1. Welcome to the Land of Smiles! U.S. military retirees and their dependents residing in      Thailand are entitled to TRICARE Standard (under 65 years of age) or TRICARE for  Life (TFL) (age 65 and older).  TRICARE is a U.S. Dept. of Defense-managed Health  Care Program.

2. TRICARE “Enrollment” is not required for TRICARE Standard or TFL-it’s automatic and there’s no enrollment fee. However, there is a common misperception that TRICARE  Prime is not available in Thailand.  Prime is not available overseas to Retirees and their family members. If you’re beneficiary residing in Thailand you must ensure you are not enrolled in TRICARE prime. Prime is further discussed in paragraph 5. Lastly, there are no Military Treatment Facilities in Thailand.

3. TRICARE Standard overseas is similar to the stateside program, including cost-shares and deductibles.  Retirees and their family members who reside overseas are not eligible to  enroll in TRICARE Prime and are covered only by TRICARE Standard.  Standard is a fee  for service option.  Enrollment is required, and you may receive care from any qualified host nation provider without a referral.  Although beneficiaries are not generally required to  have a referral for specialty care, some procedures may require prior authorization. Moreover, beneficiaries are responsible for annual deductibles and cost-shares, and are normally required to pay for care “up front” then file a claim with Wisconsin Physicians Service (WPS).

4. TRICARE for Life. TRICARE for Life overseas is available for TRICARE beneficiaries who are entitled to Medicare Part A and enrolled in Medicare Part B due to age, disability or end-stage renal.  Eligible beneficiaries, who are receiving health care overseas, can take advantage of TFL. Since Medicare does not provide benefits for medical care received overseas, TRICARE is the primary source of health benefits.  TFL provides the same coverage as TRICARE Standard, with the same cost-shares and deductibles as retirees and their family members.Information on Medicare Part B, please visit : http://www.ssa.gov/mediinfo.htm/.

5. beneficiaries Visiting Thailand.  Beneficiaries (even TRICARE Prime) visiting Thailand (i.e. not residing here) must pay “up front” for any non-emergency medical care received then file a claim with their TRICARE regional contractor Thailand medical providers do not submit TRICARE Prime (or any other) claim for retirees.  We’ll discuss claims more in Paragraph 8. Also, we sometimes receive requests assistance from visiting TRICARE beneficiaries seeking medical care in Thailand.  We are happy to help but first need the beneficiary’s Primary Care Manager (PCM) to send us their pre-authorization.  Traveling beneficiaries enrolled in TRICARE Prime normally require pre-authorization from their PCM before seeking routine, specialty or urgent medical care while visiting Thailand (not obtaining pre-authorization incurs a $300 Individual/$600 Family Deductible (per fiscal year) and a 50% cost-share (per bill) under the Point of Service option).  We can also assist your PCM and/or regional contractor should questions arise.  Please check with your stateside PCM prior to care (unless Emergency).

6. Payment “Up Front” and Reimbursement.  Retirees in Thailand first must seek medical care from a licensed provider, pay the entire medical bill “up front” (out-of-pocket) upon receipt of services (outpatient and inpatient), then file a claim with WPS for reimbursement. Reimbursement is based on TRICARE Standard guidelines, currently $150 Individual/$300 Family annual deductible and a 25% cost-share for retirees and their family members. Keep in mind the $3,000 catastrophic cap per family per fiscal year.  This means that during the fiscal year (1 Oct xx-30 Sep xx) if a beneficiary’s deductible and 25% cost share reach $3,000.  TRICARE will begin to reimburse you 100% for TRICARE covered services (allowable charges) for the remainder of that fiscal year, as opposed to only 75% (less deductible) before the catastrophic cap is reached.

7. Partial Payment Arrangement.  As previously mentioned, TRICARE in Thailand normally requires beneficiaries to pay 100% “up front”, however, inpatient care can easily become quite expensive it financially difficult for beneficiaries to afford the full payment up front.  Therefore, with prior coordination from this office, a medical care provider may be willing on a case-by-case basis, to accept partial payment (25%) from the patient pending TRICARE payment of the remaining 75% of covered services (allowable charges). In order to avoid potential confusion or misunderstandings, be advised it is the sponsor’s/patient’s responsibility to always pay 100% of non-allowable charges. “Allowable Charges”, “Annual Deductible” and “Catastrophic Cap” are further discussed in the TRICARE Handbook which can be obtained from our office or online at http://www.tricare.mil/tricaresmart/; or, if you’re reading this on a computer, you may also click on these links: TRICARE, TRICARE Standard or TFL.  If you need to make a partial payment arrangement with a medical care provider under the TRICARE program, we first need a legible copy of the patient’s valid DoD-issued Uniformed Services ID card (front and back) to verify TRICARE eligibility through DEERS (Defense Enrollment Eligibility Reporting System).  Due to recent attempts by certain individuals to defraud local healthcare providers and TRICARE, we are now all the more stringent about verifying eligibility in DEERS prior to us attempting to negotiate payment arrangements with a medical provider.  DEERS verification is currently processed by TRICARE Area Office-Pacific (Japan) during normal duty hours, and takes 3-5 days. Once we verify eligibility in DEERS, the sponsor-patient must the care provider contacts our TRICARE office at the earliest possible point in time before patient admission so we can try to negotiate a payment arrangement us in a timely manner before patient admission results in the patient paying 100% up front. So please plan accordingly for your non-emergency medical care.  Lastly, we must mention that numerous dishonest persons have “run away” and not paid their cost-share.  Be advised, we openly assist relevant authorities with debt collection.  Medical care providers have been highly successful in garnishing U.S. and Thai pensions, and other income.

8. Filling Claims.  Under federal law, retirees carrying third-party medical insurance in addition to TRICARE must always file claims with their third-party insurance company first, then TRICARE second.  Note: It is solely the patient’s responsibility to obtain any required prior authorization for medical care from their third-party insurance planation of Benefits (EOB) when you submit your TRICARE claim, otherwise WPS cannot process  your claim. To file a claim, please send a completed DD Form 2642 claim form (original signature) with Medical Certificate, OPD Report or detailed Medical Report (as applicable), and Itemized bill to: WPS-foreign Claim, P.O. Box 7985, Madison, WI 53707-7985.  If the beneficiary has not heard back from WPS within 45 days of filling, they should contact WPS at (608) 301-2310. As a TRICARE beneficiary you may obtain a blank DD Form 2642 from the internet here:     http://www.tricare.mil/mybenefit/Download/forms/dd2642.pdf.  You may also obtain forms from the RAO office or the TRICARE Area Office Pacific by email to the  tpao.cac@med.navy.mil, or by phone at (81) 6117 -43-2036.  You may also request a DD Form 2642 from the TRICARE Management Activity, 16401 E.  Centretech Parkway, Aurora, CO 80011-9066.  Lastly, most beneficiaries prefer to use a computer to complete the form since it improves legibility which, in-turn, increases chances of your claim being correctly read and processed the first time. Ensure your Name, Address and SSAN entered on the DD Form 2642 matches the information in DEERS, and that your address is in the overseas region.  Otherwise, WPS will not process your claim, and there’s no guarantee WPS will forward your claim to the correct TRICARE regional contractor.  Non-matching DEERS information and illegible claims are the main reasons claims are delayed, denied, or misplaced.

9. Provider Integrity.  Providers (doctors and hospitals) should not ask you to sign blank  claim forms. You should never agree to this practice because this is not consistent with  your certification on the forms.  Your signature and date on the form signifies that your   personal information is correct; that you actually received the care specified on the claim from the provider identified and at the location stated; and that you authorize the U.S. Government to obtain a copy of your medical records, if necessary, to adjudicate a claim. Furthermore. Your signature is authorizing the payment of  U.S. Government funds and we ask that you sign the claim form only for the healthcare services that you actually received. Lastly, we request that you notify  our office and also contact the TRICARE Management Activity, Office of Program Integrity, 16401 E. Centretech Parkway, Aurora, CO, 80011, anytime you believe TRICARE is being billed inappropriately. We need your assistance to help us fully protect your benefits.

10. TRICARE Overseas Website.  We highly encourage all eligible beneficiaries to register an account on WPS’ Website: http://www.tricare4u.com/.  As a registered user you’ll be able to view patient eligibility, amounts paid toward deductibles, track the status of your  claim, review your claim history (amount paid and EOB), and contact WPS customer service.

11. Department of Veterans Affairs.  (Information-Only) TRICARE does not process VA Foreign Medical Program (FMP) claims.  Please contact your servicing VA Regional Office if you believe your medical care may be partially or fully covered by the VA.

12. Conclusion. While our primary duty and responsibility is helping active duty personnel  and their dependents, we are often able to extend assistance on space-available basis to retirees and their dependents.  In a nutshell, our number one goal is to help place your  mind at ease when you find it necessary to seek medical care.  Please feel free to contact our office with any pertinent questions. Visit:http://www.tricare.mil/ or visit http://www.tricare4u.com/.

      
       Sincerely,

                                                                        Nurse Tipthida  Suwannadhat
                                                            CM, TRICARE Service, Representative
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Source : Department of Defense TRICARE AREA OFFICE PACIFIC October 1, 2008