MILITARY UPDATE
Many reservists see temporary setback in accessing health benefits
By Tom Philpott
A spending cap imposed by Congress and challenges in tracking TRICARE costs for mobilizing and deactivated reservists have delayed the ability of thousands of military reserve families to take full advantage of some new pre- and post-mobilization healthcare benefits.
The unusual circumstances have TRICARE officials advising reservists to save medical receipts, explanations of benefits and other documents that could be useful weeks or months from now in filing TRICARE claims for reimbursements once the full range of new benefits is available.
The benefits in question, called the Temporary Reserve Health Care Program, will improve access to care from the time reservists learn they will be mobilized through a new 180-period transition health period following active service.
President Bush signed the reserve health initiatives into law Nov. 6 as part of the $87 billion emergency spending bill for Iraq and Afghanistan. Several benefits even took effect that day. Despite the work of a special task force, implementation has been difficult.
The biggest challenge has been modifying the Defense Enrollment Eligibility Reporting System, which is used to verify that beneficiaries are properly enrolled and deemed eligible for TRICARE. DEERS is being reprogrammed to recognize several new benefits.
Modifying DEERS also is critical for tracking the cost of the reserve health initiatives, said Rear Adm. Richard A. Mayo, deputy director for TRICARE Management Activity. Congress imposed a $400 million spending limit on those initiatives from Nov. 6 of last year through Sept. 30.
The complexity of the task is reflected in details of the new benefits.
Pre-mobilization TRICARE: Coverage for Reserve or Guard members begins upon notice of a pending call-up, or receipt of a delayed-effective-date order for mobilization. Family members are covered if the planned mobilization is to last longer than 30 days.
Length of TRICARE coverage before activation can be up to 90 days, but only for individuals who learned of mobilization on or after Nov. 6. Reservists previously had been eligible for TRICARE only when on active duty.
To add more complexity to this and other benefits, it is set to expire Dec. 31 unless Congress votes to extend it.
Longer transition coverage: Military transitional health coverage is lengthened to 180 days from 60 days or 120 days, depending on length of deployment under the old rules. The extra coverage applies to those deactivated or separated from service after Nov. 6, 2003.
Members and families who intend to use the extra 60 to 120 days coverage should save their healthcare receipts and file claims for reimbursement when they receive word the benefit is available. This benefit also is set to expire Dec. 31.
Pre-activation health screening: The services received authority to screen and provide needed medical and dental care to members of the ready reserve. Reservists previously had to be on active duty to be screened and receive care. This new authority is permanent.
TRICARE for certain drilling reservists: The most controversial initiative will open TRICARE to drilling reservists who either are unemployed or have no health insurance through current employers. About 170,000 are eligible but far fewer could elect to pay the premiums, to be set roughly at $420 a year for self-coverage and $1440 for a family plan, plus usual co-payments and deductibles.
This provision will take effect when regulations are published and premium rates are set sometime later this year.
Dr. William Winkenwerder, assistant secretary of defense for health affairs, has criticized this initiative as ignoring differences "in duty and in sacrifice" between non-mobilized reservists and active duty. He also bristles at the cost which could be "in the low billions," he said.
Mayo said he expects uninsured drilling reservists to begin enrolling in TRICARE by year's end, if the $400 million hasn't already been spent. After all, he said, that money must cover "the cost of implementing the changes to DEERS, the cost of contract modification (and) the marketing enrollment costs, in addition to the healthcare costs."
Some service associations argue that Congress didn't go far enough in providing medical benefits to reservists.
Senate Minority Leader Tom Daschle of South Dakota agrees.
Daschle and other colleagues introduced legislation in late January that would open TRICARE to all drilling reservists.
Base-closing criteria
The Fleet Reserve Association has asked defense officials to modify draft criteria for judging whether a base should be spared in the base-closing round set to begin next year.
The department listed among "other considerations" for base closings the "economic impact on existing communities in the vicinity of military installations."
FRA National Executive Secretary Joseph L. Barnes said that active, reserve and retired military people often shape their livelihood around a base and will suffer "a huge financial strain" if it is closed.
Ignoring that impact, Barnes wrote to a defense officials, would be callous.
Questions, comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com. Or visit Tom Philpott's Web site.
