If you receive medical care outside the military system, and you don't have any other health insurance (or a supplemental policy) to help pay your cost-shares or co-payments, you'll be facing out-of-pocket expenses. Even though TRICARE pays a generous share of the cost of civilian medical bills, your share of the cost might be substantial, depending on whether you use TRICARE Standard (formerly known as CHAMPUS) or choose one of the other TRICARE health care options (Prime or Extra).
TRICARE supplemental insurance policies are offered by most military associations - like the Fleet Reserve Association, the American Legion, and the Military Officers Association of America - and by some private firms. They are designed to reimburse patients for the civilian medical care bills they must pay after TRICARE pays the government's share of the cost. Before you buy any supplement, carefully consider which plan is best suited to your individual needs.
Each TRICARE supplemental policy has its own rules concerning acceptance for pre-existing conditions, eligibility requirements for the family, deductibles, mental health limitations, long-term illness, well-baby care, care provided to persons with disabilities, claims under the diagnosis-related group (DRG) payment system for inpatient hospital charges, and rules concerning allowable charges.
Ask these questions when shopping for TRICARE/CHAMPUS supplements:
1. Must you meet a deductible before the plan begins paying?
2. Is there a maximum limit on benefits (lifetime, annual, etc.)?
3. Is there a pre-existing condition clause? Is there a waiting period before the policy will pay for pre-existing conditions?
4. Will the plan cover amounts beyond what TRICARE allows?
5. Does the plan pay for services that aren't covered by TRICARE?
6. Does the plan specifically not cover other conditions?
7. Must certain kinds of care be approved before getting the care?
8. Is inpatient care covered? Outpatient care? Long-term care?
9. Will the plan pay the TRICARE outpatient deductible?
10. Will the plan pay the patient's cost-share under the TRICARE diagnosis-related group (DRG) payment system?
11. Will the plan cover the TRICARE Prime enrollment fees or co-payments?
12. Does the plan offer reduced premiums or premium adjustments when you participate in Department of Defense contracted managed health care plans, such as TRICARE Prime or TRICARE Extra?
13. Does the plan convert to a Medicare supplement? If so, must it be in force as a TRICARE supplement for any specified length of time before conversion?
14. Will the plan cover you overseas? If you are overseas, you may not incur any disallowed charges under TRICARE Standard, because TRICARE Standard pays charges as billed overseas.
15. How will the plan require premium payments? Monthly? Quarterly? Can you use a credit card to charge the premiums?
16. Can premium payments be increased? Under what conditions?
17. Does the plan offer rates based on military status (active or retired), or based on an age scale? What is the scale?
18. What are the membership fees (annual, lifetime, etc.), if any, when you join the organization that sponsors the plan?
19. Does the plan cover the service member when he/she retires?
20. Does coverage continue for surviving spouses at no charge?
21. What are the time limitations, if any, for claim filing?
22. Are you a smoker? Does the plan have higher rates for smokers?
23. If you're retired military and have a health care plan (which pays before TRICARE) through a civilian job, do you still need a TRICARE supplement if, between them, your employer's plan and the TRICARE health care option you've chosen will pay most or all of your civilian medical bills?
No comments:
Post a Comment