Civilian Employer Insurance And/or Tricare?

bmather9

New Member
4
So I have a complicated health insurance situation I’m trying to figure out; the good news is I have plenty of good options, but want to make the best decision for my family.

I’m currently at National Guard member on Tricare Reserve Select, and have opted out of my civilian employer’s health insurance plan for a credit of $9.50 per week. My wife works for the same civilian employer, and is pregnant with our first born child due February 2016; she is on a PPO premium based health insurance plan with the civilian employer.

Starting 2016, the PPO plan is going away and our employer is switching everyone over to a high-deductible plan with an HSA. They will seed the HSA with $1100 for an individual or $2200 for a family for the first year, then I believe that seed will drop in half for 2017.

I will likely be called to federal active duty next year, and expect that I will continue to opt out of my employers insurance and switch myself to Tricare Prime in January (180 out from activation).

I will likely add my wife and newborn child to my Tricare, but if I do this, we are not eligible for the HSA seed money, but the insurance premiums will go away (essentially to offset the fact that we won’t get the seed money). So she would get a ‘free’ high-deductible health insurance plan from the civilian employer, along with Tricare as a secondary insurance.

So things are pretty straightforward for me, I’ll stay on Tricare reserve select, until I can go on Prime. But for my wife, we may need to keep her on Standard to stay with her current doctor? Or should we change her to Prime? What about after the child is born, should my wife and son be on Standard or Prime? And what do we do about the civilian employer’s insurance; should we keep that or should she opt-out for a $9.50 per week credit? Or she we just forget about Tricare altogether and keep her on the high-deductible plan with the HSA seed money?

Any help is appreciated! Just let me know if something isn’t clear or if more information would help.
 
I’m currently at National Guard member on Tricare Reserve Select, and have opted out of my civilian employer’s health insurance plan for a credit of $9.50 per week.
I stopped reading there due to the following.

This final rule implements section 1097c of Title 10, United States Code, as added by section 707 of the John Warner National Defense Authorization Act for Fiscal Year 2007, Public Law 109-364. This law prohibits employers from offering incentives to TRICARE-eligible employees to not enroll or to terminate enrollment in an employer-offered Group Health Plan (GHP) that is or would be primary to TRICARE.
 
Call your agent.

Tried that with limited success. Neither my employers agent nor Tricare have the whole picture and thus are not that helpful.

I stopped reading there due to the following.

That's interesting but I'm not sure about it's validity, considering my employer is a General Dynamics company, which I would like to believe has come across this before. Maybe it's because they offer this incentive to all employees, not just Tricare Eligibile employees.

If it is true, then what a bunch of BS this is. Another lost benefit for the service member. Why would I pay the $47 a month premium to have Tricare when I could just use my civilian employer's insurance?
 
That's interesting but I'm not sure about it's validity, considering my employer is a General Dynamics company, which I would like to believe has come across this before. Maybe it's because they offer this incentive to all employees, not just Tricare Eligibile employees.

If it is true, then what a bunch of BS this is. Another lost benefit for the service member. Why would I pay the $47 a month premium to have Tricare when I could just use my civilian employer's insurance?

Nope, applies to Medicare Beneficiaries as well.

1995 CMS final regulations (§411.108(a)(9)) If an employer offers a Medicare beneficiary an incentive, financial or otherwise, not to enroll in the plan, the group health plan is subject to a civil money penalty of up to $5,000 for each violation. In addition, an excise tax could be applied that would equal 25% of the plan's expenses incurred during the calendar year.

http://www.avalonbenefits.com/member_over65.php
 
Employers are prohibited from offering any inducement to Tricare or Medicare beneficiaries to steer them away from enrolling in the group health plan in favor of making either Tricare or Medicare their primary coverage.

That being said, you'd need to check with HR at your employer to find out how they have structured this $9 per week. They have lots of lawyers and I am sure that a company of that size is well familiar with those inducement rules.
 
Employers are prohibited from offering any inducement to Tricare or Medicare beneficiaries to steer them away from enrolling in the group health plan in favor of making either Tricare or Medicare their primary coverage.

That being said, you'd need to check with HR at your employer to find out how they have structured this $9 per week. They have lots of lawyers and I am sure that a company of that size is well familiar with those inducement rules.

I think the key point here is that they actually don't have an incentive to make Tricare or Medicare their primary coverage; they have an incentive for anyone to opt-out of their health insurance plan. Regardless, I don't agree with the prohibition because it seems to penalize military members who are eligible for Tricare.

So I'd bet GD's lawyers have their ducks in a row, and if they don't, I don't really care. These are the option presented to me, so what should I do?
 
You might want to try the group insurance forum. Neither of the options you are discussing are individual health insurance options, you might not get the answers you are looking for here. Some agents on here do both, others do not.
 
If the new HSA plan network is the same as the previous PPO plan network, then she would be best served to stay with the employer plan for continuity of providers. Why change things up 1 month before the event? I am sure she already has providers she is using for this pregnancy and it may not be easy to line those same providers up on Standard. And certainly more difficult on Prime which is an HMO.

If the network changes on the group HSA creating a provider network change, then you could look at Tricare Standard as an option but you'd need to calculate the Out Of Pocket Annual Max on the group health plan inclusive of the "seed money" against the Tricare out of pocket annual max at $3,000.

With Tricare Standard you are going to go out the $3,000. If the group OOP with seed money added is less than $3,000 out of pocket then it makes more sense. If it's more than $3,000 then you need to assess providers available each way and decide if a change to reduce the out of pocket exposure is worthwhile.

Also bear in mind that some medical providers will NOT accept Tricare as primary under any circumstances, only as secondary.

And to be clear I am on Tricare (TRR) as retired military so I am quite familiar with how it works.
 
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