On September 1, 2005, TRICARE's Extended Care Health Option (ECHO) replaced the existing TRICARE Program for Persons with Disabilities (PFPWD). Beneficiaries who still have authorization approvals for PFPWD can continue on those approvals until the expiration or services are requested and authorized under the ECHO program. The following is a summary of TRICARE's Extended Care Health Option:
This new program will continue to deliver financial assistance to active duty family members who have a qualifying condition as defined by law. It will also continue to offer an integrated set of services and supplies that supplement the basic TRICARE program options-TRICARE Prime (including TRICARE Prime Remote for Active Duty Family Members), TRICARE Standard or TRICARE Extra.
ECHO benefits are available with a qualifying condition to an active duty TRICARE eligible child or spouse of:
The following are qualifying conditions under both PFPWD and ECHO:
Additionally, the law added a basis for an additional qualifying condition:
Recipients may retain their eligibility for ECHO services as long as the sponsor remains on active duty. Even children of sponsors who reach the usual TRICARE eligibility age limit (21 or age 23 if enrolled in college full time) retain their eligibility for ECHO services, as long as the sponsor remains on active duty, the child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of their eligibility, and the sponsor is responsible for more than one-half the child's support.
In addition to coverage received via the primary TRICARE plan, TRICARE ECHO benefits may include:
Services covered under the basic TRICARE benefit cannot be authorized under the TRICARE ECHO program-those services must be authorized under the TRICARE program option the beneficiary is using (TRICARE Prime, TRICARE Prime Remote, TRICARE Standard, TRICARE Extra).
If a beneficiary's family member has a condition that may qualify for services under TRICARE ECHO, they should contact their regional contractor for assistance.
Additional information about the new TRICARE ECHO program will be posted on the TRICARE Web site or on the regional contractor's Web sites. Current PFPWD participants will receive letters explaining the change with directions for enrolling family members in the EMFP. For more information on the EFMP, beneficiaries may visit www.militaryhomefront.dod.mil/efm.
Go to: www.tricare.osd.mil/tricaremanuals
Click on: TRICARE Policy Manual 6010.54-M (TPM), August 2002
Click on: Browse Entire Manual (PDF File will install)
Click on: Chapter 9 - The Extended Care Health Option
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Special needs and Exceptional Family Member Program (EFMP) information
The ECHO benefit provides an increase over the PFPWD government cost-share limit from $1,000 per month to $2,500 per month, per eligible family member. In addition to other TRICARE ECHO benefits, beneficiaries who are homebound may qualify for extended in-home health care services. The $2,500 cost share does not apply to the EHHC as there is a benefit cap. For additional information on this benefit, contact your regional contractor.
Whereas PFPWD requires recipients to first use public funds and facilities to the extent that they are available and adequate, ECHO has this requirement only for a smaller subset of the ECHO benefits. Under both PFPWD and ECHO, sponsors must pay part of the monthly-authorized expenses for their family members, based on their pay grade.
Unlike PFPWD, TRICARE ECHO requires all eligible beneficiaries do the following:
For information on ECHO, visit http://www.tricare.osd.mil/echo/default.cfm.
For general information about TRICARE, call one of the many toll-free TRICARE information lines found at the TRICARE Contact Us web page.
Plan would impact retiree's benefits