TROA's Benefits information Update for October 2002

[thedrifter]

1. Medicare-Endorsed Prescription Drug Card Does Not Affect TSRx
2. Blood Donor Restrictions Apply To Many Retirees
3. Tricare Fraud/Abuse Suspicion
4. VA News Releases Available via E-mail
5. The Veterans Corporation for Veteran Entrepreneurs
6. Express Scripts to Replace Merck-Medco
7. Applying For Social Security
8. DoD and OPM Announce End of FEHBP Demonstration


1. Medicare-Endorsed Prescription Drug Card Does Not Affect TSRx

The Centers for Medicare & Medicaid Services (CMS) issued the final
regulation for drug discount cards endorsed by Medicare that will help
people who are covered by Medicare buy their prescription drugs at lower
costs and obtain other pharmacy services. The regulation establishing the
Medicare-Endorsed Prescription Drug Card Assistance Initiative was published
in the Federal Register September 4, 2002. CMS expects Medicare-endorsed
discount card programs to begin operating as soon as possible. For more
information contact Medicare at 1-800-MEDICARE (800-633-4227).

The Prescription Drug Card Assistance Initiative is entirely voluntary and
does NOT impact the Tricare Senior Pharmacy Program.

2. Blood Donor Restrictions Apply To Many Retirees

Some military retirees have been surprised to find that they are no longer
eligible to give blood, according to officials at the Armed Forces Blood
Program Office in Falls Church, VA. A substantial number of active-duty and
retired military personnel cannot donate blood because of past duty
assignments in the United Kingdom and Europe.

Officials from the Armed Services Blood Program, which provides blood
products for military hospitals and military readiness purposes, have
increased their efforts to educate retirees about the restrictions, which
were implemented last fall.
In the past few months, many retirees have come forward to donate blood
because of news reports calling for blood donations. However, some retirees
cannot give blood because of standards implemented last fall by the Food and
Drug Administration as a precautionary measure against exposure to the human
form of mad cow disease.

These retirees, as well as some active-duty personnel, cannot donate blood
because of duty assignments in the United Kingdom and Europe. The FDA
restricted donations from people who lived or traveled in these places
during specified timeframes. Department of Defense officials issued a policy
based on that of the FDA, which defers retirees, military personnel and
family members who meet any of the following criteria:

* Traveled or resided in the United Kingdom from 1980 through 1996 for a
cumulative period of three months or more.
* Traveled or resided in Europe from 1980 through 1996 for a cumulative
period of six months or more.
* Traveled or resided in Europe from 1980 to the present for a cumulative
period of five years or more.
* Received a blood transfusion in the United Kingdom since 1980.
* Received a bovine insulin product produced in the United Kingdom since
1980.

ASBPO stressed that retirees who are eligible to donate should continue to
give blood to ensure DOD supplies are met. To find out how you can give
blood through the Armed Services Blood Program, contact your local military
treatment facility.

3. Tricare Fraud/Abuse Suspicion

Nobody wants to knowingly contribute to Tricare fraud or abuse but do by
failing to report it. There are serious penalties for veterans who have
complicity in such activities. If you suspect fraud or abuse you are
required to take action. If something does not seem right about your
medical bills there may be a simple explanation. Perhaps an honest mistake
has happened such as the same item was billed twice, or you've been billed
for services you never received. If something does not seem right here's
what to do:

* Double-check the billings from your provider of care and the Explanation
of Benefits (EOB) you received from your Tricare contractor. Be sure that
the only services listed are ones you actually received.
* If you can't resolve any problems you find by talking to the provider's
billing office notify the program integrity unit of your regional Tricare
contractor. Refer to Bulletin article on Tricare Fraud/Abuse reporting for
how to do this. Explain what you think the problem is, and forward copies
of the EOB and any other relevant documents.
* If you know, or have evidence of, another individual whether it is a
provider of care or a Tricare eligible person submitting fraudulent claims
to Tricare, notify your contractor.
* Although cost-share under Tricare may vary, it's illegal for a provider to
waive those cost shares. You and Tricare are partners in the payment of
your medical expenses. Report to your regional Tricare contractor any
provider who waives your cost-share.

Tricare Fraud/Abuse Detection
The best way to determine if this has occurred in your name is to review the
Explanation of Benefits (EOB) you receive after a claim has been submitted
in your name. Specific clues would be services billed for dates indicated on
which you did not seek medical care and/or if the amount billed is radically
higher than the prevailing charge for similar treatment available elsewhere
in your community.

Some Examples of Fraud
* Submitting claims for services not rendered/used
* Falsified Claims or Medical Records
* Misrepresentation of the dates, frequency, duration, or description of the
services rendered
* Billing for services at a higher level than provided or necessary
* Falsifying eligibility
* Failure to disclose coverage under other health insurance

Some Examples of Abuse
* Pattern of waiving cost share /deductible
* Failure to maintain adequate medical or financial records
* A pattern of claims for services not medically necessary
* Refusal to furnish or allow access to medical records
* Improper billing practices

Ways to Report Fraud & Abuse
Call contractor's "800" number
or write to:
MCS Contractor's Program Integrity Office,
or write to:
TRICARE Management Activity
Attn: Program Integrity
16401 East Centretech Parkway
Aurora, Colorado 80011-9043
Aurora, Colorado 80011-9043
or fax to:
TRICARE Management Activity at fax number: (303) 676-3981

You must have the following information available when reporting fraud or
abuse:
* Who committed the fraud or abuse
* Where the fraud or abuse occurred
* When the fraud or abuse occurred (time frame)
* Detailed description of the fraudulent or abusive activity


4. VA News Releases Available via E-mail

The Department of Veterans Affairs has just implemented a new program that
will allow any interested party to obtain electronic news releases. The VA
will email all of their written products within seconds of their formal
release in Washington, DC. If you are interested, visit
http://www.va.gov/opa/pressrel/opalist_listserv.cfm and provide a name and
e-mail address.

5. The Veterans Corporation for Veteran Entrepreneurs

The Veterans Corporation was established as a business advocacy tool serving
Veterans and Service-Disabled Veterans of the U.S. Armed Forces, Reserve and
National Guard and Transitioning Military Personnel nationwide.

Their mission is to connect veterans who own or wish to own their own
business with the resources to assist them as they make their decision to
start a business, and once made -or if they already own a business- to help
make their business thrive and grow.

Veteran entrepreneurs and those who support veteran entrepreneurs may take a
look around on the site and consider registering yourself or your business
as a partner. It is free and will give you access to the entire web site.
Visit The Veterans Corporation web site at: http://www.veteranscorp.org/

6. Express Scripts to Replace Merck-Medco

The Department of Defense, TRICARE Management Activity (TMA), awarded
Express Scripts Inc. of Maryland Heights, Mo., a contract to provide mail
order pharmacy services for the TRICARE Program. The contract covers a
five-year period and is valued at approximately $275 million over the five
years. The new pharmacy contract will replace the existing National Mail
Order Pharmacy Program beginning on or about March 1, 2003. The program
will then be known as the Tricare Mail Order Pharmacy (TMOP). Please see
the TMA News Release at
http://www.tricare.osd.mil/newsrele...02/news0223.htm for more
information.

7. Applying For Social Security

You can apply for Social Security retirement benefits on the Internet at
http://www.ssa.gov/ the Social Security Administration's (SSA's) Web site.
You'll fill out the online application and send the information
electronically to the agency.

In addition, you must print out a copy of the completed application form,
sign it, and mail it or bring it to the address provided by Social Security.
Along with the signed form, SSA also needs certain documents, such as a
person's birth certificate, to establish eligibility for Social Security
benefits.

You can either mail or take these items to Social Security. The electronic
application will be stored on a database and automatically retrieved when
Social Security receives your signed application. Individuals must meet
certain conditions in order to apply for Social Security online: you must be
at least 61 years and 9 months and plan to start receiving retirement
benefits within four months.

You also can apply for Social Security by making an appointment at a local
Social Security office (look in the government listings of your local phone
book) or by calling 1-800-772-1213.


8. DoD and OPM Announce End of FEHBP Demonstration Project

The Department of Defense (DoD) Federal Employees Health Benefits Program
(FEHBP) Demonstration Project will end Dec. 31, 2002. Beginning Jan. 1,
2003,
FEHBP Demonstration Project beneficiaries will resume health care coverage
with TRICARE.

The FEHBP Demonstration Project was mandated by Congress for three years and
was jointly sponsored by DoD and the Office of Personnel Management. The
demonstration project was implemented on Jan. 1, 2000, and was among several
DoD demonstration projects targeted to improving health care options for
Medicare-eligible beneficiaries. The FEHBP Demonstration Project was
available in 10 demonstration sites within the United States and Puerto
Rico.

TRICARE options for beneficiaries enrolled in the FEHBP demonstration
project will vary according to their beneficiary category. FEHBP
Demonstration Project beneficiaries who are age 65 and over, Medicare
eligible and enrolled in
Medicare Part B may begin to use TRICARE For Life, DoD's wraparound Medicare
coverage, immediately when the demonstration ends.

Beneficiaries who are age 65 and over and Medicare eligible but who are not
enrolled in Medicare Part B may purchase Medicare Part B during a special
enrollment period that will be announced at a later date. This special
enrollment period will allow these beneficiaries to become eligible for
TRICARE For Life benefits on Jan. 1, 2003. A premium surcharge may be
imposed on beneficiaries who declined enrollment in Medicare Part B when
they first became Medicare eligible.

Health care options for beneficiaries who are not Medicare eligible may
include TRICARE Prime, TRICARE Extra and TRICARE Standard. Beneficiaries who
are under age 65 and are Medicare eligible due to a disability or end-stage
renal disease must be enrolled in Medicare Part B in order to be eligible
for TRICARE Prime, TRICARE Extra or TRICARE Standard, and they will receive
DoD's wraparound Medicare coverage, TRICARE For Life.

Under TRICARE Prime, beneficiaries may enroll with a primary care manager at
a military treatment facility (MTF) or within an established network of
civilian providers. Retirees and their families may enroll in TRICARE Prime.
Costs for
TRICARE Prime include annual enrollment fees ($230 per individual or $460
per family) and minimal co-payments for care received in the civilian
network. TRICARE Prime may not be available in all locations.

TRICARE Extra is a preferred provider option that allows beneficiaries the
freedom to choose from any TRICARE network provider. TRICARE Extra providers
agree to accept the TRICARE maximum allowable charge (TMAC) for services
rendered. Beneficiaries are responsible for a 20 percent cost share after
deductibles are met. TRICARE Extra may not be available in all locations.

TRICARE Standard is a fee-for-service option that allows beneficiaries to
choose from any TRICARE-authorized provider. Cost shares are five percent
higher than
TRICARE Extra after deductibles are met. Beneficiaries who use TRICARE
Standard may be responsible for additional charges from the provider (up to
15 percent above the TMAC). Some outpatient procedures and certain
specialized treatments may require beneficiaries to obtain nonavailability
statements from nearby MTFs before using TRICARE Standard.

TRICARE pharmacy benefits also are available. Beneficiaries may have
prescriptions filled at MTF pharmacies free of charge, or for a nominal fee,
prescriptions may be filled through the National Mail Order Pharmacy (NMOP)
or at civilian network and non-network pharmacies.

Beneficiaries are eligible for comprehensive dental benefits under the
TRICARE Retiree Dental Program (TRDP). The TRDP offers diagnostic,
preventive, basic and major restorative services, endodontic and periodontic
services, prosthodontic services, orthodontics, oral surgery, anesthesia,
drugs and post-surgical services, and emergency services. All premiums are
paid by the beneficiary and vary depending on the beneficiary's place of
residence.

TRICARE Management Activity will mail information about the demonstration
project end date and future health care options to beneficiaries of the
FEHBP
Demonstration Project. Beneficiaries also may contact the FEHBP
Demonstration Project Customer Care Center from 9:00 a.m. to 7:30 p.m. EDT
at 1-877-363-3342 (English) or at 1-866-363-3342 (Spanish) or visit the
TRICARE Web site at http://www.tricare.osd.mil/fehbp/ for more information.


Sempers,

Roger