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Hospital Happenings

News | Nov. 3, 2021

TRICARE Open Season: What does it mean for you?

By Jean Graves

TRICARE Open Season begins Monday and ends on Dec. 13. What does that mean for Soldiers, Families and retirees who live and work at the Joint Readiness Training Center and Fort Polk, Louisiana?
Open season is an opportunity for active duty Family members along with retirees and their Families to switch from TRICARE Prime to TRICARE Select and vice versa.

Outside of TRICARE open season, beneficiaries may only change plans when they experience a qualifying life event. A qualifying life event includes changes in sponsor status, family composition, change of address, government-directed changes, death of sponsor and more; for a full list visit www.tricare.mil/lifeevents.

If you are eligible to take part in TRICARE open season (www.tricare.mil/openseason) you have three choices:

1. Stay in your plan. If you want to stay in your current TRICARE health plan you don’t have to take any action. You will continue in your current health plan through 2022 or as long as you are eligible.

2. Enroll in a plan. If you are eligible for TRICARE Prime or TRICARE Select but not enrolled, you can enroll in a plan now.

3. Change Plans. If you’re already enrolled in a TRICARE Prime or Select option you can switch plans or from an individual to a family enrollment.

According to health.mil TRICARE Prime is a managed care option available in prime service areas in the United States; beneficiaries are assigned a primary care manager who provides most of their care. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option that allows patients to get care from any TRICARE-authorized provider.

Peggy Sylvest, health system manager for Humana Military, supports managed care at Bayne-Jones Army Community Hospital. She said the basic difference between prime and select is flexibility and out of pocket costs.

“TRICARE Prime requires a referral from your primary care provider, Select does not,” she said. “With Prime, patients stay at the military treatment facility for their primary care. With Select, a patient has more flexibility and can make selections from TRICARE-authorized providers in the community. Open season gives beneficiaries a choice”

Sylvest said it’s important to do the research and make an informed decision about what plan works best.

“It is important for eligible beneficiaries to take a look at their options during open season based on their health care needs for next year,” she said. “Thinking about what benefits you need and what you are willing to pay out of pocket will help you make the decision that is best for you.”

TRICARE offers dental and vision depending on who you are, your age and your TRICARE Plan. During open season TRICARE beneficiaries may also be eligible for the Federal Employees Dental and Vision Insurance Program, managed by the Office of Personnel Management. Eligibility depends on beneficiary status and requires enrollment in a TRICARE health plan. Visit www.benefeds.com to check eligibility, compare FEDVIP plans and rates, enroll in a plan, and more.

According to health.mil retired service members and their families using Prime, Select of TRICARE for Life are eligible for both the vision and dental plan. Active duty family members are eligible for the vision plan only.
In additions to open season, Sylvest emphasized a change effective Dec. 15, Wal-Mart and Sam’s Club pharmacies will no longer be in the TRICARE network.

“Beneficiaries using them for their prescriptions may want to start making decisions about where they want to transfer their prescriptions to. Local pharmacies such as BJACH, Walgreens and CVS are all options in our area as well as Express Scripts mail order option,” she said. “Pharmacy usage has nothing to do with open season, but it’s important for beneficiaries to know and start planning for this big change as well.”

Editor’s Note: The first annual TRICARE Open Season occurred in 2018, giving beneficiaries an opportunity to enroll in or make changes to their health plans without experiencing a TRICARE Qualifying Life Event (QLE). To make changes during open season visit the beneficiary web enrollment website at www.tricare.mil/bwe or go directly to https://milconnect.dmdc.osd.mil/milconnect/ and click on 'Manage Health Benefits.'
Don't forget to keep your family's information up-to-date in DEERS.