TRICARE; Notice of TRICARE Prime and TRICARE Select Plan Information for Calendar Year 2018, 673-675 [2018-00018]
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Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices
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[FR Doc. 2018–00010 Filed 1–4–18; 8:45 am]
BILLING CODE 6353–01–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID: DOD–2017–HA–0065]
Proposed Collection; Comment
Request
Office of the Assistant
Secretary of Defense for Health Affairs,
DoD.
ACTION: 60-Day information collection
notice.
AGENCY:
In compliance with the
Paperwork Reduction Act of 1995, the
Office of the Assistant Secretary of
Defense for Health Affairs announces a
proposed public information collection
and seeks public comment on the
provisions thereof. Comments are
invited on: Whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; the accuracy of the
agency’s estimate of the burden of the
proposed information collection; ways
to enhance the quality, utility, and
clarity of the information to be
collected; and ways to minimize the
burden of the information collection on
respondents, including through the use
of automated collection techniques or
other forms of information technology.
DATES: Consideration will be given to all
comments received by March 6, 2018.
ADDRESSES: You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Department of Defense, Office
of the Deputy Chief Management
Officer, Directorate for Oversight and
Compliance, Regulatory and Advisory
Committee Division, 4800 Mark Center
Drive, Mailbox #24, Suite 08D09B,
Alexandria, VA 22350–1700.
Instructions: All submissions received
must include the agency name, docket
daltland on DSKBBV9HB2PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
16:30 Jan 04, 2018
Jkt 244001
number and title for this Federal
Register document. The general policy
for comments and other submissions
from members of the public is to make
these submissions available for public
viewing on the internet at https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
Any associated form(s) for this
collection may be located within this
same electronic docket and downloaded
for review/testing. Follow the
instructions at https://
www.regulations.gov for submitting
comments. Please submit comments on
any given form identified by docket
number, form number, and title.
FOR FURTHER INFORMATION CONTACT: To
request more information on this
proposed information collection or to
obtain a copy of the proposal and
associated collection instruments,
please contact Defense Health Agency,
TRICARE Health Plan (J–10), ATTN:
Mark Ellis, 7700 Arlington Boulevard,
Falls Church, VA 22042, or call the
TRICARE Health Plan, 703–681–0039.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB
Number: TRICARE Select Enrollment,
Disenrollment, and Change Form; DD
Form 3043; OMB Control Number 0720–
0061.
Needs and Uses: The information
collection requirement is necessary to
obtain each non-active duty TRICARE
beneficiary’s personal information
needed to: (1) Complete his/her
enrollment into the TRICARE Select
health plan option, (2) dis-enroll a
beneficiary, or (3) change a beneficiary’s
enrollment information (e.g., address,
add a dependent, report other health
insurance). This information is required
to ensure the beneficiary’s TRICARE
benefits and claims are administered
based on their TRICARE plan of choice.
Without this new enrollment form, each
non-active duty TRICARE beneficiary is
automatically defaulted into direct care,
limiting their health care options to
military hospitals and clinics. These
beneficiaries would have no TRICARE
coverage when using the TRICARE
network of providers for services not
available at their local military hospital
or clinic.
Affected Public: Individuals or
Households.
Annual Burden Hours: 24,825.
Number of Respondents: 99,300.
Responses per Respondent: 1.
Annual Responses: 99,300.
Average Burden per Response: 15
minutes.
Frequency: On occasion.
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673
Respondents could be any non-active
duty TRICARE beneficiary who is not
eligible for Medicare. These
beneficiaries have the option of
enrolling into either the TRICARE Prime
or TRICARE Select plan option starting
January 1, 2018. Those choosing to
enroll in TRICARE Select can do so by
submitting the DD Form 3043, using the
BWE portal, or calling their Regional
Contractor. If they choose to use the DD
Form 3043, they must complete the
appropriate page(s) of the form and mail
the form to their Regional Contractor.
No other form is required to enroll, disenroll, or change an enrollment.
Respondents can download the form
from the DoD Forms Management
Program website, or click on the link to
the form on the TRICARE.mil website or
their Regional Contractor’s website, or
obtain a copy from their local military
hospital or clinic. The mailing address
and toll-free customer service number
for their Regional Contractor are
included on the DD Form 3043. If using
either website option, the respondent
can type in the information on the form
prior to printing it or handwrite the
information after printing the blank
form.
Dated: January 2, 2018.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2018–00007 Filed 1–4–18; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Prime
and TRICARE Select Plan Information
for Calendar Year 2018
Office of the Secretary of
Defense, Department of Defense.
ACTION: TRICARE Prime and TRICARE
Select Plan Information for Calendar
Year 2018.
AGENCY:
This notice provides a notice
of TRICARE Prime and TRICARE Plan
Information for Calendar Year 2018.
DATES: TRICARE health plan
information in this notice is valid for
services during calendar year 2018
(January 1, 2018–December 31, 2018).
ADDRESSES: Defense Health Agency,
TRICARE Health Plan, 7700 Arlington
Boulevard, Suite 5101, Falls Church,
Virginia 22042–5101.
FOR FURTHER INFORMATION CONTACT: Mr.
Mark A. Ellis, (703) 681–0039.
SUPPLEMENTARY INFORMATION: An
interim final rule published in the
SUMMARY:
E:\FR\FM\05JAN1.SGM
05JAN1
674
Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices
Federal Register (FR) on September 29,
2017 (82 FR 45438–45461) established
the requirement for the Director,
Defense Health Agency, to provide a
public notice to TRICARE program
beneficiaries with a summary of changes
to the TRICARE program each calendar
year in connection with the open season
enrollment period.
The following changes or
improvements to the TRICARE program
benefits apply for calendar year 2018:
• On January 1, 2018, TRICARE North
and South regions will combine to form
TRICARE East, while TRICARE West
region will remain mostly unchanged.
Humana Military will administer the
new East region and Health Net Federal
Services will administer the West
region. This change will allow better
coordination between the military
hospitals and clinics and the civilian
health care providers in each region. Go
to https://tricare.mil/About/Changes/
General-TRICARE-Changes/Regions for
more information.
• TRICARE Select will replace
TRICARE Standard and TRICARE Extra
on January 1, 2018. TRICARE Select
brings together the features of TRICARE
Standard and TRICARE Extra in a single
plan. Select enrollees may obtain care
from any TRICARE authorized provider
without a referral or authorization.
Enrollees who obtain services from
TRICARE network providers will pay
lower cost sharing amounts for network
care.
• All current TRICARE beneficiaries
will be automatically enrolled in their
respective plan on January 1, 2018.
TRICARE Prime plan enrollees will
remain in their TRICARE Prime plan.
TRICARE Standard and Extra
beneficiaries will be enrolled in a
TRICARE Select plan.
• Beneficiary out-of-pocket costs: A
detailed break-out of beneficiary out-ofpocket costs for 2018 is shown in
Appendix A. Some out-of-pocket costs
will be announced later in 2018 as we
define certain high-value medications
and health care services that will result
in lower out of pocket expenses for
beneficiaries.
• Improving what’s covered:
Beginning January 1, 2018:
➢ TRICARE Select enrollees may
receive most TRICARE Prime clinical
preventive services with no copayment
when furnished by a network provider.
➢ TRICARE Prime and TRICARE
Select will cover behavioral
interventions for obese adults and
children/adolescents with certain body
mass indexes to promote sustained
weight loss with no cost if furnished by
a network provider.
• TRICARE will cost share on
medically necessary foods and vitamins,
including low protein modified food
and amino acid preparation products for
dietary management of individuals with
limited or impaired capacity to absorb
other nourishment.
• Beneficiaries can choose to enroll in
or change their TRICARE Prime or
TRICARE Select coverage during an
annual open enrollment period in
November-December, 2018 for coverage
beginning on January 1, 2019. For
calendar year 2019, failure to enroll in
TRICARE Prime or TRICARE Select
results in the termination of coverage for
civilian care. These beneficiaries who
choose to not enroll may only receive
care at a military clinic or hospital on
a space available basis.
• 2018 will be a transition year with
a grace period for enrollment. To allow
beneficiaries to adjust to making their
health care option choices during an
annual open season enrollment period
or to remember to elect their coverage
when a qualifying life event (QLE)
occurs, beneficiaries can elect to make
their coverage changes anytime during
2018 to ensure they have the right
coverage in place starting in 2019.
• Referrals for civilian urgent care
visits are no longer needed for most
TRICARE Prime enrollees. Most
TRICARE Prime enrollees can now seek
care at an urgent care center without a
referral. Point of Service charges no
longer applies if seen without a referral.
As a reminder, after seeking urgent care,
it’s always a good idea to contact the
primary care manager and arrange
follow-up care as needed.
➢ However, some exceptions still
apply. Active Duty Service members
(ADSMs) must obtain authorization
before seeking urgent care services from
civilian providers.
➢ Active Duty family members
enrolled to TRICARE Overseas Program
(TOP) Prime/Prime Remote must
contact the TOP contractor to obtain an
authorization in order to ensure their
urgent care visit will be cashless/
claimless. Without this authorization,
overseas providers may request payment
upfront and the beneficiary will then
have to submit a claim for
reimbursement. Additionally, any
ADSM enrolled in TOP Prime/Prime
Remote requiring urgent care while on
temporary duty or on leave status in the
50 United States and the District of
Columbia, may access urgent care
without a referral or an authorization.
• For more information, visit
tricare.mil/changes or call your regional
TRICARE contractor.
Appendix A
See tables below for TRICARE Prime,
TRICARE Select, and TRICARE Pharmacy
out-of-pocket expenses that take effect on
January 1, 2018.
Group A beneficiaries are service members
who enlisted or were appointed in a
Uniformed Service before January 1, 2018
and their family members.
Group B are service members who enlisted
or were appointed in a Uniformed Service on
or after January 1, 2018 and their family
members.
Group B cost shares also apply to enrollees
in the TRICARE Reserve Select, TRICARE
Retired Reserve, TRICARE Young Adult, and
the Continued Health Care Benefit Program
health plans. Monthly premiums apply in
lieu of enrollment fees.
Key:
IN—Network Provider
OON—Out-of-Network Provider
TABLE 1—TRICARE SELECT AND TRICARE PRIME COST SHARING FOR ACTIVE DUTY FAMILY MEMBERS (ADFMS) FOR
CALENDAR YEAR 2018
TRICARE select group A ADFMs
daltland on DSKBBV9HB2PROD with NOTICES
Annual Enrollment ..........................
Annual Deductible ..........................
Annual Catastrophic Cap ...............
Preventive Care Outpatient Visit ....
Primary Care Outpatient Visit .........
Specialty Care Outpatient Visit ......
Emergency Room Visit ...................
Urgent Care Center ........................
Ambulatory Surgery ........................
VerDate Sep<11>2014
16:30 Jan 04, 2018
TRICARE select group B ADFMs
$0 ...................................................
E1–E4: $50/$100 E5 & above:
$150/$300.
$1,000 ............................................
$0 ...................................................
$21 IN 20% OON ...........................
$31 IN 20% OON ...........................
$81 IN 20% OON ...........................
$21 IN 20% OON ...........................
$25 .................................................
$0 ...................................................
E1–E4: $50/$100 E5 & above:
$150/$300.
$1,000 ............................................
$0 ...................................................
$15 IN 20% OON ...........................
$25 IN 20% OON ...........................
$40 IN 20% OON ...........................
$20 IN 20% OON ...........................
$25 IN 20% OON ...........................
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Fmt 4703
Sfmt 4703
E:\FR\FM\05JAN1.SGM
05JAN1
Prime group A
ADFMs
Prime group B
ADFMs
$0
0
$0
0
1,000
0
0
0
0
0
0
1,000
0
0
0
0
0
0
675
Federal Register / Vol. 83, No. 4 / Friday, January 5, 2018 / Notices
TABLE 1—TRICARE SELECT AND TRICARE PRIME COST SHARING FOR ACTIVE DUTY FAMILY MEMBERS (ADFMS) FOR
CALENDAR YEAR 2018—Continued
Prime group A
ADFMs
Prime group B
ADFMs
$15 IN 20% OON ...........................
0
0
10% IN 20% OON .........................
$60/admission IN; 20% OON ........
0
0
0
0
$25/day IN; $50/day OON .............
0
0
TRICARE select group A ADFMs
Ambulance Service (not including
air).
Durable Medical Equipment ...........
Inpatient Hospital Admission ..........
Inpatient Skilled Nursing/Rehab Facility.
TRICARE select group B ADFMs
$74 IN 20% OON ...........................
15% IN 20% OON .........................
$18.60/day, minimum $25/admission.
$18.60/day, minimum $25/admission.
TABLE 2—TRICARE SELECT AND TRICARE PRIME COST SHARING FOR RETIREE FAMILIES FOR CALENDAR YEAR 2018
TRICARE select group A retirees
TRICARE select
group B retirees
TRICARE prime
group A retirees 1
Annual Enrollment .............................
Annual Deductible .............................
$0 ...................................................
$150/$300 ......................................
$289.08/$578.16 ......
0 ...............................
$350/$700
0
Annual Catastrophic Cap ..................
Preventive Care Visit ........................
Primary Care Outpatient Visit ...........
Specialty Care Outpatient Visit .........
Emergency Room Visit .....................
Urgent Care Center Visit ...................
Ambulatory Surgery ..........................
Ambulance Service (not including
air).
Durable Med. Equip. .........................
Inpatient Admission ...........................
$3,000 ............................................
$0 ...................................................
$28 IN 25% OON ...........................
$41 IN 25% OON ...........................
$109 IN 25% OON .........................
$28 IN 25% OON ...........................
20% IN 25% OON .........................
$98 IN 25% OON ...........................
$450/$900 ................
$150/$300 IN $300/
$600 OON.
$3,500 ......................
$0 .............................
$25 IN 25% OON ....
$40 IN 25% OON ....
$80 IN 25% OON ....
$40 IN 25% OON ....
$95 IN 25% OON ....
$60 IN 25% OON ....
3,000 ........................
0 ...............................
20 .............................
30 .............................
60 .............................
30 .............................
60 .............................
40 .............................
3,500
0
20
30
60
30
60
40
20% IN 25% OON ...
$175/admission IN
25% OON.
20% .........................
150/admission .........
20%
150/admission
$50/day IN Lesser of
$300/day or 20%
OON.
30/day ......................
30/day
Inpatient Skilled Nursing/Rehab Admission.
20% IN 25% OON .........................
$250/day up to 25% hosp. charge
+ 20% separately billed services
IN $901/day up to 25% hosp.
charge + 25% separately billed
services OON.
$250/day up to 25% hospital
charge + 20% separately billed
services IN 25% OON.
TRICARE prime
group B retirees
1 TRICARE Prime enrollees who are (1) survivors of active duty deceased sponsors, or (2) medically retired Uniformed Services members and
their family members, have their TRICARE Prime enrollment fees frozen at the rate in effect when classified and enrolled in a fee paying Prime
plan. (This does not include TRICARE Young Adult (TYA) plans).
TABLE 3—PHARMACY COPAYMENTS FOR CALENDAR YEAR 2018
Year
Copayment
amount for a
30-day supply
of a retail
generic is:
Copayment
amount for a
30-day supply
of a retail
formulary is:
Copayment
amount for a
90-day supply
of a mail order
generic is:
Copayment
amount for a
90-day supply
of a mail order
formulary is:
Copayment
amount for a
90-day supply
of a mail order
non-formulary
is:
2018 .....................................................................................
$11
$28
$7
$24
$53
Note: Pharmacy copayment amounts for (1) survivors of active duty deceased sponsors, or (2) medically retired Uniformed Services members
and their family members are equal to the copayment amounts, if any, for 2017.
Dated: January 2, 2018.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2018–00018 Filed 1–4–18; 8:45 am]
DEPARTMENT OF DEFENSE
Office of the Secretary
Charter Renewal of Department of
Defense Federal Advisory Committees
daltland on DSKBBV9HB2PROD with NOTICES
BILLING CODE 5001–06–P
AGENCY:
Department of Defense.
Renewal of Federal Advisory
Committee.
ACTION:
The Department of Defense
(DoD) is publishing this notice to
announce that it is renewing the charter
SUMMARY:
VerDate Sep<11>2014
16:30 Jan 04, 2018
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for the Secretary of the Navy Advisory
Panel (‘‘the Panel’’).
FOR FURTHER INFORMATION CONTACT: Jim
Freeman, Advisory Committee
Management Officer for the Department
of Defense, 703–692–5952.
SUPPLEMENTARY INFORMATION: This
committee’s charter is being renewed in
accordance with the Federal Advisory
Committee Act (FACA) of 1972 (5
U.S.C., Appendix, as amended) and 41
CFR 102–3.50(d). The charter and
contact information for the Panel’s
Designated Federal Officer (DFO) can be
E:\FR\FM\05JAN1.SGM
05JAN1
Agencies
[Federal Register Volume 83, Number 4 (Friday, January 5, 2018)]
[Notices]
[Pages 673-675]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-00018]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Prime and TRICARE Select Plan
Information for Calendar Year 2018
AGENCY: Office of the Secretary of Defense, Department of Defense.
ACTION: TRICARE Prime and TRICARE Select Plan Information for Calendar
Year 2018.
-----------------------------------------------------------------------
SUMMARY: This notice provides a notice of TRICARE Prime and TRICARE
Plan Information for Calendar Year 2018.
DATES: TRICARE health plan information in this notice is valid for
services during calendar year 2018 (January 1, 2018-December 31, 2018).
ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Mr. Mark A. Ellis, (703) 681-0039.
SUPPLEMENTARY INFORMATION: An interim final rule published in the
[[Page 674]]
Federal Register (FR) on September 29, 2017 (82 FR 45438-45461)
established the requirement for the Director, Defense Health Agency, to
provide a public notice to TRICARE program beneficiaries with a summary
of changes to the TRICARE program each calendar year in connection with
the open season enrollment period.
The following changes or improvements to the TRICARE program
benefits apply for calendar year 2018:
On January 1, 2018, TRICARE North and South regions will
combine to form TRICARE East, while TRICARE West region will remain
mostly unchanged. Humana Military will administer the new East region
and Health Net Federal Services will administer the West region. This
change will allow better coordination between the military hospitals
and clinics and the civilian health care providers in each region. Go
to https://tricare.mil/About/Changes/General-TRICARE-Changes/Regions
for more information.
TRICARE Select will replace TRICARE Standard and TRICARE
Extra on January 1, 2018. TRICARE Select brings together the features
of TRICARE Standard and TRICARE Extra in a single plan. Select
enrollees may obtain care from any TRICARE authorized provider without
a referral or authorization. Enrollees who obtain services from TRICARE
network providers will pay lower cost sharing amounts for network care.
All current TRICARE beneficiaries will be automatically
enrolled in their respective plan on January 1, 2018. TRICARE Prime
plan enrollees will remain in their TRICARE Prime plan. TRICARE
Standard and Extra beneficiaries will be enrolled in a TRICARE Select
plan.
Beneficiary out-of-pocket costs: A detailed break-out of
beneficiary out-of-pocket costs for 2018 is shown in Appendix A. Some
out-of-pocket costs will be announced later in 2018 as we define
certain high-value medications and health care services that will
result in lower out of pocket expenses for beneficiaries.
Improving what's covered: Beginning January 1, 2018:
[rtarr8] TRICARE Select enrollees may receive most TRICARE Prime
clinical preventive services with no copayment when furnished by a
network provider.
[rtarr8] TRICARE Prime and TRICARE Select will cover behavioral
interventions for obese adults and children/adolescents with certain
body mass indexes to promote sustained weight loss with no cost if
furnished by a network provider.
TRICARE will cost share on medically necessary foods and
vitamins, including low protein modified food and amino acid
preparation products for dietary management of individuals with limited
or impaired capacity to absorb other nourishment.
Beneficiaries can choose to enroll in or change their
TRICARE Prime or TRICARE Select coverage during an annual open
enrollment period in November-December, 2018 for coverage beginning on
January 1, 2019. For calendar year 2019, failure to enroll in TRICARE
Prime or TRICARE Select results in the termination of coverage for
civilian care. These beneficiaries who choose to not enroll may only
receive care at a military clinic or hospital on a space available
basis.
2018 will be a transition year with a grace period for
enrollment. To allow beneficiaries to adjust to making their health
care option choices during an annual open season enrollment period or
to remember to elect their coverage when a qualifying life event (QLE)
occurs, beneficiaries can elect to make their coverage changes anytime
during 2018 to ensure they have the right coverage in place starting in
2019.
Referrals for civilian urgent care visits are no longer
needed for most TRICARE Prime enrollees. Most TRICARE Prime enrollees
can now seek care at an urgent care center without a referral. Point of
Service charges no longer applies if seen without a referral. As a
reminder, after seeking urgent care, it's always a good idea to contact
the primary care manager and arrange follow-up care as needed.
[rtarr8] However, some exceptions still apply. Active Duty Service
members (ADSMs) must obtain authorization before seeking urgent care
services from civilian providers.
[rtarr8] Active Duty family members enrolled to TRICARE Overseas
Program (TOP) Prime/Prime Remote must contact the TOP contractor to
obtain an authorization in order to ensure their urgent care visit will
be cashless/claimless. Without this authorization, overseas providers
may request payment upfront and the beneficiary will then have to
submit a claim for reimbursement. Additionally, any ADSM enrolled in
TOP Prime/Prime Remote requiring urgent care while on temporary duty or
on leave status in the 50 United States and the District of Columbia,
may access urgent care without a referral or an authorization.
For more information, visit tricare.mil/changes or call
your regional TRICARE contractor.
Appendix A
See tables below for TRICARE Prime, TRICARE Select, and TRICARE
Pharmacy out-of-pocket expenses that take effect on January 1, 2018.
Group A beneficiaries are service members who enlisted or were
appointed in a Uniformed Service before January 1, 2018 and their
family members.
Group B are service members who enlisted or were appointed in a
Uniformed Service on or after January 1, 2018 and their family
members.
Group B cost shares also apply to enrollees in the TRICARE
Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and
the Continued Health Care Benefit Program health plans. Monthly
premiums apply in lieu of enrollment fees.
Key:
IN--Network Provider
OON--Out-of-Network Provider
Table 1--TRICARE Select and TRICARE Prime Cost Sharing for Active Duty Family Members (ADFMs) for Calendar Year
2018
----------------------------------------------------------------------------------------------------------------
TRICARE select group A TRICARE select group B Prime group A Prime group B
ADFMs ADFMs ADFMs ADFMs
----------------------------------------------------------------------------------------------------------------
Annual Enrollment.............. $0..................... $0.................... $0 $0
Annual Deductible.............. E1-E4: $50/$100 E5 & E1-E4: $50/$100 E5 & 0 0
above: $150/$300. above: $150/$300.
Annual Catastrophic Cap........ $1,000................. $1,000................ 1,000 1,000
Preventive Care Outpatient $0..................... $0.................... 0 0
Visit.
Primary Care Outpatient Visit.. $21 IN 20% OON......... $15 IN 20% OON........ 0 0
Specialty Care Outpatient Visit $31 IN 20% OON......... $25 IN 20% OON........ 0 0
Emergency Room Visit........... $81 IN 20% OON......... $40 IN 20% OON........ 0 0
Urgent Care Center............. $21 IN 20% OON......... $20 IN 20% OON........ 0 0
Ambulatory Surgery............. $25.................... $25 IN 20% OON........ 0 0
[[Page 675]]
Ambulance Service (not $74 IN 20% OON......... $15 IN 20% OON........ 0 0
including air).
Durable Medical Equipment...... 15% IN 20% OON......... 10% IN 20% OON........ 0 0
Inpatient Hospital Admission... $18.60/day, minimum $25/ $60/admission IN; 20% 0 0
admission. OON.
Inpatient Skilled Nursing/Rehab $18.60/day, minimum $25/ $25/day IN; $50/day 0 0
Facility. admission. OON.
----------------------------------------------------------------------------------------------------------------
Table 2--TRICARE Select and TRICARE Prime Cost Sharing for Retiree Families for Calendar Year 2018
----------------------------------------------------------------------------------------------------------------
TRICARE prime
TRICARE select group A TRICARE select group A retirees TRICARE prime
retirees group B retirees \1\ group B retirees
----------------------------------------------------------------------------------------------------------------
Annual Enrollment.............. $0.................... $450/$900........ $289.08/$578.16.. $350/$700
Annual Deductible.............. $150/$300............. $150/$300 IN $300/ 0................ 0
$600 OON.
Annual Catastrophic Cap........ $3,000................ $3,500........... 3,000............ 3,500
Preventive Care Visit.......... $0.................... $0............... 0................ 0
Primary Care Outpatient Visit.. $28 IN 25% OON........ $25 IN 25% OON... 20............... 20
Specialty Care Outpatient Visit $41 IN 25% OON........ $40 IN 25% OON... 30............... 30
Emergency Room Visit........... $109 IN 25% OON....... $80 IN 25% OON... 60............... 60
Urgent Care Center Visit....... $28 IN 25% OON........ $40 IN 25% OON... 30............... 30
Ambulatory Surgery............. 20% IN 25% OON........ $95 IN 25% OON... 60............... 60
Ambulance Service (not $98 IN 25% OON........ $60 IN 25% OON... 40............... 40
including air).
Durable Med. Equip............. 20% IN 25% OON........ 20% IN 25% OON... 20%.............. 20%
Inpatient Admission............ $250/day up to 25% $175/admission IN 150/admission.... 150/admission
hosp. charge + 20% 25% OON.
separately billed
services IN $901/day
up to 25% hosp.
charge + 25%
separately billed
services OON.
Inpatient Skilled Nursing/Rehab $250/day up to 25% $50/day IN Lesser 30/day........... 30/day
Admission. hospital charge + 20% of $300/day or
separately billed 20% OON.
services IN 25% OON.
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\1\ TRICARE Prime enrollees who are (1) survivors of active duty deceased sponsors, or (2) medically retired
Uniformed Services members and their family members, have their TRICARE Prime enrollment fees frozen at the
rate in effect when classified and enrolled in a fee paying Prime plan. (This does not include TRICARE Young
Adult (TYA) plans).
Table 3--Pharmacy Copayments for Calendar Year 2018
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Copayment Copayment Copayment Copayment Copayment
amount for a 30- amount for a 30- amount for a 90- amount for a 90- amount for a 90-
Year day supply of a day supply of a day supply of a day supply of a day supply of a
retail generic retail mail order mail order mail order non-
is: formulary is: generic is: formulary is: formulary is:
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2018............................................................... $11 $28 $7 $24 $53
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Note: Pharmacy copayment amounts for (1) survivors of active duty deceased sponsors, or (2) medically retired Uniformed Services members and their
family members are equal to the copayment amounts, if any, for 2017.
Dated: January 2, 2018.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2018-00018 Filed 1-4-18; 8:45 am]
BILLING CODE 5001-06-P