• FY 2017 National Defense Authorization Act (NDAA) •
* Reform of TRICARE and Military Health System *
*** Attention U.S. Military Retirees ***
Significant TRICARE changes are being implemented effective January 1, 2018.
If at anytime you have questions, please contact TRICARE Overseas (below).
*** Keep DEERS Updated ***
It's essential that YOU keep information in DEERS up-to-date for you and your family!
• TRICARE Overseas (Pacific Area) - International SOS, Singapore •
> > > Email: email@example.com < < <
• Customer Service •
Regional Direct: +65-6339-2676
Toll Free: 0018004418952
• Medical Assistance •
Regional Direct: +65-6338-9277
Toll Free: 0018004417902
• • •
• TRICARE Claims Inquiries (USA) •
Wisconsin Physicians Service (WPS)
Telephone: 1-877-451-8659 (Toll Outside U.S.)
Client Service Hours: Sunday, 7pm CST - Friday, 7pm CST
(Open 24 hours in between those days/times and closed on Saturday)
"By making the personal choice to reside outside of the United States it is our individual responsibility to study and to understand the effects of that choice, notably regarding access to health care, and to Federal/State/Local assistance."
• Our Mission •
1. Our Mission. The funded charter of the JUSMAGTHAI TRICARE office is to assist active duty personnel and their dependents assigned to the mission. Even though we are sometimes able to extend limited assistance on a space-available basis to retirees and eligible dependents of retirees residing in Thailand, we are not funded or staffed to do so. Therefore, please direct pertinent TRICARE inquiries to TRICARE Overseas (contact info is also at the top and bottom of this page).
2. General. *Thank You* to the Chief, JUSMAGTHAI who authorizes this webpage, and to Khun Eddy who manages its many technical aspects. This page provides general information on TRICARE® Health Benefits for U.S. military retirees and eligible dependents of retirees residing in Thailand. This webpage primarily contains and supplements official U.S. Government (USG) sources. If you believe information on this webpage conflicts with information provided by other official USG sources, please contact us for clarification. If you act on unofficial information you do so at your own risk! Again, seek clarity. For complete TRICARE information please visit the official TRICARE website at https://tricare.mil/, and visit International SOS' TRICARE Overseas website at http://www.tricare-overseas.com/.
*** TRICARE NEWS + TRICARE Overseas News *** <<< Read the Latest TRICARE News!
• Rules of Engagement •
• Integrity, Privacy & Professionalism •
1. Foreword. The HQ JUSMAGTHAI TRICARE office is not funded to assist the retiree community, but we gladly do so as a courtesy, mission duties permitting. Please be professional, courteous, and respectful in your interaction with us. If you have a legitimate need to seek TRICARE assistance from our office, please bring your current DoD ID card and all documents pertinent to your visit. In most cases it's your personal responsibility to assemble and complete your own paperwork, make your own copies (TRICARE and RAO staff don't make copies), and promptly leave the office when you've been assisted--be considerate. Limited client service hours for retirees and eligible dependents of retirees are Tuesday-Wednesday-Thursday, 0800-1100. Please respect our schedule. (Bldg. "J", Rm. J-202).
2. Integrity. An integral part of our duties and responsibilities includes being good stewards with U.S. taxpayer dollars. Be advised and forewarned that we will not knowingly help applicants file false claims! Any attempts to intentionally file a false claim to defraud the USG will immediately terminate assistance from our office, and your name being forwarded to the Chief, JUSMAGTHAI, TRICARE Pacific, and to the Defense Health Agency. Complete honesty is the only lawfully-acceptable method.
3. Courtesy and Respect. We routinely handle a large amount of Privacy Act and HIPAA information that is protected by law, and plainly speaking, is none of anyone else’s business. Therefore, please show us, and any clients ahead of you in the queue, the proper respect and courtesy by not barging into our office or interrupting when we’re assisting clients--whether or not a client is sitting in front of us. Don't assume that because a client isn't currently sitting in front of us, that we aren't fully engaged in assistance to them. We will assist you as soon as we are finished with the task at hand, and in queue order. It is our professional promise that we will take every reasonable precaution possible to respect and safeguard the privacy and dignity of all clients. Thank you in advance for your cooperation.
4. Privacy Act and Release of Information. Beneficiary information is protected by the Privacy Act of 1974 (amended) and medical information is further protected by The Health Insurance Portability & Accountability Act (HIPAA) of 1996. By law, we are only authorized to release limited information. Other release of information must be authorized by the beneficiary. For Example: We sometimes need to share information with other agencies to help a beneficiary, but only if authorized to do so by that beneficiary.
5. Emailing Our Office. Even though retirees should submit questions directly to TRICARE Overseas (for faster service), we do welcome emails, but due to the large volume of active duty-related emails we receive daily--and to help us efficiently use our time--we simply ask you to keep it Professional, Official, and Constructive. Please keep emails brief, clear, and to the point, and by all means absolutely NO rude/abusive language or anti-policy rants. Also, before emailing with questions please first review this webpage and our Frequently Asked Questions. The answers to most general retiree TRICARE benefits questions are contained on and linked through this webpage.
6. Telephoning Our Office. We welcome your calls, just please note that telephone calls go unanswered
when we’re busy assisting clients. While we prefer email contact, if you do phone, the best option is to phone our office after 1300 hours, as we are
usually very busy in the morning. Also, please keep your phone calls brief, clear, and to the point, background noise to a minimum, and don't shout. Thank You!
7. 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 JUSMAGTHAI TRICARE Office address. Using your DEERS address will help you receive your reimbursement check sooner. (Better yet, sign up online for TRICARE Overseas' new Direct Deposit service, and elect to receive your Explanation of Benefits (EOB) electronically).
• TRICARE Fraud Prevention •
1. TRICARE Fraud Prevention. Care providers should not ask you to sign blank claim forms! You should never agree to this practice because this is inconsistent with your certification on the forms. Your signature and date on the form signifies that your personal information is correct; that you actually received the care specified on the claim from the provider identified and at the location stated; and that you authorize the U.S. Government to obtain a copy of your medical records, if necessary, to adjudicate a claim. Also, your signature is authorizing the payment of U.S. Government funds and that you sign the claim form only for the health care services that you actually received. Compare your EOB (Explanation of Benefits) to actual medical care and medication received. Lastly, we request that you notify our office and also contact the Defense Health Agency, Attn: Program Integrity, 16401 E. Centretech Parkway, Aurora, CO 80011-9066, anytime you believe TRICARE is being billed inappropriately. Please help us to fully protect your benefits!
2. TRICARE Fraud Examples (prohibited by 32 CFR, §199.9):
3. Possible Penalties:
• TRICARE and the Affordable Care Act (ACA) •
1. TRICARE and the Affordable Care Act (ACA). The Affordable Care Act, also known as the health care reform law, requires you to maintain basic health care coverage--called minimum essential coverage. Beginning in 2014, if you don't have minimum essential coverage, you may have to pay a fee for each month you aren’t covered. Note: TRICARE Standard Overseas and TRICARE For Life meet the minimum essential coverage required by the health care reform law. Unless you’re considering other health coverage, you don’t need to take any action at this time. ACA Tax Information - DFAS.
• TRICARE Reform (FY 2017 NDAA) •
1. The Fiscal Year (FY) 2017 National Defense Authorization Act (NDAA) was signed into law by then President Obama on December 23, 2016. The FY 2017 NDAA mandates Reform of TRICARE and the Military Health System.
2. Upcoming Changes to TRICARE. This section of our webpage focuses on current U.S. military retirees and eligible family members (retired category; "TRICARE Select Group A") that reside outside of the U.S., and are covered by TRICARE Standard Overseas. Significant TRICARE program changes will be phased in during the next several calendar years (CY) starting in CY 2018. The first change to affect current U.S. military retirees covered by TRICARE Standard is that TRICARE Select replaces TRICARE Standard on January 1, 2018.
3. TRICARE Select - Chronological summary of what's in the FY 2017 NDAA:
January 1, 2018
: TRICARE Select replaces TRICARE Standard. (Pages 181 and 188) (See: Health Plans
CY 2020: Annual TRICARE Select enrollment fee of $150 (individual) or $300 (family). (In subsequent years, the enrollment fee will be indexed to retired pay COLA). In the retired category, the enrollment fee shall not apply to Chapter 61 retirees or being a dependent of such a member, and survivors whose military sponsors died on active duty. (Pages 183-184)
4. Health Plan Costs for Calendar Year 2018. Costs for TRICARE benefits will be charged by Calendar Year (January - December) instead of Fiscal Year (October - September).
5. Improving What's Covered. TRICARE covers services that are medically necessary and considered proven. Starting January 1, 2018, we will cover more services.
6. Frequently Asked Questions. TRICARE updates will continue to be published at https://tricare.mil/About/Changes/ by the Defense Health Agency when they become available. You may also sign up for email updates and eCorrespondence about changes to your TRICARE coverage.
7. JUSMAGTHAI TRICARE Office Notes:
It's essential that YOU
always keep information in DEERS
up-to-date for you and your family!
As TRICARE reform is implemented, there will surely be many questions (and opinions) from the local retiree community. That said, please direct all questions to TRICARE Overseas
. (If you reside in the U.S., or are otherwise enrolled in TRICARE Prime, please direct all questions to your TRICARE Regional Contractor
• TRICARE in Thailand - *Retiree Basics* •
• TRICARE Overseas Program (TOP) •
1. TRICARE Overseas Program. International SOS (not the West Region contractor) is the TRICARE Overseas Program manager and will provide the assistance you need for claims, finding a provider, authorization, and much more. If International SOS is unable to directly answer your TRICARE questions they will refer you to the office that can. Email TRICARE Overseas (Pacific Area - International SOS, Singapore): firstname.lastname@example.org.
2. Online Account Registration. We highly encourage all eligible beneficiaries to register an account on International SOS' website. As a registered user you’ll be able to view patient eligibility, authorize TRICARE Overseas to disclose information to family members, submit claims electronically, amounts paid toward deductibles, track the status of your claim, review your claims history (amount paid and EOB), and contact customer service.
a. Password Tip. You have two login choices: (1) DMDC login, or; (2) TRICARE-Overseas.com login. If you're not using a DMDC login, and you're having difficulty creating a TRICARE-Overseas.com login password, or resetting an expired password, please read the following: Your TRICARE-Overseas.com account password must be 15 characters long, with at least 2 upper case letters, 2 lower case letters, 2 numbers, and 2 special characters (the only special characters permitted are # and $).
• Secure Messaging Via TRICARE Overseas Portal: Generally, TRICARE Overseas will respond to a beneficiary's secure message in 14 calendar days. If you desire a more timely response, consider emailing or phoning TRICARE Overseas.
• Know Your Benefits Before You Travel •
3. Traveling to Thailand. If you're reading this in the U.S. as part of your pre-visit or pre-move to Thailand, excellent! While most TRICARE retiree beneficiaries study and understand how TRICARE works in Thailand before making the personal choice to visit or relocate here, unfortunately, many do not. By reading and studying this webpage before you travel or before you need medical care, you have made an informative decision. Also, before you travel overseas contact your current TRICARE Region regarding what travel rules may apply.
• Frequently Asked Question: Do Thailand providers accept TRICARE? If by "accept TRICARE" you mean that the provider will provide medical services and then file claims on your behalf without requiring payment up front, Thailand providers typically do not. TRICARE cannot compel foreign providers--nor for that fact CONUS non-network providers--to file claims on behalf of TRICARE beneficiaries. Normally, payment is 100% up front (out-of-pocket) and you file your own claim with TRICARE.
• Covered elsewhere on this webpage are three key things to remember:
• U.S. State Department: Medical Emergencies | Your Health Abroad | Travel Medical Insurance Providers.
4. Traveling Abroad (from Thailand). A number of working age U.S. military retirees are traveling abroad (from Thailand) for employment, notably to Southwest Asia, and typically under contract. Before traveling abroad (for work or leisure), we highly recommend you contact TRICARE Overseas to learn more about TRICARE benefits / coverage and authorized providers specific to the country(ies) you intend to visit. Not all contract employees have medical coverage under their contract, and they also likely are ineligible for routine medical care at a military treatment facility. Educate yourself before you travel.
5. TOP Beneficiaries Traveling in the United States. All TRICARE Overseas Program (TOP) beneficiaries traveling in the United States are encouraged to seek care from a U.S. Military Treatment Facility, if one is located nearby. If this is not possible, then TOP beneficiaries should seek care from a TRICARE Approved Provider in the United States. (For information pertaining to Emergency Care, Urgent Care, Routine Care, Claims Filing, and Contacting TOP, please visit the TRICARE Overseas link at the beginning of this paragraph).
• TRICARE Standard Overseas & TRICARE For Life•
| * Referrals & Prior Authorization *
"Referrals are not required but you may need prior authorization from the Overseas Contractor for some types of services."
6. Retiree Beneficiary Education Letter. U.S. Military Retirees and eligible Dependents of retirees residing in Thailand are entitled to TRICARE Standard Overseas (under 65 years of age) or TRICARE For Life (TFL) (age 65 and older, and have enrolled in Medicare Part B). There are also certain criteria when a beneficiary under the age of 65 must enroll in Medicare Part B in order to retain TRICARE benefits (see our Medicare & TRICARE section). Also see our local Frequently Asked Questions.
7. There are no Military Treatment Facilities (MTF) in Thailand. Payment normally is 100% up front to a licensed health care provider (see paragraph 13 below), and then file a claim for payment consideration with TRICARE (see our Claims section).
• TRICARE Prime Overseas is Not Available to Retirees •
8. Retirees and Their Families May Not Enroll in TRICARE Prime Overseas. Furthermore, a number of retiree beneficiaries who are enrolled in TRICARE Prime in the U.S.--but are now residing in Thailand--have not studied the higher out-of-pocket costs incurred when using TRICARE Prime's Point-of-Service Option in Thailand (for non-emergency services). When seeking non-emergency medical care under the Point-of-Service Option, retiree beneficiaries incur an annual deductible ($300 Individual / $600 Family) and a 50% cost-share of covered services (after the deductible is met). The annual deductible and 50% cost-share under the Point-of-Service Option is in addition to TRICARE Prime's annual enrollment fee. Whether residing in Thailand or just visiting, if you're a U.S. military retiree currently enrolled in TRICARE Prime (and choose to remain enrolled), for full details educate yourself now about using TRICARE Prime while you are outside of the U.S. (If you’re a retiree presently enrolled in TRICARE Prime but wish to disenroll, contact the TRICARE regional contractor where you are enrolled).
• Enrollment •
9. *Enrollment* is not required for TRICARE Standard Overseas or TRICARE For Life (TFL)--enrollment is automatic (as long as you are registered in DEERS and DEERS shows you as being eligible)--there's no enrollment fee, nor is there a *TRICARE Health Benefits Card* issued to Standard or TFL beneficiaries. However, in order to be eligible for TFL, beneficiaries must first enroll in Medicare Part B (see our Medicare & TRICARE section).
a. See: Enrollment Changes Beginning January 1, 2018
10. Enrollment and payment of premiums is required for TRICARE Retiree Dental Program, TRICARE Retired Reserve, and TRICARE Young Adult.
• Verify Eligibility •
11. Verify Eligibility. To
verify your TRICARE eligibility you can check your DEERS account in milConnect, TRICARE
Overseas, or by Phone, Fax, or Mail to DSO (DEERS) in California, or visit the
nearest DoD ID card issuing facility (JUSMAGTHAI DEERS is the only such facility in Thailand). (Note: JUSMAGTHAI DEERS is not authorized to verify TRICARE eligibility by email, phone, fax, or mail--verification is done in-person only).
• Dependent(s) Not Yet Registered in DEERS •
12. Dependent(s) Not Yet Registered in DEERS. If you recently gained a new dependent(s) through marriage, birth, adoption, etc., but have not yet registered them in DEERS, the TRICARE Overseas claims processor WPS will deny any claims filed by (or for) that dependent while that dependent remains unregistered (please also see paragraph 12a below). If a TRICARE claim is denied in these circumstances, the beneficiary may resubmit the claim after the dependent is registered in DEERS. In certain cases, a new dependent's DEERS registration may be backdated to the date the new dependent was legally gained (if applicable, also see Claims for Same-Sex Spouses). We emphasize this point because we wouldn't want someone delaying needed medical care due to uncertainty over the administrative process--a person's health is vastly more important. If the DEERS system at JUSMAGTHAI is unavailable you may register your dependent(s) in DEERS by contacting the Defense Manpower Data Center Support Office (DSO) in California.
a. Getting TRICARE for Your Child. You need to register your child in DEERS within one year (365 days) of his or her birth or adoption. On day 366, your child won’t be able to receive benefits until you register them in DEERS.
• Payment - 100% *Up Front*•
* TRICARE Overseas Program (TOP) *
"When seeking care from an overseas host nation provider or a stateside non-network provider, be prepared to pay up front for services and file a claim with International SOS for reimbursement in the overseas region where you live."
13. Pay 100% *Up Front* (Out-of-Pocket). Normal TRICARE Standard procedure for retirees in Thailand historically has been and still is to "Pay 100% Up Front” (out-of-pocket) for medical care (unless an individual health care provider agrees to direct bill TRICARE). Being that there are no TRICARE network providers in Thailand for retirees, retirees in Thailand normally first seek medical care from a licensed provider, pay the entire medical bill *up front* (out-of-pocket) upon receipt of services (outpatient and inpatient), and then file a claim with International SOS (processed by Wisconsin Physicians Service (WPS)) for payment consideration (claims address). Reimbursement is based on TRICARE Standard Overseas guidelines--see our section on annual deductible, 25% cost-share, and annual catastrophic cap.
a. No Network Providers with Direct Billing. TRICARE cannot compel foreign providers to file claims on behalf of TRICARE beneficiaries. Several hospitals in Thailand list *TRICARE* on their webpage as *insurance* they accept, which historically has been for active duty personnel and their eligible dependents. Before you assume it includes retirees, it would be prudent to ask the hospital before you receive treatment. Over the years, various hospitals in Thailand have attempted legitimate TRICARE direct billing for retiree inpatient care, only for each attempt to eventually end in failure. Reasons why? Primarily due to care providers not adhering to TRICARE claims filing procedures and losing a lot of money on unreimbursed claims. Added to that are dishonest retirees who commit fraud against health care providers. Just kindly be advised that an individual hospital or other health care provider that may be trialing or offering direct billing today, may abruptly end that service tomorrow. If a particular health care provider agrees to legitimately direct bill TRICARE, that's strictly their private decision to make.
b. Facts and Truth. Further compounding the payment confusion issue is health care providers routinely--and falsely--telling retiree patients that they cannot direct bill TRICARE because our local TRICARE office "won't authorize" the direct billing. FACT: TRICARE staff has no authority in a care provider's private decision whether or not to direct bill TRICARE--each provider knows this. The truth is that care providers normally first want *Guarantee Payment* from the U.S. Government before they will even consider direct billing TRICARE. Point in Fact: "Our International 3rd Party Payer Services team will coordinate with your insurance provider for the approval of a Guarantee of Payment for your medical expenses." The U.S. Government does not provide *Guarantee Payment* for retiree beneficiaries. Again, nothing prevents a health care provider from direct billing TRICARE, but they normally won't do so unless *Guarantee Payment* is given.
c. Misleading and Incorrect Information. Equally problematic to retirees is the misleading and incorrect TRICARE information that continues to be published year after year by an UNOFFICIAL source in Thailand. Unfortunately, the UNOFFICIAL source has repeatedly declined to take corrective action. If you act on the misleading and incorrect information, you do so at your own financial risk.
d. Legal Consequences for Not Paying. No matter the reason, if a patient refuses to pay or make payment arrangements for any or all services rendered, it's well within a medical care provider's legal right to take legal action against the non-payer. Non-payment is a legal issue between the patient and care provider, and DOES NOT involve TRICARE or the U.S. Government. Obstinately refusing to pay can result in arrest and detention. If you wish to avoid the Thai legal system, paying for services rendered is the only legal, sensible choice.
• TRICARE Retiree Dental Program •
14. TRICARE Retiree Dental Program. The TRICARE Retiree Dental Program (TRDP) is a voluntary, premium-based dental insurance plan. TRDP offers coverage in the continental U.S. and in all overseas locations. Please visit www.trdp.org for a complete list of benefits and program information. We also encourage you to view this short Introduction Video.
a. Note: "The current TRICARE Retiree Dental Program will end December 31, 2018. We are replacing it with the Office of Personnel Management's Federal Dental and Vision Program (FEDVIP). Vision plans will also be available to eligible TRICARE beneficiaries through FEDVIP. If you are eligible, you can start enrolling in FEDVIP in November 2018. Coverage will start January 1, 2019. We will provide more information closer to enrollment."
• Survivors of Retired Service Members •
15. Survivors of Retired Service Members. If a sponsor dies after retiring from active duty (either regular or a medical retirement), surviving family members remain eligible for TRICARE with the same health plan options and costs they had before their sponsor passed away. Surviving spouses remain eligible for TRICARE unless they remarry and children remain eligible until they age out or lose eligibility for TRICARE for other reasons. Also see: Survivors.
• Covered Services •
• Covered Services •
1. Covered Services. TRICARE covers most inpatient and outpatient care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all. Some services or treatments require prior authorization. For Example: Inpatient non-emergency behavioral health care specifically requires prior authorization from TRICARE as does inpatient cancer treatment (the inpatient non-emergency behavioral health care and inpatient cancer examples are not all inclusive). Certain services below are specifically mentioned in this section due to high topical interest. If you're uncertain if prior authorization is required for your situation, contact TRICARE Overseas (contact info is also at the top and bottom of this page).
a. Mental Health Care. Mental health problems can affect your thoughts, mood and behavior. For general information of what's covered and what's not, please visit: Covered Treatments and Exclusions. If you believe you may need mental health care, contact TRICARE Overseas for current coverage information and if prior authorization or a referral is required.
Emergency Mental Health Care
. You have an emergency if the patient
: Is at immediate risk of serious harm to self or others as a result of mental disorder; Needs immediate continuous skilled observation at the acute level of care (based on a psychiatric evaluation). If you have a mental health emergency in Thailand have someone take you to the nearest emergency room. You may of course dial 911 (police), 1669 (ambulance), or contact your local hospital's emergency service, but going directly to the nearest emergency room is your best course of action. You don't need prior authorization. If admitted, call TRICARE Overseas
(regional contractor) within 24 hours or the next business day. Admissions must
be reported within 72 hours. If you need emergency mental health care seek help immediately!
Do you need prescription drugs for a mental health condition? You must be under the care of a provider who can prescribe drugs and manage your dosage. Some types of mental health providers can prescribe drugs, but others cannot. >> Learn More
b. Physical Therapy and Occupational Therapy. Important Note: These two common services are not automatically covered. These two services may or may not be deemed by TRICARE to be medically necessary and considered proven for your specific case. Before starting a Physical Therapy or Occupational Therapy regimen we recommend you contact TRICARE Overseas for specific limitations to the Physical Therapy or Occupational Therapy benefit. (Note: Claim filing details unique to Physical Therapy are further discussed on this webpage in our Claims section).
c. Ambulance Services. Most emergency ambulance services are covered. There are some exceptions.
d. Air Evacuation. Only covered when medically necessary to the closest safe location.
• Prescription Medication •
2. TRICARE Pharmacy. TRICARE covers most prescription medications approved by the U.S. Food & Drug Administration (Drugs@FDA). TRICARE does not cover medications that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness. To find out if a specific medication is covered, visit: TRICARE Formulary. (Note: Over-the-counter (OTC) medicine purchases are not a covered benefit).
3. Filling Prescriptions Overseas. You may also have prescriptions filled at host nation pharmacies, if necessary. Host nation pharmacies are considered to be non-network pharmacies, but in some cases, a host nation pharmacy may be your only option. You may have to pay for the total amount first and then file a claim for reimbursement. Retired service members will receive a partial reimbursement based on non-network pharmacy costs.
• Pharmacy Home Delivery •
4. TRICARE Pharmacy Home Delivery. TRICARE prescription drug coverage is available to all TRICARE-eligible beneficiaries who are enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). When updating DEERS with your personal information, be sure to update your address with a physical address. If living outside of the United States, be sure to list your APO/FPO address, if you have one, as your mailing address. Important: Express Scripts will only ship to an APO/FPO address, and not to a Thai street address. As well, *Home Delivery* to APO/FPO addresses is subject to local customs laws. Be Advised: Prescription drugs sent to APO/FPO addresses may be seized by customs authorities. If your prescription drugs are seized, contact Express Scripts at 1-877-363-1303. Moreover, by law, only prescriptions written by prescribers licensed in the United States, District of Columbia or a U.S. territory are considered valid. For controlled substances, the prescriber must have and provide his or her individual DEA number. (Note: There is no known U.S. licensed prescriber in Thailand with a DEA number). Lastly, prescribers cannot write prescriptions for family members. TRICARE Pharmacy Program Handbook.
5. Important Notice:
• Annual Deductible, Catastrophic Cap & Cost-Shares •
• TRICARE Reform (FY 2017 NDAA) •
1. Will deductibles or cost shares reset in October or January? "Payments that would normally count toward catastrophic caps and deductibles until October 1, 2017, will continue to count until January 1, 2018. This means that enrollees who reach their fiscal year (October 1 - September 30) 2017 catastrophic caps will not have additional out-of-pockets costs for authorized TRICARE-covered services for the last three months of calendar year 2017."
• Annual Deductible •
2. Annual Deductible (TRICARE Standard and TFL Overseas) = $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 paragraph 2 below). Patient always pays 100% of non-allowable charges.
• Catastrophic Cap •
3. Catastrophic Cap = $3,000 per Family per Fiscal Year (FY) (1 October - 30 September). 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 year, TRICARE will begin to reimburse you 100% for TRICARE covered services (allowable charges) for the remainder of that year, as opposed to only 75% (less deductible) before the catastrophic cap is reached. Patient always pays 100% of non-allowable charges.
• Cost-Shares •
4. Cost-Shares. You're responsible to pay a cost share based on the type of care. Some inpatient cost shares are annually subject to change.
• Claims Filing •
• Overseas Claims •
1. Claims Filing (Overseas Medical Claims). To help prevent *forgetting* to file a claim, TRICARE strongly recommends filing a claim as soon as possible after medical services are received. Timely Filing Period: 1) Outpatient - Must file no later than Three (3) Years after medical services received. 2) Inpatient - Must file no later than Three (3) Years after discharge. We receive many requests for help from beneficiaries when their claims are denied because they submitted their claims after the timely filing period, or WPS didn't receive the claim within the timely filing period. Unless there are justifiable reasons we normally cannot help you if you exceed the timely filing limit. TRICARE Claims Inquiries (WPS): 1-877-451-8659 (Toll Outside U.S.).
• Note: Wisconsin Physicians Service (WPS) is sub-contracted by International SOS (TRICARE Overseas Program (TOP) Manager) to manage medical claims processing for the TRICARE Overseas Program.
a. Filing Claims with Your New DoD Benefits Number (DBN). The Department of Defense (DoD) is removing Social Security Numbers (SSN) from uniformed services identification (ID) cards, as part of the continued effort to protect the privacy and security of TRICARE’s 9.6 million beneficiaries. With removal of SSNs, two new numbers are being printed on newly-issued DoD ID cards--a 10-digit DoD ID Number on the front, and an 11-digit DoD Benefits Number (DBN) on the back. The 10-digit DoD ID Number on the front replaces the SSN. If you have DoD benefits, (e.g., health care, commissary privileges, exchange privileges), an 11-digit DBN is also printed on the back of the ID card. The 11-digit DBN is a unique number that ensures your records are clearly aligned with your
treatments. You can find the DBN above the bar code on the back of your uniformed services ID card. Health care, pharmacy and dental claims can be submitted using the sponsor’s SSN or DBN, or the beneficiary’s DBN (eligible former spouses should use their own SSN or DBN, not the sponsor’s). Claims cannot be processed using the 10-digit DoD ID Number on the front of the ID card. Note: You do not need to make a special trip to update or renew your ID card until it is 30 days from expiration. The replacement process is expected to last several years, until all current DoD ID cards are replaced as they come up for renewal. Until all cards are updated, you can use both SSNs and DBNs to submit claims and verify TRICARE eligibility. For more information, visit https://tricare.mil/ssn.
b. Your Guide to Duplicate Claims Submissions. When you submit a claim to your TRICARE Overseas Program (TOP) claims processor, it can take up to 30 days from the date it was received for the claim to be processed. If you want to check the status of a claim, wait at least 21 days and then contact either TRICARE Overseas (Pacific Area), or WPS. Claims customer service representatives can tell you when the claim was received, where it is in the process and when you should expect to receive reimbursement. If you choose to resubmit a claim (due to mail loss of the original claim, for example), wait at least 45 days from when you submitted the first claim before submitting a duplicate. Be sure to clearly note on the paperwork “Second Submission". This will help ensure that your claim is identified as a resubmission and will help expedite claims processing. For more information, visit TRICARE Overseas or contact your TOP Regional Call Center and select option 2 for claims assistance.
• Bundling Claims •
2. Bundling Claims. If your goal is timely reimbursement of your claim, submit separate claim forms for each unique patient encounter/date of service. It's not advisable to include too many different conditions or treatments in a single claim. For example, even if you're thinking about submitting a single claim for one year's worth of monthly follow-ups for the same medical condition, it's a better choice to submit two claims instead, each covering a six month period. Including too many treatments in a single claim greatly ups the chance that a busy claims clerk will miss something, and in-turn, you requesting reconsideration (followed by filing an appeal, and then a grievance if the appeal is denied). Use your best judgment. (Also see paragraph 7a below about submitting Proof of Payment with bundled claims).
• DD Form 2642 - Claim Form •
3. DD Form 2642 (Claim Form). Carefully read ALL instructions! For Example: Many claims are delayed due to the beneficiary not fully completing and/or signing and dating the DD-2642. Other Specific Reasons for Delay: Not including your address, not check-marking the appropriate OHI block, not providing complete prescription medication details, not providing complete Physiotherapy details, not including Proof of Payment, and sending claims to the West Region instead of to WPS (don't send claims to the West Region contractor!). Also, so that WPS may process your claim quickly and correctly, TRICARE recommends that when you pay the provider directly (out-of-pocket), on top of the DD-2642 write *Payment Up Front* and the amount paid. TRICARE also recommends that if/when you check the *Payment in Local Currency* box in Block 13, in large letters also write *Thai Baht* so as to avoid a potential reimbursement check currency error. Lastly, a DD-2642 has two *copies*--*Processor's Copy* and *Patient's Copy*. Submit the *Processor's Copy*, not *Patient's Copy*.
• DD Form 2527 - Possible Third-Party Liability •
4. Third Party Liability. DD Form 2527 (Statement of Personal Injury - Possible Third Party Liability). If your claim is the result of an injury, don't forget to also include a DD-2527 with your claim. If unsure whether 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.”
• English Language Documents & Statements •
5. English Language Documents & Statements. While beneficiaries may select providers of their choice, it is recommended that the selected providers have the ability to produce their medical documents and billing statements in English. Documentation and billing statements that are submitted in a foreign language will require contracted translation services which will delay claims processing and payment. For claim integrity reasons, translations by anyone other than the provider or the TRICARE translation contractor will not be accepted. Lastly, remember to always keep a copy of each claim you submit.
• Inpatient Billing Statement •
6. Inpatient Billing Statement. As an integral part of TRICARE's ongoing fraud prevention efforts, for inpatient hospital stays TRICARE requires detailed itemized inpatient billing statements from health care providers. For example, inpatient billing statements must show the precise date a medical service and/or medication was provided. No longer accepted is only listing the inpatient period. A daily record of services and/or medication is required. What does "daily record" mean? It simply means that on the billing statement there's a date next to the service and/or medication provided. It isn't necessary to list by day (e.g., On July 25, 2017 the following was provided...) unless of course a care provider wishes to provide an inpatient billing statement in that format. Lastly, remember to always submit Proof of Payment with your TRICARE claim. If you have Other Health Insurance you must first file a claim with that third-party insurance provider before filing a claim with TRICARE. If any pertinent questions please contact TRICARE Overseas.
• Proof of Payment •
*** Important Note ***
• TRICARE Overseas requires *Proof of Payment* submitted with EACH claim, regardless of payment amount (please also carefully read paragraph 7c below) •
7. Proof of Payment for Overseas Claims. Proof of payment is needed for TRICARE to protect the money you spend on health care. Due to fraud prevention efforts, beginning September 1, 2012, beneficiaries are required to submit proof of payment with all overseas health care and pharmacy claims (regardless of amount), including claims for care received when traveling overseas. So that WPS may process your claim quickly and correctly, TRICARE recommends that when you pay the provider directly (out-of-pocket), on top of the DD Form 2642 write *Patient Paid in Full* (submit *Processor's Copy*, not *Patient's Copy*). For each claim include the following: (1) Itemized bill or invoice; (2) Diagnosis describing why the medical care is needed, and; (3) Explanation of Benefits from your Other Health Insurance (if you have other health insurance). Also, make sure the care provider clearly annotates *Paid* on each invoice. Claims over $1,000 require additional proof of payment.
a. Proof of Payment for Bundled Claims. If you are bundling more than one claim on a single claim form, you must submit proof of payment for each service. Each individual claim will be reviewed as if it was submitted separately. Any items that do not have proof of payment will be returned to you for further documentation.
b. Proof of Payment Examples. As proof of payment, send any of the following items (as applicable) along with the provider's itemized invoice or bill (clearly marked as being paid), based on these guidelines: (1) Cancelled check; (2) Credit (or debit) card receipt, or: (3) Electronic funds transfer receipt (bank-to-bank transfer, ATM slip, withdrawal slip, etc.). For example, if you paid the provider with cash, you have to show proof of the cash withdrawal from your financial institution (e.g., ATM slip, withdrawal slip, bank-to-bank transfer, copy of your bank statement, or copy of your bank passbook). If you withdrew funds from an ATM to fund your cash payment, but did not retain the ATM slip, we suggest you print out a record of your bank statement showing the date and amount of your ATM withdrawal. If submitting a bank or credit card statement, or copy of bank passbook, make sure your name is clearly legible, the pertinent withdrawal transaction and amount is properly annotated (you may blank out all other entries), and your account number is blanked out (for your protection). It's possible that you may still receive a letter from TRICARE requesting additional proof of payment in order to process your claim. Use Common Sense: What do you need to provide to convince a busy claims clerk that you in fact paid the claim?
c. Refusal to Submit Proof of Payment. If you or someone you know has received a claim reimbursement without submitting proof of payment, consider yourself lucky, but don't expect that luck to carry forward each time. Every now and then a retiree beneficiary will stubbornly refuse to submit proof of payment with their claim and then ignore TRICARE's follow-up request to submit proof of payment. If you refuse to submit proof of payment, any reimbursement due you will instead automatically be sent by TRICARE to the care provider. When this occurs don't expect to receive reimbursement until YOU submit proof of payment. In this scenario, to receive any reimbursement due you, YOU would still need to FIRST provide proof of payment to TRICARE (WPS), then the care provider must return the funds to TRICARE, and only then will TRICARE eventually send the reimbursement to you. Refusal to submit proof of payment and ignoring TRICARE's follow-up request to do so is counter-productive and self-defeating.
• Other Health Insurance (OHI) •
8. Other Health Insurance (OHI). Under U.S. Federal Law, retirees carrying third-party medical insurance in addition to TRICARE must always file claims with their third-party insurance company first, then TRICARE second. Be Advised: It is solely the patient’s responsibility to obtain any required prior authorization for medical care from their third-party insurance company. Lastly, you must include a copy of your third-party insurance Explanation of Benefits (EOB) when you submit your TRICARE claim, else, WPS cannot process your claim. TRICARE OHI Questionnaire. (Also see DD Form 2642).
• Physiotherapy (Physical Therapy) •
9. Physical Therapy. While *Physical Therapy* is the more commonly known street name, and is also the name used on the TRICARE.mil website, in medical jargon it's *Physiotherapy*; or *PT* for short. In order to ensure that any claimed physiotherapy is medically necessary (not all physiotherapy is medically necessary), TRICARE Overseas requires certain specific details. (In practice, we recommend you contact TRICARE Overseas for specific limitations to the Physical Therapy benefit before you start a Physical Therapy regimen). The Physiotherapy Report Form, when properly completed, provides TRICARE with the required information to process your claim. If your care provider uses a similar form that provides the same details you may instead submit their form with your TRICARE claim in lieu of the TRICARE Overseas form. If you didn't bring the TRICARE Overseas Physiotherapy Report Form to your care provider to complete, the best solution is to ask your care provider to download/print the Physiotherapy Report Form from this webpage. If for whatever reason a physiotherapy report form is not completed, ensure your care provider includes the required details in a Medical Certificate or Report, else, the processing of your claim will be delayed until you submit the required details to TRICARE. (Note: *Occupational Therapy* is different from Physical Therapy and is briefly discussed on our webpage here).
• Take-Home Medication •
10. *Take-Home Medication*. When discharged after inpatient hospitalization, beneficiaries are often prescribed *Take-Home Medication* (aka *Home Medication*). When this occurs, send WPS a separate claim only for the take-home medication. For timely payment consideration of your take-home medication claim be sure to include 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).
a. Separate Itemized Billing Statement Required for *Take-Home Medication*. As stated in paragraph 10 immediately above, in order for TRICARE to reimburse *Take-Home Medication*, the take-home medication must be separately invoiced, and not included on the inpatient billing statement, nor can any other items be included on the take-home medication itemized bill. If not separately invoiced, the take-home medication will not be reimbursed. Once again, during inpatient discharge you must obtain a separate itemized bill for *Take-Home Medication*.
• File Claims by Mail •
• Wisconsin Physicians Service (WPS) - Claims Address•
• WPS - Customer Service •
WPS - TRICARE
P.O. Box 7985
P.O. Box 7992
Madison, WI 53707-7985
Madison, WI 53707-7992
Tel: 1-877-451-8659 (Toll Outside U.S.)
Tel: 1-877-451-8659 (Toll Outside U.S.)
(Sunday, 7pm CST through Friday, 7pm CST)
(Sunday, 7pm CST through Friday, 7pm CST)
11. File Claims by Mail. Submit claims with Proof of Payment (see paragraph 7 above) to the TRICARE Overseas claims processor, WPS, at the above address. For care received overseas, including in U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands), submit claims to the TRICARE Overseas Program claims processor (WPS), regardless of your home region. If you're a dual-eligible beneficiary (Medicare & TRICARE), WPS is your claims processor. Once again, it's the beneficiary's responsibility to make photocopies and mail claims. 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 claim check from WPS (see paragraph 15 below). Better yet, sign up for claim reimbursement via Direct Deposit (see paragraph 13 below).
• Note: If you prefer to receive electronic payment of your TRICARE Overseas claim, that option is now available! To learn more about TRICARE Overseas' Direct Deposit service for claim reimbursement, please see paragraph 13 below for more information.
• File Claims Electronically •
12. File Claims Electronically. The fastest way to get money back is to file your claim
online and sign up for direct deposit (see next paragraph). Once you’ve established a Beneficiary login account by registering on the TRICARE Overseas portal, and once you log in, you may submit your claim(s) electronically (proof of payment is still required). For details on the filing method, and to help ensure a smooth, trouble-free electronic claim(s) submission, please review the TRICARE Overseas electronic claims filing guide.
• Claim Reimbursement - Direct Deposit •
13. Claim Reimbursement Via Direct Deposit. Automated direct deposit is now available! Beneficiaries registered on the secure claims portal at http://www.tricare-overseas.com can sign up to receive payment for their TOP Claims via direct deposit. Once signed up, you will receive payments in USD currency (only) to your U.S. bank account through an Automated Clearing House (ACH). It's quick, safe and convenient. Visit the secure claims portal (TRICARE Overseas website) today to sign up! Contact your TOP Regional Call Center and press option #2 if you have questions or need assistance. Click here to learn how to register for Automated Direct Deposit.
• JUSMAGTHAI TRICARE Office Note: Per TRICARE Overseas policy, claim reimbursement via Direct Deposit is available only to a U.S. bank account via the U.S. ACH system. TRICARE Overseas has stipulated that the bank or branch must be domiciled in the U.S. and must have a valid 9-digit numeric ABA routing number (SWIFT codes are not acceptable).
We highly encourage you to take advantage of Automated Direct Deposit. Be rest assured though that TRICARE beneficiaries who do not have a U.S. bank account, or have not yet signed up for claim reimbursement via direct deposit, can still receive reimbursement via paper check in USD or Thai Baht--the currency choice stipulated by the beneficiary in Block 13 on the DD-2642 claim form. Again, please contact TRICARE Overseas if you have questions or need assistance.
• Reimbursement Check - *Currency Error* •
14. Check in Wrong Currency. If your claim reimbursement paper check is not in the correct currency you requested (THB or USD), YOU need to contact the TRICARE Overseas claims processor (WPS) to request check reissue. For example, sometimes when you request reimbursement in *Local Currency* (i.e., Thai Baht), WPS mistakenly issues the reimbursement check in U.S. dollars. Naturally, WPS will not reissue a check until the current check is returned (or it expires after 120 days). Unfortunately, this error does sometimes occur and if you absolutely must have Thai Baht, just be advised that it can easily take many months to resolve. Lastly, before you return a check to WPS for reissue we recommend you write *VOID* across the face of it and also make and keep a photocopy of it for your records. (Direct Deposit: To avoid the hassle of currency errors when you desire reimbursement in USD, TRICARE Overseas now offers a Direct Deposit option for claim reimbursement in USD--please see paragraph 13 above).
• Reimbursement Check - *Expired* •
15. Check Expired. TRICARE reimbursement paper checks have a relatively short 120-day expiration date from the date of issue. If you don't deposit or cash your check before it expires, YOU will need to contact WPS to request check reissue. Before you return a check to WPS for reissue we recommend you write *VOID* across the face of it and also make and keep a photocopy of it for your records. (Direct Deposit: To avoid the hassle of expired (or lost) paper checks when you desire reimbursement in USD, TRICARE Overseas now offers a Direct Deposit option for claim reimbursement in USD--please see paragraph 13 above).
• Reimbursement Mistakenly Sent to Care Provider •
16. Provider Mistakenly Paid. Every now and then TRICARE mistakenly sends a claim reimbursement due a beneficiary to the care provider instead. When this occurs the care provider typically tries to contact the beneficiary to inform them of the error, and also notifies TRICARE. This is one of the reasons why it's extremely important that YOU ensure your care provider and WPS (TRICARE Overseas claim processor) have your current contact information (the same applies to keeping your DEERS record updated). Also, the care provider will first have to remit the reimbursement back to TRICARE before TRICARE will reimburse you. Due to the high volume of claims processed by WPS errors of various types sometimes do occur (also see our Appeals & Grievances section on this webpage). In order to receive a claim reimbursement due you when this type of payment error happens, please remain calm and be cooperative to help resolve the matter. Thank You!
• Medical Bills of Deceased Sponsor •
17. Medical Bills of Deceased Sponsor. (Please first contact the TRICARE office before filing a claim). The TRICARE Overseas claims processor, WPS, normally delays claim processing until it's proven who paid the unreimbursed medical expenses of the deceased beneficiary. While the person who paid for end-of-life unreimbursed medical expenses is likely to be the Primary Next-of-Kin (PNOK), this isn't always the case. This is the primary reason why WPS delays claim processing until it can be proven exactly who paid those bills. When an individual uses a credit card to make payment it's typically easy to prove exactly who paid. In situations where cash was used or a bank transfer was made, it may not be clear who paid. As well, if other existing unreimbursed medical expenses were paid by the then living beneficiary, the same now deceased beneficiary clearly cannot be reimbursed. In these situations, WPS typically requests the deceased beneficiary's NOK or representative to obtain a court judgement essentially stating that a specific individual (or the Estate) is entitled to any TRICARE claim reimbursements. In one high profile case years ago, claim reimbursement was issued to the PNOK (widow) but it was later proven that the decedent's daughter had in fact paid the medical expenses. Unfortunately, the widow refused to return the money to TRICARE or remit it to the daughter. At that point it became a civil matter between daughter and widow. There was nothing TRICARE legally could do except to revise claims policy to delay processing of future claims involving deceased beneficiaries ... which has brought us to present day policy. (Note: Also see the Overseas Estate Notification form).
• Appeals & Grievances •
• File an Appeal •
1. Filing an Appeal. Beneficiaries who disagree with certain benefit-related
decisions made by the Defense Health Agency (DHA) or by a TRICARE contractor have the right to appeal those decisions. The appeals process varies depending on whether the denial of benefits involves a medical necessity determination, factual determination, provider authorization, provider sanction, and/or a dual-eligible determination. Beneficiaries will be notified of
the appeals process they should follow at the same time they receive a written decision. All initial determination and appeal denials explain how, where, and by when to file the next level of appeal. For issues that can't be appealed, such as concerns with the quality of health care service you received, TRICARE provides a grievance process that allows you to submit in writing your concern or complaint.
2. Pharmacy Appeals. If you disagree with the decision on your pharmacy claim (e.g., if your claim is denied), or if your request for medical necessity or prior authorization is denied, you may file an appeal. The request for reconsideration--or appeal--of your pharmacy claim, medical necessity or prior authorization decision must be in writing, signed, and postmarked or received by Express Scripts within 90 calendar days from the date of the decision, and must include a copy of the claim decision.
• File a Grievance •
3. File a Grievance. If you have a complaint about the quality of the care you received, if a provider/facility behaved inappropriately or any other non-appealable issue, you can submit a grievance. The grievance process allows you the opportunity to report in writing any concern or complaint regarding your health care quality or service. Any TRICARE beneficiary can file a grievance and a sponsor, parent or guardian or other representative may file on behalf of a dependent child.
4. Overseas. A grievance is a written complaint or concern about a non-appealable issue regarding a perceived failure by any member of the health care delivery team--including authorized providers, military providers, a TRICARE contractor, or subcontractor personnel--to provide appropriate and timely health care services, access, or quality, or to deliver the proper level of care or service. The grievance process allows you to report in writing any concern or complaint regarding health care quality or service. Any TRICARE civilian or military provider; TRICARE beneficiary; sponsor; or parent, guardian, or other representative of an eligible dependent child may file a grievance. International SOS as the TRICARE Overseas Program (TOP) Contractor is responsible for investigating and resolving all grievances. Grievances are generally resolved within 60 days of receipt. Following resolution, International SOS will notify the party submitting the grievance that the review is complete.
5. Pharmacy. All grievances about a pharmacy provider, such as a network pharmacy, go directly to Express Scripts.
• Medicare & TRICARE •
• Medicare Part B & TRICARE •
(Note: When accessing milConnect, you may first need to click on *Continue to this Website*)
1. Medicare & TRICARE. Age 65 is when most (not all) individuals first become eligible for premium-free Medicare Part A (hospital insurance). In order to keep your TRICARE benefits (TRICARE For Life) when you first become eligible for premium-free Medicare Part A (due to age 65, or earlier due to certain disabilities, end-stage renal disease, or Lou Gehrig's disease), you must enroll in Medicare Part B (premiums): "TRICARE beneficiaries who live overseas and who are eligible for premium-free Medicare Part A must have Part B to remain eligible for TRICARE even though Medicare does not provide coverage overseas." Important Note: "Residents of Puerto Rico or foreign countries will not receive Part B automatically. They must elect this benefit." In certain situations you may apply online for Medicare Part B, or you may have to email or phone SSA Manila to start the Medicare Part B enrollment process (or to confirm enrollment). Learn More: How To Apply Online For Just Medicare. U.S. Citizen Services (U.S. Embassy, Bangkok) also provides some basic information on Medicare Part A and Part B: https://th.usembassy.gov/u-s-citizen-services/federal-benefits/medicare/.
• JUSMAGTHAI TRICARE Office Note: Contrary to incorrect information published by an unqualified source in Thailand stating that "... registering for MEDICARE Part B are handled by the DEERS office.", the JUSMAGTHAI DEERS Office DOES NOT handle Medicare Part B enrollment! No DEERS office does. The Social Security Administration manages Medicare Part B enrollment. What DEERS offices worldwide can do is to verify if Medicare Part B enrollment is reflected in your DEERS record after you enroll in Medicare Part B. When the member enrolls in Medicare Part B, Medicare [normally] notifies DSO (DEERS) that Part B has been obtained. If Medicare does not automatically notify DSO (DEERS), you can present your official Medicare Part A/B card to DEERS office staff and they in-turn can use your official Medicare card to update your DEERS record. Again, Medicare Part B enrollment is managed by the Social Security Administration.
a. Frequently Asked Question: Since Medicare does not provide coverage outside of the United States then why must I enroll in Medicare Part B at age 65 if I want to keep my TRICARE benefits? Answer: Federal law was written as such and signed into law in the FY 2001 National Defense Authorization Act (NDAA) (Public Law 106–398--Oct. 30, 2000): http://www.dod.mil/dodgc/olc/docs/2001NDAA.pdf (Section 712, p. 176).
b. Beneficiaries Who Don't Qualify for Medicare Part A. Pertaining to Medicare Part B enrollment at age 65, in certain limited cases you may not be required to enroll in Medicare Part B at age 65 to retain your TRICARE eligibility. The operative word being may. One such scenario is having less than the required 40 Social Security work credits (10 years of work). In two contrasting actual examples concerning two retirees that each did not have the required number of Social Security work credits, one was required to enroll in Medicare Part B at age 65 to remain TRICARE eligible, the other was not. The difference? Even though the first retiree did not have the required number of work credits (quarters of coverage), he did pay Medicare taxes for the required quarters of coverage while employed to be eligible for premium-free Medicare Part A. (This topic is explained in further detail at: Original Medicare (Part A and B) Eligibility and Enrollment).
c. TRICARE Eligibility Determination. The service branches through the Defense Manpower Data Center (DMDC) Support Office (DSO) (DEERS) are the only legally authorized agencies to rule on TRICARE eligibility--not TRICARE, and not SSA. Therefore, if at age 65 you have less than 40 Social Security work credits (10 years of work) and you're unsure as to whether or not you're required to enroll in Medicare Part B to remain TRICARE-eligible, it may be in your best interest to request a TRICARE eligibility case review and ruling from DSO (DEERS). DSO will coordinate with SSA and then notify you of their ruling once your case review is completed. If you request a case review and ruling from DSO, it's best that you request it well before you enter your Medicare Initial Enrollment Period (see paragraph 3 below) just in case DSO rules that you're still required to enroll in Medicare Part B to retain your TRICARE eligibility at age 65.
• Information Mailed to Beneficiaries •
2. "What publications and correspondence are sent to beneficiaries to inform them
that they must purchase Medicare Part B to retain TRICARE benefits?" Medicare-related publications and correspondence that is routinely mailed to beneficiaries (you and, where applicable, your spouse or children): (Source: milConnect -
The Medicare & You Handbook is mailed by Medicare when the beneficiary
becomes Medicare Part A eligible.
The Welcome to Medicare Pamphlet is mailed
by Medicare three months prior to the beneficiary's Medicare effective date.
The Turning 65 Medicare *Postcard* or *Email* is prepared
by TRICARE and mailed by DMDC five
months prior to the month that the beneficiary turns 65.
The Under 65 Medicare *Postcard* or *Email* is prepared by
TRICARE and mailed by DMDC after CMS (Centers for Medicare &
Medicaid Services) notifies DMDC that the beneficiary is Medicare
a. Important Note! In order to receive important Medicare & TRICARE information, YOU must keep your mailing address updated with the Social Security Administration and keep your mailing address updated in DEERS (see our DEERS section). As well, when you read your Medicare notification letter from TRICARE, please take the time needed to fully understand it. The same applies to the Medicare & You Handbook. Each informational product contains important TRICARE and Medicare benefits information.
• Avoid a Break in TRICARE Coverage •
3. Retired Service Members and Families. If you aren’t receiving Social Security benefits, RRB benefits, or a federal annuity from the Office of Personnel Management, you must sign-up for Medicare Part A and Part B. To avoid the Medicare surcharge for late enrollment, you must enroll in Part B during your Medicare Initial Enrollment Period (seven-month period that begins three months before you turn 65, or four months if your birthday is on the first of the month). To avoid a break in TRICARE coverage be sure to enroll no later than two months before you turn 65. If you enroll any later, your Part B effective date will be delayed and you will have a break in TRICARE coverage.
• Medicare Part B Effective Date •
4. Inspect Your Medicare Card. Once you receive your Medicare Part B card, ensure the effective date is correct and Medicare Part B enrollment is reflected in your DEERS record. If you believe the effective date is incorrect YOU must contact Medicare. Lastly, ensure Medicare Part B is reflected in your DEERS
record before you renew your DoD ID card. If you didn't receive your Medicare Card (or you misplaced it) you may click here to request a replacement.
• Late Enrollment in Medicare Part B •
5. Late Enrollment in Medicare Part B. Since Medicare does not provide benefits for medical care received outside of the U.S., TRICARE is the primary source of health benefits. Further, for every 12-month period beyond your Medicare Part B initial enrollment period (based on your 65th birthday, or earlier due to certain disabilities, end-stage renal disease, or Lou Gehrig's disease) that you wait before you enroll, you incur a 10% surcharge that's added to the monthly premium, and in this scenario, you can then only enroll in Medicare Part B during the annual general enrollment period of January-February-March (effective date of Medicare Part B becomes 1 July of that year). To enroll (or to confirm enrollment) in Medicare Part B email or phone SSA Manila. For more information on Medicare Part B, please visit one or more of the SSA and Medicare links in paragraph 1 above in this section.
• Defense Enrollment Eligibility Reporting System (DEERS) •
• Keep DEERS Information Updated •
1. Why must I keep my information in DEERS up-to-date? It is essential to keep information in the Defense Enrollment Eligibility Reporting System (DEERS) current for you and your family. Failure to update DEERS to accurately reflect the sponsor’s or family member’s residential address and/or the ineligibility of a former dependent could be considered fraud and a basis for administrative, disciplinary, and/or other appropriate action.
• Important Note: Your Social Security number (SSN) and the SSNs of each of your covered family members should be included in DEERS for TRICARE coverage to be reflected accurately. To register your family members in DEERS, you must visit your local ID card office. (The only DoD ID Card/DEERS office in Thailand is located at JUSMAGTHAI in central Bangkok). For more information, visit https://tricare.mil/Plans/Eligibility/DEERS.
• Your Address in DEERS •
2. Whenever you move, near or far, the first thing you should do after you move is update DEERS with your new address, phone number and other personal information. Your TRICARE eligibility doesn't change when you move, but it may change your health plan options.
3. For TRICARE beneficiaries residing in Thailand, to avoid a delay in TRICARE claims processing for overseas treatment, your address in DEERS must be in the Overseas Region and must be kept updated! DEERS has provisions to record a residential address and a mailing address--many retirees (that still mail in claims) use their APO Box-R mailing address on their TRICARE claims, which is perfectly acceptable. For simple address changes, you can update your DEERS address via several different methods: In-person at JUSMAGTHAI (DEERS & DoD ID Cards); Online via milConnect (use your DS Logon or DFAS myPay Login); or by Phone, Fax, or Mail to DSO (DEERS) in California.
4. Important Note! Updating your DEERS record does
not update your information with DFAS, and updating your information with DFAS does
not update your DEERS record--you must separately update your DEERS and DFAS records.
• DEERS Verification of TRICARE Eligibility •
*** Important Notice ***
• JUSMAGTHAI TRICARE staff is not authorized access to DEERS! •
5. DEERS Verification. As previously stated in paragraph 11 under *Retiree Basics*, to
verify your TRICARE eligibility you can check your DEERS account in milConnect, TRICARE
Overseas, or by Phone, Fax, or Mail to DSO (DEERS) in California, or visit the
nearest DoD ID card issuing facility (JUSMAGTHAI is the only such facility in Thailand). (Note: JUSMAGTHAI is not authorized to verify TRICARE eligibility by email, phone, fax, or mail--verification is done in-person only).
6. *** READ ME! *** TRICARE staff (worldwide) do not approve or deny--nor cannot change--a patient's TRICARE eligibility. DEERS is the only official source for TRICARE eligibility and access to TRICARE benefits. Therefore, if you believe your TRICARE eligibility status in DEERS may be in error, it is your personal responsibility to contact the DMDC Support Office (DSO) in California for resolution--sooner rather than later is best. (Note: DSO manages DEERS).
• In Case of Emergency (ICE) •
1. 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? Be ready for what can happen without warning and what you can do now to prepare: Emergency Personal Health Record & Contact Info Form. This form and more comprehensive info may be found at: http://www.ice4safety.com/.
• Provider Resources •
• VA Foreign Medical Program (FMP) •
1. VA Foreign Medical Program (FMP). *** Information Only *** There is no VA Medical Facility in Thailand. Moreover, TRICARE does not process VA FMP claims nor do we schedule FMP appointments for VA-related medical care. Contact FMP if you believe your medical care may be covered under the VA Foreign Medical Program.