[Federal Register Volume 87, Number 208 (Friday, October 28, 2022)]
[Notices]
[Pages 65195-65197]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-23465]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year
2023
AGENCY: Office of the Secretary of Defense, Department of Defense
(DoD).
ACTION: TRICARE plan program changes for calendar year 2023.
-----------------------------------------------------------------------
SUMMARY: This notice provides information regarding TRICARE plan
program changes for Calendar Year 2023.
DATES: TRICARE health plan information in this notice is valid for
services during calendar year (CY) 2023 (January 1, 2023-December 31,
2023).
ADDRESSES: Defense Health Agency, TRICARE Health Plan Division, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, (703) 275-6224.
SUPPLEMENTARY INFORMATION: A final rule published in the Federal
Register (FR) on February 15, 2019 (84 FR 4326-4333) established the
requirement for the Director, Defense Health Agency (DHA), to provide
public notice to TRICARE program beneficiaries with a summary of
changes to the TRICARE program each calendar year in connection with
the annual open season enrollment period.
Announcement of Open Season
Open Season is an annual period when beneficiaries can enroll in or
make changes to their healthcare, dental and vision coverage for the
next calendar year.
The TRICARE Open Season runs from November 14, 2022, through
December 13, 2022, during which time beneficiaries can enroll in or
change their TRICARE Prime or TRICARE Select plan.
The Federal Employee Dental and Vision Insurance Program (FEDVIP)
Open Season runs from November 14, 2022, through December 12, 2022. The
U.S. Office of Personnel Management offers FEDVIP enrollment to
qualified beneficiaries of the Military Health System, including
TRICARE for Life beneficiaries. During the FEDVIP Open Season
beneficiaries may enroll in or make changes to their dental and vision
plans.
Any changes beneficiaries make during open season will take effect
on January 1, 2023. If a beneficiary remains eligible and does not make
any changes during Open Season, then their coverage will stay the same
for 2023.
Annual Announcements
The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual
TRICARE Open Season.
Urgent Care Visits: Except for most Active Duty Service members,
there continues to be no limit to the number of urgent care visits a
TRICARE Prime enrollee may receive without a referral for Plan Year
2023. They may receive urgent care from any TRICARE-authorized urgent
care center (UCC), either network or non-network. They may also receive
urgent care from any TRICARE network provider. If the TRICARE Prime
enrollee seeks care from a non-network TRICARE authorized provider
(outside of a TRICARE-authorized UCC), the usual TRICARE Prime Point of
Service deductible and cost-shares shall apply. Beneficiaries may also
call the Military Health System Nurse Advice Line (NAL) for health care
guidance from a specially trained registered nurse. The NAL is
available 24/7 to all TRICARE beneficiaries in the United States (U.S.)
except those enrolled in the US Family Health Plan. Beneficiaries who
live overseas can call the NAL for health care advice when traveling in
the U.S., but must coordinate care with their Overseas Regional Call
Center. For additional information, call the servicing TRICARE
contractor or visit https://www.tricare.mil/ContactUs/CallUs/NAL.
Prime Service Area Changes: Prime Service Areas (PSAs) are
geographic areas around military Medical Treatment Facilities and Base
Realignment and Closure sites. PSAs ensure medical readiness of active
duty members by adding to the capability and capacity of military
hospitals and
[[Page 65196]]
clinics. There is no change to geographic locations where TRICARE Prime
will be offered.
Coronavirus Disease 2023 (COVID-19) Continued Response: A temporary
waiver to the referral requirement remains in effect for TRICARE Prime
enrollees, not including Active Duty Service Members (ADSMs), so they
may receive COVID-19 vaccines, a clinical preventive service, from any
TRICARE Basic (medical) program authorized non-network provider without
incurring POS charges where applicable. This waiver will expire when
the President of the United States declares the national emergency is
terminated. As part of the COVID-19 response, the following temporary
changes for care and treatment continue to be in effect: temporary
coverage of the treatment use of investigational drugs under expanded
access when for the treatment of COVID-19; temporary coverage of
National Institute for Allergy and Infectious Disease (NIAID) sponsored
clinical trials when for the prevention or treatment of COVID-19 or its
associated sequalae; temporary interstate and international licensing,
which allows the temporary waiver of licensing requirements for
providers practicing (both in person and via telehealth) in a state or
host-nation in which they are not licensed, when licensed in another
state or nation and such practice is permitted by state, federal, or
host-nation law; and temporary coverage of temporary facilities
registered with Medicare's Hospitals Without Walls initiative. These
temporary changes remain in effect until the President of the United
States issues a declaration that the Public Health Emergency has
terminated, unless terminated, extended, or otherwise modified in a
final rule published in the Federal Register.
What's New
The following changes or improvements to the TRICARE program
benefits apply to calendar year 2023 (although, some changes were
implemented in 2022):
Telephonic Office Visit: Introduced during the COVID-19 pandemic,
the telephonic office visit (audio-only telehealth) benefit was made
permanent for all TRICARE enrollees effective July 1, 2022. A
telephonic office visit is a TRICARE-covered service provided via a
telephone call between an established TRICARE patient and his or her
TRICARE-authorized provider. TRICARE can cover telephonic office visits
for otherwise covered medically necessary and appropriate care that
does not require face-to-face, hands-on treatment or visual evaluation.
However, not all TRICARE covered services are appropriate for
telephonic office visits. For example, evaluation of a skin lesion
would require visual evaluation that cannot be completed via a
telephone-only visit. Similarly, the services rendered through an
intensive outpatient program would likewise be inappropriate to
administer via telephone only. Another example, removal of a cast,
would require hands-on treatment and would not be suitable for a
telephonic visit.
Female Contraception and Sterilization: Active Duty service Members
and TRICARE health plan enrollees enjoy access to a comprehensive range
of contraceptive care under the TRICARE Program. Effective July 28,
2022, DHA eliminated cost-shares and copayments for reversible medical
contraceptives as preventive services under TRICARE Prime and TRICARE
Select. Reversible medical contraceptives include the FDA-approved
implant, shot, and intrauterine devices. Beneficiaries can request
refunds from their servicing TRICARE contractor on or after October 17,
2022, for any cost-share or copayment paid for these services performed
on or after the effective date of July 28, 2022. DHA cannot eliminate
cost-shares and/or copayments for daily use prescription birth control
pills because TRICARE Pharmacy Program cost-sharing is mandated by law.
However, effective January 1, 2023, TRICARE Prime and Select
beneficiaries seeking female surgical sterilization services (i.e.,
surgical procedure where the fallopian tubes are cut, tied, or blocked
to permanently prevent pregnancy) will also enjoy cost-share and
copayment free access to these preventive services when performed by a
TRICARE network provider.
Comprehensive Autism Care Demonstration
The Comprehensive Autism Care Demonstration (ACD) for Applied
Behavior Analysis (ABA) services for TRICARE beneficiaries diagnosed
with Autism Spectrum Disorder (ASD) has been extended through December
31, 2028. The ACD renders clinically necessary and appropriate ABA
services for the core symptoms of ASD.
Planned Changes
Effective January 1, 2023, the annual premium increase for
Continued Health Care Benefit Program (CHCBP) will transition from a
Fiscal Year basis (October 1 each year) to a Calendar Year basis
(January 1 each year). This change aligns CHCBP with the premium-based
TRICARE health plans for uniformity in premium collections and reduces
complexity for beneficiaries.
For more information, visit tricare.mil/changes or call the
servicing TRICARE contractor.
Appendix A
Certain TRICARE enrollee out-of-pocket costs (enrollment fees,
premiums, catastrophic caps, deductibles, and copayments) are adjusted
annually by Federal law and regulations based on the annual Cost of
Living Adjustment (COLA) applied to Uniformed Service member retired
pay. A difference in copayments remains between those who joined a
Uniformed Service before January 1, 2018 (Group A), and those who
joined on or after that date (Group B).
The retiree COLA was announced October 2022. The COLA increase was
8.7 percent. Beneficiary out-of-pocket expenses impacted by the 2023
COLA will be posted to the tricare.mil/changes web page before TRICARE
Open Season starts November 14, 2022.
Premiums for Calendar Year 2023
----------------------------------------------------------------------------------------------------------------
TRICARE Reserve Select TRICARE Retired Reserve Continued Health Care
TRICARE Young Adult (TYA) (TRS) (TRR) Benefit Program (CHCBP)
----------------------------------------------------------------------------------------------------------------
TYA Prime Individual $570.00 monthly. TRS Member-Only $48.47 TRR Member-Only $549.35 CHCBP Single $1,654.00
monthly. monthly. quarterly
TYA Select Individual $291.00 monthly TRS Member & Family TRR Member & Family CHCBP Family $4,134.00
$239.69 monthly. $1,320.76 monthly. quarterly
----------------------------------------------------------------------------------------------------------------
[[Page 65197]]
Pharmacy Out-of-Pocket Expenses for CY 2023
TRICARE Pharmacy copayments continue January 1, 2023 unchanged from
2022:
Pharmacy Copayments for Calendar Year 2023 *
--------------------------------------------------------------------------------------------------------------------------------------------------------
Retail network Mail order &
Retail network brand-name Mail order generic Mail order brand- retail network
Year generic formulary formulary 30-day formulary 90-day name formulary 90- non-formulary 90-
30-day supply supply supply day supply day supply
--------------------------------------------------------------------------------------------------------------------------------------------------------
2023................................................ $14 $38 $12 $34 $68 **
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Active Duty Service Members enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except active duty service members, select brand-name maintenance medications (taken for long-term conditions) may only be
filled twice at retail and then must be filled via home delivery or military pharmacy.
Dated: October 24, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-23465 Filed 10-27-22; 8:45 am]
BILLING CODE 5001-06-P