04/03/2013
Remember that the Tricare transition happened yesterday. Here were some details that were shared with the staff.
The following update is provided on the TRICARE West Region contract transition, which includes Minnesota.
BLUF: The TRICARE contract transition from Tri-West to United Health Care (UHC) will take effect 1 April 2013 for D9 (MN), D11, D13, D14, and D17. All systems have been validated for the conversion. There will generally be no change for our beneficiaries on where or how they get their health care as a result of the new contract.
DISCUSSION: In short, most Primary Care Managers (PCMs) serving our beneficiaries will remain in place, and in fact, UHC has done a great job expanding the network in some locations to offer our personnel more choices where TRICARE Prime is offered. In managing the transition, we've identified a few rare instances where a CG beneficiary will have to change providers because their current PCM is not signing up with UHC. CG health benefit coordinators have been working with UHC to find local solutions for those individuals.
Communicating the details of the transition, UHC has sent each beneficiary materials on the potential changes to them as well as updated phone numbers and contact information to assist with any questions. In addition, HSWL Department Heads at Base commands have been socializing and working the details of this transition for the last several months in a variety of forums: PAC meetings, information bulletins, presentations at local events, retiree councils, e-mails to some major commands, etc.
The biggest challenge for UHC and Tri-West as the 1 April deadline approaches is referral management. Inevitably, some referrals will be approved before 1 April but will need to be paid or get executed after the transition (for example urgent care and ER during the weekend of 30-31 March 2013). This is a specific "behind the scenes" task and is not a concern or will result in more work for the beneficiary. We're working closely with DOD, UHC and Tri-West to ensure this remains as seamless as possible to the end user.
Any specific questions personnel may have should be directed to their benefits coordinators at their CG clinic, UHC or the CG Health Benefits line at 1-800-9HBA-HBA. Command level concerns or feedback, as with any other HSWL concerns, can always be directed to the Base or HSWL Service Center.
One Note: This transition should not be confused with the Prime Service Area (PSA) reductions taking place 1 Oct 2013, which was messaged a few weeks ago. UHC is building their PSA network in conjunction with those reductions. As a reminder, as a result of PSA reductions, Active duty members and their eligible family members will remain in TRICARE Prime, regardless of their location with the potential exceptions to geographical bachelors an members on unaccompanied tours. The primary impact to PSA reductions is the retiree community where some may be forced to enroll in TRICARE Standard or drive further to an MTF.
