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Changes to Prime Service Areas

Posted 1/25/2013   Updated 1/25/2013 Email story   Print story



1/25/2013 - TYNDALL AIR FORCE BASE, Fla. -- Beginning October 1, 2013, TRICARE Prime will no longer be available to beneficiaries living in certain areas. Prime Service Areas (PSAs) -- geographic areas where TRICARE Prime is offered -- are being realigned, and some PSAs are being eliminated as a result. PSAs were created to ensure medical readiness of the active duty force by augmenting the capability and capacity of military hospitals and clinics. The affected PSAs are not close to existing military hospitals or clinics and have never augmented care around military hospitals or clinics or Base Realignment and Closure (BRAC) locations.

If you live in an area affected by the PSA realignment, you will be notified by mail. Your letter will include information about your remaining TRICARE health care options as well as where to get more information. Your TRICARE Prime benefit will remain available through the end of September as long as your enrollment fees are paid, you do not disenroll early or lose eligibility.

Even if TRICARE Prime is no longer available where you live, you will still be able to use the highly-rated TRICARE Standard and Extra <http://www.tricare.mil/Welcome/Plans/TSE.aspx> option. TRICARE Standard and Extra is a convenient option that has no enrollment fees and offers the freedom to see any TRICARE-authorized provider for routine or specialty care. An assigned primary care manager (PCM) is not required, and cost shares for a wide range of preventive medical services have been eliminated. With TRICARE Extra, you choose hospitals and providers within the TRICARE network, where available, and pay a lower cost share.

Why the Change?

The Department of Defense (DoD) has planned to make PSA reductions since 2007, when proposals were requested for the next generation of TRICARE contracts (known as T-3). Bidders for the three U.S. regional contracts were only required to establish PSAs around military hospitals or clinics and in areas that lost military hospitals or clinics due to BRAC decisions.

Although PSA reductions under T-3 were intended to take place simultaneously, contract delays in all three U.S. regions resulted in a staggered transition. DoD senior leadership determined that existing PSAs be kept in place until all regions could fully transition to T-3. The North Region transitioned in April 2011 and the South Region followed in April 2012. The West Region will be the final region to transition under a new contractor on April 1, 2013.

In recognition of the need for beneficiaries to plan for critical health care decisions, PSAs will be continued in all regions until October 1, 2013, to coincide with the deadline for annual TRICARE Prime enrollments and fee adjustments.

What areas are affected?

TRICARE will soon offer a ZIP code lookup tool that will help you find out if you live in an area that is affected. Sign up now to receive e-mail alerts about this topic and to learn when the ZIP code lookup tool becomes available.

<https://public.govdelivery.com/accounts/USMHSTMA/subscriber/topics?qsp=USMHSTMA_1> .

What does the Change Mean to Me?

Active Duty Service Members

Active duty service members, including activated National Guard and Reserve members, will not be affected by PSA reductions. They will remain enrolled in TRICARE Prime or TRICARE Prime Remote, as appropriate.

Active Duty Family Members

Active duty family members enrolled in TRICARE Prime in affected PSAs will remain in TRICARE Prime as long as they are in the same location and eligible. As always, active duty family members also have the option of using the highly-rated TRICARE Standard program.

Retirees and Dependents

Retirees and their family members enrolled in TRICARE Prime in the affected PSAs may be able to reenroll in TRICARE Prime at a military hospital or clinic or with a primary care manager in a remaining PSA. They must fill out a new TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (DD Form 2876) and sign Section V waiving their drive-time standards. Beneficiaries should be aware that waiving drive-time standards may require them to drive long distances for primary and specialty care. Those who do not reenroll in TRICARE Prime can use TRICARE Standard, which is consistently rated high in beneficiary surveys. TRICARE Standard is the basic entitlement by law.

Beneficiaries Enrolled in the TRICARE Young Adult (TYA)-Prime Option

Young adults whose sponsors are active duty service members will not be affected. Other young adults with TYA Prime in the affected PSAs may be able to waive their drive-time standards and fill out a new TRICARE Young Adult Application (DD Form 2947) to reenroll in TYA Prime at a military hospital or clinic or with a primary care manager in a remaining PSA. Those who do not reenroll in TYA Prime can purchase coverage under TYA Standard, which is $152 monthly, compared with $176 for TYA Prime.

Affected beneficiaries may also have the option to enroll in the US Family Health Plan (USFHP), a TRICARE Prime managed care option available through networks of not-for-profit health care systems in six areas of the United States. For more information, visit www.tricare.mil/usfhp.

Beneficiaries Using Other Plans

Those who already use TRICARE for Life, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Standard and Extra will not be affected.

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