ROE | Privacy | Enrollment | Medicare | Payment | Deductible | Catastrophic Cap | Covered Services | Medication | DEERS | Fraud | Claims | VA | ICE
*** Important Notes! ***
1. Rules of Engagement (ROE). The HQ JUSMAG-THAI TRICARE office is not funded to assist the retiree community, but does so as a courtesy, 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. Just remember, 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 their eligible dependents, and eligible survivors of retirees are Tuesday-Wednesday-Thursday, 0800-1100. Please respect our schedule. (Rm J-202). Email International SOS, Singapore: sin.tricare@internationalsos.com | Telephone SOS, Singapore, Customer Service Regional Direct: +65-6339-2676 or Customer Service Toll Free: 0018004418952. Telephone WPS (Wisconsin Physicians Service), TRICARE Claims Inquiries: 1-877-451-8659 (Toll Outside U.S.).
2. Patient Confidentiality. 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 may only be authorized by the beneficiary. 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.
3. "Enrollment" is not required for TRICARE Standard or TRICARE For Life (TFL)--TRICARE enrollment is automatic--there's no TRICARE 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 join Medicare Part B (see Note #4 below regarding enrollment in Medicare Part B). There is also an occasional misperception that TRICARE Prime is available in Thailand. TRICARE Prime is not available in Thailand: Retirees and their families may not enroll in TRICARE Prime Overseas. Moreover, there are no Military Treatment Facilities (MTF) in Thailand. Payment is 100% up front to a licensed health care provider, then file for payment consideration with TRICARE (see Note #5 below).
• Enrollment and payment of premiums is required for TRICARE Retiree Dental Program, TRICARE Retired Reserve, and TRICARE Young Adult.
4. Medicare & TRICARE. Age 65 is when most individuals first become eligible for Medicare Part A. In order to keep your TRICARE benefits (TRICARE For Life) when you first become eligible for Medicare Part A (due to age 65, disability, or end-stage renal 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."
•> Individuals who become Medicare Part A eligible at age 65 should enroll in Medicare Part B 90 days before their 65th birthday in order to avoid a gap in TRICARE coverage (120 days if their birthday is the first day of the month). Since Medicare does not provide benefits for medical care received overseas, TRICARE is the primary source of health benefits. Further, for every 12-month period beyond your 65th birthday that you wait before you join, you incur a 10% penalty that's added to the monthly premium, and in this scenario, you can then only join Medicare Part B during the annual general enrollment period of January-February-March. To enroll in Medicare Part B, email or phone SSA Manila: Email: FBU.Manila@ssa.gov | Telephone: +63-2-301-2000 (Follow Voice Prompts or Press 9, then Press 2). For more information on Medicare Part B, please visit: Medicare.gov + Medicare & You | SSA: Medicare + Medicare Resources.
5. Pay 100% “Up Front” (Out-of-Pocket). Retirees in Thailand 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 Wisconsin Physicians Service (WPS) for payment consideration (claims address). Reimbursement is based on TRICARE Standard guidelines--more below on annual deductible, 25% cost-share, and annual catastrophic cap.
6. 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 Note #7 below). Patient always pays 100% of non-allowable charges.
7. 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. Patient always pays 100% of non-allowable charges.
8. 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). If you're uncertain as to if prior authorization is required for your situation, contact TRICARE Overseas (contact info also at the bottom of this page).
9. Medications. 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 the TRICARE Formulary Search Tool.
10. Your Address in DEERS (Defense Enrollment Eligibility Reporting System) must be in the Overseas Region and must be kept updated! DEERS has provisions to record a Residential address and a Mailing address. For example, a retiree well known to our office has a U.S. address in DEERS as his Residential address, and a Box-R APO box for his Mailing address--he uses his Box-R address on his TRICARE claims, which is perfectly acceptable. For simple address updates, you may do so online: DEERS (use your DFAS myPay Log-in ID & Password).
11. DEERS Verification. We are very stringent about verifying a patient’s TRICARE eligibility in DEERS. The JUSMAG-THAI Joint Support Section performs DEERS verification only during normal duty hours from Monday-Friday (excluding U.S. & Thai holidays). Therefore, if your situation requires TRICARE eligibility verification, you may have to wait several days before your eligibility can be confirmed.
12. 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 healthcare 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 TRICARE Management Activity, Office of Program Integrity, 16401 E. Centretech Parkway, Aurora, CO, 80011, anytime you believe TRICARE is being billed inappropriately. Please help us to fully protect your benefits!
13. Claims Filing: 1) Outpatient - Must file no later than One (1) Year after medical services received. 2) Inpatient - 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. TRICARE Claims Inquiries (WPS): 1-877-451-8659 (Toll Outside U.S.)
• 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. (See DD Form 2642.)
• Read ALL instructions on the DD Form 2642. Example: Many claims are frequently delayed due to incomplete prescription medication details, or Proof of Payment not being included. 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, with Proof of Payment, 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. 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 check from WPS.
• File Claims Electronically. Once you’ve established a Beneficiary login account on the TRICARE Overseas website, and once you login, you may submit your claim(s) electronically. For exact details, and to help ensure a smooth, trouble-free electronic claim(s) submission, please view the online tutorial.
• When discharged after hospitalization, beneficiaries are often prescribed take-home medication. For timely payment consideration 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).
• Proof of Payment. You may be asked to provide proof of payment information, such as a cancelled check or credit card receipt showing payment made to the provider/supplier. If the provider/supplier was paid in cash, TRICARE may ask for proof of cash withdrawal from your bank/credit union along with a receipt from the provider for the cash payment. The occasional request for proof of payment is necessary to validate the claim in order for TRICARE to fulfill its responsibility in safeguarding benefit dollars. Note: As a means of fraud prevention, TRICARE is increasingly asking for proof. The smart, time-saving thing to do is to automatically include your proof of payment with each claim.
14. 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.
15. Department of Veterans Affairs (VA). (Information-Only). There is no VA Medical Facility in Thailand. Further, 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 or VA FMP if you believe your medical care may be partially or fully covered by the VA. FMP Registration Form | FMP Claim Cover Sheet. Email FMP: hac.fmp@med.va.gov | Telephone FMP: 1-303-331-7590 | VA Health Care Benefits, Telephone: 1-877-222-8387 | Contact VA: IRIS (VA prefers internet-using Veterans residing overseas to use IRIS in lieu of telephoning.) VA General Tel: 1-800-827-1000.
16. 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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• TRICARE Overseas - International SOS, Singapore •
> > > Email: sin.tricare@internationalsos.com < < <
Telephone Regional Direct: +65-6339-2676 or Toll Free: 0018004418952
Telephone Wisconsin Physicians Service (WPS), TRICARE Claims Inquiries: 1-877-451-8659 (Toll Outside U.S.)
Web: http://www.tricare-overseas.com
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* TRICARE Pacific Health Benefits Advisor - Bangkok, Thailand *
• Retiree Client Service Hours •
Tuesday - Wednesday - Thursday
... 0800 to 1100 ! ...
• Lengthy or Complicated Issues, Please Email or Call to make an Appointment •
Bldg. "J", Room J-202 (Opposite Mail Room - Up the Stairs to 2nd Floor)
Nurse Tipthida Suwannadhat
Tel: 02-287-1036 Ext. 512
Email: nursetida.th@jusmagthai.org
If urgent or emergent, please seek proper medical attention as soon as possible!
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HQ JUSMAG-THAI
TRICARE Services, Rm. J-202
7 Sathorn Tai Rd.
Bangkok 10120 Thailand
Fax: 02-287-1575
Updated: 1 September 2011 • |
Nurse Pranee Swaddikit
Tel: 02-287-1036 Ext. 511
Email: nursepranee.ctr.th@jusmagthai.org
If urgent or emergent, please seek proper medical attention as soon as possible!
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