83 FR 673 - TRICARE; Notice of TRICARE Prime and TRICARE Select Plan Information for Calendar Year 2018
DEPARTMENT OF DEFENSE
Office of the Secretary Federal Register Volume 83, Issue 4 (January 5, 2018)
Office of the Secretary
Federal Register Volume 83, Issue 4 (January 5, 2018)
| Page Range | 673-675 | |
| FR Document | 2018-00018 |
[Federal Register Volume 83, Number 4 (Friday, January 5, 2018)] [Notices] [Pages 673-675] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-00018] ----------------------------------------------------------------------- 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. ----------------------------------------------------------------------- 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: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. 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. 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. 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. 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. 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. 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. 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. 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. 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 ---------------------------------------------------------------------------------------------------------------- TRICARE select group A TRICARE select group B Prime group A Prime group B ADFMs ADFMs ADFMs ADFMs ---------------------------------------------------------------------------------------------------------------- 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. ---------------------------------------------------------------------------------------------------------------- Table 2--TRICARE Select and TRICARE Prime Cost Sharing for Retiree Families for Calendar Year 2018 ---------------------------------------------------------------------------------------------------------------- TRICARE prime TRICARE select group A TRICARE select group A retirees TRICARE prime retirees group B retirees \1\ group B retirees ---------------------------------------------------------------------------------------------------------------- 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. ---------------------------------------------------------------------------------------------------------------- \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 -------------------------------------------------------------------------------------------------------------------------------------------------------- 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: -------------------------------------------------------------------------------------------------------------------------------------------------------- 2018............................................................... $11 $28 $7 $24 $53 -------------------------------------------------------------------------------------------------------------------------------------------------------- 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
![Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices 673
8455–00–NSH–0001—Logo, BDU Coat and number and title for this Federal Respondents could be any non-active
Shirt Register document. The general policy duty TRICARE beneficiary who is not
8455–00–NSH–0002—Logo, BDU Coat and for comments and other submissions eligible for Medicare. These
Shirt from members of the public is to make beneficiaries have the option of
Mandatory Source of Supply: Southeastern
Kentucky Rehabilitation Industries, Inc.,
these submissions available for public enrolling into either the TRICARE Prime
Corbin, KY viewing on the internet at http:// or TRICARE Select plan option starting
Contracting Activity: Defense Logistics www.regulations.gov as they are January 1, 2018. Those choosing to
Agency Troop Support received without change, including any enroll in TRICARE Select can do so by
personal identifiers or contact submitting the DD Form 3043, using the
Amy B. Jensen, information. BWE portal, or calling their Regional
Director, Business Operations. Any associated form(s) for this Contractor. If they choose to use the DD
[FR Doc. 2018–00010 Filed 1–4–18; 8:45 am] collection may be located within this Form 3043, they must complete the
BILLING CODE 6353–01–P same electronic docket and downloaded appropriate page(s) of the form and mail
for review/testing. Follow the the form to their Regional Contractor.
instructions at http:// No other form is required to enroll, dis-
DEPARTMENT OF DEFENSE www.regulations.gov for submitting enroll, or change an enrollment.
comments. Please submit comments on Respondents can download the form
Office of the Secretary any given form identified by docket from the DoD Forms Management
number, form number, and title. Program website, or click on the link to
[Docket ID: DOD–2017–HA–0065]
FOR FURTHER INFORMATION CONTACT: To the form on the TRICARE.mil website or
Proposed Collection; Comment request more information on this their Regional Contractor’s website, or
Request proposed information collection or to obtain a copy from their local military
obtain a copy of the proposal and hospital or clinic. The mailing address
AGENCY: Office of the Assistant associated collection instruments, and toll-free customer service number
Secretary of Defense for Health Affairs, please contact Defense Health Agency, for their Regional Contractor are
DoD. TRICARE Health Plan (J–10), ATTN: included on the DD Form 3043. If using
ACTION: 60-Day information collection Mark Ellis, 7700 Arlington Boulevard, either website option, the respondent
notice. Falls Church, VA 22042, or call the can type in the information on the form
TRICARE Health Plan, 703–681–0039. prior to printing it or handwrite the
SUMMARY: In compliance with the information after printing the blank
SUPPLEMENTARY INFORMATION:
Paperwork Reduction Act of 1995, the form.
Title; Associated Form; and OMB
Office of the Assistant Secretary of
Number: TRICARE Select Enrollment, Dated: January 2, 2018.
Defense for Health Affairs announces a
Disenrollment, and Change Form; DD Aaron Siegel,
proposed public information collection
Form 3043; OMB Control Number 0720– Alternate OSD Federal Register Liaison
and seeks public comment on the
0061. Officer, Department of Defense.
provisions thereof. Comments are
Needs and Uses: The information [FR Doc. 2018–00007 Filed 1–4–18; 8:45 am]
invited on: Whether the proposed
collection requirement is necessary to
collection of information is necessary BILLING CODE 5001–06–P
obtain each non-active duty TRICARE
for the proper performance of the
beneficiary’s personal information
functions of the agency, including
needed to: (1) Complete his/her DEPARTMENT OF DEFENSE
whether the information shall have
enrollment into the TRICARE Select
practical utility; the accuracy of the Office of the Secretary
health plan option, (2) dis-enroll a
agency’s estimate of the burden of the
beneficiary, or (3) change a beneficiary’s
proposed information collection; ways TRICARE; Notice of TRICARE Prime
enrollment information (e.g., address,
to enhance the quality, utility, and and TRICARE Select Plan Information
add a dependent, report other health
clarity of the information to be for Calendar Year 2018
insurance). This information is required
collected; and ways to minimize the
to ensure the beneficiary’s TRICARE AGENCY: Office of the Secretary of
burden of the information collection on
benefits and claims are administered Defense, Department of Defense.
respondents, including through the use
based on their TRICARE plan of choice.
of automated collection techniques or ACTION: TRICARE Prime and TRICARE
Without this new enrollment form, each
other forms of information technology. Select Plan Information for Calendar
non-active duty TRICARE beneficiary is
DATES: Consideration will be given to all Year 2018.
automatically defaulted into direct care,
comments received by March 6, 2018. limiting their health care options to SUMMARY: This notice provides a notice
ADDRESSES: You may submit comments, military hospitals and clinics. These of TRICARE Prime and TRICARE Plan
identified by docket number and title, beneficiaries would have no TRICARE Information for Calendar Year 2018.
by any of the following methods: coverage when using the TRICARE DATES: TRICARE health plan
• Federal eRulemaking Portal: http:// network of providers for services not information in this notice is valid for
www.regulations.gov. Follow the available at their local military hospital services during calendar year 2018
instructions for submitting comments. or clinic. (January 1, 2018–December 31, 2018).
• Mail: Department of Defense, Office Affected Public: Individuals or
of the Deputy Chief Management ADDRESSES: Defense Health Agency,
Households.
daltland on DSKBBV9HB2PROD with NOTICES
Officer, Directorate for Oversight and Annual Burden Hours: 24,825. TRICARE Health Plan, 7700 Arlington
Compliance, Regulatory and Advisory Number of Respondents: 99,300. Boulevard, Suite 5101, Falls Church,
Committee Division, 4800 Mark Center Responses per Respondent: 1. Virginia 22042–5101.
Drive, Mailbox #24, Suite 08D09B, Annual Responses: 99,300. FOR FURTHER INFORMATION CONTACT: Mr.
Alexandria, VA 22350–1700. Average Burden per Response: 15 Mark A. Ellis, (703) 681–0039.
Instructions: All submissions received minutes. SUPPLEMENTARY INFORMATION: An
must include the agency name, docket Frequency: On occasion. interim final rule published in the
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![Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices 675
TABLE 1—TRICARE SELECT AND TRICARE PRIME COST SHARING FOR ACTIVE DUTY FAMILY MEMBERS (ADFMS) FOR
CALENDAR YEAR 2018—Continued
Prime group A Prime group B
TRICARE select group A ADFMs TRICARE select group B ADFMs ADFMs ADFMs
Ambulance Service (not including $74 IN 20% OON ........................... $15 IN 20% OON ........................... 0 0
air).
Durable Medical Equipment ........... 15% IN 20% OON ......................... 10% IN 20% OON ......................... 0 0
Inpatient Hospital Admission .......... $18.60/day, minimum $25/admis- $60/admission IN; 20% OON ........ 0 0
sion.
Inpatient Skilled Nursing/Rehab Fa- $18.60/day, minimum $25/admis- $25/day IN; $50/day OON ............. 0 0
cility. sion.
TABLE 2—TRICARE SELECT AND TRICARE PRIME COST SHARING FOR RETIREE FAMILIES FOR CALENDAR YEAR 2018
TRICARE select TRICARE prime TRICARE prime
TRICARE select group A retirees group B retirees group A retirees 1 group B retirees
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 including $98 IN 25% OON ........................... $60 IN 25% OON .... 40 ............................. 40
air).
Durable Med. Equip. ......................... 20% IN 25% OON ......................... 20% IN 25% OON ... 20% ......................... 20%
Inpatient Admission ........................... $250/day up to 25% hosp. charge $175/admission IN 150/admission ......... 150/admission
+ 20% separately billed services 25% OON.
IN $901/day up to 25% hosp.
charge + 25% separately billed
services OON.
Inpatient Skilled Nursing/Rehab Ad- $250/day up to 25% hospital $50/day IN Lesser of 30/day ...................... 30/day
mission. charge + 20% separately billed $300/day or 20%
services IN 25% OON. OON.
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
Copayment
Copayment Copayment Copayment Copayment amount for a
amount for a amount for a amount for a amount for a 90-day supply
Year 30-day supply 30-day supply 90-day supply 90-day supply of a mail order
of a retail of a retail of a mail order of a mail order non-formulary
generic is: formulary is: generic is: formulary is: is:
2018 ..................................................................................... $11 $28 $7 $24 $53
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. DEPARTMENT OF DEFENSE for the Secretary of the Navy Advisory
Aaron Siegel, Panel (‘‘the Panel’’).
Alternate OSD Federal Register Liaison Office of the Secretary FOR FURTHER INFORMATION CONTACT: Jim
Officer, Department of Defense. Freeman, Advisory Committee
Charter Renewal of Department of Management Officer for the Department
[FR Doc. 2018–00018 Filed 1–4–18; 8:45 am]
Defense Federal Advisory Committees of Defense, 703–692–5952.
BILLING CODE 5001–06–P
AGENCY: Department of Defense. SUPPLEMENTARY INFORMATION: This
daltland on DSKBBV9HB2PROD with NOTICES
committee’s charter is being renewed in
Renewal of Federal Advisory
ACTION: accordance with the Federal Advisory
Committee. Committee Act (FACA) of 1972 (5
U.S.C., Appendix, as amended) and 41
SUMMARY: The Department of Defense CFR 102–3.50(d). The charter and
(DoD) is publishing this notice to contact information for the Panel’s
announce that it is renewing the charter Designated Federal Officer (DFO) can be
VerDate Sep<11>2014 16:30 Jan 04, 2018 Jkt 244001 PO 00000 Frm 00022 Fmt 4703 Sfmt 4703 E:\FR\FM\05JAN1.SGM 05JAN1](https://thefederalregister.org/doc/83_FR_677/page/3.svg)
Document Created: 2018-10-26 09:31:58
Document Modified: 2018-10-26 09:31:58
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | TRICARE Prime and TRICARE Select 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). | |
| Contact | Mr. Mark A. Ellis, (703) 681-0039. | |
| FR Citation | 83 FR 673 |
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