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Tricare Help: Tricare Standard offers more when changing doctors

Oct. 25, 2012 - 04:10PM   |   Last Updated: Oct. 25, 2012 - 04:10PM  |  
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Q. I'm trying to switch from military facility doctors to a private family physician. I have Tricare Prime and don't care for the services offered at our local Army clinic. What can I do?

A. If you're unhappy with Tricare Prime, your most fundamental alternative is Tricare Standard.

Prime offers lower out-of-pocket costs than Standard, which charges annual deductibles. However, Standard allows a much wider choice of health care providers, which is what you seem to be seeking.

Standard is widely available, has no enrollment fee, and allows beneficiaries to also use Tricare Extra. That option is for Tricare Standard beneficiaries who want to save on out-of-pocket expenses by making an appointment with a Tricare Prime network provider (doctor, nurse practitioner, lab, etc.). The appointment with the in-network provider would cost 5 percent less than it would with a non-network provider.

And since Tricare Standard beneficiaries are not assigned a primary care manager as Prime enrollees are, they generally can refer themselves for specialty care without prior authorization.

Your first step is to disenroll from Prime. You can find the necessary forms at this Web link: http://www.tricare.mil/mybenefit/Forms.do">www.tricare.mil/mybenefit/Forms.do. Be sure to fill out the form for the Tricare region where you live, and mail it to the Tricare contractor for your region.

It will take about seven to 10 business days for your Prime disenrollment form to be received and processed. Once you're confirmed as disenrolled from Prime, that's all you should have to do. You'll receive a Tricare Standard handbook covering pertinent information regarding your benefits and eligibility for medical services.

The patient administration office at your local military treatment facility also can help you with this.

Q. I'm a retired Air Force officer with Tricare Prime coverage for myself and family. We're in litigation to obtain permanent guardianship of our 5-year-old grandson. If we succeed, will I be able to add him to my Tricare Prime coverage?

A. Tricare officials have said the only way for a grandchild to be eligible for Tricare under a grandparent's sponsorship is if the grandparent legally adopts the grandchild. But some legal advocates say the rules on this are unclear, and they maintain that legal guardianship is sufficient to establish Tricare eligibility in such circumstances.

Tricare cannot make such eligibility determinations; only the military services may do that. You should contact the Defense Enrollment Eligibility Reporting System support office toll-free at 1-800-538-9552 and discuss the matter. DEERS is the Defense Department's eligibility portal for Tricare.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at www.militarytimes.com/tricarehelp.

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