Health Care: Expired ID card cases get temporary relief.

DoD Pledges User-Friendly TFL

Meeting Jan. 30 with Assistant Secretary of Defense (Health Affairs) Dr. William Winkenwerder, TROA President Lt. Gen. Mike Nelson, usaf-Ret., applauded Winkenwerder and his staff for their hard work in successfully bringing tricare For Life (TFL) to reality for the vast majority of the 1.4 million TFL-eligible beneficiaries.

But he also expressed the need for urgency in fixing several initial TFL claims-processing glitches that had inconvenienced a minority of beneficiaries. In a large population, even a small percentage represents several hundred thousand people. And these older beneficiaries—many of whom canceled their other health insurance—need to be reassured that TFL will work for them, too.

Winkenwerder told Nelson he was committed to seeing those issues resolved in the beneficiaries' favor. Winkenwerder subsequently repeated that commitment in an address to a 2002 tricare Conference audience that included Department of Defense (DoD) and service health officials, contractors, and beneficiary advocates.

"I pledge an aggressive approach, with early intervention to address any problems," said the assistant secretary. "The responsibility for solving the problems is on us, not our customers. We will be aggressive in addressing them and adopt a customer-service approach to problem solving."

Winkenwerder later announced that DoD would pay claims for TFL beneficiaries whose claims initially were denied because their military id cards had expired. DoD will give such individuals "the benefit of the doubt," acknowledging that many older spouses and widows never before had much incentive to renew their cards if they didn't use on-base hospitals or commissaries. DoD will process and pay these beneficiaries' claims until July 2002, to allow time to renew their id cards and avoid a break in TFL eligibility.

Those needing help getting new id cards can contact the Defense Manpower Data Center Support Office at (800) 538-9522.

We suspect that many of those without current id cards are individuals who are unaware of TFL benefits, who depend on their children or others for their personal affairs, or who reside in nursing homes.

We are most appreciative that DoD is sensitive to putting these beneficiaries' interests first. TROA will continue working closely with DoD health care officials to reach out to beneficiaries and educate them on what they need to do to enable their government-sponsored health care benefits.

FORCES AUGMENTED FOR WAR ON TERROR

The number of National Guard and Reserve members on active duty to support the war on terrorism continues to grow, according to Department of Defense (DoD) witnesses testifying at a recent Senate hearing. As of Feb. 13, there were nearly 80,000 reserve component members on duty supporting operations Noble Eagle and Enduring Freedom, including 7,000 Army and Air National Guard members recalled to protect domestic airports. David Chu, undersecretary of defense for Personnel and Readiness, testified that the activated troops are performing force protection and security duties here in the United States, flying refueling missions over central Asia, and serving on the ground in Afghanistan. Chu said DoD has made it easier for reservists (activated for more than 30 days) to obtain TRICARE health benefits. A new DoD test program waives TRICARE deductible fees and removes nonavailability statement requirements for family members of activated guardmembers and reservists being treated outside military treatment facilities. This test allows health care payments up to 15 percent above TRICARE’s normal allowable charges for families using providers who don’t participate in TRICARE. Craig Duehring, principal deputy assistant secretary for Reserve Affairs, acknowledged at the same hearing that reserve activations often cause “economic strains” on activated reservists and families. Duehring said DoD would explore options to provide reservists better debt-management skills. Another significant activation-related problem is that the 7,000 National Guard members activated to perform homeland security missions are not afforded creditor protections under the Soldiers’ and Sailors’ Civil Relief Act (SSCRA). This is because of the technicality that they were recalled by their governors “at the request of the president” rather than under a direct federal call-up. TROA and The Military Coalition support amending the SSCRA to permit Guard personnel activated for this unique mission to be afforded SSCRA protection. National Guard and Reserve Members on Active Duty (as of Feb. 20, 2002) Service Component Number Activated Service Component Number Activated Army National Guard/ Army Reserve 24,160 Air National Guard/ Air Force Reserve 35,241 Naval Reserve 10,597 Coast Guard Reserve 1,888 Marine Corps Reserve 4,388 TOTAL 76,274

Health Care: Initial glitches being resolved.

TFL Claims Update: Fixes in Place

Winkenwerder's pledge for speedy action (see previous page) was backed up by significant progress later in February.

By the end of the month, the Department of Defense (DoD) had received more than 7.6 million tricare For Life (TFL) claims and had processed more than 7 million, paying out $243 million in health care benefits. Claims-processing contractors reported that nearly all of the initial TFL hiccups either already had been resolved or would be by mid-March. Here's a recap of the status of the main initial problems:

Electronic Claims Omission. About 13 percent of beneficiaries were inadvertently left out of TFL's initial data exchange with Medicare. Because Medicare was unaware these people were in TFL, their Medicare claims were not forwarded to TFL. This group was reentered into the electronic process by mid-December. But the affected beneficiaries needed to file a paper tricare claim to receive reimbursement for doctor visits between Oct. 1 and approximately Dec. 7. Status: TFL contractors report they already have processed large numbers of these claims, but only beneficiaries know how many remain to be submitted. Beneficiary action needed: Beneficiaries who had unpaid claims for visits during that period must file a paper tricare claim (Form DD-2642) plus a copy of the Medicare Summary Notice for the relevant visit.

Excess Charges Payment. Three percent to 4 percent of beneficiaries visited doctors who do not "accept Medicare assignment." Providers who don't accept assignment may charge up to 115 percent of the Medicare-allowable charge. TFL will cover this extra 15 percent charge. However, the tricare claims processors initially didn't get the word and initially denied the extra payment. Status: TFL had made corrected payments for all of the previously underpaid claims as of mid-February. Beneficiary action needed: None.

OHI Indicator. Some members who canceled other health insurance (OHI) in conjunction with switching to TFL coverage and advised TFL of the cancellation had initial TFL claims denied because the Medicare claim system still indicated their OHI was active. (By law, the OHI must pay first.) In some cases, this was a simple processing delay. In others, the other insurance company delayed notifying Medicare to avoid missing any delayed claims for medical visits before the cancellation. Status: TFL processes have been changed to override the Medicare OHI indication if the beneficiary has notified DoD of the OHI cancellation, either by mail or by phone. More than 160,000 erroneously denied claims had been corrected and reprocessed by the end of February. Beneficiary action needed: None.

Beneficiary Notification Failure. Members who canceled their OHI but who did not notify TFL of such cancellation also may have their claims denied as discussed in the previous paragraph. Status: TFL can't correct the problem unless officials are made aware of the cancellation. Beneficiary action needed: If notified your TFL claim was denied for this reason, call the TFL call center toll-free at (888) 363-5433. The call center can provide a state or regional phone number you can call to update your TFL records to show your OHI has been canceled. Claims for care after the cancellation date then can be reprocessed automatically.

The single most frequent reason for a denied claim (almost half of all denials) is that something in Medicare or TFL files shows the beneficiary has OHI.

If a beneficiary has previously used OHI, the existence of that other insurance often still is reflected in Medicare or tricare electronic records—unless the beneficiary reports to TFL that it has been canceled. If the tricare system indicates you still have Medicare supplemental coverage, your TFL claim will be denied.

Another problem could occur if you hold on to your supplemental coverage and haven't told DoD. This could cause TFL in some cases to make a duplicate payment to your doctor (in addition to the payment from your other policy) that later may have to be recouped. This means administrative problems for DoD, your doctor, and you. These administrative problems could result in TFL getting a bad name with providers, and that could hurt all military beneficiaries.

The success of the program depends on TFL beneficiaries doing their part to make sure that the claims processors have accurate information about their coverage. So if you are a Medicare-eligible member, it is important for you to confirm with DoD whether you have OHI; if so, whether you plan to retain or cancel it; and if the latter, the effective date of any planned cancellation.

Last summer DoD sent a TFL mailing to all 1.4 million Medicare-eligible uniformed services retirees, family members, and survivors requesting that they respond with their OHI intentions. If you have not responded to the mailing, it is not too late to update your files. You should call DoD today (toll free at (888) 363-5433 (dod-life)) and furnish this important information.

Contacting DoD has no effect on your current Medicare supplement. If you wish to make any changes to your existing supplemental coverage, you have to contact your insurance carrier to make those arrangements. You are under no obligation to cancel your Medicare supplement, but you do need to communicate your intentions to DoD.

If you need additional TFL information, visit the tricare Web site via TROA's links page, www.TROA.org/magazine/links.asp, or call DoD at the toll-free number at left for assistance with resolution of any claims problems.

CLASS ACT LAWSUIT UPDATE
At press time, the U.S. Court of Appeals for the Federal Circuit was scheduled to hear oral arguments March 6 for Col. George “Bud” Day’s, USAF-Ret., Class Act health care lawsuit against the government. This is the case’s third appeal. In February 2001, a three-judge panel of the same court overturned a lower court decision and ruled that the government had “abused its discretion” by refusing to provide promised lifetime health care to retirees who entered service before June 7, 1956. That is the date of the first statutory reference to space-available care for retirees. But the government appealed that ruling and won a rehearing before the full court. Should the suit ultimately be successful, this class of retirees would be due compensation of up to $10,000 each. Day and many others have worked hard on this lawsuit, which we hope is successful. If it is, we will join those who will urge the administration not to appeal the case to the U.S. Supreme Court. But if the case is appealed by either party to the Supreme Court, TROA will support Day with an amicus curiae (friend of the court) brief. We will report the court’s decision as soon as it is available.

Retired Pay Coalition visits Budget Committee members.

Lobbying for Concurrent Receipt

In a series of coordinated visits to the Hill on Feb. 14, teams representing TROA, the Fleet Reserve Association, Veterans of Foreign Wars, Non Commissioned Officers Association, National Military Families Association, Disabled American Veterans, amvets, and National Association for Uniformed Services made personal visits to the offices of all 43 House Budget Committee members to urge funding for concurrent receipt (of military retired pay and Department of Veterans Affairs (va) disability compensation) in the FY 2003 Budget Resolution.

With 86 percent of House members, including 37 out of 43 Budget Committee members, supporting concurrent receipt legislation, many might expect that earmarking funds in the FY 2003 budget resolution would be automatic. Unfortunately that's not necessarily the case. When the administration failed to propose the needed funding in its budget for the next fiscal year, the action was passed back to Congress and the Budget committees, which allocate binding spending limits for all other congressional committees. In the past, the limit on the Armed Services Committee hasn't allowed for concurrent receipt legislation.

Also on Feb. 14, perennial concurrent receipt champion Rep. Michael Bilirakis (R-Fla.) testified before the Budget Committee expressing his strong support for the cause he has pursued for more than 17 years. In calling again for Budget Committee action, Bilirakis said, "Indeed, a number of our brave servicemen and -women have already sustained serious injuries while fighting our war against terrorism. How can we possibly expect to maintain a viable national defense if servicemembers realize that if they experience a service-connected disability, they cannot receive both va disability compensation and military retired pay?"

To support concurrent receipt lobbying efforts, TROA launched a letter-writing campaign in February, sending 35,000 letters to TROA members whose legislators are members of the House and Senate Budget committees. The selected members were provided a suggested letter and prestamped, preaddressed envelope with which to urge their legislators to earmark funding in the upcoming budget resolution.

Veterans' Benefits: Budget targets nondisabled veterans.

$1,500 Deductible for VA Care?

The administration's FY 2003 budget for veterans' health care asks Congress to authorize a $1,500 annual deductible on veterans enrolled in the lowest category (Priority Group 7, or pg-7) for Department of Veterans Affairs (va) health care. pg-7 includes military retirees with no compensable disability and incomes above $24,000 a year.

The proposal has gotten a chilly reception on Capitol Hill and among military and veterans' groups—including TROA.

The proposal surprised retiree and veterans' groups. Late last year, va Secretary Anthony Principi announced that certain copayments for pg-7 veterans enrolled in va care, including military retirees, would be lowered significantly (from more than $50 to $15 for a doctor visit) beginning Dec. 1, 2001. Principi said at the time that the White House had agreed to continue accepting all honorably discharged veterans for va health care and that the administration would work with Congress to fund the cost of continued open enrollment. The apparent solution is to find the money in the pocketbooks of pg-7 veteran enrollees.

All the details of the administration's proposal are not known, but the out-of-pocket impact on some pg-7 veterans could be substantial, especially for those with no other health insurance. There are 1.7 million veterans presently enrolled in pg-7.

Under the administration-proposed plan, pg-7 veterans would have to pay up to a $1,500 annual deductible at a rate of 45 percent of va's reasonable charges for each episode of care. Normal inpatient and outpatient copayments would kick in after the deductible was met. Any other health insurance held by a pg-7 veteran would be billed by the va for the deductible.

What's wrong with an annual deductible of $1,500? For more than three years, the va has aggressively recruited pg-7 veterans into va health care, and they now account for about 22 percent of total enrollees. The va justified increasing its health care budget requests, building hundreds more community-based outpatient clinics, and holding on to aging infrastructure by opening its doors to pg-7 veterans. Now a victim of its own previous initiatives, the va is being contradictory to change the rules so abruptly—especially after just recently lowering outpatient copayments for this group—and unfair to impose such a high tax on the very group that helped the va get resources to improve health care services for all enrollees.

Rep. Chris Smith (R-N.J.), chairman of the House Veterans Affairs Committee, blasted the proposal in a hearing on the va budget for FY 2003 before his committee on Feb. 13. "Congress should not endorse a policy designed to discourage veterans from obtaining health care from the va," he said. "This proposal is a nonstarter, and I will oppose it."

TROA agrees. The administration should ask for sufficient funds for all veterans enrolled in va health care. Congress also should authorize a test of the feasibility of allowing Medicare to partially reimburse the va for treating Medicare-eligible pg-7 veterans, because about 58 percent in the category are Medicare-eligible.

	AFWOA JOINS TMC
	At its monthly meeting in February, The Military Coalition (TMC) voted unanimously to admit the Air Force Women Officers Associated (AFWOA) as the coalition’s 32nd member organization. Formed in 1975, AFWOA represents the interests of nearly 1,000 active duty, National Guard, Reserve, retired, and former women officers of the Air Force. In addition to advocating personnel policy and legislative improvements with TMC, AFWOA’s purposes include preserving the history and promoting recognition of the role of military women. TMC was founded in 1986 and represents the interests of more than 5.5 million members of the uniformed services community including active duty and National Guard and Reserve servicemembers, military retirees, family members, survivors, and veterans. TROA and our TMC partners are most pleased to welcome AFWOA to the coalition, and we look forward to a long and productive working relationship. More information on AFWOA can be found on its Web site, accessible via TROA’s links page, www.troa.org/magazine/links.asp.

Military Pay: Individual raises may range from 4.1 percent to 6.5 percent.

2003 Raise May Average 4.8%

The president's FY 2003 budget seeks $1.9 billion for an across-the-board 4.1 percent pay raise, which is one-half of a percentage point higher than private-sector wage growth. The budget also includes another $300 million for additional "targeted raises" for mid-grade enlisted personnel and officers, including warrant officers. The plan calls for total raises for the latter groups in the 5.5 percent to 6.5 percent range, depending on grade and years of service.

Counting both the across-the-board and targeted elements, DoD officials indicated the proposal would provide an overall average 4.8 percent raise, if Congress approves it.

TROA is encouraged by the administration's and Congress' continuing efforts in recent years to reduce the significant gap that has accumulated between military members' raises and those of the average American over the last two decades.

At its worst point in 1998 and 1999, the accumulated pay-raise gap had reached 13.5 percent. As of 2002, the gap has been reduced to 7.6 percent, and the president's budget proposal for next year, if enacted, would decrease it to 6.4 percent.

Benefits Cut would hit jobs, service.

Commissaries Face 13% Funding Cut

The budget the administration submitted to Congress for FY 2003 envisions cutting commissary funding by $137 million compared to 2002, including elimination of more than 2,600 jobs from stores and Defense Commissary Agency (DeCA) headquarters. The Department of Defense (DoD) claims that more than a thousand of these positions are already vacant and that the cuts would entail no loss in service to the customer.

Approximately $90 million of the reduction is proposed for repayments to the services for loans they made to DeCA in restoring a seriously deficient surcharge fund.

While reimbursing the services is appropriate, TROA is concerned about taking that money from the current budget. Clearly, that budget already was pretty tight if it had to be supplemented in previous years from the capital fund.

The $137 million represents a 13 percent cut in the commissary subsidy. And the kinds of jobs being cut include meat and produce managers, shelf-stockers, and cashiers—people whose work has a direct impact on customers.

Such reductions almost have to indicate the likelihood of additional store closings, reduced operating hours, less stock on store shelves, and longer lines at the checkout counter.

Last year, the administration proposed testing privatization of commissaries at some locations. Secretary of Defense Donald Rumsfeld testified before the full House Armed Services Committee (HASC) in early February that he still thinks that's a good idea. Fortunately, Congress has refused to go down that road, recognizing that eliminating the federal subsidy for commissaries has to reduce the value of the benefit. Rep. Roscoe Bartlett (R-Md.), chairman of the House Morale, Welfare, and Recreation Panel of the hasc, made this stance perfectly clear to Rumsfeld at the February hearing. The same argument applies to this new proposed cutback.

Surveys show consistently that the commissary is the second most important nonpay military benefit, behind health care. Any substantial subsidy reduction inevitably will reduce the benefit, and TROA can't support that.

Retirement Savings: 30 percent enroll during initial open season.

Savings Plan Attracts Officers

The initial open enrollment season for the new military Thrift Savings Plan (tsp) ended Jan. 31, 2002, with about 30 percent of active duty officers, but only 10 percent of enlisted members, having enrolled.

The plan allows active duty and Selected Reserve members to invest up to 7 percent of their basic pay and up to 100 percent of bonuses and special pays (up to a maximum of $11,000 in 2002) in a tax-deferred 401(k)-style retirement savings program. The maximum percentage of basic pay and maximum annual deposit will increase over the next several years. Enrollees can choose from five investment funds, including money market, bond, and stock funds.

Previously, the tsp was available only to federal civilian employees. The military version allows servicemembers the opportunity to build retirement savings on their own without waiting 20 years for military retirement benefits.

Sign-up rates varied significantly between services, with the Navy and Air Force leading the way. Only about 4 percent of Guard and Reserve members have enrolled, in part because 7 percent of their smaller basic pay entitlement yields a relatively small deposit for most.

Two more open seasons are set for May 15 through July 31 and Nov. 15 through Jan. 31, 2003.