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HEIDELBERG, Germany — When the new TRICARE Overseas contract begins Sept. 1, a new partner will be available to help Europe Regional Medical Command beneficiaries when they receive care at host nation medical facilities.
International SOS Assistance, Inc., which has offices in 66 countries with 250 full-time physicians and a medical referral network in more than 175 countries worldwide, will coordinate for health care and process claims for TRICARE Prime beneficiaries living overseas.
TRICARE Management Activity announced the selection of International SOS on Oct. 16, 2009.
According to the TRICARE Overseas Program Web site, as the new managed care contractor, International SOS will operate an integrated health care delivery system for TRICARE beneficiaries living overseas by:
• Ensuring delivery of the highest quality health care;
• Establishing host-nation provider networks near Military Treatment Facilities and in remote locations; and
• Providing customer-friendly service.
The new TOP contract will consolidate overseas TRICARE Prime enrollment, overseas claims processing, TRICARE Global Remote Overseas and TRICARE Puerto Rico Prime.
ERMC officials said these positive changes are part of the new TOP contract:
• The International SOS Call Center will be available 24/7 for assistance with questions about benefits questions and location of the nearest medical facility/network provider for emergency care while traveling.
• Multilingual translation services are available at the International SOS Call Center if patients require communication assistance with a host nation provider.
• International SOS will pre-authorize care for TRICARE Prime beneficiaries and process payments and claims on their behalf.
If urgent care is needed after MTF operating hours, beneficiaries should contact International SOS to locate the nearest provider and obtain pre-approval for urgent care.
In an emergency, go immediately to the nearest emergency care facility or call the Medical Assistance number for your region. Prior authorization is not required. However, patients who are admitted (or their sponsor) must call their Patient Liaison or TRICARE Service Center, Primary Care Manager, and TOP Regional Call Center before leaving the facility, preferably within 24 hours or on the next business day to coordinate authorization, continued care, and payment.
TRICARE Management Activity mailed letters July 19 to TRICARE Prime and Standard beneficiaries containing enrollment guidance, phone numbers, and other benefit information.
The Europe Regional Medical Command’s Host Nation Patient Liaison Program will continue. Patient Liaisons will continue to assist beneficiaries who receive inpatient care at Host Nation hospitals and, if available, on initial visits for outpatient specialty care by a Host Nation provider.
Retirees and all non-Prime patients will now need to file claims directly with Wisconsin Physicians Service (WPS), the overseas claims processor using DD Form 2642.
Previously, clinic TRICARE Service Centers may have taken responsibility for sending claims on behalf of the beneficiary.
Additional information, including a new TRICARE Overseas Program Handbook and an Overseas Commanders Toolkit, are now available on the TOP Contract Web site at www.tricare.mil/topcontract/.
The TOP Handbook offers detailed benefit and claims processing information. Army health clinic leaders and clinic TRICARE Service Center representatives will reach out to their respective communities with information about contract changes meaningful to their beneficiaries.
They will provide briefings at community town hall meetings, Family Readiness Group meetings, unit gatherings and other venues, as well as publish information in local military newspapers to facilitate a smooth contract transition.
(Courtesy of ERMC Public Affairs Office)
