Defense Health Care:

Status of Fiscal Year 2004 Requirements for Reservists' Benefits and Monitoring Beneficiaries' Access to Care

GAO-04-563R: Published: Mar 17, 2004. Publicly Released: Mar 17, 2004.

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Since September 2001, about 360,000 reservists have been called to active duty to support the war on terrorism, conflicts in Afghanistan and Iraq, and other operations. Some reservists have been on active duty for a year or more, and the pace of reserve operations is expected to remain high for the foreseeable future. When mobilized for active duty under federal authorities, reservists are eligible to receive health care benefits through DOD's military health care system, TRICARE. When reservists are ordered to active duty for more than 30 days, their families are also eligible for health benefits. DOD supplements its military health care facilities with civilian health care providers through its triple-option TRICARE program. DOD's beneficiaries may enroll in TRICARE's Prime option and go to a network provider to receive care; without enrolling, they can see a network provider through the preferred provider option, Extra; or they may elect to use Standard, the fee-for-service option. Some beneficiaries have raised concerns about difficulties in finding civilian providers--particularly Standard, non-network providers--who will accept TRICARE beneficiaries as patients. The National Defense Authorization Act (NDAA) for Fiscal Year 2004, enacted on November 24, 2003, required the Department of Defense (DOD) to make changes in its delivery and monitoring of health benefits. In addition, the law directed us to review and report on aspects of these requirements. As agreed with the committees of jurisdiction, we are providing the status of DOD's progress in implementing five requirements--three related to health benefits for reservists and two related to monitoring beneficiaries' access to care under TRICARE Standard.

In summary, DOD is in various stages of implementing the three requirements related to health care coverage for reservists. DOD has implemented the requirement extending the time reservists and their families can use TRICARE and is in the process of implementing the other two requirements. DOD has not implemented the two requirements directed at enhanced monitoring of beneficiaries' access to care under TRICARE Standard. We will report further on these requirements as DOD makes progress.

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