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TRICAREYour Military Health Plan: 

1 TRICARE Your Military Health Plan New Parents Seminar Version 2 November 2005 BR421602BET1105W

Covered Maternity Care: 

2 Covered Maternity Care TRICARE covers maternity care, which includes prenatal care, delivery, and postpartum care If TRICARE eligibility ends during the pregnancy, TRICARE does not cover any remaining maternity care, unless the family qualifies for the Transitional Assistance Management Program (TAMP) or has enrolled in the Continued Health Care Benefits Program (CHCBP) BR421602BET1105W

Eligible Beneficiary Categories: 

3 Eligible Beneficiary Categories Expectant mothers Active duty and retired service members Active duty and retired family members Spouse Dependent daughter Newborns Newborn claims are billed separately from claims for expectant mothers Dependent daughter’s newborn is covered under TRICARE if the father of the baby is an active duty or retired service member BR421602BET1105W

Defense Enrollment Eligibility Reporting System (DEERS): 

4 Defense Enrollment Eligibility Reporting System (DEERS) Sponsor must register newborn in DEERS Obtain a copy of your child’s birth certificate or certificate of live birth Newborn is covered under TRICARE Prime for the first 60 days after birth At least one family member is enrolled in TRICARE Prime or TRICARE Prime Remote Fill out enrollment application and enroll in DEERS to ensure continuous TRICARE Prime Coverage After 60 days, newborn claims will process as TRICARE Standard if not enrolled in DEERS and formally enrolled in TRICARE Prime Eligibility for TRICARE Standard ends 365 days after birth for newborns who are not properly registered in DEERS BR421602BET1105W

Updating DEERS Information: 

5 Visit an ID card issuing facility; locate one near you at www.dmdc.osd.mil/rsl Call 1-800-538-9552 Mail changes to: Defense Manpower Data Center Support Office Attn: COA 400 Gigling Road Seaside, CA 93955-6771 Make address changes online at: www.tricare.osd.mil/DEERSAddress Updating DEERS Information BR421602BET1105W

Maternity Health Care Choices—Military Treatment Facilities (MTFs): 

6 Maternity Health Care Choices—Military Treatment Facilities (MTFs) Offers family-centered care for the least out-of-pocket costs to beneficiaries—overall the best value TRICARE Prime enrollees have priority access to care Beneficiaries using TRICARE Extra or TRICARE Standard may seek care at the MTF if space is available, but are not required to use the MTF for maternity care BR421602BET1105W

MTFs—Family-Centered Care: 

7 MTFs—Family-Centered Care Offers families standardized services starting with the first obstetric visit and continuing after the birth of the child Respect for your emotional well-being, privacy, and personal preferences Empowerment through honoring your family’s personal and cultural beliefs Choices in treatment Flexibility to welcome fathers, significant others, and siblings to be a part of your childbirth experience BR421602BET1105W

MTFs—Family-Centered Care: 

8 MTFs—Family-Centered Care Improved continuity of providers for prenatal care Careful, seamless coordination between facilities if you need to transfer Personalized pain management Individualized birth plans Improved access to first trimester appointments Private postpartum rooms Lactation education and support BR421602BET1105W

Maternity Health Care Choices—Civilian Facilities: 

9 Maternity Health Care Choices—Civilian Facilities TRICARE Prime beneficiaries may be able to seek care from TRICARE network if MTF cannot provide services TRICARE Extra beneficiaries seek care from TRICARE network providers TRICARE Standard beneficiaries seek care from any TRICARE-authorized provider BR421602BET1105W

TRICARE Prime: 

10 TRICARE Prime In most cases, expectant mothers enrolled in TRICARE Prime will have their prenatal care and deliveries in an MTF No annual deductibles No enrollment fees for active duty family members; retirees and family members pay $230/individual or $460/family Copayments are less under TRICARE Prime Newborns are deemed TRICARE Prime enrollees if at least one family member is enrolled in TRICARE Prime BR421602BET1105W

TRICARE Prime Costs—Active Duty Family Members: 

11 TRICARE Prime Costs— Active Duty Family Members This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Prime Costs—Active Duty Family Members: 

12 TRICARE Prime Costs— Active Duty Family Members This chart depicts maternity costs for the newborn BR421602BET1105W

TRICARE Prime Costs—Retirees and their Family Members: 

13 TRICARE Prime Costs— Retirees and their Family Members This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Prime Costs—Retirees and their Family Members: 

14 TRICARE Prime Costs— Retirees and their Family Members This chart depicts maternity costs for the newborn BR421602BET1105W

TRICARE Prime Maternity Referrals and Authorizations: 

15 TRICARE Prime Maternity Referrals and Authorizations Must obtain a referral from the primary care manager (PCM) for civilian maternity care Authorization includes prenatal and postnatal care, including a six-week follow-up visit The referral does not include conditions not related to pregnancy (i.e., a sprained ankle, ear infection) BR421602BET1105W

Additional Maternity Authorizations: 

16 Additional Maternity Authorizations For other specialty care or more than 16 office visits This includes perinatal, genetic, special testing procedures, and high-risk pregnancies If the admission is not authorized, you will be responsible for TRICARE Prime point-of-service (POS) charges BR421602BET1105W

Maternity Care— Point-of-Service Option: 

17 Maternity Care— Point-of-Service Option Maternity care from a network provider without obtaining a referral: POS option Responsible for annual deductible $300 for an individual $600 for a family Out-of-pocket cost-shares 50% of the TRICARE allowable charge Responsible for any additional charges from non-network providers, up to 15% above the TRICARE allowable charge BR421602BET1105W

Should you Disenroll from TRICARE Prime?: 

18 Should you Disenroll from TRICARE Prime? It’s your decision, but before you do… Check for available TRICARE network or authorized obstetricians Check for available TRICARE network or authorized pediatricians for your newborn Consider the increased costs not only for maternity care, but also for other health care BR421602BET1105W

Converting to TRICARE Extra or TRICARE Standard: 

19 Converting to TRICARE Extra or TRICARE Standard Must disenroll from TRICARE Prime Subject to a one-year lockout from TRICARE Prime Does not apply to families whose sponsor is E-4 or below Patients needing medical attention, other than maternity care, will be subject to TRICARE Extra or TRICARE Standard cost-shares and deductibles Care at MTF on a space-available basis—no guaranteed access to care at the MTF BR421602BET1105W

Maternity Expenses—TRICARE Extra and TRICARE Standard: 

20 Maternity Expenses—TRICARE Extra and TRICARE Standard Prenatal care, labor and delivery, and postnatal care with a civilian provider Beneficiaries are responsible for annual deductibles and cost-shares The amount of the cost-share varies based on the length of stay in the hospital and the medical needs of the mother and baby BR421602BET1105W

TRICARE Extra: 

21 TRICARE Extra Seek maternity care from TRICARE network providers Annual deductibles apply when you choose to deliver at home or as an outpatient Active duty family members E1-E4: $50/individual and $100/family E5 and above: $150/individual and $300/family Retiree/Retiree family members $150/individual $300/family BR421602BET1105W

TRICARE Extra Costs—Active Duty Family Members: 

22 TRICARE Extra Costs— Active Duty Family Members This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Extra Costs—Active Duty Family Members: 

23 TRICARE Extra Costs— Active Duty Family Members This chart depicts maternity costs for the newborn BR421602BET1105W

TRICARE Extra Costs—Retiree or Retiree Family Member: 

24 TRICARE Extra Costs— Retiree or Retiree Family Member This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Extra Costs—Retiree or Retiree Family Member: 

25 TRICARE Extra Costs— Retiree or Retiree Family Member This chart depicts maternity costs for the newborn *This cost-share does not apply if the newborn is deemed enrolled in TRICARE Prime because at least one family member is enrolled in TRICARE Prime. The newborn costs would be the same as for other retiree family members enrolled in TRICARE Prime. BR421602BET1105W

TRICARE Standard : 

26 TRICARE Standard Seek care from any TRICARE-authorized provider Annual deductibles apply when you choose to deliver at home or as an outpatient Active duty family member E1-E4: $50/individual and $100/family E5 and above: $150/individual and $300/family Retiree/Retiree family member $150/individual $300/family BR421602BET1105W

TRICARE Standard Costs—Active Duty Family Members: 

27 TRICARE Standard Costs— Active Duty Family Members This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Standard Costs—Active Duty Family Members: 

28 TRICARE Standard Costs— Active Duty Family Members This chart depicts maternity costs for the newborn BR421602BET1105W

TRICARE Standard Costs—Retiree or Retiree Family Member: 

29 TRICARE Standard Costs— Retiree or Retiree Family Member This chart depicts maternity costs for the mother BR421602BET1105W

TRICARE Standard Costs—Retiree or Retiree Family Member: 

30 TRICARE Standard Costs— Retiree or Retiree Family Member This chart depicts maternity costs for the newborn BR421602BET1105W *This cost-share does not apply if the newborn is deemed enrolled in TRICARE Prime because at least one family member is enrolled in TRICARE Prime. The newborn costs would be the same as for other retiree family members enrolled in TRICARE Prime.

Well-Baby and Well-Child Care: 

31 Well-Baby and Well-Child Care TRICARE offers well-baby and well-child care for newborns up to age 6 Available to all TRICARE beneficiaries TRICARE Prime continues to offer the best value to you No copayments Enhanced vision benefit Priority access to care Deductibles and cost-shares apply when using TRICARE Extra and TRICARE Standard BR421602BET1105W

If Your Sponsor is Mobilized: 

32 If Your Sponsor is Mobilized The other parent or guardian should be prepared to show power of attorney to register newborn in DEERS Some expectant mothers may elect to return to their families while their sponsor is mobilized and/or deployed These beneficiaries must follow certain guidelines to ensure that their claims are paid and that point-of-service (POS) charges are not incurred This refers to moves within and outside of your current region BR421602BET1105W

TRICARE Regional Contractors: 

33 TRICARE Regional Contractors TRICARE North Region Health Net Federal Services, Inc. www.healthnetfederalservices.com 1-877-TRICARE (1-877-874-2273) TRICARE South Region Humana Military Healthcare Services, Inc. www.humana-military.com 1-800-444-5445 TRICARE West Region TriWest Healthcare Alliance www.triwest.com 1-888-TRIWEST (1-888-874-9378) BR421602BET1105W

Thank You!: 

34 TRICARE offers a comprehensive maternity benefit for you and your newborn From preventive health services to better coordination with our civilian system and lower out-of-pocket costs for families, we have designed and fully implemented a strong, more uniform benefit Wherever we maintain medical capability and capacity, whether through military or civilian services, our goal is a world-class health benefit that serves the needs of our members Thank You! BR421602BET1105W

TRICARE Product Feedback : 

35 Please provide feedback on this presentation at: http://www.tricare.osd.mil/evaluations/presentations TRICARE Product Feedback BR421602BET1105W