Tricare For Life Eligibility Verification For Providers – FORT POLK, La. — TRICARE open season begins Monday and ends Dec. 13. What does this mean for Soldiers, families and retirees who live and work at the Joint Readiness Training Center and Fort Polk in Louisiana?
Open Season is an opportunity for active duty family members and retirees and their families to transition from TRICARE Prime to TRICARE Select and vice versa.
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Tricare For Life Eligibility Verification For Providers
Outside of the TRICARE open season, beneficiaries can only change plans if they experience a qualifying life event. Eligible life events include change in sponsor status, family composition, change of address, government mandated change, death of sponsor etc.; For a complete list, visit www.tricare.mil/lifeevents.
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1. Stick to your plan. If you want to stay with your current TRICARE health plan, you don’t need to take action. You will continue with your current health plan until 2022 or as long as you are eligible.
2. Plan enrollment. If you are eligible for TRICARE Prime or TRICARE Select but are not enrolled, you can enroll in the plan now.
3. Change plans. If you’re already enrolled in TRICARE Prime or Select, you can switch plans or from individual enrollment to family enrollment.
According to health.mil, TRICARE Prime is a managed care option available in major service areas of the United States; Beneficiaries are assigned a primary care manager who provides most of their care. TRICARE Select is a self-administered preferred provider network plan. TRICARE Select is a fee-based service that allows patients to receive care from any TRICARE-authorized provider.
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Peggy Sylvest, Humana Military Health System Manager, supports managed care at Bayne-Jones Army Community Hospital. He said the main difference between primary and choice is flexibility and cost, which are not available.
“TRICARE Prime requires a referral from your primary care provider, Choice does not,” he said. “With Prime, patients stay at a military treatment facility for primary care. With Select, the patient has more flexibility and can choose from TRICARE-authorized providers in the community. The Open Season gives recipients a choice.”
Silvest said it’s important to do your research and make an informed decision about which plan is best.
“It is important that eligible beneficiaries look at their options during the open season based on their health care needs in the coming year,” he said. “Thinking about what benefits you need and what you’re willing to pay out of pocket will help you make the best decision.”
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TRICARE offers dental and vision depending on who you are, your age, and your TRICARE plan. During the open period, TRICARE recipients may also be eligible for the federal Employee Dental and Vision Insurance Program administered by the Office of Personnel Management. Eligibility depends on the beneficiary’s status and requires enrollment in a TRICARE health plan. Visit www.benefeds.com to check eligibility, compare FEDVIP plans and rates, enroll in a plan and more.
According to health.mil, retired service members and their families who use Prime, Select of TRICARE for Life, are eligible for a vision and dental plan. Active duty family members are only eligible for the vision plan.
In addition to open season, Sylvest emphasized that when the change goes into effect on December 15, Wal-Mart and Sam’s Club pharmacies will no longer be part of the TRICARE network.
“Beneficiaries who use it for their prescriptions can decide where they want to transfer their prescriptions. Local pharmacies like BJACH, Walgreens and CVS are all options in our area, as well as express scripts by mail,” he said. “The dispensary has nothing to do with the open season, but it’s important for recipients to know and start planning for this big change.”
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Editor’s note: TRICARE’s first annual open season was held in 2018 and provided an opportunity for beneficiaries to enroll in or change their health plans without experiencing a TRICARE qualifying life event (QLE). To make changes during the open season, visit the beneficiary enrollment website at www.tricare.mil/bwe or go directly to https://milconnect.dmdc.osd.mil/milconnect/ and click on Manage Health Benefits.
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