[Federal Register Volume 84, Number 69 (Wednesday, April 10, 2019)]
[Notices]
[Pages 14353-14354]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-07067]



[[Page 14353]]

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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Calendar Year (CY) 2019 TRICARE Prime and TRICARE Select 
Out of Pocket Expenses

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Notice of Calendar Year (CY) 2019 TRICARE Prime and TRICARE 
Select Out of Pocket Expenses.

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SUMMARY: This notice provides the Calendar Year (CY) 2019 TRICARE Prime 
and TRICARE Select Out of Pocket Expenses.

DATES: The CY19 rates contained in this notice are effective for 
services on or after January 1, 2019, unless otherwise indicated.

ADDRESSES: Defense Health Agency (DHA), TRICARE Health Plan, 7700 
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Mark A. Ellis, telephone (703) 275-
6234.

SUPPLEMENTARY INFORMATION: The National Defense Authorization Acts 
(NDAAs) for Fiscal Year (FY) 2012 and 2017 established rates for 
TRICARE beneficiary out of pocket expenses and how they may be 
increased by either the annual cost of living adjustment (COLA) 
percentage used to increase military retired pay or via budget 
neutrality rules. The FY 2019 retiree COLA increase is 2.8%. The 
``TRICARE Select and Other TRICARE Reforms'' final rule (published 
February 15, 2019 at 84 FR 4326-4333) allows for adjustments to 
beneficiary out of pocket expenses for Group A beneficiaries (sponsor 
enlisted or was commissioned in a Uniformed Service before January 1, 
2018) to maintain budget neutrality compared to the previous year.
    The DHA has updated the CY19 fees as shown below:

                     Table 1--TRICARE Prime and TRICARE Select Out of Pocket Expenses for CY19--Retirees and Retiree Family Members
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                      Select Group A retirees  Select Group B retirees
                                                CY19                     CY19            Prime** Group A retirees CY19    Prime** Group B retirees CY19
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual enrollment fee:
    Individual......................  $0.....................  $462...................  $297...........................  $360.
    Family..........................  $0.....................  $924...................  $594...........................  $720.
Annual Deductible:
    Individual......................  $150...................  $154 (IN); $308 (OON)..  $0.............................  $0.
    Family..........................  $300...................  $308 (IN); $616 (OON)..  $0.............................  $0.
Annual catastrophic cap.............  $3,000.................  $3,598.................  $3,000.........................  $3,598.
Preventive visit....................  $0.....................  $0.....................  $0.............................  $0.
Primary care........................  $29 (IN)...............  $25 (IN)...............  $20............................  $20.
                                      25% (OON)..............  25% (OON)..............
Specialty care......................  $41 (IN)...............  $41 (IN)...............  $30............................  $30.
                                      25% (OON)..............  25% (OON)..............
ER visit............................  $111 (IN)..............  $82 (IN)...............  $61............................  $61.
                                      25% (OON)..............  25% (OON)..............
Urgent care center visit............  $29 (IN)...............  $41 (IN)...............  $30............................  $30.
                                      25% (OON)..............  25% (OON)..............
Ambulatory surgery..................  20% (IN)...............  $97 (IN)...............  $61............................  $61.
                                      25% (OON)..............  25% (OON)..............
Ambulance, outpatient ground........  $102 (IN)..............  $61 (IN)...............  $41............................  $41.
                                      25% (OON)..............  25% (OON)..............
Ambulance, outpatient air...........  25% (IN or OON)........  25% (IN or OON)........  $20............................  $20.
Durable medical equipment...........  20% (IN)...............  20% (ON)...............  20%............................  20%.
                                      25% (OON)..............  25% (OON)..............
Inpatient admission:
    In-network......................  $250/day up to 25% of    $179 per adm...........  $154 per adm...................  $154 per adm.
                                       hospital charges, plus
                                       20% of sep. billed
                                       services.
    Out of network..................  * $953/day up to 25% of  25%....................  $154 per adm...................  $154 per adm.
                                       hosp. charges, plus
                                       25% of sep. billed
                                       services.
Inpatient SNF/rehab facility........  $250/day up to 25% of    $51 per day (IN);        $30 per day....................  $30 per day.
                                       hospital charges, plus   lesser of $308 per day
                                       20% of sep. billed       or 20% (OON).
                                       services (IN); 25%
                                       (OON).
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IN: In Network.
OON: Out of Network.
* Per day rate change effective October 1, 2018.
** When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent inpatient care without a referral from a
  network provider and/or authorization from the regional contractor, the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE
  Prime copayments.


      Table 2--TRICARE Prime and TRICARE Select Out of Pocket Expenses for CY19--Active Duty Family Members
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                                    Select Group A      Select Group B     Prime ** Group A    Prime ** Group B
                                       ADFM CY19           ADFM CY19           ADFM CY19           ADFM CY19
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Annual enrollment fee:
    Individual..................  $0................  $0................                  $0                  $0

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    Family......................  $0................  $0................                   0                   0
Annual Deductible:
    E1-E4, individual...........  $50...............  $51...............                   0                   0
    E1-E4, family...............  $100..............  $102..............                   0                   0
    E5 & above, individual......  $150..............  $154..............                   0                   0
    E5 & above, family..........  $300..............  $308..............                   0                   0
Annual catastrophic cap.........  $1,000............  $1,028............               1,000               1,028
Preventive visit................  $0................  $0................                   0                   0
Primary care....................  $21 (IN)..........  $15 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Specialty care..................  $31 (IN)..........  $25 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
ER visit........................  $83 (IN)..........  $41 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Urgent care center visit........  $21 (IN)..........  $20 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Ambulatory surgery..............  $25 (IN)..........  $25 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Ambulance, outpatient ground....  $76 (IN)..........  $15 (IN)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Ambulance, outpatient air.......  20% (IN or OON)...  20% (IN or OON)...                   0                   0
Durable medical equipment.......  15% (IN)..........  10% (ON)..........                   0                   0
                                  20% (OON).........  20% (OON).........
Inpatient admission.............  * $19.05 per day;   $61 per adm. (IN);                   0                   0
                                   $25 min. per        20% (OON).
                                   admission.
Inpatient SNF/rehab facility....  *$19.05 per day;    $25 per day (IN);                    0                   0
                                   $25 min. per        $51 per day (OON).
                                   admission.
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IN: In Network.
OON: Out of Network.
* Per day rate change effective October 1, 2018.
** When TRICARE Prime enrollees other than active duty service members self-refer to specialty or non-emergent
  inpatient care without a referral from a network provider and/or authorization from the regional contractor,
  the TRICARE Point of Service deductible and copayment applies in lieu of TRICARE Prime copayments.

    The above rates are effective for services rendered on or after 
January 1, 2019 unless otherwise indicated.

    Dated: April 5, 2019.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2019-07067 Filed 4-9-19; 8:45 am]
 BILLING CODE 5001-06-P