TRICARE starts its first healthcare open season next week

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Next week, the 4.6 million TRICARE beneficiaries are going to undergo their first open season.

From Nov. 12 to Dec. 10, people who use TRICARE will have some important decisions to make as the government adopts an insurance model familiar to those who work in the private sector or as federal civilian employees.

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During the open season period, TRICARE beneficiaries will pick between two plans: TRICARE Prime and Select. They will also be able to change their enrollment type from single to family. If beneficiaries do not want to make a change, then their insurance will stay the same.

Previously, “if you wanted to switch between plans, you could do that,” Patrick Grady, chief of the TRICARE health plan told reporters Monday. “But then you were locked out for 12 months. You could not go back and forth between plans for obvious reasons. What this open season does now, it syncs us with the way industry has done this.”

In addition to healthcare, dental and vision care for TRICARE retiree beneficiaries will be transferred to the Federal Employees Dental and Vision Insurance Program (FEDVIP). Retirees will be able to choose from 10 different dental carriers and four vision carriers. Signing up for vision and dental is a completely separate open season and not through the TRICARE system.

Defense Health Agency Director Vice Adm. Raquel Bono said the new TRICARE open season is all about choice.

We want to “give our patients the opportunity to select the plan that best works for them,” Bono said. “Some of our folks, depending on where they are or what family members they are covering — if they have children in school or young kids at home — may find certain benefits to being part of TRICARE Prime program or moving to TRICARE Select.”

TRICARE Prime offers a lower cost, but fewer options for providers. TRICARE Select, on the other hand, can be more expensive, but offers more providers and patients do not need referrals.

With all of the changes TRICARE beneficiaries are facing, DHA is preparing for questions from its customers — particularly from those who will be transitioning into FEDVIP for the first time. Those questions will be fielded by BENEFEDS, the vision and dental plan administrator.

Laurie Bodenheimer, deputy director of healthcare and insurance for the Office of Personnel Management said Federal Benefit Enrollment call centers have a good idea of the volume of calls to expect.

“We’ve done a lot of modeling for call patterns using this expanded population,” Bodenheimer said. “Things start out for the first few days of open season being fairly busy, then there is a lull around Thanksgiving, where people are otherwise occupied. Things start to perk up again after the Thanksgiving holiday, with the final day of open season on Monday, Dec. 10 being unbelievably busy.”

Federal Benefits Enrollment plans to have a peak of 1,400 customer service representatives in 11 locations across all time zones to help service beneficiaries’ questions.

“They also have a plan B in case that turns out not to be enough because of demand and we will ramp up more representatives as the need arises,” Bodenheimer said. “They are monitoring this very carefully and they’ve got more than one plan … We cannot promise a 30 second wait time. If you wait until the last day, then you wait. You call will be answered as long as you are in the queue before midnight Eastern time.”

Read more of the DoD Personnel Notebook.