Defense

DoD resumes health enrollments after 3 week hiatus

DoD used planned system outage to prepare for transition to new TRICARE contractors, changes to health benefits

Jared Serbu@jserbuWFED

December 27, 2017 7:35 am

2 min read

The Defense Department said Tuesday that it had begun accepting new enrollments into its health care system after a planned computer outage took some of its coverage systems offline for more than three weeks.

The outage, which also kept existing beneficiaries from changing their primary care managers, was planned so that DoD’s TRICARE system could prepare for major changes to its health plans and contractors in 2018.

Officials said they had also started working through a backlog of paper-based applications for coverage and primary care changes that beneficiaries filed during the enrollment “freeze,” which began on Dec. 1. They said those changes would take time to process, and that patients should continue to see their old primary care provider until they were notified that their requests for changes had been approved.

The Defense Health Agency said the lengthy outage was necessary so that DoD could transfer patient data from the three vendors who currently manage the TRICARE system in the continental U.S. to the two – Humana and Health Net – that will take over operations in newly-configured East and West regions beginning on Jan. 1, officials said.

DHA also used the outage to reconfigure its systems for major changes to TRICARE health benefits that will begin affecting military families and retirees in 2018.

Among the changes taking effect at the start of the New Year: New beneficiaries will only be able to apply for coverage during an annual open enrollment period, the same schedule used by the Federal Employee Health Benefits Program.

However, those who already have TRICARE coverage will be automatically enrolled in 2018.

The benefit plans are also changing. DoD’s fee-for-service plans, TRICARE Standard and TRICARE Extra, will be combined into a new one called TRICARE Select. The new plan’s out of pocket fees will be structured so that beneficiaries pay a fixed, per-visit cost based on the type of treatment they’re receiving, rather than a percentage of TRICARE’s negotiated payments to medical providers.

The fee structure for TRICARE’s Prime plan, the managed care option that primarily serves areas with large concentrations of military members, remains largely unchanged, but the rule makes several changes that officials said were designed to improve access to care.

For instance, if TRICARE’s contractors don’t offer an appointment with a managed care provider within a timeframe that meets DoD’s access standards, the patient will be allowed to see an out-of-network provider without paying additional fees.

The department says it will also waive some of its previous requirements that patients get referrals or pre-authorizations before patients visit specialty care providers or urgent care clinics, and treatments for obesity are specifically called out in the rule as covered care.