TRICARE Program Options for Maternity and Newborn Care Coverage Webinar / HealthChoice

00:00

welcome to today's webinar titled TRICARE program options for maternity and newborn care coverage we are thrilled to have with us today Miss Ilan Greene misalign Green is chief of the medical benefits and reimbursement division at the defense health agency the medical benefits and reimbursement division develops for Kelly responsible and state of the science healthcare policy for TRICARE through identifying researching and formulating medical

00:31

benefit coverage and reimbursement systems without further delay I will turn things over to miss Ellen green hi good morning Thank You Stan first of all I want to say thank you to everybody listening in today and participating in this webinar it is truly a privilege and an honor to serve you so moving forward today we're going to be talking about TRICARE program options for maternity and newborn care and as Stan mentioned my name's Alan Greene so I'll move on to

01:02

the second slide I have to revisit this disclaimer for everybody so the appearance of hyperlinks does not constitute endorsement by the Department of Defense of this website or the information product or services contained therein for other than authorized activities such as military exchanges in Morale Welfare and Recreation sites the Department of Defense did not exercise any editorial control over the information you may find at these locations such links are provided consistent with the stated purpose of this Department of Defense

01:34

sponsored webinar I will move on to slide 3 this is our agenda we'll talk about who is covered what services are covered what is not covered who the providers can be from maternity care how to get maternity care your options for delivery and special considerations to think about when when your child is born or adopted overseas how to get coverage for your child we'll talk about what's available for newborn and well baby care

02:07

and then give you some additional resources and then finally we'll have questions and answers those and mentioned that you can put those in through the portal if I'm not able to answer them today I believe and correct me if I'm wrong I believe that we can take them back and we'll answer them later yep so okay great so I will move on to slide number four who is covered so TRICARE covers expectant mothers who are active duty service members retired

02:39

service members National Guard and Reserve members or their eligible family members you must be registered in the defense enrollment eligibility reporting system or deers and have a uniformed services ID card you must take action to enroll in a tricare prime option or TRICARE select option within 90 days of eligibility or you'll only be eligible for care at military hospitals and clinics so that's very important you need to enroll in one of those options

03:09

within nine ninety days of obtaining eligibility so continuing on who is covered on slide five for 2018 you may continue to enroll in or make changes at any time based on your eligibility and for 2019 coverage we're having some changes so this is also important to remember you'll be only be able to enroll in or change your enrollment during the fall 2018 open season or following a qualifying life

03:41

event or qle and some examples of those getting married having a baby or adopting a baby or becoming Medicare eligible or losing other health coverage so those would be times outside of the fall open season enrollment period in which you could enroll or make changes to your health plan so moving on to slide number six what services are covered so TRICARE

04:11

covers medically necessary maternity care TRICARE provides a robust maternity care benefit and includes everything from the point at which you find out you're pregnant to part of a newborn care so things that are covered include obstetric visits throughout your pregnancy fetal ultrasound when they're medically necessary hospitalizations for labor delivery and postpartum care as well as hospitalization that you may need during maternity anesthesia for

04:43

pain management including things like epidurals for labor and delivery TRICARE covers cesarean sections when medically necessary TRICARE also covers the management of high-risk or complicated pregnancies and the services required for those further TRICARE covers deliveries at TRICARE authorized Hospital we also cover deliveries at freestanding or Hospital based birthing centers and then also we

05:16

will under some circumstances cover deliveries that are done as completed at home and then following birth TRICARE covers breast pumps breast pump supplies and breastfeeding or lactation counseling services moving on to slide 7 talking about the services that are not covered so medically ultrasounds that are not medically necessary you know sometimes

05:47

you see those offering to reveal a baby's gender or give pictures those are not covered because they're not medically necessary services and supplies related to non caudal reproductive procedures are not covered under the regular TRICARE program for example artificial insemination is a non covered service however the pregnancy and birth following those sorts of procedures would be covered TRICARE does

06:18

not cover the management of uterine contractions when it's done with drugs that are really not approved for that use TRICARE doesn't cover home uterine activity modern monitoring and related services sometimes those items are sold online from you know home heartbeat monitoring and things like that that's not generally medically necessary necessary and would therefore not be covered TRICARE doesn't cover private hospital rooms unproven procedures are also not

06:51

covered and unproven means that it is not proven to be safe and effective for the treatment of a specific condition and then TRICARE also doesn't cover umbilical cords collection and silica cord blood or a vocal cord collection and storage except for those patients who undergo a covered umbilical cord blood transplant and then moving on to slide eight there special considerations for overseas location so for example international

07:26

SOS government services or IFOS which is the TRICARE overseas program contractor will not authorize medical care that doesn't meet internationally recognized and accepted standards so if you're overseas it is a good idea to check with and stay in close contact with IFOS regarding your maternity care some move on to slide number nine and we'll start talking about who can provide maternity care so TRICARE only covers care that is provided by TRICARE authorized providers

07:59

and there's that has a specific meaning it's a specific list of providers that TRICARE considers to be authorized to provide medical care so this includes but isn't limited to an obstetrician or gynecologists certified nurse midwives family medicine physicians general practitioners or primary care managers and you can visit this website that there's a hyperlink try caramell slash find a provider and you can find a full list of TRICARE authorized providers so

08:32

it's important to note that TRICARE does not cover midwives unless they're nurse midwives so that would include lay midwives certified professional midwives or certified certified midwives those midwives are not covered and so again to reiterate certified nurse midwives are covered but other types of midwives are not TRICARE does also does not cover non-medical support during labor and childbirth and that would be for

09:01

instance the doula or a labor coach so there's nothing there's TRICARE does not cover services provided by those individuals I'll move on to slide number 10 how to get care under TRICARE Prime so under TRICARE prime you would go to your primary care manager and you have priority access to care at military hospitals and clinics referrals are required and prior authorization is required for active duty service members

09:33

and their family there are no costs for care under TRICARE Prime and then there are minimal costs for retired service members and their families and there's a hyperlink for more information and cost charts below there's also another hyperlink TRICARE mil slash cost and will give you a detailed break out of what your out-of-pocket costs may be from maternity care so I'll move on to slide number 11 this is how to get care

10:04

if you're in Tricare Prime remote or DPR so if you have an assigned primary care manager or PCM your PCM will direct your care otherwise you may go to a network provider with prior authorization from your regional contractor and then as I mentioned earlier active-duty servicemembers and their family do not have any costs for maternity care under TRICARE prime or Tricare Prime remote all others have co-payments and there's a hyperlink again where you can go and find those co-payments you can also go

10:35

to TRICARE dot mil flush cot to find those so I will move on to slide number 10 this is TRICARE select it's the newest TRICARE option offered in 2018 and so under TRICARE select you may see any TRICARE authorized provider for maternity care so those are your obstetricians and certified nurse-midwives primary care provider those folks and so generally a network provider cost you less out of pocket and

11:07

the provider will file the claims for you if you choose to see a non-network provider as long as they're TRICARE authorized benefits will be extended however the care will cost you more out-of-pocket and you may have to file your own claim referrals are not required for most services however prior authorization may be required for certain services and the deductible must be met before cost shares apply so I will move on to slide number 13 we'll talk a little bit about maternity

11:42

care under the TRICARE overseas program so the TRICARE overseas program or top for those enrolled in prime you would get care from your primary care manager or PCM at a military hospital or clinic and if you're not located near a military hospital or clinic or care is otherwise unavailable your PCM will give you a referral to a TRICARE authorized gazillion provider in your overseas area under to track the TRICARE overseas

12:12

program remote option you would need to coordinate care with your top regional call center and then there's a hyperlink below that directs you to more information about getting care overseas on the next slide slide 14 if you are top select you may seek care from almost any TRICARE authorized provider without a referral and again active-duty service members and family and their family members with overseas prime options

12:44

either top prime or top Prime remote have no cost from eternity care top Prime and top Prime remote a BFMs may use the point of service option to self refer to obstetrician however higher out-of-pocket cost would apply and so moving on to slide 15 some of the other TRICARE program we'll talk about TRICARE young adult TRICARE reserve select and TRICARE retired reserve so under TRICARE young adult or tya your

13:16

maternity care is covered but the newborn care would not be covered you need to follow the rules of a plan that you have either tri caring an adult prime or TRICARE young adult select and then there's a hyperlink here for more information about TRICARE young adult and the cost associated with that program under TRICARE reserve select and TRICARE retired reserve these are premium based TRICARE program options qualified sponsors may purchase coverage for themselves and/or their family members and the plans are similar to

13:48

TRICARE select or TRICARE overseas select and there are some hyperlinks here for more information about those programs in their class and we will move on to slide 16 delivery option so where you deliver is dependent on your TRICARE Plus plan your cost may vary depending on where your delivery occurs such as in a military hospital or click a civilian hospital a TRICARE certified birthing center Hospital based outpatient birthing room professional

14:22

office birthing suite or in the home which is important to note is not covered overseeing so as you can see TRICARE offers a wide variety for delivery options for whatever works best for you and your family so on slide 17 we'll talk a little bit about what happens after your child is born so overseas I'm sorry so we're talking specifically now for when your child is born or adopted overseas so

14:53

first you would register your child in the defense enrollment eligibility reporting system or deers you would need to contact the nearest US Embassy or consulate to get a social security number for your child I'm sorry you would need to contact your Embassy or consulate and then get a social security number for your child family members are automatically enrolled in TRICARE overseas program select and dependents of retirees must elect to enroll within 120 days of birth or adoption so moving on to slide 18 we'll talk

15:32

about getting coverage for your child and this is not just overseas but anywhere so all biological and adopted children of active duty service members National Guard and Reserve members and retirees are eligible for TRICARE you need to register your child in the earth right away you must enroll in deers for TRICARE coverage you don't need a social security number to register your child in deers once you have one update years with that number so it can take a few weeks to get

16:02

a Social Security number there's no need to wait until you get the Social Security card to register your child you can register your child without that and then update years later then you'll need to choose a TRICARE program and enroll your child and there's a hyperlink down here that on the slide that says that has more information about how to get care for your child and enrollment information so I'll move on to slide 19

16:34

we're going to talk a little bit about coverage and enrollment so as mentioned all new born and adopted children must be registered in deers and it must be done within 90 days state time or 120 days overseas stateside children of active duty service members or a DSM's are automatically enrolled in tricare prime if they're registered in deers and they live in a stateside prime

17:04

service area or BSA if you don't live in a PSA your child will be automatically enrolled in TRICARE select overseas children of active duty service members are automatically enrolled and top select if they're registered in deers and retirees both stateside and overseas must take action to enroll their child in a TRICARE plan so I think that's important to highlight again if you're a retiree and planning to have a baby or adopt a baby

17:36

you must take an action to ensure your child health moving on to slide 20 we'll continue talking about tricare prime and select coverage once children of active duty service members are registered in deers and are automatically enrolled in TRICARE plan you can change your child's of coverage to another TRICARE plan within 90 days and that's both stateside and overseas so to restate ads once your

18:08

child is registered in deers if you want to make a change to their plan you may do so within 90 days starting in 2019 after the allotted time period which is 90 days you must wait until another qualifying life event or open season to change your child's coverage and you can learn more about qualifying life events at TRICARE dot mil slash life events if your child isn't enrolled in deers by name day 90 or by day 120 if they're overseas they'll only be able to receive care at a military hospital or clinic on

18:40

a space available basis your child will not show with TRICARE eligible and treichel will not pay on any claim starting when the child is 91 days old stateside or 121 days old overseas so I think to reiterate that just please make sure that your child is enrolled in deers so we'll move on to slide 21 TRICARE reserve select and TRICARE retired reserve coverage so to ensure TRICARE reserve blessed or

19:14

TRS or try to retire Reserve or TR our coverage for your child you must register your child in Deer and enroll in TRS or TR our family coverage and submit the Reserve Component health coverage request form which is DD form to eight nine six - one two your regional contractor within 90 days or two your top regional call center within 120 days if you're overseas you may be

19:45

required to pay for care up front until your child is covered by TRS or TRR if your child is covered within 90 days or 120 days of what if if you're overseas your claims will be paid retroactively Li you must purchase TRS or TR are for your child to be covered so if you are TRS or TR are it's very important to take all of these actions within the establish timeframes 90 days or 120 days to make sure that your child have coverage

20:15

so I will move on to slide 22 we'll talk a little bit about what's covered under tricare's newborn and well baby care benefits so TRICARE covers newborn well baby and well child care for TRICARE beneficiaries from birth until age 6 and covered services include circumcision routine newborn care health promotion and disease prevention exams vision and hearing screenings heat height weight

20:47

and head circumference measurements routine vaccines and developmental and behavioral assessment in addition to this preventive care TRICARE also would of course cover any sort of medically necessary care for those children I will move on to slide 23 and this is a listing of TRICARE resources as well as contact information for your managed care support contractor just to highlight that the contractors changed

21:18

in January so there are new contractors in their regions there's only two now Humana military in the East and Health Net federal services in the West on the left side of this slide are hyperlinks to various publications and brochures with more information on maternity care on slide the slide 24 we have more contact information for your overseas regional contractors and call center and so these are the folks that will help

21:49

you out if you are located overseas and so that concludes the presentation I'm happy to take questions at this time so I think you can submit them through the portal to Stan yep questions have started to come in let's see here the first question we will start with okay says I have a couple of questions I know that one

22:25

vision exam is covered a year being that vision can change during pregnancy are we allowed another exam when expecting I'll just go through and just read the two questions if there's only two that was the first question I'm currently enrolled in prime but will be temporarily moving to Maui for a few months where there are no prime options how would coverage work then for doctor's visits ER visit better if

22:56

switched over to select for my for myself and my kids would I be able to switch back over to prime once we are back at a location that has prime options okay so I'll answer the question on vision and then I'll defer eligibility enrollment question for the customer service so on vision yes as you mentioned there is one exam covered per year that's not there are no changes made for pregnancy however if you have

23:26

an injury or some sort of disease you know that would be covered as medically necessary care and so I'll turn over the other question of customer service because I believe it's an association hello this is Francine for Estill and I work in customer service and for that moving between a prime location and the select and back to prime in order for you to get coverage as a qualifying life event to be able to change your enrollment each time you move you're going to first need to update your address in deers to the new location and

23:59

as soon as you do that you can call the regional contractor let's say if you're stateside now and you're going overseas after you update your address in deers you then have none days to notify the overseas contractor that you are in that location and that you are select you might not live in a prime service area or don't qualify for Tricare Prime remote overseas then when you come back stateside let's say and you want to be Prime again you have to do the same thing make sure you update

24:29

your address in deers to show that you are in a prime location and within the 90 days of putting your address in deers you need to call that regional contractor and let them know then now you have want to enroll in Prime again there is no guarantee that you would get if you're like let's say if you move back to that same location that you were Prime before there is no guarantee however that you would get the same primary care manager that you had before you left so update address in deers because that starts the 90-day clock

25:00

ticking and then within 90 days you can go ahead and transfer that if you are a retiree you would need to make sure that you make the payments back to the date of that move the date that you put your family in deers to show that you moved that's all thank you okay thank you the next question reads will TRICARE cover I UD replacement after delivery or immediately postpartum when a beneficiary delivers in a military or

25:32

civilian hospital so yes TRICARE covers IUD as well as a broad range of other family planning services there aren't any limitations right now on TRICARE policy about when that can happen so as long as it's medically appropriate to do TRICARE would cover those sorts of family planning services okay the next question reads patients are calling into TRICARE and they are being told that if

26:05

they have TRICARE select they won't pay anything for their maternity care and that their service shouldn't be applied to their deductible or cost share but for this webinar that is incorrect so cost sharing of course depends on your beneficiary category as well as the plan that you're in so activities for example active service members who are prime pay nothing for their covered services however if you're under TRICARE

26:39

select you would have depending on your category you would have of course enrollment fees and annual deductibles as well as cost shares and I'm looking at my cost share right now so for instance if you have an inpatient delivery all of your maternity care is included in your inpatient delivery cost share and say you're a Group B with TRICARE select retiree it would be a

27:10

hundred and seventy-five dollars for all of that maternity care so and and I can I don't know miss for Estelle do you have any other information on that but I would say you know at the cost years really truly depends on your beneficiary plan or your beneficiary category and your health plan correct the plan and the category the individual makes a difference as to any types of cluster I agree wholeheartedly mm-hmm okay

27:40

I hope that answers that question all right thank you the next question reads where can I find the guidance that states home home childbirth is not covered overseas sorry I have to come off mute so overseas home burns are not covered because the physician oversight of the Midwife care can't be established and I'm looking for that let's see I'm looking for the policy reference now so

28:19

midwives overseas need to meet the requirements listed in the criteria annual which is in chapter 11 section 3 point 12 and then that section also specifically excludes lay Midwife who is neither a certified nurse midwife nor a registered nurse and then if that doesn't answer that question we can follow up later okay thank you

28:49

the next question reads what is the referral process for a home birth what will TRICARE cover are there different rules for active duty so I checked with our services on this one so the referral process shouldn't be any different compared to other health care services for active duty active duty service members and then for everybody home delivery when performed by a TRICARE

29:21

network or non-network provider including a certified nurse midwife would be covered so on home deliveries you know you still have to have a TRICARE authorized provider so it couldn't be a lay midwife but a certified nurse nurse midwives may perform a home delivery the referral process would follow the normal referral processes depending on your TRICARE plan and then in terms of what TRICARE covers it would be the same services that were outlined you know your regular routine

29:53

prenatal visits and then the delivery the delivery itself so I hope that answers that question Stan this is Calvin Keller also with customer service and Ilan let me add to that when it comes to home birds for active duty and by active duty family members especially if you are trying to have a home birth on a military installation regardless of whether you have a referral from your primary care manager it is at the discretion of the

30:31

base commander whether they will authorize you to have a home birth on-base so please also keep that in mind that just because you have a referral does not mean that that the base will authorize you to do home birth thank you Thank You Calvin the next question reads slide 22 is a bit misleading I read that coverage for children changes the day they turn age 6 to

31:04

clinical preventive care let me go to slide so I have slide 22 on the screen if you wanted to answer that question the screen um so yes so new board and well baby or well childcare is so are those services that are provided from beneficiaries from birth until age six and they're listed below and then after age six TRICARE continues to cover

31:40

preventive care services although it's under a separate policy provision and those would include you know things like health promotion and disease prevention examinations well women examinations and then other clinical preventive services so it's correct that you know TRICARE at age six TRICARE begins covering a different set of services and then these well baby and well child services are are only available for children under

32:12

age or until age they're okay thank you the next question reads do you cover childbirth classes or aunt or breastfeeding classes so TRICARE does not cover educational services are not medically necessary so that would include childbirth classes or breastfeeding or lactation classes however lactation counseling breastfeeding counseling provided by a

32:45

TRICARE authorized provider is covered and any sort of guidance that's given during prenatal that would be included with TRICARE what TRICARE would pay for the overall maternity episode but no we'll have our separate standalone classes okay the next question redo we call the TRICARE regional contractor regarding a referral for an in-network provider would just

33:14

talk to our provider so Francine I may defer to you on this one in general it's a good idea to touch base with your managed care support contractor but I'm not sure if there are any special rules that this individual should be aware of so typically if you're Prime and enrolled to a primary care manager you really should be seeking those services from that PCM should write the referral for you to go ahead and be treated outside now be aware that MTF don't have

33:48

to release you if they have pregnancy care services available within that military treatment facility so be aware of that and as was pointed out in the slide if you are Tricare Prime remote as long as you are using a TRICARE authorized provider to deliver your services that would be great but oftentimes in Tricare Prime remote locations you are a find a primary care provider that again should probably put in that referral once you are established with a TRICARE authorized

34:21

network provider then they can if there's any additional services that you need related to that pregnancy they can go ahead and do that as long as it is a covered service and it is a network provider you don't have to go back to your PCM but if you choose to use a non authorized imeem a non-network provider then at that point it's always advisable to go back to your primary care manager just for oversight of what that non-network provider is offering because they aren't always aware of what all the

34:53

tricare prime rules are and like let's say if they wanted to do an ultrasound because you want to know the sex of your baby they may do that but TRICARE wouldn't pay for that and that provider wouldn't be held accountable for that the beneficiary would be held accountable for the cost for that so I was try to get to a network provider whenever possible if you have an assigned PCM get a referral for pregnancy care from your PCM that's all okay thank you

35:26

the next question reads which drugs are not are not approved for uterine contractions on their reference slide seven sure if you'll give me one moment and I'm also putting this screen to slide 7 so that all can see you you you and I'm sorry I'm not finding the specific drug right now in the policy manual however I be happy to follow up

36:20

later okay thank you the next question reads so what cost should we charge TRICARE select global OB patients on their first visit we don't have to charge them for copay for each of their OB visits so that's correct there aren't separate co-payments or cost shares for each distinct OB visit and instead pasta is dependent on the

36:54

planned site of delivery so for most folks at the hospital and so the overall cost share would be based on the TRICARE cost share for inpatient hospitalizations and that amount depends on the beneficiary category and the health plan and then for birthing centers freestanding birthing centers the cost share again there's not distinct cost years for each visit instead it's based on the ambulatory surgery center cost share which again

37:26

depends on the beneficiary category and plan and then finally for home deliveries same thing there's only one cost share applied and it's based on the outpatient visit cost shares and so you can find more information detailed break outs of all of these cost years at TRICARE dot mil slash cost but to reiterate there's not separate cost shares for every single visit that happens in a veteran of the episode and instead it's based on the anticipated or

37:58

plan delivery site okay thank you next question reads for breast pump and supplies what kind of coverage is needed and also what kind of prescription should I have also how much of breast pump supplies is covered and for how long sure so TRICARE covers a breast pump and associated supplies following a what's called a birth event

38:31

and that could include either adoption or a childbirth event and I am pulling up more details on the breast pump right now so in general TRICARE covers one standard breast pump or I apologize I'm looking down one manual or one standard electric breast pump

39:02

may be covered per birth event and then TRICARE also covers the supplies that are necessary to operate the breast pump like a power adapter tubing adapters bottle caps and storage bags and other items when they're necessary for up to 36 months post the birth event and TRICARE in order to be covered a prescription is required from a TRICARE authorized physician physician assistant nurse practitioner or nurse midwife and

39:33

the prescription must indicate the type of breast pump prescribed in our manual or standard Electric and then if you need a hospital grade breast pump and these are these are different than the standard ones that you might purchase or see at Target so these are specialized heavy duty hospital grade breast pumps that can be used by multiple people with specialized kids those are covered by TRICARE for mothers of premature infants

40:04

and so they're covered when the premature infant for instance is in the NICU and then they may be covered after the infinite discharged when a physician documents the medical reason there's a medical reason for continued use of the heavy duty hospital grade breast pump so hopefully that answers that question TRICARE as I mentioned also covers Brett's breastfeeding and lactation counseling when provided by a TRICARE

40:36

authorized provider and then TRICARE covers necessary replacement supplies and things like milk bags okay next question at what point can we submit for reimbursement for a breast pump can it be before the birth or does it have to be after the birth I'm sorry I had to come off here so yes it's yeah it's a good to note that you may currently go out and

41:12

purchase a breast pump and submit a claim for reimbursement on I am looking through the policy on on when the birth event begins let's see and there's currently not a limitation on when that needs to be done however you would need to comply with the rules for submitting and appropriately improperly complete a

41:47

claim form with a copy of the prescription and an itemized receipt and hopefully that answers that question are there Francine do you have anything else on the breast pump so I think you pretty much covered it again it isn't limited to after you have the baby but when your provider fills out the prescription ask that they put the diagnostic code that you are pregnant we recommend that you may use a network DME provider again because they'll understand the rules a little bit better

42:17

but you aren't limited by that and as she indicated if you're going to file your own claim send in a copy of the prescription and a copy of the receipt you can't take these up in your AC you know your centers on your installation you can go online and purchase them but you're gonna make sure you keep a copy at home as well keep the original and submit copies then for reimbursement exactly thank you okay next question

42:48

Risa TRICARE covers maternity at a hundred percent but TRICARE select is maternity covered at 80% so I assume this question is about cost and so it depends on again your beneficiary category so for instance active duty service pregnant active-duty servicemembers or a pregnant active-duty family member would pay nothing for

43:18

covered services however if you are prime retiree you may have cautious similarly for TRICARE select depends on Kashar depends on if your group a or Group B or if your active duty or retiree and it also depends for both options if you see an in-network or out-of-network provider so you know it's not that if you're select that you're going to pay 20% of

43:51

that's that would only apply in very specific situations perhaps where you go out-of-network so again I encourage folks to go and look at TRICARE dot mil flash cost and you can see a detailed break out by health plan and beneficiary category to identify the cost years that may apply in your specific situation and this is Francine if you do go into TRICARE dot mil slash costs and then you put down whether you're an active duty family member or retiree there is a chart there and they do have now

44:24

maternity care listed and so for instance right now maternity office care for a group a at the MTF is 1860 per day because you are getting subsistence you're getting your meals in your laundry done network that's eighteen sixty per day and then network eighteen sixty per day groobie network at sixty dollars and non network is 20% so strickley's to say that select is 80/20 is not necessarily the case if a group B beneficiary who means the sponsor came

44:56

on active service after 1 January it would be a sixty dollar cost so look under those tables in order to figure out where you fit and then what your cost would actually be okay thank you the next question raised on with a provider's office do we need to notify TRICARE when a patient comes in pregnant and obtained and authorization so in general the first pregnancy visit and francium please correct me if I have

45:32

this wrong the first pregnancy visit is usually submitted on a claim by a provider's office and then I think notification referrals and that kind of thing are really determined by the beneficiaries health plan and so if for instance if you have a tricare prime individual who is seeing you as an out-of-network provider the rules are different than if there are TRICARE select beneficiary franciene maybe you can weigh in on that

46:03

provide a little more detail I again I you know it's it's the type of plan and what your beneficiary category is but as she indicates oftentimes that first visit is really for the purpose of establishing your pregnancy and then if you're a network provider and you do determine that this beneficiary is pregnant and you're going to continue care our suggestion would be at that particular time if they show up as a tricare prime enrollee then you advise that beneficiary to if and if your network then you could submit a referral

46:36

to go ahead and see that individual however I mean that's the way it works now it used to be you always had to send them back to their prime their primary care manager but now if you are a network select provider and you've determined they're pregnant and you're going to continue to serve them during their pregnancy then what you need to do is you go ahead and submit a referral to your regional contractor for them to approve or deny that referral now in some locations it may be that if that

47:08

MTF has the capability and capacity they may pull that beneficiary back into the military treatment facility for the purpose of those providers of being able to do maintain their licensure and continue to get the experience that they need for that as well so be aware that that may happen as a provider and and also let me add this is Calvin agrees keep in mind now with the new changes that are going to be taking effect especially with the open season enrollment is that if you're prime and

47:40

you say well I want to disenroll from prime and do select during my pregnancy you will be locked out of time until you are you are a lock you are only eligible for direct care after you disenroll until either the next open season or that qualifying life event meaning your child is born so please note that and please take off to that and the other thing I would advise if there's any other providers on

48:10

the call since enrollment will be required for TRICARE services in the future somebody may be eligible but that does not necessarily mean they're enrolled so if you have any questions make sure you go online confirm their that they are actually enrolled in prime or select or if they show a direct care only meaning they can you only get care at military you know hospitals or clinics you're gonna have to tell them at that point that you can no longer see them that's all I have okay thank you

48:42

next question will TRICARE consider a newborn as prime for those first 90 days as long as one family member is prime and resides in a PSA so this is a line I'm scrolling back up [Music] Francine I can jump it on yellow thank you okay yeah as long as one other family member is enrolled in Prime they will go ahead and treat that first 90 days stateside 120 days overseas they

49:15

will process claims as long as that claim got submitted under the proper sponsors SSN but that 1908 is strictly for claims processing you still need to take action to enroll in prime or select a lot of people that census while these claims are paying and they are so you don't think you have a problem but day 91 day 121 when the claims coverage ends then you're gonna have problems so as soon as you have that baby make sure you're trying to get them enrolled in

49:46

deers as soon as possible registered in deers and as soon as they're in deers call the regional contractor to get them enrolled perfect and then I think the steps are outlined in slides 18 19 and 20 on the specific steps that need to be need to take place you okay thank you next question our belly support bands or tops being covered to help relieve some back discomfort that

50:18

can occur with pregnancy postpartum tops or bands being covered post baby so items that are prescribed and that are considered durable medical equipment may be covered they would need to be medically necessary and then generally provided by a TRICARE authorized provider and so sometimes there are abrasives and things like that that maybe if they are considered

50:50

durable medical equipment and prescribed by a TRICARE authorized provider may be covered you know there's there's I can't emphasize the medically necessary part enough it's not that these things would automatically be covered or you would be reimbursed for them potentially if you were to buy them off the shelf it needs to be something that is prescribed by a medical provider in that it also may at Strykers definition of durable medical equipment okay let's see here next question reads

51:29

how our hospital days counted is it overnight or a 24-hour period if you're if you're at a cut-off point and stay an additional night is it covered so TRICARE would cover a stay as long as it was medically necessary so if there are complications you know that for which additional stay would be required that would be covered so the mother and

52:06

child Hospital length of stay is not less than 48 hours following a normal vaginal delivery in 96 hours following the cesarean section you the physician may choose to discharge earlier in consultation with a mother but there aren't any restrictions less than that and then for inpatient stays longer than that they would be covered so long as they were medically necessary for both

52:37

mother and baby in terms of how the Perry earth at that time is established I believe it's a midnight rule but I would need to check and follow up on that okay next question is there a link that we can view to see the different benefit plans and what their cost shares would be for maternity coverage uh so I think this is a LAN I think TRICARE dot

53:08

mil slash cost it's a great website and then Francine I'm sure there's one in the resources section but is there a quick hyperlink for the overview of each plan not at this particular point in time again because the beneficiary categories whether they're Group a group B active-duty versus retiree starting with the cost page is really the best and then identify what type of beneficiary category you are in at this point there isn't a separate maternity cost table

53:43

okay next question I did a survey I found the answer to that question about the drug its subcutaneous terbutaline as a subcutaneous terbutaline pump and home use of maintenance subcutaneous terbutaline to suppress labor so that's the item that was not covered okay next question reads can ad SMS deliver at home in the US or use a birthing center so both after do

54:21

servicemembers and active duty family members may utilize birthing centers as long as they met the TRICARE there's a list of requirements that need to be met in order for a birthing center to be considered TRICARE authorized but yes those options are available provided within your health plan you follow the appropriate rules for the health plan whether it be using in network providers referrals and that sort of thing Francine anything else to add on that one

54:52

no she is right in the fact that oftentimes they have to be participating providers and they have to have an agreement with a hospital so that if something would occur that they have already access to those types of services so yes you can't just go out and do it you really do need to make sure that you are using the appropriate type of TRICARE provider for those types of birth okay the next question how do we find our PCM so I believe that these are assigned to

55:29

you but I'll defer to Francine on that since I think it's a referral question right basically to find your PCM there's a couple of different ways of doing for your own convenience if you get a DS logon account you can go into the mill connect website I'm not sure if that's one of the resource websites or not but you can always look online there you can go in through the beneficiary web enrollment tool and you can also just call the regional contractor those are the three ways that you can confirm who

56:01

your PCM is and if you are enrolled to an MTF mr. Keller pointed out if you use the TRICARE online to make like your appointments at that particular point in time that would also identify who your primary care manager is as well that's all I have okay and since we are on the top of the hour I'm going to just read one more question and the question reads what kind of document do you need to provide proof that the breast pump

56:37

supplies are medically necessary if I'm breastfeeding for a year so the contractors can establish their rules about what's required for replacement supplies there isn't specific mention in the president policy about what specifically is required but in general you would need to have a prescription specifying it's at a minimum the type of

57:08

pump that's needed so either that standard or electric pump and then beyond that your contractor may have some additional requirements or documentation request and so I suggest that you would touch base with them when you file your claim okay that concludes our question-and-answer session so I would like to thank mr. green for sharing her valuable experience and expertise along with the customer service group Francine and Calvin I would also like to thank

57:42

our attendees for participating in today's webinar and if you find yourself having questions after the webinar is over or if we were unable to answer your question today please contact your regional contractor also many of the answers to questions related to TRICARE benefit can be found on the TRICARE website at WWE this concludes today's webinar on TRICARE program options for maternity

58:12

and newborn care coverage thank you all for attending and have a great day

TRICARE Program Options for Maternity and Newborn Care Coverage Webinar

Table of Contents

More in Lectorium

SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE