Military Update
Called-up reservists likely to get TRICARE upgrade

Military Update focuses on issues affecting pay, benefits and lifestyle of active and retired servicepeople. Its author, Tom Philpott, is a Virginia-based syndicated columnist and freelance writer. He has covered military issues for almost 25 years, including six years as editor of Navy Times. For 17 years he worked as a writer and senior editor for Army Times Publishing Co. Philpott, 49, enlisted in the U.S. Coast Guard in 1973 and served as an information officer from 1974-77.

By Tom Philpott

Defense Secretary Donald Rumsfeld is expected to sign a policy memo this month that will reduce out-of-pocket medical costs under the TRICARE Standard and

TRICARE Extra options for families of reservists and National Guard members called to active duty in the war on terrorism.

Craig W. Duehring, Rumsfeld's top reserve affairs official, said healthcare improvements for families of mobilized reservists were moving toward final approval as part of a broader effort to ease the sudden and often difficult transition for families from civilian to military life.

By Oct. 3, the Defense Department had activated for Operation Enduring Freedom more than 22,000 reservists and Guard members from 140 units across 44 states, the District of Columbia and Puerto Rico. In that total were more than 12,700 airmen, 4,400 soldiers, 2,700 Coast Guard personnel, 2,100 sailors and 250 Marines. Up to 50,000 could be called under the limited mobilization order signed by President Bush after the Sept. 11 terrorist attacks.

The call-up already is the largest since 1990, when U.S. forces prepared to fight the Persian Gulf War. Because U.S. military leaders can't be sure how long combat operations against terrorists in Afghanistan, or elsewhere, will last, mobilization orders are being written, generally, to last a year. With luck, most reservists will be deactivated long before those original orders expire.

But for now, said Duehring, the reservists are invaluable.

"You can't create any type of an operation without immediately involving the Guard and Reserve," he said. A call-up, he added, also signals national resolve.

Most mobilized reservists will be based in the United States, backing up deployed units and strengthening homeland defense, Duehring said. Air National Guard pilots and their crews are obvious exceptions, being among some of the first units called, and relied upon heavily for airlift. Other reserve specialties tapped are in port security and operations, medical and engineering support, power generation, transportation, base security, air defense, force protection, intelligence, search and rescue, mortuary affairs, counseling and chaplain services.

The Uniformed Services Employment and Re-employment Rights Act requires civilian employers to continue to offer medical coverage, for up to 18 months, to employees called to active duty. But if reservists are gone longer than 30 days, employers can remove their insurance subsidies and force reservists to pay full premiums themselves, plus a 2 percent administrative fee.

The TRICARE changes planned, lumped under the title TRICARE Reserve Family Demonstration Project, would benefit families of activated reservists in three ways, sources said.

• One, by waiving TRICARE Standard's $300 annual deductible.

Background: Families of reservists activated for longer than 179 days are eligible immediately to enroll in TRICARE Prime, the military's managed care program. But Prime might be impractical for many reserve families given the uncertainty over length of activation. A better fit would be either: 1) TRICARE Standard, formerly called CHAMPUS, a traditional fee-for-service insurance under which families can use physicians of their choice or 2) TRICARE Extra, which offers discounts on co-payments if patients use physicians from the TRICARE provider network.

Defense officials have decided that families of mobilized reservists who use TRICARE Standard should not have to pay the $300 deductible before coverage kicks in. After all, they reason, many reservists might have paid an annual deductible already on their employer's health plan. "We might be hitting them with a double whammy," said a Reserve official.

• Two, by waiving TRICARE Standard's maximum allowable charge.

Background: Active duty families who use Standard must pay a 20 percent co-pay on their medical costs. Out-of-pocket costs can be even higher, however, if the physician doesn't accept what TRICARE sets as the "maximum allowable charge for each service provided.

Families, in other words, are responsible for physician fees that exceed TRICARE ceilings.

Defense officials want to reduce that cost risk for families of mobilized reservists by agreeing that TRICARE Standard will pay up to 115 percent of the TRICARE maximum allowable charge. In other words, physician fees can exceed TRICARE standard limits by 15 percent before reservists get stuck with more costs.

• Three, by waiving a requirement that reserve family members get a "non-availability statement" before receiving non-emergency inpatient care from a civilian provider.

Background: Military families living within a 50-mile radius of a base must check with the base hospital or clinic before seeking non-emergency inpatient care, under TRICARE, from a civilian hospital.

If care isn't available in-house, then patients are given a "non-availability statement" to file with their TRICARE Standard claim.

Defense officials want to shelve this requirement for families of mobilized reservists so that, for example, a pregnant spouse doesn't have to change her obstetrician just because such care is available on base.

If, as expected, Rumsfeld approves the three-part "demonstration," it would run through Nov. 1, 2003, officials said, and serve as the basis for a permanent solution to reserve family health care during future national emergencies.

Reservists and their civilian employers can get information on rights and obligations during mobilization by calling: 1-800-336-4590, or by visiting the Web site for the Employer Support of the Guard and Reserve at www.esgr.org

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