Defense Secretary Donald Rumsfeld in mid-October significantly improved TriCare benefits for the families of reservists activated for the war on terrorism. The changes were seen as a significant factor in a broader effort to ease the sudden, often difficult transition from civilian to military life.
The TriCare Reserve Family Demonstration Project was established to help families of mobilized reservists with waivers of: TriCare Standard's $300 annual deductible; TriCare Standard's maximum allowable charge; and a requirement that families living near a military hospital obtain a non-availability statement before obtaining nonemergency inpatient care from a civilian hospital.
By mid-October, the involuntary call-up for Operation Enduring Freedom already was the largest since 1990 for the Gulf War. The Defense Department had activated more than 28,000 reservists and guardsmen from 140 units across 44 states, the District of Columbia, and Puerto Rico. In that total were more than 12,700 airmen, 9,500 soldiers, 2,700 Coast Guard personnel, 2,400 sailors, and 330 Marines. Up to 55,000 could be called under the limited mobilization order signed by President George Bush after the 11 September mass murders in New York City, Washington, D.C., and Pennsylvania.
Because U.S. military leaders cannot be sure how long combat operations against terrorists will last, mobilization orders were being written to expire in a year. But with luck, most reservists will be deactivated long before those orders expire.
Here is background information on each of the changes to TriCare for families and deployed reservists:
Waiver of TriCare Standard's deductible—Families of reservists activated for longer than 179 days are eligible to enroll in TriCare Prime, the military's managed care program. But Prime might be impractical for many reserve families, considering the uncertainty about length of activation. A better fit would be either: TriCare Standard, a traditional fee-for-service insurance under which families can use physicians of their choice; or TriCare Extra, which offers discounts on copayments if patients use physicians from the TriCare provider network.
Defense officials decided that families of mobilized reservists who use TriCare Standard should not have to pay the $300 deductible before coverage kicks in. After all, many reservists might have paid an annual deductible already on their employers' health plans. "We might be hitting them with a double whammy," said a Reserve official.
Waiver of TriCare Standard's maximum allowable charge—Active-duty families who use Standard must pay 20% copay on their medical costs. Out-of-pocket costs can be higher, however, if the physician does not accept what TriCare sets as the maximum allowable charge for each service provided. In other words, families must cover physician fees that exceed TriCare ceilings.
Defense officials want to reduce that cost risk for families of mobilized reservists by having TriCare Standard pay up to 115% of the TriCare maximum allowable charge. That is, physician fees can exceed TriCare Standard limits by 15% before reservists get stuck with additional costs.
Waiver of the nonavailability statement requirement—Military families living within a 40-mile radius of a base must check with the base hospital before seeking nonemergency inpatient care from a civilian hospital. If care is not available in house, then patients are given a nonavailability statement to file with their TriCare Standard claim. Defense officials want to shelve this requirement for families of mobilized reservists so that, for example, a pregnant spouse does not have to change her obstetrician just because such care is available on base.
The TriCare changes would run through 1 November 2003, officials said. Then they likely would be the basis for a permanent solution to reserve family health care during future national emergencies.
The Uniformed Services Employment and Reemployment Rights Act requires civilian employers to continue to offer medical coverage for up to 18 months to employees called to active duty. But if reservists are gone longer than 30 days, employers can remove their insurance subsidies and force reservists to pay full premium themselves, plus a 2% administrative fee.
Reservists and their civilian employers can get information on rights and obligations during mobilization by calling (800) 336-4590, or by visiting the web site for employer support of the National Guard and Reserve at www.esgr.org/.