Medical care in the Armed Forces is currently in transistion between two systems: CHAMPUS (the old system) and TRICARE (the new HMO type system). Which system will cover you and your family depends on where you are stationed and you personal preferences in healthcare.

ACTIVE DUTY MILITARY PESONELL

All militatry memebers receive free medical benefits. These benefits are accessed by using on base "sick call", on base branch medical services, and using your military identification card at any and all hospitals (generally reserved for emegencies or situations requiring immediate medical attention while you are on leave away from you command).

DEPENDENTS OF ACTIVE DUTY MILITARY PERSONELL

All military dependents listed on the military member's "page 2", (this is part of your spouse's service record that alerts his chain of command and your insurance system that the member is married and/or has children) are elligible for healthcare benenfits. The first step toward assuring yourself of these benefits is to enroll in the DEERS system. This is the computer listing that allows you to receive your dependent's identification card and all health care benefits. It is extremely important that you are enrolled in DEERS and check your status in the DEERS system regularly (the system has been known to mysteriously lose member records and dependent records for no explained reason). To check your status in the DEERS system contact your local TRICARE office, or dail 1(800)333-5331 and have your spouse's Social Security Number handy, this is how you are found in the DEERS system.

The second step in securing your healthcare benefits is to obtain a dependent ID card (this card is not needed for dependents under 10 years of age). To obtain this document first find and call your local PSD (Personell Support Detachment), then take copies of your spouse's "Page 2", marriage certificate, Social Security Number and your Social Security Card to their office. There you should be given the appropriate paper work to fill out and they will take your picture and issue you an ID card. A word of caution regarding PSD: in my expireince, it is best to try to obtain services through this office between the hours of 8a.m. and 3 p.m.,it has been my expirience that this service opens late and closes early. This ID card secures health benefits on the TRICARE Standard and CHAMPUS systems

After obtaining this ID Card, your choices in healthcare will depend on where you are stationed. For example, as of May 1998, the New England area is still in the process of converting from CHAMPUS to TRICARE; therefore all benefits are handled under the CHAMPUS system. In Charleston,S.C., on the other hand, the conversion to TRICARE is complete therefore offering more choices to the member families stationed there.

CHAMPUS, the older government health care system is a model of freedom in healthcare benefits. Using your dependent ID you can see any doctor that will file your claims. There is no approved physicians' list or certain hospital that you must use. Under this system, the patient pays 20% of all medical treatment, including but not limited to doctor visits, medications, hosptial stays and emergency room visits. The insurance will pay 80% of the allowed amount of the treatment cost.

Under TRICARE, the new HMO type healthcare system member families can chose between three different levels of care: Standard, Extra, and Prime.

Standard: using this option there is no enrollment, no approved physicians list, and very little else to limit your healthcare options. As in the old CHAMPUS system the patient pays 20% of all medical treatment, while the insurasnce pays 80% of the allowed amount, afterthe member family meets a $100 family/ $50 individual deductible. When asked for an insurance card or group number present you dependent ID.

Extra: using this option makes the medical care a little more complicated, but with less out of pocket expense to both the patient and the insurance company. In this option there is no enrollment, however there are approved physicians and hospitals. These healthcare professionals work with the insurance company based on a discounted rate for services and therefore save everyone a little cash. To use this option use must use an approve physician and/or hospital. To find approved physiacians and hospitals in your area call the TRICARE Health Care Finder at 1 (800) 333-4040. Under this option the patient pays 15% of doctor's office services, lab work , X-rays, outpaitient mental health, routine gynecological visits, ER visits and medically necessary ambulance service,after meeting the $100 family/$50 individual deductible. Some costs may vary with the allowable amount. Hospital stays are covered at $25 per day. When asked for an insurance card or group number present you dependent ID.

Prime: by far the most complicated of the three options, also the least costly to the member family. Using this option ALL(this includes dependent under 10 years of age)dependents MUST enroll and choose a primary care physician (usually a family or general practioner or pediatrician) from the approved physicians list. The patient MUST see this doctor and receive a referal before going to any specialist or other physician. For example: if you believe or even if you know that you are pregnant, before TRICARE Prime will cover you, you must see your primary care physician for a test and he will refer you to an approved OB/GYN. Cost shares to the Prime family are as follows:

$6: doctor's office services, labwork, mediaclly necessary home health care,and family health services(immunizations, well-baby care)

$0: routine PAP smears and periodic physical exams

$10/occurence: medically necessary ambulance and Emergency room visits.

$5: per precription drug up to 90 supply (also available at no charge if abotained at a military treatment facility

$25minimum and $11 per day:hospitalization, maternity, and skilled nursing faciltiy care (all include semi-private room, general nusring and hospital services.

To enroll in TRICARE Prime call the Health Care information Line at 1(800)333-5331. They should mail you the appropriate forms for enrollment. Allow 4to 6 weeks for the enrollment to process. If you have not received you TRICARE Prime insurance card 7 to 10 after this period call the TBIS line 1(800)444-5445. they should have your card(s) to you withing 10 days, if not, call them back and continue to do so until you receive this very important ID.

All of this information is available through your local TRICARE office and in the brochures that will be provided to you. It is my recomendation that you listen to your representive and read all information that is sent to you very carefully. This includes all EOB document mailed after you have received a medical service. The EOB (Explanation of Benefits) is marked with a highly visible "THIS IS NOT A BILL" statement, although very comforting in the beginning, if you do not carefully examine its contents, you could very well receive your doctor's bill in the mail next. The portion of the EOB that is of greatest signifcance to you is the "amount paid to provider" section. This will tell you how much of the claim TRICARE/CHAMPUS has paid. Do not be alarmed if the "amount allowed" and the "amount paid to provider" sections differ. The doctors in both CHAMPUS and TRICARE systems see these patients based on a discounted service rate. You SHOULD NOT recieve a bill for the balance of services. Any bills received should be for the amount of you respective cost shares (20%,15%, or $6). If you do receive such bill contact your local TRICARE representive immediately (this may require a trip to the office), or call ther Beneficiary Information Services Line at 1(800)444-5445.

This information is all completely true to the best of my knowledge. If you have any questions, contact the national TRICARE SERVICES LINE : 1(800)333-5331 and good luck to you.