If I have other health insurance (OHI), can I get TRICARE reimbursement for my copayments?

Postscript The TRICARE fiscal year catastrophic cap was reduced from $7,500 to $3,000 a year per family for uniformed services retirees, their family members, and survivors. This is not a benefit cap but a cap on the out-of-pocket costs paid by the beneficiary and is retroactive to Oct. 1, 2000. Reimbursement payments will be issued to those beneficiaries who paid more than $3,000 and have saved their receipts. For more information, visit TRICARE's Web site via TROA's links page, www.troa.org/magazine/links.asp.

Yes. You can submit a copy of the pharmacy receipt (showing the cost of the medication and the copayment paid for the other insurance) to the tricare claims processor for your region. If you use a tricare network pharmacy, you will be reimbursed the full copayment. If you use a non-tricare network pharmacy, you must pay the annual tricare deductible (if it has not been met already). Once you’ve met the deductible, the Department of Defense (DoD) will refund the copayment amount. For additional information, call the DoD pharmacy call center, (877) 363-6337 (dod-meds) Monday through Friday, 8 a.m. to 11 p.m., Saturday from 10 a.m. to 8 p.m., or Sunday from 10 a.m. to 5:30 p.m., Eastern time.

Claims Processing
If my provider does not participate in TRICARE, how will my TRICARE For Life (TFL) claims be processed?

From a practical point of view, provider participation in TRICARE doesn’t matter. Medicare is the primary payer under TFL, and almost all providers accept Medicare patients and bill Medicare directly, a practice that will continue under TFL. Based on a data match between Medicare and tricare, both Medicare and tricare will reimburse the provider (unless there is ohi). In most cases, Medicare will pay first, and the remaining out-of-pocket expenses will be paid by TRICARE.

FEHBP Suspension
I have FEHBP (Federal Employees Health Benefits Program). Will you explain how I can suspend it to use TFL?

The Office of Personnel Management (opm) has issued further guidance on considerations for FEHBP-covered annuitants and former spouses who qualify for the TFL program for uniformed services Medicare eligible retirees, spouses, and survivors. opm notes that many eligible people may wish to switch from FEHBP to TFL because the military program covers Medicare’s coinsurance and deductibles and prescription drugs, very much like an FEHBP plan without the 25 percent to 28 percent enrollee premium contribution required under FEHBP.

How to get out of FEHBP: opm says that eligible annuitants can suspend FEHBP coverage to use TFL at any time by calling opm’s Retirement Information Office, (888) 767-6738 (in the Washington, D.C., calling area, (202) 606-0500), to obtain a suspension form. Former spouses can get the form from their employment office or the retirement system maintaining their enrollment.

Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TFL during the period beginning 31 days before and ending 31 days after the date they designate to begin suspension of their FEHBP coverage. Similar policies apply to those eligible for the Uniformed Services Family Health Plan.

How to get back in FEHBP from TFL: If you suspend FEHBP coverage to use TFL, you can reenroll in FEHBP for any reason during the next open season. If you are involuntarily disenrolled from TFL, you will be eligible to reenroll immediately in FEHBP. Your request to reenroll must be received within the period beginning 31 days before and ending 60 days after your TFL coverage ends. Otherwise, you must wait until the next FEHBP open season.