1. Take Command Thank you for having me with you today.
This brief provides an overview of upcoming TRICARE changes that affect your medical benefits.

2. Today’s Agenda
TRICARE is our health care program for uniformed service members and their families around the world.
The vision is for TRICARE to be a world-class health care system that supports the military mission by fostering, protecting, sustaining and restoring health.
The Defense Health Agency, or DHA, is modernizing the Military Health System to better serve our 9.4 million beneficiaries worldwide and respond to changes in law and policy.
On Jan. 1, 2018, there will be several changes to your TRICARE benefit. As a TRICARE beneficiary, you can expect a modernized and easier to understand plan with:
More benefit choices
Improved access to care
Simplified cost-shares, and more
This brief outlines a few of the changes you will notice in 2018 and some recent updates to your TRICARE benefit that have already occurred. Today we will talk through the eight listed on this slide:
Increasing access to care
Benefit updates
Consolidating TRICARE regions
Moving to TRICARE Select
Enrollment changes
National Guard and Reserve Program Options
Health plan costs
Prepare today
Take command of your health care:
TRICARE is changing: Changes are coming to TRICARE beginning Jan. 1, 2018.
This is your benefit: We want to you to be aware of the changes to your TRICARE benefit and connect you to resources to navigate your benefit.
Are you ready?: We will help you know when and how to take action to prepare for the upcoming changes.

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4. Increasing Access to Care
The Defense Health Agency, or DHA, initiated many improvements to improve the focus on patients, starting with better access to care:
Nurse Advice Line: You can talk to a registered nurse 24/7 who can help you determine the right level of care you need for yourself or your child, schedule military hospital or clinic appointments and much more.
Mobile Health/eHealth: Access to care was expanded through online and mobile apps. There are now many ways to engage with a doctor.
Urgent Care: There will be more access to urgent care services without a preauthorization.
One Call Resolution: This planned policy is intended to resolve appointment requests on the first call from the patient. Under this policy, beneficiaries will not be asked to call back for an appointment at military hospitals and clinics. This policy is already in place in Army facilities.
Expanded Hours: We understand the challenges of working families and expanded hours for primary care services to serve beneficiaries, now mandated by Congress. Check with your local military hospital or clinic for options in your area.
Put all of these together, and we have one of the most accessible primary health systems in the country. But, there are more opportunities ahead that DHA is quickly working to modernize health care benefits.
In 2018, you will have even greater access to care. At military hospitals and clinics, this will include:
More appointments available, especially after work or school.
More urgent care clinics opening at facilities with high demand and volume.
Faster specialty care appointing once you get a referral for care.
A streamlined process for getting network referred appointment results.
Also, we will partner with designated network urgent care clinics to provide integrated, seamless access to care.

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6. Expanding Mental Health Benefits
TRICARE expanded mental health and substance use disorder, or SUD, medical benefits by adding intensive outpatient programs and expanding options for opioid treatment.
Improvements in coverage now include:
Increased access to mental health and SUD programs, including opioid treatment programs and office-based opioid treatment
Inpatient, residential and outpatient care for mental health and SUD
Reduced restrictions on the number of treatments for SUD treatment, smoking cessation counseling and outpatient treatment
Lower out-of-pocket costs
In addition to other improvements, this expansion improves access to care and increases opportunities for mental health and SUD treatment. It also makes it easier for beneficiaries to access the right level of care for their health and wellness needs.
Families will pay the same out-of-pocket costs for mental health and SUD services that they pay for medical and surgical care.
The mental health and SUD benefit covers dependent beneficiaries and retirees, but doesn’t apply to active duty service members.
To find a provider, beneficiaries can contact their respective regional contractor or visit
Learn more about mental health and substance use disorder care at
When you have a mental health emergency, call 911 or go to the nearest emergency room. For emergencies overseas, call your TRICARE Overseas Program Regional Call Center and choose option 1 for medical assistance.

7. ESI Automatic Refill Program
With Express Scripts Automatic Refill program, your prescriptions are automatically refilled for you and delivered right to your home.
As of Sept. 1, 2017, Express Scripts requires annual consent from patients who want to receive automatic refills of their medications enrolled in TRICARE Pharmacy Home Delivery.
When the last refill of a medication enrolled in the Auto Refill program ships, Express Scripts will contact you by telephone and/or to know:
If you would like your doctor to be contacted to renew the prescription and
If you would like to continue in the Auto Refill program
Express Scripts will not re-enroll your medication unless they hear from you. You have several ways to respond:
Online at
Via the automated phone call from Express Scripts
By calling an Express Scripts Patient Advocate at
Learn more about this change and what action is required at

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9. TRICARE 2017 (T2017): Two Regions
There are also additional changes in store that will impact how TRICARE is managed and delivered to beneficiaries.
In 2016, the Defense Health Agency, or DHA, awarded new regional contracts. These are known as the T2017 contracts that consolidate the current three regions into two.
Starting Jan. 1, 2018, TRICARE North and South will combine to form TRICARE East, while TRICARE West will remain mostly unchanged.
Humana Military, of Louisville, Kentucky, will manage the East Region contract.
Health Net Federal Services, LLC, of Rancho Cordova, California, will manage the West Region contract.
There will be added improvements in the delivery, quality and cost of your health care from previous contracts.
An example of an improvement is a hip or knee replacement. TRICARE will cover a global fee for up to 30 days post surgery, so hospitals and doctors are incentivized to get you to the right physical therapy, and the right home support services, so you recover more quickly and don’t need to be readmitted.
Such changes will address Congress’ requirement to introduce “value based payments” that means beneficiaries will pay for the outcomes they receive.
The DHA is looking for opportunities to do more around the concept of “value based care” with the patient’s needs in mind first. We want to look at simplifying the rules, and make it easier for patients to connect with their doctors without an appointment. If you have ideas, please share them.
Changes will be minimal for overseas beneficiaries.
To make sure you are prepared for the transition, please visit the TRICARE website at

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11. Moving to TRICARE Select
Starting Jan. 1, 2018, TRICARE Select replaces the TRICARE Standard and TRICARE Extra health plans, and acts as a preferred provider organization, or PPO, style plan.
Most provisions will go into effect on Jan. 1, 2018, with full implementation occurring on Jan. 1, 2019.
Those currently eligible for TRICARE Standard or TRICARE Extra will be converted to the new plan, TRICARE Select.
New active duty family members will be enrolled in TRICARE Prime if their ZIP code is in a Prime Service Area, or PSA. If active duty family members live outside a PSA or overseas, they will be enrolled in TRICARE Select.
Otherwise, beneficiaries eligible for TRICARE Standard or TRICARE Extra will need to select either TRICARE Prime or TRICARE Select to maintain purchased care coverage.
Beneficiaries who change to TRICARE Select will not have a decrease in coverage.
TRICARE Reserve Select, TRICARE Retired Reserve and TRICARE Young Adult plans will continue as is with comparable co-pays to TRICARE Select.

12. TRICARE Select
With TRICARE Select, you can see any TRICARE-authorized provider, but you save money when you use network providers.
Enrollment is required and you must be registered in the Defense Enrollment Eligibility Reporting System, or DEERS.
There is a yearly deductible for TRICARE services and you pay cost-shares for most services.
Referrals are not required for most health care services, but some services require prior authorization from your regional contractor.
Visit for more information and costs.

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14. TRICARE Prime and TRICARE Select Enrollment
Enrollment is required for TRICARE Prime and TRICARE Select coverage.
There are three ways to enroll:
Enroll online through the Beneficiary Web Enrollment website.
Call your regional contractor.
Download a TRICARE Prime or TRICARE Select enrollment form from the TRICARE website or your regional contractor’s website and mail the completed and signed form to your regional contractor.

15. TRICARE Prime and TRICARE Select Enrollment Continued
If you currently have TRICARE coverage, you’ll be automatically converted to your respective TRICARE plan in 2018. 
New active duty service members are automatically enrolled in TRICARE Prime if they live in a Prime Service Area or TRICARE Select if they live outside one. This includes National Guard and Reserve members ordered to active duty service for more than 30 consecutive days.
If you currently have TRICARE Prime or TRICARE Standard and aren’t automatically converted on Jan. 1, 2018, contact the contractor for your region by visiting
Premium-based plan enrollees will remain enrolled in current plan and have Group B cost-shares beginning Jan. 1, 2018.

16. Enrollment Changes
The administration of the TRICARE benefit transitions from a fiscal year (October – September) to a calendar year (January – December).
There will be a transition period for beneficiaries from Oct. 1, 2017 to Dec. 31, During this time:
Enrollment fees will be prorated for the three-month period (Oct. 1, 2017 – Dec. 31, 2017) and billed accordingly for beneficiaries who pay on a monthly or quarterly basis.
Beneficiaries who pay fees on an annual basis will be billed for the fees to cover the three-month period (Oct. 1, 2017 – Dec. 31, 2017) and will receive a billing notice for the annual fee for calendar year 2018.
TRICARE Reserve Select and TRICARE Retired Reserve enrollees need to re-establish their monthly premium payment methods if they’re using an electronic funds transfer or recurring credit card with their new regional contractor.
Beneficiaries may enroll and disenroll in TRICARE health plans at will during the grace period between Jan. 1, 2018 and Dec. 1, 2018.
Beginning Jan. 1, 2019, if beneficiaries choose to switch between TRICARE Prime and TRICARE Select, they must do so during an open enrollment period or within 90 days of a qualifying life event like marriage, divorce, child birth, moving and others.

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18. Status: Pre-Activation (Early Eligibility)/Activation
TRICARE has many programs that enable National Guard and Reserve members and their families to have continuous coverage throughout the TRICARE-eligibility lifecycle.
When active duty orders are received for more than 30 days, sponsors and family members may become eligible for active duty TRICARE benefits. These benefits continue throughout active duty service.
Pre-Activation/Early Eligibility status includes National Guard and Reserve members called or ordered to active service for more than 30 days in support of a contingency operation. Pre-activation service members may be eligible for active duty health and dental benefits (early eligibility) up to 180 days before active duty begins, as shown in DEERS.
National Guard and Reserve members’ health care options include:
TRICARE Prime
TRICARE Prime Remote
TRICARE Prime Overseas
TRICARE Prime Remote Overseas
Enrollment is required.

19. Family Members: Program Options
Family members may have different program options depending on their location.
All active duty family members, or ADFMs, become eligible for TRICARE coverage as soon as they show as eligible in DEERS.
Depending on where they live, ADFMs will be enrolled into TRICARE Prime or TRICARE Select. They will then have 90 days to elect to change their coverage.
TRICARE Prime is available to beneficiaries living in Prime Service Areas, or PSAs, in the U.S. and areas near military hospitals or clinics overseas. If living in a PSA, beneficiaries can enroll in TRICARE Prime.
If you do not live in a PSA, you can enroll in TRICARE Select.
TRICARE Prime Remote for active duty family members is similar to TRICARE Prime, but it’s available to families of activated National Guard and Reserve members living and working in remote locations.
National Guard or Reserve member and family must reside together in a TRICARE Prime Remote ZIP code at the start of early eligibility or at activation, which is earlier.
TRICARE Young Adult, or TYA, is a premium-based health care plan available for purchase by qualified dependents.
TYA offers TRICARE Prime and TRICARE Select coverage for qualified dependents who are at least 21 (or age 23 if previously enrolled in a full-time course of study at an approved institution of higher learning and if the sponsor provided over 50 percent of the financial support), but have not yet reached age 26.
Family members living in certain areas are also eligible for the US Family Health Plan, or USFHP, which is a TRICARE Prime option available in six designated areas across the U.S. TYA coverage may be purchased to extend USFHP benefits to qualified dependents.

20. Status: Deactivated
Deactivated status includes National Guard and Reserve members released from a period of active duty.
Non-activated members of the Selected Reserve may qualify to purchase TRICARE Reserve Select, or TRS, for themselves and their family members.
Retired Reserve members may qualify to purchase TRICARE Retired Reserve, or TRR, for themselves and their family members.
Note: Former spouses and remarried surviving spouses do not qualify to purchase TRS.
TRS and TRR are similar to TRICARE Select (in the U.S.) or the TRICARE Overseas Program Select (overseas).
You will not qualify for TRS or TRR if you are eligible for the Federal Employees Health Benefits, or FEHB, Program based on civilian employment or if enrolled in FEHB through a family member.
Note: Surviving family members who are eligible for or enrolled in FEHB may purchase TRS or TRR.
Note: Contact your Reserve component personnel office with any questions regarding qualifying for TRS or TRR, especially if you or your spouse is a federal employee and may be eligible for FEHB.
Upon reaching age 60 and collecting retirement pay, TRR members will be disenrolled from TRR and will be eligible for other TRICARE programs as a retiree.
TRS and TRR members have the flexibility to go to any TRICARE-authorized provider.
Although referrals aren’t required for most health care services, some services require prior authorization to determine medical necessity.
TRS and TRR members may also get care at military hospitals and clinics on a space-available basis.

21. Status: Deactivated Transitional Assistance Management Program
Once active duty ends, sponsors and family members may become eligible for transitional benefits. Transitional benefits include the Transitional Assistance Management Program, or TAMP, and the Continued Health Care Benefit Program, or CHCBP.
If a National Guard or Reserve member is called or ordered to active service for more than 30 days in support of a contingency operation, they and their family members are eligible for TAMP.
Note: TAMP eligibility is determined by the services, so eligibility questions should be directed to each unit’s personnel.
TAMP provides 180 days of transitional health care benefits beginning the day after separating from active duty to help in the transition to civilian life.
During the TAMP period, service members and their families are all covered as active duty family members. There is no enrollment fee, but cost-shares and copayments apply.
When released from active duty, the sponsor’s status in DEERS changes. If eligible, you may elect to re-enroll in TRICARE Reserve Select, or TRS, TRICARE Select or TRICARE Prime. You have 90 days from last date on active duty to re-enroll in TRS or TRICARE Select. For TRICARE Prime, you can re-enroll any time prior to the expiration of your TAMP period.
Note: TAMP doesn’t cover Line of Duty care.

22. Status: Deactivated Continued Health Care Benefit Program
One active duty ends, sponsors and family members may become eligible for transitional benefits. Transitional benefits include the Transitional Assistance Management Program, or TAMP, and the Continued Health Care Benefit Program, or CHCBP.
If a National Guard or Reserve member doesn’t qualify for TRICARE Reserve Select or TRICARE Retired Reserve at the end of the TAMP period, they may qualify for CHCBP.
Note: CHCBP is not their sole option for health care after loss of TAMP coverage. You may be eligible for other options such as employer sponsored coverage, marketplace coverage, college-sponsored plans or others.
CHCBP is a premium-based health care program that provides 18 to 36 months of transitional health care coverage for service members released from active duty, eligible family members and others.
With CHCBP, the service member can choose to purchase an individual or family plan. CHCBP allows the freedom to choose provides.
You must enroll in CHCBP within 60 days of losing TAMP or other military coverage and make premium payments for continuous coverage.

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24. Health Plan Costs (2018)
Starting on Jan. 1, 2018, costs for TRICARE benefits will be charged by calendar year (January – December) instead of fiscal year (October – September).
You will fall into one of two groups based on the date when you or your sponsor entered the military.
Each group will have different enrollment fees and out-of-pocket costs: 
Group A: If your or your sponsor’s initial enlistment or appointment occurred before Jan. 1, 2018, you are in Group A.
Group B: If your or your sponsor’s initial enlistment or appointment occurs on or after Jan. 1, 2018, you are in Group B.
Effective Jan. 1, 2018, enrollees in premium-based plans, including TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and Continued Health Care Benefit Program have Group B cost-shares, regardless of when the sponsor first joined the military.
You may need to pay an enrollment fee, depending on your plan and when you became eligible for TRICARE.
Some costs will change annually starting on Jan. 1, 2018.

25. TRICARE Select: Costs
The TRICARE Select deductible is waived for National Guard and Reserve family members whose sponsor is called or ordered to active service for more than 30 days in support of a contingency operation.
Note: For the TRICARE Assistance Management Program, Group A and Group B cost-shares apply based on when the sponsor was first enlisted or appointed.
Sponsors and their family members are responsible for copayments.
For the most up-to-date cost information, go to

26. Costs: Active Duty Family Members
If you’re an active duty family member using a TRICARE Prime plan or TRICARE Select plan:
You won’t pay an annual enrollment fee, but you may have to pay cost-shares when you get care outside of the military hospital or clinic.
Regardless of health plan, your family catastrophic cap will be $1,000 each year.
If you use TRICARE Select, you will also have individual and family deductibles.
If you’re in TRICARE Prime and choose to get specialty care without referral or authorization, that is our point-of-service, or POS, option. With POS, you will have to pay the deductible and 50 percent of the cost for your TRICARE covered treatment. Any deductibles or cost-shares for POS don’t count toward your catastrophic cap.
TRICARE costs are subject to change. Special conditions for differing costs may exist.
Go to for the most up-to-date cost information. Additional TRICARE costs are available online.

27. Costs: Active Duty Family Members (1)
TRICARE Select out-of-network cost-shares for outpatient care are 20 percent of the allowed charges.
TRICARE costs are subject to change. Special conditions for differing costs may exist.
Go to for the most up-to-date cost information. Additional TRICARE costs are available online.

28. Costs: Retirees, Family + Other Users
If you’re a retired service member, retiree family member or using any of the premium-based plans:
You may pay an enrollment fee depending on your group and your plan.
You may also have deductibles, copays and cost-shares.
Regardless of health plan, you will be protected by a catastrophic cap.
If you’re in TRICARE Prime and choose to get specialty care without referral or authorization, that is our point-of-service, or POS, option. With POS, you will have to pay the deductible and 50 percent of the cost for your TRICARE covered treatment. Any deductibles or cost-shares for POS don’t count toward your catastrophic cap.
Premium-based plans include:
TRICARE Young Adult
TRICARE Retired Reserve
TRICARE Reserve Select
Continued Health Care Benefit Program
If you have a premium-based plan, you will continue to see your yearly premiums adjusted each year on Jan. 1 the way they have been in the past. These yearly adjustments are required by law, and will be calculated the same way they are today.
Costs won’t change for TRICARE For Life, or TFL. Also, there are no changes in TFL eligibility, benefits, or the requirement to have Medicare Part A and B. 
TRICARE costs are subject to change. Special conditions for differing costs may exist.
Go to for the most up-to-date cost information. Additional TRICARE costs are available online.

29. Costs: Retirees, Family + Other Users (2)
TRICARE Select out-of-network cost-shares for outpatient care are 25 percent of the allowed charges.
TRICARE costs are subject to change. Special conditions for differing costs may exist.
Go to for the most up-to-date cost information. Additional TRICARE costs are available online.

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31. Prepare Today!
To have more control over your health care, prepare for the upcoming changes to TRICARE by taking the following actions:
Update your contact information in the Defense Enrollment Eligibility Reporting System, or DEERS, for you and your family.
Go to
Call (TTY/TDD: ).
Fax updates to
Sign up for eCorrespondence in milConnect to get notifications.
Log in to and update your profile.
Visit the TRICARE website.
Go to
Sign up for alerts about the changes at the link available at