TRICARE Prime Travel Access Standards Changes

NON-ACTIVE MILIATRY Retired.
As a practical matter, DoD never really enforced TRICARE travel access standards But it will be enforced now. TRICARE has long had established policy to help beneficiaries receive timely health care. The standards require that enrollees shouldn't be assigned a primary care manager (PCM) at a military hospital or clinic that's more than a 30-minute drive from the beneficiary's home address. If they want to continue to be seen in the MTF, current Prime enrollees in the U.S. who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF commander or the TRICARE Regional Office. To learn more, read the following articles on Military.com:

Possible Changes to TRICARE Prime

June 05, 2009

You Could be Bounced from TRICARE Prime

A new DoD policy aimed at "cleaning up" TRICARE Prime enrollment at military treatment facilities (MTF) could mean some significant changes for many Prime enrollees.

TRICARE has long had established travel access standards to help beneficiaries receive timely health care. The standards require that enrollees shouldn't be assigned a primary care manager (PCM) at a military hospital or clinic that's more than a 30-minute drive from the beneficiary's home address.

As a practical matter, DoD never really enforced that policy. But it will be enforced now.

If they want to continue to be seen in the MTF, current Prime enrollees in the U.S. who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF commander or the TRICARE Regional Office. Drive times will be determined by a computer program similar to MapQuest. Approved waivers will have to be renewed annually from now on.

Unless they apply for and are granted a waiver before October 1, enrollees who live more than 30 minutes (but less than 40 miles) from the MTF will be assigned a civilian primary care manager closer to their residence. Absent a waiver, those who live more than 40 miles from the MTF will be disenrolled from Prime and revert to TRICARE Standard as of October 1.
TRICARE contractors are mailing letters to all affected beneficiaries, providing detailed instructions on the waiver process.
MOAA Leigslative Update www.moaa.org.
Possible Changes to TRICARE Prime
Waiving Access Standards for Primary Care

Waiving Access Standards for Primary Care
June 11, 2009

Waiving TRICARE Access Standards for Primary Care
If you are a non-active duty TRICARE benefi ciary using TRICARE Prime, a military treatment facility (MTF) may be your first choice when it comes to where you and your family receive health care. Assignment of a primary care manager (PCM) at an MTF is determined by provider availability and the MTF’s policy for the TRICARE Prime Service Area.
TRICARE has access standards in place to help ensure you receive timely health care. The drive-time access standard states that your PCM should not be located more than 30 minutes’ drive time from your home address. If you are a non-active duty beneficiary in the 50 United States and you live more than 30 minutes’ travel time from the MTF where you want to enroll, you must waive TRICARE’s access standards using one of the following options:
• Enroll through the Benefi ciary Web Enrollment Web site at https://www.dmdc.osd.mil/appj/bwe/, which confirms that you waive your access standards.
• Submit a DD Form 2876 TRICARE Prime Enrollment Application and PCM Change Form and sign Sections V and VI.
Note: A signed waiver is also required when choosing a civilian PCM outside the access standards.
If you live more than 30 minutes but less than 100 miles from the MTF, your waiver request must be approved by the MTF. The MTF must also approve any waivers for those living 100 miles or more from the MTF.
If your waiver is approved, it remains in effect through your current enrollment period, as long as you don’t change your residence. Since an MTF’s provider availability can change over time, the MTF may not always renew your waiver at the end of your enrollment period. If this happens, your regional contractor will notify you at least two months before your enrollment expires. If your request is initially denied or your waiver is not renewed at the end of your enrollment period, you have several other TRICARE options. These include:
• Enrolling at another MTF within your area
• Enrolling with a civilian PCM if you live in or within 100 miles of a TRICARE Prime Service Area
• Enrolling in the US Family Health Plan if you live in an area where it is offered
• Using TRICARE Standard and TRICARE Extra for your health care needs
With several options available to you and your family, TRICARE is working every day to provide you and your family the best access to its world-class health care system.
How do you feel about this action? Contact S. Ward Casscells, Assistant Secretary for Health Affairs and Director of TRICARE Management Activity.