1.0 POLICY
1.1 Extended
Care Health Option (ECHO) allowable amounts are not subject to a
deductible amount.
1.2 The sponsor/beneficiary ECHO
cost-share for every month in which ECHO benefits, including the
ECHO Home Health Care (EHHC) benefits, are received is according
to the sponsor’s pay grade as specified below, regardless of the
number of dependents of that same sponsor receiving ECHO benefits in
that month:
|
ECHO
Cost-Share Amounts
|
|
Sponsor
Pay Grade Code
|
Sponsor
Cost-Share Amount
|
|
E-1 through E-5
|
$25
|
|
E-6
|
30
|
|
E-7 and O-1
|
35
|
|
E-8 and O-2
|
40
|
|
E-9, WO/WO-1,
CWO-2, and O-3
|
45
|
|
CWO-3, CWO-4,
and O-4
|
50
|
|
CWO-5, O-5
|
65
|
|
O-6
|
75
|
|
O-7
|
100
|
|
O-8
|
150
|
|
O-9
|
200
|
|
O-10
|
250
|
1.3 The sponsor/beneficiary is
responsible for the appropriate amount shown in the above table plus
any amount in excess of the Government’s maximum coverage for any
benefits received in an enrollment (calendar beginning 2019; see
paragraph 1.9) year,
including the 90 day period the beneficiary is given “provisional”
status.
1.4 The sponsor/beneficiary cost-shares under the
ECHO are in addition to those incurred for services and items received
through the TRICARE plan options.
1.5 The sponsor/beneficiary cost-shares
under the ECHO do not accrue to meeting the catastrophic cap in
the TRICARE Basic Program.
1.6 The sponsor/beneficiary cost-shares
in the above table that are applicable for ECHO benefits, other
than EHHC services, do not accrue to the EHHC benefit cap.
1.7 The Government’s
maximum annual year cost-share for ECHO benefits applies to each beneficiary,
regardless of the number of dependents with the same sponsor receiving
ECHO benefits in that year.
1.8 The allowed cost of all services
provided by this chapter, except the EHHC,
through
December 31, 2018, accrue to the Government’s maximum
fiscal
year cost-share of $36,000. The contractor shall prorate
the $36,000 cap for the last quarter of CY 2018 (i.e., $9,000 max)
per new
32 CFR 199.5(a)(3) to transition the regulation
from FY to CY.
1.9 The allowed cost of all services
provided by this chapter, except the EHHC, on or after January 1, 2019,
accrue to the Government’s maximum calendar year cost-share of $36,000.
1.10 For services received prior to January 1, 2019,
deductibles and catastrophic loss protection are applicable on a
fiscal year basis. For services received on or after January 1,
2018, deductibles and catastrophic loss protection are applicable
on a calendar year basis.
1.11 In order to transition deductibles
and catastrophic loss protection from a fiscal year to a calendar
basis, the deductible and catastrophic loss protection amounts for
FY 2018 will be applicable to services received during the 15 month
period of October 1, 2017, through December 31, 2018.
1.12 The Government’s maximum annual cost-share
for the EHHC benefit is as calculated in
Section 15.1.