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News Release


Release No: 702-94
December 15, 1994


The Department of Defense announced today a new, uniform health benefit option for military families, retirees and their families which will significantly reduce the cost of health care to beneficiaries and to the federal government. Under this new health maintenance organization (HMO) option, TRICARE Prime, all patients treated in military treatment facilities will continue to receive care without having to share in the cost of the services provided. This HMO option establishes fees and copayments for care provided to beneficiaries in participating civilian medical facilities which are, on the average, significantly less than existing fees and copayments.

Family members of uniformed services personnel, and survivors and retired members and their families will have the choice of three health care delivery options, including the HMO option, when TRICARE is fully implemented in their locations. These new provisions will go into effect as the TRICARE managed care support contracts are begun in each of the 12 TRICARE Regions across the country. The first Region (Region 11, which includes Washington and Oregon) will offer the HMO option beginning in March 1995.

TRICARE is the DoD regional managed care program that brings together the health care delivery systems of each of the military services, as well as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), in a cooperative and supportive effort to better serve military patients and to better use the resources available to military medicine. In addition to the HMO option, TRICARE Prime, there are TRICARE Extra and TRICARE Standard.

TRICARE Prime is the voluntary enrollment option that offers patients the advantages of managed health care, such as primary care managers, assistance in making specialty appointments, and someone else to do their claims filing. The Prime option offers the scope of coverage available today under CHAMPUS, plus additional preventive and primary care services. For Prime enrollees, the new cost sharing provisions do away with the usual standard CHAMPUS cost sharing. Of particular note, families of active duty personnel will have no enrollment fees. CHAMPUS-eligible retirees who enroll in Prime will pay an enrollment fee; but will pay only $11 per day for civilian inpatient care in comparison to the $323 per day plus 25% of professional fees charge faced by those retirees who use TRICARE Standard. For Prime enrollees there will be copayments for care received from civilian providers. These copayments are significantly less than the other two options and are detailed on the chart below.

CHAMPUS-eligible beneficiaries may elect to enroll in TRICARE Prime on an annual basis. The other two choices for health care delivery under TRICARE are:

TRICARE Standard - This option is the same as the standard CHAMPUS program.

TRICARE Extra - In the TRICARE Extra program, when a CHAMPUS-eligible beneficiary uses a preferred network provider, he/she receives an out-of-pocket discount and usually does not have to file any claim forms. CHAMPUS beneficiaries do not enroll in TRICARE Extra, but may participate in Extra on a case-by-case basis just by using the network providers.

The uniform HMO benefit fee and copayment schedule follows:

                                  E4 and Below        E5 and Above         Retirees and       
                                 Family Members      Family Members     Survivors and Their   
                                                                          Family Members      
Annual Enrollment Fee                  $0                  $0                $230/$460        
Copayments for  services                                                                      
outside Military Treatment                                                                    
Outpatient Visits, Including            $6                 $12                  $12           
Separate Radiology or Lab                                                                     
Services and Home Health                                                                      
Emergency Room Visits                  $10         $30                 $30                    
Mental Health Visits,                  $10         $20                 $25                    
Mental Health Visits, Group            $6          $12                 $17                    
Ambulatory Surgery                     $25         $25                 $25                    
Prescriptions                          $5          $5                  $9                     
Ambulance Services                     $10         $15                 $20                    
Durable medical equipment,         10 percent      15 percent          20 percent             
Prostheses, Supplies                                                                          
Inpatient Per Diem, General            $11         $11                 $11                    
Inpatient Per Diem, Mental             $20                $20                   $40           
Health/Substance Use                                                                          
Estimated Annual Savings per          $170         $240                $100                   
Enrolled Family                                                                               

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