R 101400Z OCT 03
FM CMC WASHINGTON DC(uc)
TO AL MARADMIN(uc)
MARADMIN
BT
UNCLASSIFIED
MARADMIN 482/03
MSGID/GENADMIN/CMC WASHINGTON DC HS//
SUBJ/OCONUS URGENT AND EMERGENT HEALTH CARE FOR DEPLOYED USN AND USMC
/ACTIVE DUTY SERVICE MEMBERS THROUGH THE TRICARE GLOBAL REMOTE
/OVERSEAS HEALTHCARE CONTRACT (TGRO) WITH INTERNATIONAL SOS//
REF/A/DOC/ASD(HA)/-/09DEC2002//
REF/B/RMG/CINCPACFLT PEARL HARBOR HI/210357ZMAY2002//
REF/C/DOC/BUMED/-/21FEB1996//
NARR/REF A IS ASD(HA) LTR TO NAVY SURGEON GENERAL ADVISING OF
CONTRACT AWARD FOR TRICARE GLOBAL REMOTE OVERSEAS HEALTHCARE
CONTRACT.  REF B IS PACADMIN 015/02, SUBJ TRICARE-FLEET PROCEDURES.
REF C IS BUMEDINST 6320.72 WHICH PROVIDES GUIDANCE AND POLICY FOR
OBTAINING AND FUNDING NON-NAVAL HEALTHCARE.//
POC/GERARD R. COX/CAPT/HS/-/TEL:703-614-4478
/EMAIL:COXGR@HQMC.USMC.MIL//
GENTEXT/REMARKS/1.  REF A ADVISED THAT THE TRICARE MANAGEMENT
ACTIVITY (TMA) AWARDED THE TRICARE GLOBAL REMOTE OVERSEAS HEALTH CARE
CONTRACT (TGRO) TO INTERNATIONAL SOS ASSISTANCE, INC (INTERNATIONAL
SOS).  INTERNATIONAL SOS IS A LEADING GLOBAL HEALTH SERVICES AND
ASSISTANCE COMPANY SERVING FORTUNE 500 COMPANIES AND OTHER CLIENTS
THROUGH A WORLDWIDE NETWORK OF HEALTH CARE PROVIDERS, INCLUDING INPATIENT
AND MEDEVAC CAPABILITIES.  FULL DON COVERAGE UNDER TGRO COMMENCES
01 OCTOBER 2003.  THE CONTRACT REPLACES PREVIOUS CONTRACTS HELD
INDIVIDUALLY BY THE TRICARE OVERSEAS REGIONS.  THE CONTRACT PERIOD IS
ONE YEAR, PLUS FOUR OPTION YEARS.
2.  THIS MESSAGE PROVIDES INFORMATION ON ONE ELEMENT OF THE TGRO:
THE PROVISION OF URGENT AND EMERGENT HEALTH CARE FOR ACTIVE DUTY
SERVICE MEMBERS WHO ARE DEPLOYED, TAD/TDY OR IN AN AUTHORIZED LEAVE
STATUS IN "REMOTE OVERSEAS LOCATIONS," I.E., COUNTRIES IN WHICH
THERE IS NO DOD MEDICAL TREATMENT FACILITY.  (THE OTHER ELEMENT OF
THE TGRO, PROVISION OF HEALTH SERVICES TO ACTIVE DUTY SERVICE MEMBERS
AND THEIR ACCOMPANYING FAMILY MEMBERS ENROLLED IN THE TRICARE OVERSEAS
PROGRAM PRIME IN REMOTE OVERSEAS LOCATIONS, IS NOT ADDRESSED IN THIS
MESSAGE.  FURTHER INQUIRIES ON THIS ASPECT OF THE TGRO SHOULD BE REFERRED
TO THE APPROPRIATE TRICARE OVERSEAS PROGRAM OFFICE.)
3.  THE NAVY AND MARINE CORPS ARE JOINING THE OTHER SERVICES IN MAKING
THIS BENEFIT AVAILABLE GLOBALLY ON A "CASHLESS, CLAIMLESS" BASIS TO
DEPLOYED/TAD/TDY/ON LEAVE ACTIVE DUTY SERVICE MEMBERS REQUIRING
URGENT/EMERGENT HEALTH CARE IN REMOTE OCONUS LOCATIONS.  A REVISED
FUNDING MECHANISM ENABLES CLAIMS PAYMENT FOR SERVICES PROVIDED UNDER
THE TGRO AT THE TMA/SERVICE LEVEL AND AFFORDS CENTRALIZED FUNDING AND
OVERSIGHT ALONG WITH SIGNIFICANTLY ENHANCED ACCESS TO CARE IN REMOTE
OCONUS LOCALES.
4.  ELIGIBILITY FOR TGRO.  EFFECTIVE 01 OCTOBER 2003, ALL NAVY AND
MARINE CORPS ACTIVE DUTY SERVICE MEMBERS ARE ELIGIBLE FOR URGENT AND
EMERGENT HEALTH CARE WHILE THEY ARE IN REMOTE OCONUS LOCATIONS DEFINED IN
THE TGRO, REGARDLESS OF THEIR PARENT COMMAND AND CONUS TRICARE PRIME
ENROLLMENT STATUS.  (PRIOR TO 01 OCTOBER 2003, EXISTING OPERATIONAL
COMMANDERS DIRECTIVES SIMILAR TO REF B DETERMINED USN/USMC AUTHORIZATION
TO ACCESS CONTRACTOR-PROVIDED URGENT/EMERGENT HEALTH CARE IN REMOTE
OCONUS LOCATIONS.)
5.  TRICARE OVERSEAS PROGRAM (TOP) REGION OVERSIGHT RESPONSIBILITIES.
A.  THE TGRO IS ADMINISTERED BY THE THREE TOP REGIONAL OFFICES:  TRICARE
PACIFIC, TRICARE EUROPE, AND TRICARE LATIN AMERICA/CANADA.
(1) TRICARE PACIFIC WILL OVERSEE THE TGRO IN THOSE GEOGRAPHIC AREAS
WITHIN THE U.S. PACIFIC COMMAND (USPACOM) AOR.
(2) TRICARE EUROPE WILL OVERSEE THE TGRO IN THOSE GEOGRAPHIC AREAS WITHIN
THE U.S. CENTRAL COMMAND (USCENTCOM) AND U.S. EUROPEAN COMMAND (USEUCOM)
AORS.
(3) TRICARE LATIN AMERICA/CANADA WILL OVERSEE THE TGRO IN THOSE GEOGRAPHIC
AREAS WITHIN THE U.S. SOUTHERN COMMAND (USSOUTHCOM) AOR.
B.  REGION-SPECIFIC QUESTIONS SHOULD BE DIRECTED TO THE APPROPRIATE TOP
REGIONAL OFFICE BY CALLING (888) 777-8343 AND SELECTING THE APPROPRIATE
REGION FROM THE MENU PROVIDED.  THE TOP REGIONS, TMA, AND INTERNATIONAL
SOS ALSO HAVE WEBSITES AVAILABLE FOR ADDITIONAL INFORMATION:
TRICARE PACIFIC HTTP://TRICARE-PAC.TAMC.AMEDD.ARMY.MIL
TRICARE EUROPE HTTP://WWW.EUROPE.TRICARE.OSD.MIL
TRICARE LATIN AMERICA/
CANADA HTTP://TRICARE15.ARMY.MIL
TMA HTTP://WWW.TRICARE.OSD.MIL
INTERNATIONAL SOS HTTP://WWW.INTERNATIONALSOS.COM/PRIVATE/TRICARE
6.  COVERAGE AREAS.  "REMOTE" LOCATIONS UNDER THE TGRO ARE PREDOMINANTLY DEFINED
AS THOSE COUNTRIES WITHOUT DEPARTMENT OF DEFENSE MEDICAL TREATMENT FACILITIES
(DOD MTF). 
A.  SERVICE MEMBERS NEEDING URGENT OR EMERGENT HEALTH CARE IN A REMOTE
OCONUS LOCATION SHOULD BE REFERRED DIRECTLY TO INTERNATIONAL SOS.
B.  SERVICE MEMBERS NEEDING URGENT OR EMERGENT CARE IN A COUNTRY/TERRITORY
WHERE THERE IS A DOD MTF (I.E., UNITED KINGDOM, SPAIN, AZORES, BELGIUM,
ICELAND, BAHRAIN, GERMANY, ITALY, TURKEY, SOUTH KOREA, JAPAN, GUAM,
PUERTO RICO, AND THE AREAS SERVED BY U.S. NAVAL HOSPITAL GUANTANAMO
BAY CUBA AND THE CLINIC IN SOTO CANO, HONDURAS) REQUIRE DIFFERENT REFERRAL
PROCEDURES.  WHEN A SERVICE MEMBER NEEDING URGENT OR EMERGENT CARE IS IN
THE VICINITY OF AN MTF, THE MTF SHOULD BE CONTACTED FIRST TO DETERMINE ITS
ABILITY TO CARE FOR THE PATIENT.  IF THE MTF CANNOT PROVIDE THE SERVICES
REQUIRED, THE PATIENT SHOULD BE REFERRED TO APPROPRIATE CIVILIAN HEALTHCARE
PROVIDERS IN ACCORDANCE WITH GUIDANCE OFFERED BY THE MTF OR THE REGIONAL
COMMANDERS' OPERATIONAL DIRECTIVES.  IN THOSE COUNTRIES/TERRITORIES WHERE
INTERNATIONAL SOS SERVICE UNDER THE TGRO IS NOT AVAILABLE, COSTS FOR
PATIENTS REFERRED TO CIVILIAN FACILITIES WITHOUT BEING SEEN IN AN MTF WILL
REMAIN THE FUNDING RESPONSIBILITY OF THE OPERATIONAL COMMANDER.
7.  PROCEDURES FOR ACCESSING CARE UNDER THE TGRO.  THE PATIENT OR
THE PATIENT'S PARENT COMMAND MEDICAL DEPARTMENT REPRESENTATIVE WILL
BE THE PRIMARY SOURCES OF REFERRAL TO INTERNATONAL SOS.  INTERNATIONAL SOS
OPERATES NUMEROUS GLOBAL 24/7 OPERATIONS CENTERS TO FACILITATE ACCESSING CARE.
REFERRALS SHOULD BE MADE TO THE INTERNATIONAL SOS OPERATIONS CENTER SERVING
THE REGION WHERE THE CARE IS REQUIRED, AS FOLLOWS:
A.  FOR CARE IN TRICARE PACIFIC REGION, CONTACT INTERNATIONAL SOS MEDICAL
OPERATIONS CENTER SINGAPORE, DIRECT OR COLLECT, AT (65) 6338-9277.
ALTERNATIVELY, THE SYDNEY, AUSTRALIA OPERATIONS CENTER IS AVAILABLE,
DIRECT OR COLLECT, AT 61-2-9372-2468.
B.  FOR CARE IN TRICARE EUROPE REGION, CONTACT INTERNATIONAL SOS MEDICAL
OPERATIONS CENTER LONDON, DIRECT OR COLLECT, AT (44) 20-8762-8133.
C.  FOR CARE IN TRICARE LATIN AMERICA/CANADA REGION, CONTACT INTERNATIONAL
SOS MEDICAL OPERATIONS CENTER PHILADELPHIA DIRECT AT (800)-834-5514 OR COLLECT
AT (215) 701-2800.
D.  TGRO COVERAGE FOR DEPLOYED SERVICE MEMBERS IS EXPRESSLY DESIGNED TO PROVIDE
CARE OF AN URGENT OR EMERGENT NATURE.  ROUTINE CARE SHOULD NOT BE PURSUED FROM
INTERNATIONAL SOS.  INTERNATIONAL SOS WILL PERFORM APPROPRIATE TRIAGE AND
CONFIRM ELIGIBILITY VIA THE DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM
(DEERS) AT THE TIME THEY RECEIVE A CASE REFERRAL.
E.  UPON CONFIRMING ELIGIBILITY AND CARE REQUIRED, INTERNATIONAL SOS WILL
IDENTIFY THE PROVIDER WHO WILL SEE THE PATIENT AND VERIFY THAT APPROPRIATE
TRANSPORTATION FOR THE PATIENT HAS BEEN ARRANGED.
F.  TO ENSURE SENSITIVE PATIENT INFORMATION IS ADEQUATELY PROTECTED,
INTERNATIONAL SOS WILL ROUTINELY PROVIDE PATIENT INFORMATION DIRECTLY TO THE
RESPECTIVE TOP REGIONAL OFFICE.  THAT OFFICE WILL FURTHER PROVIDE INFORMATION
TO APPROPRIATE AUTHORITIES INCLUDING FLEET/OPERATIONAL COMMANDERS AND THEIR
SURGEONS/SENIOR MEDICAL REPRESENTATIVES.
G.  INTERNATIONAL SOS HAS EXECUTED GUARANTEES OF PAYMENT WITH PROVIDERS TO
WHOM THEY REFER PATIENTS.  DEPLOYED ACTIVE DUTY SERVICE MEMBERS WHO ARE
PROPERLY REFERRED FOR CARE WILL NOT BE ASKED TO PAY FOR MEDICAL SERVICES.
INTERNATIONAL SOS WILL PAY PROVIDERS DIRECTLY AND SUBMIT CLAIMS FOR
REIMBURSEMENT TO TMA VIA THE TRICARE OVERSEAS CLAIMS PROCESSOR.
8.  OPERATIONAL COMMANDERS' RESPONSIBILITIES.   FLEET AND MARFOR COMMANDERS
ARE ENCOURAGED, AS THEY DEEM APPROPRIATE, TO PUBLISH COMMAND-SPECIFIC
GUIDANCE SIMILAR TO REF B RELATIVE TO THE 01 OCTOBER 2003 COMMENCEMENT OF
GLOBAL NAVY AND MARINE CORPS ELIGIBILITY FOR URGENT/EMERGENT CARE UNDER THE
TGRO.  MEDICAL CARE AVAILABLE FROM INTERNATIONAL SOS VIA THE TGRO IS INTENDED
TO SUPPLEMENT DEPLOYED UNITS MEDICAL ASSETS WHEN URGENT OR EMERGENT PATIENT
NEEDS EXCEED THE UNITS' OWN ORGANIC MEDICAL CAPABILITIES.  COMMANDERS MUST
ENSURE THAT CONTINGENCY PLANNING FOR UNITS IN THEIR RESPECTIVE AORS REFLECTS
THAT THE TGRO IS NOT   REPEAT - NOT A SUBSTITUTE FOR PROVIDING APPROPRIATE
ORGANIC MEDICAL ASSETS FOR DEPLOYING UNITS.  COMMANDERS SHOULD ENSURE THAT
DEERS REGISTRATION IS CURRENT FOR ALL PERSONNEL TO FACILITATE VERIFICATION
OF ELIGIBILITY.  PATIENT REFERRAL UNDER TGRO DOES NOT SUPPLANT REQUIREMENTS
FOR CASUALTY REPORTING.  COMMANDERS SHOULD ALSO ENSURE THAT PATIENTS AND ANY
ACCOMPANYING MEDICAL OR NON-MEDICAL ATTENDANTS ARE PROVIDED FULLY FUNDED
ORDERS TO COVER TRANSPORTATION/BERTHING EXPENSES PURSUANT TO ACQUIRING CARE
UNDER THE TGRO IAW JFTR AND OTHER APPROPRIATE TRAVEL FUNDING GUIDANCE.
9.  THE INFORMATION IN THIS MESSAGE WILL BE REFLECTED IN THE NEXT
REVISION OF REFERENCE C.//