuse you too much, but DO file a DD-2642 for “Home Medication” that a patient paid for 100% up front after hospitalization. Lastly, be sure to keep the in-patient and Home Medication bills separate (don’t mix them up!).
9. Claims Filing: 1) Outpatient - You must file no later than One (1) Year after medical services received. 2) Inpatient - You must file no later than One (1) Year after discharge. We receive many requests for help from beneficiaries when their claims are denied because they submitted their claims after the ONE-YEAR time limit. Unless there are justifiable reasons we normally cannot help you if you exceed the ONE-YEAR time limit.
• Read ALL instructions on the DD Form 2642. Example: Many claims are frequently delayed due to incomplete prescription medication details. Also, if your claim is the result of an injury, don't forget to include a DD Form 2527 (Statement of Personal Injury - Possible Third Party Liability) with your DD 2642. If in doubt whether or not to submit a DD 2527, submit it! It’s better to submit one than have WPS delay the processing of your claim until you do. “Payment of your claims has been suspended until we receive more information. Your claims, and any related claims that are subsequently received, will be denied if this form is not completed and returned within 35 days from the date of this letter.”
• Submit claims to the TRICARE Overseas claims processor, "WPS". If you still have a U.S. address in DEERS, mail your claim to your stateside TRICARE regional contractor. If you're a dual-eligible beneficiary (Medicare & TRICARE), WPS is your claims processor. Moreover, it is the beneficiary's responsibility to make photocopies and mail claims (our office has neither a copy machine nor postage stamps). Lastly, reimbursement checks have a 120-day expiration so be sure to deposit in a timely manner, else, it's up to YOU to request a replacement check.
• When discharged after hospitalization, beneficiaries are often prescribed take-home medication. Since some medication is not covered by TRICARE, you must pay for any “Home Medication” up front (it’s not included in a PPA), and then file a separate claim with WPS. For timely reimbursement of your claim send WPS the following: (1) DD Form 2642 stating in Block 8a: “Home Medication due to Hospitalization for _____________” (Block 8c: Check “Pharmacy”); (2) Inpatient Medical Report, and; (3) Separate Itemized Bill with only the Home Medication listed (all medication details clearly stated).
10. Retiree Mail and APO Mailboxes. TRICARE personnel are not authorized to open retiree postal mail and/or retrieve TRICARE postal mail from retiree APO mailboxes. On a related note, be sure to input your Street or APO Box address (as listed in DEERS) on the DD Form 2642, not the JUSMAG-TRICARE Office address. Using your DEERS address will help you receive your reimbursement check sooner.
11. TRICARE Overseas Website. We highly encourage all eligible beneficiaries to register an account on WPS’ website: http://www.tricare4u.com/. As a registered user you’ll be able to view patient eligibility, amounts paid toward deductibles, track the status of your claim, review your claims history (amount paid and EOB), and contact WPS customer service. (EOB = Explanation of Benefits).
12. Department of Veterans Affairs. (Information-Only). TRICARE does not process VA Foreign Medical Program (FMP) claims nor do we schedule FMP appointments for VA-related medical care. Please contact your servicing VA Regional Office if you believe your medical care may be partially or fully covered by the VA. For more information on the VA’s Foreign Medical Program please click here.
13. In Case of Emergency (ICE). We quite often think, "It will never happen to me", but, all too often it does happen to "me". Are you and your loved ones prepared to help you if you become incapacitated as the result of an accident or sudden serious illness? Please click here for a sobering article on what can happen without warning and what you can do now to prepare. In the article is a link to this very useful form: Emergency Personal Health Record & Contact Info Form. This form and more comprehensive info may be found at http://www.ice4safety.com/.
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HQ-JUSMAGTHAI
TRICARE Services, Room J-202
7 South Sathorn Rd., Yannawa
Bangkok 10120 Thailand
Fax: 02-287-1575
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Nurse Tipthida Suwannadhat
Tel: 02-287-1036~45 Ext. 512
Email: nursetida.th@san.osd.mil
Mobile: 081-751-0963 (Emergency)(Secondary After-Hours Contact)
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Nurse Pranee Swaddikit
Tel: 02-287-1036~45 Ext. 511
Email: nursepranee.ctr.th@san.osd.mil
Mobile: 081-633-3793 (Emergency) (Primary After-Hours Contact)
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• Client Service Hours: 0800-1100 & 1300-1500, Wednesday & Thursday. 1300-1400, Friday •
• Lengthy or Complicated Issues, Please Call or Email to make an Appointment •
~ TRICARE Pacific Health Benefits Advisor - Thailand ~
(The appearance of hyperlinks does not constitute endorsement by the U.S. Department of Defense (DoD) or the information, products or services contained therein.)
