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 calendar
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 (FY) cost-share of $36,000.
1.9 The contractor shall prorate
the $36,000 cap for the last quarter of calendar year (CY) 2018
(i.e., $9,000 max) per new
32 CFR 199.5(a)(3) to transition the regulation
from FY to CY.
1.10 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
CY cost-share of $36,000.
1.11 For services
received prior to January 1, 2019, deductibles and catastrophic
loss protection are applicable on an FY basis. For services received
on or after January 1, 2018, deductibles and catastrophic loss protection
are applicable on a CY basis.
1.12 In order
to transition deductibles and catastrophic loss protection from
an FY to a CY 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.
1.13 The Government’s maximum annual
cost-share for the EHHC benefit is as calculated in
Section 15.1.