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Life Health > Health Insurance

GAO: TRICARE Confuses Families Of Reservists

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NU Online News Service, March 24, 2003, 5:15 p.m. EST – Officials at the U.S. General Accounting Office say the U.S. military is trying to do a better job of educating reservists about the health benefits available to their families.

When the military calls reservists to active duty, dependents can sign up for a free health insurance program called TRICARE.

TRICARE covers the complete cost of care at military health care facilities.

Members who are willing to shoulder the cost of co-payments and deductibles can use TRICARE to cover care from doctors and hospitals in TRICARE’s civilian provider network, and from out-of-network civilian providers who are willing to accept TRICARE rates.

The organizations that administer TRICARE are large, well-known private-sector managed care companies, such as Sierra Health Services Inc., Las Vegas, Nev.

But Derek Stewart, the GAO director who assesses defense capabilities and management, testified at a recent hearing of the House Total Force Subcommittee that the relatives of many activated reservists avoid using the TRICARE system.

Even though TRICARE is free, “many reserve family members elect to maintain their civilian health care insurance during mobilizations,” Stewart said at the hearing, according to a written version of his remarks.

In 2000, for example, the U.S. Department of Defense surveyed families of activated reservists.

“Of reservists with civilian coverage, about 90% maintained it during their mobilization,” Stewart said.

Reservists said their families kept the civilian coverage to ensure continuity of health benefits and care for dependents, and many of the reservists whose families switched to TRICARE did end up having problems with finding TRICARE providers, establishing eligibility, understanding TRICARE benefits and knowing where to go for help with problems, Stewart said.

Families of activated reservists have a particularly hard time understanding and using the TRICARE system because 75% live more than 50 miles from military treatment facilities, Stewart said.

But Stewart said the Defense Department has responded to past GAO suggestions by setting up an excellent TRICARE Web site and organizing a pilot program that experiments with eliminating some of the red tape associated with TRICARE.

The pilot program eases one major restriction by exempting program members from a requirement that they obtain statements saying that inpatient care is not available at a military treatment facility before they can obtain non-emergency treatment from a civilian hospital.

The GAO is still waiting for the results of the pilot program, Stewart said.

The text of the GAO report is available at //


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