[Federal Register Volume 83, Number 4 (Friday, January 5, 2018)]
[Notices]
[Pages 673-675]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-00018]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Notice of TRICARE Prime and TRICARE Select Plan 
Information for Calendar Year 2018

AGENCY: Office of the Secretary of Defense, Department of Defense.

ACTION: TRICARE Prime and TRICARE Select Plan Information for Calendar 
Year 2018.

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SUMMARY: This notice provides a notice of TRICARE Prime and TRICARE 
Plan Information for Calendar Year 2018.

DATES: TRICARE health plan information in this notice is valid for 
services during calendar year 2018 (January 1, 2018-December 31, 2018).

ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington 
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Mr. Mark A. Ellis, (703) 681-0039.

SUPPLEMENTARY INFORMATION: An interim final rule published in the

[[Page 674]]

Federal Register (FR) on September 29, 2017 (82 FR 45438-45461) 
established the requirement for the Director, Defense Health Agency, to 
provide a public notice to TRICARE program beneficiaries with a summary 
of changes to the TRICARE program each calendar year in connection with 
the open season enrollment period.
    The following changes or improvements to the TRICARE program 
benefits apply for calendar year 2018:
    <bullet> On January 1, 2018, TRICARE North and South regions will 
combine to form TRICARE East, while TRICARE West region will remain 
mostly unchanged. Humana Military will administer the new East region 
and Health Net Federal Services will administer the West region. This 
change will allow better coordination between the military hospitals 
and clinics and the civilian health care providers in each region. Go 
to https://tricare.mil/About/Changes/General-TRICARE-Changes/Regions 
for more information.
    <bullet> TRICARE Select will replace TRICARE Standard and TRICARE 
Extra on January 1, 2018. TRICARE Select brings together the features 
of TRICARE Standard and TRICARE Extra in a single plan. Select 
enrollees may obtain care from any TRICARE authorized provider without 
a referral or authorization. Enrollees who obtain services from TRICARE 
network providers will pay lower cost sharing amounts for network care.
    <bullet> All current TRICARE beneficiaries will be automatically 
enrolled in their respective plan on January 1, 2018. TRICARE Prime 
plan enrollees will remain in their TRICARE Prime plan. TRICARE 
Standard and Extra beneficiaries will be enrolled in a TRICARE Select 
plan.
    <bullet> Beneficiary out-of-pocket costs: A detailed break-out of 
beneficiary out-of-pocket costs for 2018 is shown in Appendix A. Some 
out-of-pocket costs will be announced later in 2018 as we define 
certain high-value medications and health care services that will 
result in lower out of pocket expenses for beneficiaries.
    <bullet> Improving what's covered: Beginning January 1, 2018:
    [rtarr8] TRICARE Select enrollees may receive most TRICARE Prime 
clinical preventive services with no copayment when furnished by a 
network provider.
    [rtarr8] TRICARE Prime and TRICARE Select will cover behavioral 
interventions for obese adults and children/adolescents with certain 
body mass indexes to promote sustained weight loss with no cost if 
furnished by a network provider.
    <bullet> TRICARE will cost share on medically necessary foods and 
vitamins, including low protein modified food and amino acid 
preparation products for dietary management of individuals with limited 
or impaired capacity to absorb other nourishment.
    <bullet> Beneficiaries can choose to enroll in or change their 
TRICARE Prime or TRICARE Select coverage during an annual open 
enrollment period in November-December, 2018 for coverage beginning on 
January 1, 2019. For calendar year 2019, failure to enroll in TRICARE 
Prime or TRICARE Select results in the termination of coverage for 
civilian care. These beneficiaries who choose to not enroll may only 
receive care at a military clinic or hospital on a space available 
basis.
    <bullet> 2018 will be a transition year with a grace period for 
enrollment. To allow beneficiaries to adjust to making their health 
care option choices during an annual open season enrollment period or 
to remember to elect their coverage when a qualifying life event (QLE) 
occurs, beneficiaries can elect to make their coverage changes anytime 
during 2018 to ensure they have the right coverage in place starting in 
2019.
    <bullet> Referrals for civilian urgent care visits are no longer 
needed for most TRICARE Prime enrollees. Most TRICARE Prime enrollees 
can now seek care at an urgent care center without a referral. Point of 
Service charges no longer applies if seen without a referral. As a 
reminder, after seeking urgent care, it's always a good idea to contact 
the primary care manager and arrange follow-up care as needed.
    [rtarr8] However, some exceptions still apply. Active Duty Service 
members (ADSMs) must obtain authorization before seeking urgent care 
services from civilian providers.
    [rtarr8] Active Duty family members enrolled to TRICARE Overseas 
Program (TOP) Prime/Prime Remote must contact the TOP contractor to 
obtain an authorization in order to ensure their urgent care visit will 
be cashless/claimless. Without this authorization, overseas providers 
may request payment upfront and the beneficiary will then have to 
submit a claim for reimbursement. Additionally, any ADSM enrolled in 
TOP Prime/Prime Remote requiring urgent care while on temporary duty or 
on leave status in the 50 United States and the District of Columbia, 
may access urgent care without a referral or an authorization.
    <bullet> For more information, visit tricare.mil/changes or call 
your regional TRICARE contractor.

Appendix A

    See tables below for TRICARE Prime, TRICARE Select, and TRICARE 
Pharmacy out-of-pocket expenses that take effect on January 1, 2018.
    Group A beneficiaries are service members who enlisted or were 
appointed in a Uniformed Service before January 1, 2018 and their 
family members.
    Group B are service members who enlisted or were appointed in a 
Uniformed Service on or after January 1, 2018 and their family 
members.
    Group B cost shares also apply to enrollees in the TRICARE 
Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and 
the Continued Health Care Benefit Program health plans. Monthly 
premiums apply in lieu of enrollment fees.
Key:
IN--Network Provider
OON--Out-of-Network Provider

 Table 1--TRICARE Select and TRICARE Prime Cost Sharing for Active Duty Family Members (ADFMs) for Calendar Year
                                                      2018
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                                  TRICARE select group A  TRICARE select group B   Prime group A   Prime group B
                                          ADFMs                    ADFMs               ADFMs           ADFMs
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Annual Enrollment..............  $0.....................  $0....................              $0              $0
Annual Deductible..............  E1-E4: $50/$100 E5 &     E1-E4: $50/$100 E5 &                 0               0
                                  above: $150/$300.        above: $150/$300.
Annual Catastrophic Cap........  $1,000.................  $1,000................           1,000           1,000
Preventive Care Outpatient       $0.....................  $0....................               0               0
 Visit.
Primary Care Outpatient Visit..  $21 IN 20% OON.........  $15 IN 20% OON........               0               0
Specialty Care Outpatient Visit  $31 IN 20% OON.........  $25 IN 20% OON........               0               0
Emergency Room Visit...........  $81 IN 20% OON.........  $40 IN 20% OON........               0               0
Urgent Care Center.............  $21 IN 20% OON.........  $20 IN 20% OON........               0               0
Ambulatory Surgery.............  $25....................  $25 IN 20% OON........               0               0

[[Page 675]]

 
Ambulance Service (not           $74 IN 20% OON.........  $15 IN 20% OON........               0               0
 including air).
Durable Medical Equipment......  15% IN 20% OON.........  10% IN 20% OON........               0               0
Inpatient Hospital Admission...  $18.60/day, minimum $25/ $60/admission IN; 20%                0               0
                                  admission.               OON.
Inpatient Skilled Nursing/Rehab  $18.60/day, minimum $25/ $25/day IN; $50/day                  0               0
 Facility.                        admission.               OON.
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       Table 2--TRICARE Select and TRICARE Prime Cost Sharing for Retiree Families for Calendar Year 2018
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                                                                              TRICARE prime
                                 TRICARE select group A    TRICARE select    group A retirees    TRICARE prime
                                        retirees          group B retirees         \1\          group B retirees
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Annual Enrollment..............  $0....................  $450/$900........  $289.08/$578.16..  $350/$700
Annual Deductible..............  $150/$300.............  $150/$300 IN $300/ 0................  0
                                                          $600 OON.
Annual Catastrophic Cap........  $3,000................  $3,500...........  3,000............  3,500
Preventive Care Visit..........  $0....................  $0...............  0................  0
Primary Care Outpatient Visit..  $28 IN 25% OON........  $25 IN 25% OON...  20...............  20
Specialty Care Outpatient Visit  $41 IN 25% OON........  $40 IN 25% OON...  30...............  30
Emergency Room Visit...........  $109 IN 25% OON.......  $80 IN 25% OON...  60...............  60
Urgent Care Center Visit.......  $28 IN 25% OON........  $40 IN 25% OON...  30...............  30
Ambulatory Surgery.............  20% IN 25% OON........  $95 IN 25% OON...  60...............  60
Ambulance Service (not           $98 IN 25% OON........  $60 IN 25% OON...  40...............  40
 including air).
Durable Med. Equip.............  20% IN 25% OON........  20% IN 25% OON...  20%..............  20%
Inpatient Admission............  $250/day up to 25%      $175/admission IN  150/admission....  150/admission
                                  hosp. charge + 20%      25% OON.
                                  separately billed
                                  services IN $901/day
                                  up to 25% hosp.
                                  charge + 25%
                                  separately billed
                                  services OON.
Inpatient Skilled Nursing/Rehab  $250/day up to 25%      $50/day IN Lesser  30/day...........  30/day
 Admission.                       hospital charge + 20%   of $300/day or
                                  separately billed       20% OON.
                                  services IN 25% OON.
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\1\ TRICARE Prime enrollees who are (1) survivors of active duty deceased sponsors, or (2) medically retired
  Uniformed Services members and their family members, have their TRICARE Prime enrollment fees frozen at the
  rate in effect when classified and enrolled in a fee paying Prime plan. (This does not include TRICARE Young
  Adult (TYA) plans).


                                                   Table 3--Pharmacy Copayments for Calendar Year 2018
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                                                                        Copayment        Copayment        Copayment        Copayment        Copayment
                                                                     amount for a 30- amount for a 30- amount for a 90- amount for a 90- amount for a 90-
                                Year                                 day supply of a  day supply of a  day supply of a  day supply of a  day supply of a
                                                                      retail generic       retail         mail order       mail order    mail order non-
                                                                           is:         formulary is:     generic is:     formulary is:    formulary is:
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2018...............................................................             $11              $28               $7              $24              $53
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Note: Pharmacy copayment amounts for (1) survivors of active duty deceased sponsors, or (2) medically retired Uniformed Services members and their
  family members are equal to the copayment amounts, if any, for 2017.


    Dated: January 2, 2018.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2018-00018 Filed 1-4-18; 8:45 am]
 BILLING CODE 5001-06-P