HEALTHCARE ELIGIBILITY FOR INTERNATIONAL MILITARY PERSONNEL AND DEPENDENTS AT US MILITARY TREATMENT FACILITIES

Am I, and my dependents, eligible to use the US military healthcare system? YES. As a matter of US policy, international active duty personnel and dependents posted in the United States pursuant to the NATO or PfP Status of Forces Agreements (SOFA) are eligible to receive health or medical care at US Military Treatment Facilities (MTF). Dependents are eligible to seek private civilian care and seek reimbursement through TRICARE (subject to meeting a deductible and cost share) or are able to see a TRICARE-participating doctor and have the doctor submit the request for payment (more information later in this section).

What is an MTF? A military treatment facility (MTF) is facility operated by the US Department of Defense that provides healthcare to eligible personnel.

In practical terms, how do we establish eligibility at an MTF? To establish eligibility for care, military personnel and their dependents must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). Enrollment in DEERS occurs automatically when your US Department of Defense (DoD) ID card is produced (at the ID Card Lab). During this process, individuals are assigned a unique number which corresponds with their status (e.g., “DoD ID number” is assigned to active-duty military personnel; “DoD benefits number” is assigned to eligible dependents) It is recommended that you visit an MTF to “mini-register”, i.e. complete the required paperwork to set up a medical file prior to an appointment.

What is a the purpose of the DoD ‘ID number’ and ‘benefits number’? As part of your check-in process at HQ SACT, military staff members and their eligible dependents will obtain identification and privileges cards (DD Form 1172), which will allow your access to US Department of Defense facilities such as medical (“military treatment facility”), food (“commissary”) and goods (“exchange”) stores. The “ID” or “benefits” numbers on your ID card is assigned to you by the ID card lab and is used to retrieve information from a database connected with medical care eligibility.

Where are the local US MTFs? There are nine (9) MTFs throughout the region. The two most popular ‘outpatient’ clinics for personnel and dependents are Sewells Point Branch Health Clinic located on the Norfolk Naval Station in close proximity to the HQ, and Boone Clinic located on the Naval Amphibious Base, which although geographically situated in the city of Norfolk, is on the border of Virginia Beach. Flag and General Officers and their dependents are permitted to use the Executive Medicine Clinic located at Sewells Point Branch Health Clinic upon registration. Please contact a representative of Legal Affairs at +1 757 747 3640/3228 for information on registration, enrollment and contact information for appointments.

How can I contact an MTF? At Annex D-1 is a list of regional MTFs and telephone numbers to make appointments and for benefit information.

How do I make an appointment for outpatient care? A dependent should call the MTF directly to make an appointment—do not use the TRICARE appointment line. Dependents of international personnel, whilst eligible as stated above, are not recognised in the general system.

I’m having difficulty making an appointment. Who can assist me? If you have any problems making appointments request to speak to the Health Benefits Advisor (HBA) at the MTF.

Is my access and treatment the same as that which is provided to US military personnel and their dependents? YES. The care provided at local MTFs to international military personnel and their dependents is the same priority of care as US military personnel and their dependents.

Do I have to pay for the care at a US MTF? NO, if you were provided health care as an “outpatient” at an MTF.   Inpatients will be billed for their care.

What is an “outpatient”? An outpatient is a patient who seeks care, both preventative and curative, and is simply treated for the ailment or medical issue at a MTF and leaves the facility.

Do I have to pay for this outpatient care? NO. Reimbursement is not required for outpatient care provided at MTFs.

What is an “inpatient”? An inpatient is a patient who receives care and whose admission to the MTF exceeds 23 hours, or a patient who is admitted by the treating physician to the hospital and classified as an inpatient at some point during their visit.

Does my nation have to pay for my care as an inpatient? If so, how much and why? Likely YES. Your nation will have to pay for the care, or if your nation does not pay, you will be required to pay for inpatient care. While the SOFAs stipulate that the Sending Nation will reimburse the host nation for healthcare and only require the host nation to provide “access” to care, US policy is to provide outpatient medical care without charge.   Inpatient care, however, is subject to the Reciprocal Healthcare Agreements as indicated in this section.

US policy is to provide MTF inpatient care on a reimbursable (“fee-for-service”) basis at rates established by DoD, unless a Reciprocal Healthcare Agreement exists between the US and the sending nation. (Reference: DoD Instruction 6015.23, “Delivery of Healthcare at Military Treatment Facilities”.)

How/where are the charges billed? Inpatient charges at an MTF are billed in accordance with an established schedule. The charges are ordinarily billed directly to your nation through the Embassy or MOD, although in the absence of a point of contact you may receive an invoice directly from the Medical Services Office, Naval Medical Center Portsmouth.

What nations have Reciprocal Healthcare Agreements (RHCA)? Currently, France, Georgia, Germany, Ukraine, and the United Kingdom have Reciprocal Healthcare Agreements (RHCA) with the United States concerning entitlement to healthcare and terms of reimbursement. HOWEVER, these agreements vary by country, and periodically lapse or are renegotiated so you should consult your national authorities PRIOR to relying on this list

Where can I obtain a copy of my nation’s RHCA? You can request a copy of the RHCA from your NLR or PNLR, or from Legal Affairs. If such an agreement exists, the provisions of the agreement determine the terms of reimbursement, though most agreements make MTF inpatient care available to military personnel without cost (except for a minimal subsistence charge).

Am I eligible to have elective (voluntary) surgery at Naval Medical Center Portsmouth? YES, ordinarily. Contact the MTF/health provider for information. However, international military personnel and dependents are individually responsible for full payment of inpatient care received from civilian treatment facilities, and also MTFs (subject to the provisions of the Reciprocal Healthcare Agreement, if applicable).

Personnel should follow national guidelines for coordinating reimbursement for services rendered and should consult with their NLR/PNLR before scheduling elective inpatient care, whether in civilian facilities or MTF.

Inpatient care in the US is very high quality, but is also very expensive. Due to prior staff misunderstandings over eligibility for inpatient care, sponsoring nation coverage and reimbursement policies, and receipt of unexpected bills for services rendered, members are advised to contact the MTF’s HBA or billing department representative regarding specific eligibility and reimbursement requirements. This should be done prior to scheduling elective inpatient care, and to document the context of that conversation.

Can the HBA tell me how much the procedure/surgery will cost? NO. Given the unpredictable nature of surgery and other inpatient care outcomes, HBAs and billing representatives are unable to provide a specific treatment cost estimate prior to that treatment being rendered.

Who can assist me if I am experiencing difficulty with an MTF or with an invoice? The HBAs are located at most MTFs and are the best source of information.

Can HQ personnel assist me with health-care related issues? YES, however, assistance is limited as HQ personnel are not experts in this area—the best source remains the HBAs at the MTFs. Detailed information regarding eligibility in the US military healthcare system and participating TRICARE providers is available from any HBA or on the TRICARE website (http://www.tricare.mil).

Legal Affairs’ representatives can meet with you regarding a particular issue and provide general assistance; however, personnel should review HQ SACT Directive 45-6, “Access to Healthcare & Reimbursement Requirements at MTF by International Military Personnel and Dependents”, which is provided during Legal’s orientation session for specific guidance.

I heard about a “medical brief”. When and where is this held? Legal Affairs arranges for HBAs to come to the HQ periodically to brief personnel on medical issues, MTFs, TRICARE, and related information. This “Medical Brief” is designed specifically for international personnel and their dependents—normally held in the spring and the fall. Such briefs are well advertised and are highly recommended for personnel and their spouses.

What occurs during that appointment? The HBA registers each eligible family member and establishes a medical record for each person. During that visit, general information will be provided concerning care, scheduling appointments, general clinic and other information. This minimizes confusion and undesirable outcomes when healthcare is required. At Annex D-1 is the list of MTFs and telephone numbers.

Can I see a civilian/private doctor or treatment facility? YES, however when scheduling these appointments they will request your insurance information.

Do I have health insurance? Maybe. Dependents have access to a US government provided health insurance program called “TRICARE”. NATO/PfP active-duty personnel are not ordinarily eligible for reimbursement from TRICARE for medical services provided by a civilian doctor or treatment facility—including emergency treatment and referrals to a civilian provider by a MTF. Also some nations have purchased private or supplemental insurance policies for their personnel and family members.

What is TRICARE? TRICARE is a US government provided health insurance program–“TRICARE is the uniformed services health care program for active duty service members and their families” (Reference: https://www.hnfs.net/common/companyInfo/What+Is+TRICARE.htm). This programme is managed by the TRICARE Management Activity (http://www.tricare.mil).

How do I use TRICARE at a private doctor/civilian treatment facility? Dependents simply show their US Department of Defense dependent identification card upon check-in. To benefit from TRICARE reimbursement, however, it is advisable to initially confirm the civilian provider’s participation in TRICARE. Otherwise, you will likely have to file the insurance personally and your out-of-pocket costs will likely be greater.

How can I ensure that my doctor participates in the TRICARE system? Ask the provider if they accept TRICARE, and confirm that their fees are in accordance with TRICARE’s allowable charges to avoid being overcharged for services rendered. Ensure that they are on TRICARE’s list of providers found at: http://www.mytricare.com/internet/tric/tri/tricare.nsf or http://www.tricare.mil, or contact the HBA.

How much will TRICARE pay for my dependent’s healthcare received from a civilian provider? TRICARE will pay a portion of the cost of care rendered to dependents directly to the civilian treatment facility provided that the facility is a member of the TRICARE network (a “participating provider”). The portion TRICARE will pay is ordinarily 80% of the “allowable charge” once the deductible has been met. The patient is responsible for the remaining amount of the cost of care—which includes the remaining 20% (with TRICARE having paid 80%) plus the portion of the cost of the care which exceeds TRICARE’s ”allowable’ charge” but not greater than 115% of TRICARE’s “allowable charge”. If a participating provider (who has agreed to accept TRICARE) charges more than 115% of the allowable amount, the patient is NOT responsible for the remaining amount.

What is an allowable charge? An allowable charge is the fixed rate for a particular service established by the US Department of Defense. A civilian doctor or treatment facility that is a TRICARE participating provider should not charge a TRICARE patient more than 115% of TRICARE’s allowable charge.

What is a deductible, and how much is the TRICARE deductible? A deductible is the annual amount that an individual must pay prior to TRICARE’s beginning to ‘share’ the cost of medical care. Currently it is $150 per person/per year, with a maximum of $300 for a family no matter how many dependents. Please note that the fiscal year for the US government begins 01 October of each year.

Here is an example, which presumes the $150 deductible has been met: Doctor charges $200 for an office visit. TRICARE’s allowable charge for that visit is $150. TRICARE will pay 80% of the allowable charge (which is $120); the dependent/patient will be responsible for 20% of the $150 allowable charge (which is $30). The dependent/patient will also be responsible for the difference between TRICARE’s allowable charge of $150 and 115% of that allowable charge that TRICARE allows—which is $172.50 (115% of $150) leaving the patient responsible for an additional amount of $22.50. In total, the patient will be responsible—in this example—for $52.50. The remaining amount is ‘absorbed’ (forgiven) by the TRICARE participating doctor.

What if my dependent receives healthcare from a civilian provider who does NOT accept TRICARE? The dependent/patient will ordinarily have to submit a request for reimbursement through the TRICARE network. TRICARE will pay 80% of the “allowable charge” and the patient will be responsible for the remaining amount as discussed in the above example—no matter how much the healthcare provider charges for that service. In other words, the provider can charge 200% of TRICARE’s allowable charge, and the dependent/patient will be responsible for any amount that TRICARE doesn’t pay. Therefore, it is strongly encouraged that dependents only seek care from civilian healthcare providers who accept TRICARE.

How will I know if my civilian provider who participates in TRICARE charges more than 115% of TRICARE’s allowable charge? When you receive your statement from TRICARE (an “explanation of benefits”) following receipt of your care, the amount that TRICARE allowed for the service is printed on that statement. If you have questions regarding your bill, you should contact a Health Benefits Advisor at one of the local MTFs (contact information at Annex D-1).

Do I have to pay the civilian doctor when I receive the care? Most participating local (civilian) practitioners will bill TRICARE directly for care provided to eligible beneficiaries. While TRICARE will reimburse a significant portion of the bill, the patient is responsible for the “co-pay,” that portion of the bill TRICARE will not reimburse. The patient will receive a bill for their portion if not paid at the time of treatment.

I am pregnant and am seeing a private (civilian) doctor. Will TRICARE cost-share for (or pay a portion of the costs of) the prenatal visits? NO. The cost of visits related to maternity, including doctor visits (prenatal (pre-delivery) and post-natal (after delivery)) and hospital charges are handled by TRICARE as a “global obstetric” charge, which means it is considered as inpatient care. They do not separate the prenatal visits from the actual delivery of the baby in the hospital.

Do I have to call the MTF to schedule an appointment with a private (civilian) doctor? NO. It is not necessary for the dependents of international military personnel to make appointments for civilian outpatient care through the TRICARE appointment system. You would contact the civilian doctor directly.

May I receive dental care at the US military dental facility? Routine dental care at military dental treatment facilities is available only to active duty personnel—including international personnel—at no cost.

Are my dependents eligible for dental care at a US military dental facility? Dependents of NATO and PfP personnel may receive treatment on an emergent or space-available basis, which is the same policy for the dependents of US military personnel. However, ordinarily there is no space available. If they do receive care, they will not be scheduled for routine or follow-on care, and charges may apply. This policy also applies to US military dependents, since DoD provides civilian dental care to dependents through United Concordia, a contracted dental provider network.

Can my dependents use the United Concordia contracted dental provider? Regrettably NO. United Concordia, a private dental insurance provider with whom the US government has a contract, will not extend insurance benefits to the dependents of NATO and Partner personnel.

May I have my prescriptions filled at an MTF? If so, do I have to pay any costs? YES, you may have your prescriptions filled at an MTF. There are no charges for the medicines. Also, some MTF pharmacies carry some over-the-counter medicines which you may receive in limited quantities at no charge if available.

I am unable to have my prescription filled at an MTF. May I use a civilian pharmacy, and if so, are there any related costs? YES, you may have your prescriptions filled at a local pharmacy; however, charges will apply and vary in accordance with your status. Active-duty personnel are not eligible for reimbursement or cost-share from TRICARE, but are recommended to consult their national authorities. Eligible dependents may receive partial reimbursement/cost-share from TRICARE, once the deductible has been met (see previous question in this section).

May I have my eyes (sight) examined at an MTF? YES. Both active-duty personnel and dependents are eligible to have eye exams conducted at MTFs at no cost to the patient.

Will the MTF provide free eye glasses to active-duty personnel? YES. MTFs will issue ‘standard’ (i.e., Navy issue) eye glasses to active-duty personnel at no cost.

Will the MTF provide free eye glasses to dependents? NO. If corrective glasses or contacts are required or prescribed to a dependent, they will receive a prescription which you can take to a private provider and obtain glasses or contacts at personal cost.

Am I eligible for reimbursement for eye glasses or contacts from TRICARE? NO. There is no TRICARE reimbursement available for corrective glasses or contacts for either active-duty personnel or dependents.

What healthcare arrangements/insurance exist for NATO international civilians? Information regarding the healthcare scheme for NATO international civilians will be provided by Civilian Human Resources officials upon check-in at the Headquarters.

SOCIAL SECURITY NUMBER (SSN)

 What is a Social Security Number? The social security number (SSN) is a nine-digit number, which serves as a unique identifying number and is issued to each American citizen shortly after birth by the Social Security Administration (SSA). Without this number, many ordinary business transactions, although not impossible, can become very frustrating.

Am I eligible to apply for an SSN? YES. NATO active-duty personnel and NATO civilian staff are eligible to apply for a SSN if they choose, but are not legally required to obtain one.

Are my dependents eligible to apply for an SSN? Maybe. Dependent family members are not eligible to apply for an SSN unless they have been previously granted employment authorization from the US Citizenship and Immigration Services (see “Employment Authorization—NATO Dependents” in the next section of this Guide). A dependent that receives employment authorization must obtain a SSN before beginning to work. Employers are required to report earnings to the Internal Revenue Service using the SSN. Please note that family members must pay all local, state and Federal income taxes on such earnings pursuant to the regulations governing NATO dependent employment authorization found at 8 CFR 214(s).

How do I apply for an SSN? In order to apply for an SSN, you must have a visa and CBP Form I-94 (additional information can be found in the earlier section entitled “United States Immigration, Passports, Visa and Travel Information”) and are required to visit a local office of the SSA. Application forms for an SSN (Form SS-5, “Application for a Social Security Number”) are available from HQ SACT Legal Affairs, on the SSA web site at http://www.ssa.gov, or at the local SSA office. It is suggested that you wait approximately 10-14 days after you arrive in the United States to apply for a SSN. Why? The information from Form I-94 is entered into a central system documenting your physical presence/arrival in the United States. The I-94 is verified by SSA officials before a SSN is issued.

Where is the local SSA office? There are several SSA offices throughout the area. You can find the office closest to your home by consulting the blue page section of the telephone book or by linking through the SSA home page at: http://www.ssa.gov. The office closest to HQ SACT (zip (postal) code 23551) is located at 5850 Lake Herbert Drive, Norfolk. Their telephone number is +1 866 858 6089.

Driving directions to 5850 Lake Herbert Drive from HQ SACT: Travel on 64 East (towards Virginia Beach) and take the “Military Highway” exit, number 281. Travel through the first set of traffic lights, crossing over Northampton Blvd. Turn left onto Lake Herbert Drive between the Norfolk Technical Center and the Wachovia Bank, the SSA is located at the end of the street on the left. SSA offices are open Monday through Friday (except US Federal Holidays) from 0845 to 1545. It is best to avoid SSA offices at the beginning of each month or on Mondays, as those are typically very busy times.

I applied for my SSN over one month ago and still haven’t received it. Who can assist me? Please visit Legal Affairs with your passport containing your visa and Form I-94, along with the letter you received from SSA upon application, and they will assist.

May I use the DoD ID number or benefits number on the US Government-issued Common Access Card (CAC) or military dependent ID card instead of or as an SSN? NO. This is not an SSN and should not be used for any purpose other than medical care eligibility.

What is the DoD ‘ID number’ and ‘benefits number’? As part of your check-in process at HQ SACT, military staff members and their eligible dependents will obtain identification and privileges cards (DD Form 1172), which will allow your access to US Department of Defense facilities such as medical (“military treatment facility”), food (“commissary”) and goods (“exchange”) stores. The “ID” or “benefits” numbers on your ID card is assigned to you by the ID card lab and is used to retrieve information from a database connected with medical care eligibility.