Happy Fall! Did you know that US Family Health Plan covers the full TRICARE Prime benefit plus some nice extras? Year after year, we're among the most highly rated health plans, military or otherwise, in the country. And there isn't a more affordable TRICARE plan out there. While my focus and Stephanie's focus is on you, the providers and your staff, we can also help your military families decide if US Family Health Plan is the best fit for them. Just share our contact information with your military patients and we'll have one of our local field representatives get in touch with them.
As always, thank you for caring for our uniformed services families!
Sincerely,
Billy Partain, RN
Manager, Provider Relations and Contracting
To avoid duplication of coverage under government-sponsored programs, US Family Health Plan members may not use Medicare for services covered by US Family Health Plan. Providers should only bill US Family Health Plan for those services.
Exceptions
Medicare may be billed for services not covered by US Family Health Plan, such as end-stage renal disease. For members with end-stage renal disease, Medicare should be billed first and then US Family Health Plan.
US Family Health Plan cannot pay any claim that has been billed first to Medicare. Providers must first reimburse Medicare for any payment made and then bill US Family Health Plan.
Except for Medicare supplements, any private insurance should be billed before US Family Health Plan, including federal and state employee insurances.
If you have questions, please contact Stephanie or Billy
.
Effective October 3, 2016, TRICARE will be changing its policy for mental health services to align with medical benefits under mental health parity. There will no longer be arbitrary limits placed on mental-health or substance-abuse admissions for frequency and length of stay Instead, decisions will be made based on medical necessity. Out-of-area and non-emergent admissions may be authorized at the point-of-service level of benefits. Co-pays for outpatient and inpatient mental-health services will align with medical benefits for non-active duty family members. Active duty family members and retirees with Medicare do not have co-pays.
New member ID cards will be issued with the co-pay changes for affected members. Authorization for mental-health benefits beyond the initial eight visits must still be obtained through Tufts Health Plan.
There has also been a change to the benefits for gender -identity disorder. To comply with current medical-necessity guidelines, TRICARE will allow for non-surgical treatment of gender identity disorder. Surgical treatment is not a benefit by statute.
