As of October 1, 2013, TRICARE Prime will no longer be available to beneficiaries living in certain areas in the United States. Prime Service Areas (PSAs) are geographic areas where TRICARE Prime is offered. PSAs were created to ensure medical readiness of the active duty force by augmenting the capability and capacity of military hospitals and clinics. The affected PSAs are not close to existing military hospitals or clinics and have never augmented care around military hospitals or clinics or Base Realignment and Closure (BRAC) locations.
If you live in an area affected by the PSA changes, you will be notified by mail. Your letter will include information about your remaining TRICARE health care options as well as where to get more information. Your TRICARE Prime benefit will remain available through the end of September as long as your enrollment fees are paid, you do not disenroll early or lose eligibility.
We want to assure you that elimination of any PSAs will not change the TRICARE benefit for our active duty service members or their families currently living in these locations and enrolled in Prime. They will remain enrolled in Prime, ensuring their access to care and out-of-pocket costs do not change.
Even if TRICARE Prime is no longer available where you live, you will still be able to use the highly-rated TRICARE Standard and Extra option. TRICARE Standard and Extra is a convenient option that has no enrollment fees and offers the freedom to see any TRICARE-authorized provider for routine or specialty care. An assigned primary care manager (PCM) is not required, and cost shares for a wide range of preventive medical services have been eliminated. With TRICARE Extra, you choose hospitals and providers within the TRICARE network, where available, and pay a lower cost share.
Why the Change?
The Department of Defense (DoD) has planned to make PSA reductions since 2007, when proposals were requested for the next generation of TRICARE contracts (known as T-3). Bidders for the three U.S. regional contracts were only required to establish PSAs around military hospitals or clinics and in areas that lost military hospitals or clinics due to BRAC decisions.
Although PSA reductions under T-3 were intended to take place simultaneously, contract delays in all three U.S. regions resulted in a staggered transition. DoD senior leadership determined that existing PSAs be kept in place until all regions could fully transition to T-3. The North Region transitioned in April 2011 and the South Region followed in April 2012. The West Region will be the final region to transition under a new contractor on April 1, 2013.
In recognition of the need for beneficiaries to plan for critical health care decisions, PSAs will be continued in all regions until October 1, 2013, to coincide with the deadline for annual TRICARE Prime enrollments and fee adjustments.
What areas are affected?
TRICARE will soon offer a ZIP code lookup tool that will help you find out if you live in an area that is affected. Sign up now to receive e-mail alerts about this topic and to learn when the ZIP code lookup tool becomes available.
What does the Change Mean to Me?
Active Duty Service Members
Active duty service members, including activated National Guard and Reserve members, will not be affected by PSA reductions. They will remain enrolled in TRICARE Prime or TRICARE Prime Remote, as appropriate.
Active Duty Family Members
Active duty family members enrolled in TRICARE Prime in affected PSAs will remain in TRICARE Prime as long as they are in the same location and eligible. As always, active duty family members also have the option of using the highly-rated TRICARE Standard and Extra health Plan option.
Retirees and Dependents
Retirees and their family members enrolled in TRICARE Prime in the affected PSAs may be able to reenroll in TRICARE Prime at a military hospital or clinic or with a primary care manager in a remaining PSA. They must fill out a new TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (DD Form 2876) and sign Section V waiving their drive-time standards. Beneficiaries should be aware that waiving drive-time standards may require them to drive long distances for primary and specialty care. Those who do not reenroll in TRICARE Prime can use TRICARE Standard and Extra, which is consistently rated highly in beneficiary surveys. TRICARE Standard is the basic entitlement by law.
If you are a surviving spouse of a deceased active duty service member, how your coverage may change depends on your survivor status.
The coverage for surviving spouses and children together with their differences can be difficult to understand. Please contact your regional contractor or a Beneficiary Counseling and Assistance Coordinator for help understanding how these changes will affect you.
Beneficiaries Enrolled in the TRICARE Young Adult (TYA)-Prime Option
Young adults whose sponsors are active duty service members will not be affected. Other young adults with TYA Prime in the affected PSAs may be able to waive their drive-time standards and fill out a new TRICARE Young Adult Application (DD Form 2947) to reenroll in TYA Prime at an military hospitals or clinics or with a primary care manager in a remaining PSA. Those who do not reenroll in TYA Prime can purchase coverage under TYA Standard, which is $152 monthly, compared with $176 for TYA Prime.
Affected beneficiaries may also have the option to enroll in the US Family Health Plan, a TRICARE Prime managed care option available through networks of not-for-profit health care systems in six areas of the United States.
Beneficiaries Using Other Plans
Those who already use TRICARE for Life, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Standard and Extra will not be affected.
TRICARE Prime Payment Increase for FY 2013
Effective October 1, 2012, the enrollment fee for TRICARE Prime will increase as displayed below. Beneficiaries will begin receiving notices from Billing and Enrollment toward the end of August, but many will soon learn of the fee increase from other TRICARE Management Activity (TMA) sources. In addition, a notice will appear on Humana-Military.com during the first week in July, and an article will be included in the November Beneficiary Newsletter.
Fee Increase Exceptions
Beneficiaries who had been enrolled prior to October 1, 2011 did not experience an increase for FY 2012. As a consequence, the FY 2013 payment increase will be the first increase for those beneficiaries since the beginning of the TRICARE contract.
Possible Additional Increase for FY 2013
Key Beneficiary Message
TSG's MHS Plenary Video - Injury to Recovery
Update from TRICARE Management Activity:
On September 14, 2011, Science Applications International Corporation (SAIC) reported a data breach involving personally identifiable and protected health information (PII/PHI) impacting an estimated 4.9 million military clinic and hospital patients. The information was contained on backup tapes from an electronic health care record used in the Military Health System (MHS) to capture patient data from 1992 through September 7, 2011, and may include Social Security numbers, addresses and phone numbers, and some personal health data such as clinical notes, laboratory tests and prescriptions. There is no financial data, such as credit card or bank account information, on the backup tapes.
The risk of harm to patients is judged to be low despite the data elements involved since retrieving the data on the tapes would require knowledge of and access to specific hardware and software and knowledge of the system and data structure. Considering the totality of the circumstances, the Assistant Secretary of Defense (Health Affairs) determined that potentially impacted persons or households will be individually notified of this incident by letter. SAIC will begin mailing these letters in early November and it will take approximately three weeks for all letters to be delivered. In the interim, the TRICARE Management Activity (TMA) will continually update this general announcement to keep everyone aware of the situation.
Risk to Patients from Data Breach Met with Proactive Response
A loss of computer tapes by Science Applications International Corporation (SAIC) may have placed TRICARE patient data at risk. There is no evidence that any of the data has actually been accessed by a third party, and analysis shows the chance any data was actually compromised is low, but proactive measures are being taken to ensure that potentially affected patients are kept informed and protected.
SAIC is a contractor for the TRICARE Management Activity. On September 14, TMA learned that an SAIC employee reported that on September 12 computer tapes containing personally identifiable and protected health information (PII/PHI) of 4.9 million military clinic and hospital patients in Texas, or those patients who had laboratory exams sent to the military hospitals in Texas, were stolen. The data contained on the tapes may include names, Social Security numbers, addresses and phone numbers, and some personal health data such as clinical notes, laboratory tests and prescriptions. There is no financial data, such as credit card or bank account information, on the backup tapes.
"We take this incident very seriously," said Brigadier General W. Bryan Gamble, TMA deputy director. "The risk to our patients is low, but the Department of Defense is taking steps to keep affected patients informed and protected."
TMA has directed SAIC to provide one year of credit monitoring and restoration services to patients who express concern about their credit. SAIC will also conduct analysis of all available data to help TMA determine if identity theft occurs due to the data breach.
"These measures exceed the industry standard to protect against the risk of identity theft," Gamble said. "We take very seriously our responsibility to offer patients peace of mind that their credit and quality of life will be unaffected by this breach."
The risk of harm is judged to be low despite the sensitive data involved. Retrieving data from the tapes requires knowledge of and access to specific hardware and software and knowledge of the system and data structure. However, as a standard practice individuals may protect their personal information by taking the steps suggested by the Federal Trade Commission at: http://www.ftc.gov/bcp/edu/pubs/consumer/idtheft/idt04.shtm .
Concerned patients may contact the SAIC Incident Response Call Center, Monday through Friday, 9 a.m. to 6 p.m. Eastern Time, at (855) 366-0140 (toll free) for United States callers and (952) 556-8312 (collect) internationally.