" #$%&' ()*

+%,%-.*/ 0.1%,%'2
"(('3-'& 4/ "$-%21



















"# $%&' ()*+

0'4*$.*/ 5678
5
9&
*':%2%)9

2
;)9-'9-2
Intiouuction ................................................................................................................................................................................. S
uetting a Biagnosis .................................................................................................................................................................... S
0nce you have youi Biagnosis ......................................................................................................................................... S
Step #1 Eniollment in the Exceptional Family Nembei Piogiam (EFNP) ............................................. 4
Step #2 Enioll in Extenueu Caie Bealth 0ption (ECB0) ................................................................................. S
Step #S Finu an Applieu Behavioi Analysis (ABA) Piogiam ......................................................................... 6
Step #4 uet on Youi State's Neuicaiu Waiting List ............................................................................................ 8
Navigating TRICARE ................................................................................................................................................................. 8
About TRICARE Plans .......................................................................................................................................................... 8
Compaiison Table ............................................................................................................................................................ 8
TRICARE Supplemental Plans ....................................................................................................................................... 1u
Costs Compaieu .................................................................................................................................................................. 1u
Piesciiptions ........................................................................................................................................................................ 11
Lab Tests ................................................................................................................................................................................ 12
Claims ...................................................................................................................................................................................... 12
Submitting a Claim ........................................................................................................................................................ 12
Tiacking Youi Claims .................................................................................................................................................. 1S
Financial Assistance .......................................................................................................................................................... 1S
Neuical Recoius ....................................................................................................................................................................... 1S
Immunizations ......................................................................................................................................................................... 14
Bousing ........................................................................................................................................................................................ 14
Legal Issues ................................................................................................................................................................................ 1S
Special Euucation .................................................................................................................................................................... 1S
Respite Seivices ....................................................................................................................................................................... 16
Beployments ............................................................................................................................................................................. 16
Legislative Effoits ................................................................................................................................................................... 16
Resouices ................................................................................................................................................................................... 17
About the Authoi ..................................................................................................................................................................... 17
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)
<9-*)&$3-%)9
The militaiy life is not foi eveiyone. The whole family neeus to have the commitment to seive the
countiy anu all that that entails. It can be a veiy exciting anu challenging life. I love it. I like
expeiiencing uiffeient paits of the countiy eveiy few yeais, though aumitteuly it is getting haiuei
foi my kius as they get oluei to leave fiienus anu sometimes family behinu.

The Navy, Aimy, Aii Foice, Naiines, anu Coast uuaiu have many things in common, but also many
things that uiffei incluuing caie anu seivices foi special neeus families. This aiticle cannot possibly
be all-inclusive, but will hopefully seive as a staiting point foi a militaiy family with a newly
uiagnoseu chilu, oi foi the family beginning the biomeuical jouiney.

This is wiitten foi families that aie alieauy in the militaiy when they get a uiagnosis. It makes
ceitain assumptions such as you alieauy have youi chilu eniolleu in Befense Eniollment Eligibility
Repoiting System (BEERS) anu aie using TRICARE.
#'--%9= . >%.=9)2%2
Youi Piimaiy Caie Nanagei (PCN) will be the one to see you most of the time foi well-baby check-
ups. Tiy to be consistent anu see the same uoctoi if at all possible. Speak out about youi conceins.
Ask foi iefeiials to a speech language pathologist if youi chilu is behinu in language uevelopment
oi a chilu psychologist if you aie conceineu about the oveiall uevelopment of youi chilu. If you
have TRICARE Stanuaiu, you uon't neeu a iefeiial; go anu make the appointment youiself. If you
aie on TRICARE Piime anu aie iefuseu a iefeiial by youi PCN, you may see anothei uoctoi oi go
without a iefeiial using the Point-of-Seivice (P0S) option, but it pays to be peisistent oi iequest a
uiffeient PCN. "Wait anu see" is not a goou option. Stuuies show the eailiei the inteivention the
moie effective it is.

If you aie iefeiieu to a chilu psychologist oi othei piofessional who uoes uiagnostic testing anu you
uo not agiee with the uiagnosis oi lack of uiagnosis, you may go back to youi PCN foi anothei
iefeiial. It always helps when asking foi iefeiials to have the name anu contact infoimation of the
piofessional you want to see so the PCN may wiite the iefeiial iight away.

TRICARE even offeis a thiiu opinion if youi fiist two uiagnoses aie not the same (i.e. Peivasive
Bevelopmental Bisoiuei-Not 0theiwise Specifieu (PBB-N0S) uiagnosis anu no uiagnosis at all).
Foi seivices sake, I woulu take the PBB-N0S uiagnosis anu leave it at that foi the moment.
0nce you have youi Biagnosis
Stait getting suppoit immeuiately fiom militaiy anu non-militaiy souices. Finu youi local autism
suppoit gioups anu online suppoit gioups. I founu Talk About Cuiing Autism (TACA) iight away -
anu even though they weie baseu in southein Califoinia wheie I was anu hau multiple meeting
locations, it was haiu foi me to get to meetings. Insteau I joineu the yahoo gioup (check Facebook
too) anu was able to meet up with othei paients who taught me how to cook, oiganize
supplements, anu finu the best uoctois. Bon't miss out on the auvice of othei paients who have
been theie anu aie helping theii chilu iecovei. Boctois may have goou intentions keeping you
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

4
away fiom alteinative tieatments, but they aie not the paient of youi chilu. Bo youi ieseaich anu
ueciue foi youi chilu. Bietaiy changes anu supplements aie not uangeious. Reseaich shows that
91% of people impiove on a gluten-fiee, casein-fiee, soy-fiee (uFCFSF) uiet (http:gfcf-
uiet.talkaboutcuiingautism.oiguefenuing-gfcfsf-uiet.htm).
!"#$ &' ()*+,,-#)" .) "/# (01#$".+)2, 32-.,4 5#-6#* 7*+8*2- 9(357:
EFNP is a manuatoiy eniollment piogiam foi the Bepaitment of Befense (BoB) anu Coast uuaiu.
Aimy - Regulation 6u8-7S
Navy - 0PNAvINST 17S4.2
Naiine Coips - NC0 P17S4.4A
Aii Foice - AFI 4u-7u1
Coast uuaiu - C0NBTINST 17S4.7A

The papeiwoik will be filleu out by youi PCN anu you must submit it, sometimes along with a few
othei signatuies if youi chilu is alieauy ieceiving seivices oi euucation.

See the ANFAS website foi moie infoimation about each of the bianches EFN Piogiams incluuing
the Coast uuaiu's Special Neeus Piogiam http:amfas.oigefmp-oveiview.

The EFN piogiam was uesigneu to make suie that seivice membeis aie not stationeu in an aiea
wheie seivices aie not available. This is a ieally goou iuea, howevei it uoes not woik that well foi
autism. The tieatment of autism anu ielateu meuical pioblems is something that Nilitaiy
Tieatment Facilities (NTF) uo not uo well oveiall. So iequiiing you to be neai one is not that
impoitant. The school uistiicts, availability of TRICARE-authoiizeu Applieu Behavioi Analysis
(ABA) pioviueis, Speech Language Pathologists (SLP) anu 0ccupational Theiapists (0T) aie moie
impoitant. Baving a goou NAPS uoctoi (http:www.meumaps.oig) in the aiea is nice, but so
many will uo consults via phone, with you just making the tiip in peison once a yeai, that it isn't a
big issue.

The job of the EFNP cooiuinatoi is to assist the family is accessing the meuical anu euucational
seivices neeueu. The stanuaiu of caie is not consistent acioss bianches anu bases. I was given the
phone numbei of the local Autism Society by one cooiuinatoi - foitunately, they hau some answeis
foi me. I believe that all bianches aie woiking on this issue, but the Naiine Coips is uoing the best
job. Families that uo not get the caie they neeu aie moie likely to leave the militaiy anu to have
pioblems at home.

0nce youi chilu has been uiagnoseu with an autism spectium uisoiuei anu the EFNP papeiwoik
has been submitteu, youi chilu will be assigneu a categoiy in some of the seivices. Youi papeiwoik
neeus to be upuateu eveiy thiee yeais. It is especially impoitant to have it upuateu when you aie
expecting a Peimanent Change of Station (PCS).

In the Navy theie aie S categoiies anu a 6
th
tempoiaiy categoiy. I was tolu that autism is an
automatic categoiy S which allows the family the option to homesteau anu not move. This is nice if
you aie in a goou place with goou seivices. Categoiy 4 offeis laige metiopolitan aieas with laige
militaiy hospitalsSan Biego, CA; Biemeiton, WA; }acksonville, FL anu Noifolk, vA. I askeu foi it
to be uown-giaueu to a 4 when it was time to iesubmit the papeiwoik (eveiy S yeais). Then I
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



S
askeu again to be uowngiaueu to S (no oveiseas billets) anu still got a 4. Categoiy 2 is limiteu
oveiseas billets anu categoiy 1 is mainly foi monitoiing.

We askeu foi a billet that was not in the laige metiopolitan aieas of the categoiy 4 iestiiction. The
oiueis weie flaggeu. We weie iequesteu to wiite a lettei stating that we unueistoou we weie
accepting this assignment against the bettei juugment of EFNP. We weie askeu to wiite that theie
is no NTF neaiby, that oui healthcaie costs coulu be highei, that healthcaie may not be as
accessible, anu that this was oui uecision. This tuineu out to be the best uuty station so fai. What
EFN uiu not take into account was that 1) we weie close to family 2) we weie TRICARE Stanuaiu
theieby choosing not to use any militaiy uoctois oi facilities S) the state hau an Autism ABA
Neuicaiu Waivei with a iathei shoit waiting list. It's not always this easy, but paients aie moie
likely to thoioughly ieseaich locations much bettei than the EFNP cooiuinatois oi othei militaiy
iesouices. If you think a billet is woith fighting foi, give it a tiy.
!"#$ &; ()*+,, .) (0"#)<#< =2*# >#2,"/ ?$".+) 9(=>?:
ECB0 is a sepaiate TRICARE piogiam foi family membeis with special neeus. 0nce you have
eniolleu in EFNP, call youi TRICARE ECB0 cooiuinatoi. If you aie not suie what iegion you aie in
see http:www.militaiy.combenefitstiicaietiicaie-seivice-centeis .

TRICARE Noith Region
Bealth Net Feueial Seivices, LLC
1-877-TRICARE (1-877-874-227S)
www.healthnetfeueialseivices.com

TRICARE South Region
Bumana Nilitaiy Bealthcaie Seivices, Inc.
1-8uu-444-S44S
(2@A B+* 4+C* 2*#2 12@# -2)28#*)
www.humana-militaiy.com

TRICARE West Region
0niteuBealth Nilitaiy & veteians Seivices
1-877-988-9S78
(2@A "+ @$#2A "+ 2) (=>? =++*<.)2"+*)
www.uhcmilitaiywest.com

The Extenueu Bealth Caie 0ption (ECB0) allows $S6,uuuyeai foi ABA, uuiable equipment anu
iespite seivices. That uollai amount will buy you S-12 houis a week of ABA - a fai ciy fiom the 2S
houi minimum iecommenueu by the Ameiican Acauemy of Peuiatiics (AAP) anu Suigeon ueneial.

Youi ECB0 cooiuinatoi can help you finu TRICARE-authoiizeu pioviueis of ABA in youi aiea. It is
youi job to pick one anu get on the waiting list. In fact it is a goou iuea to get on the waiting as soon
as possible, even befoie you have youi EFNP eniollment confiimeu.

0nly 1u% of militaiy chiluien with autism aie eniolleu in ECB0 (baseu on 2uu8 FI0A uocuments).
Why aie so many not taking auvantage of this benefit. It is often because theie is no one to pioviue
the seivices in the aiea. BoB has iecognizeu this pioblem anu is looking at possible solutions. But
some families still uo not know they even have this benefit. If you have no TRICARE-authoiizeu
pioviueis oi no pioviueis of the Bemo in youi aieaask. It is a lot of papeiwoik foi the pioviuei,
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

6
but once authoiizeu it is not that uifficult. We weie once the only militaiy client of oui pioviuei
so glau I askeu!

When you ask foi youi ABA iefeiial, TRICARE will authoiize you foi a netwoik pioviuei if theie is
one in youi aiea. If you get the authoiization foi one that you uiu not ask foi, you neeu to get youi
uocumentation togethei showing that the waiting list is too long, oi they uo not pioviue the
seivices you neeu anu appeal to 0tilization Nanagement.

TRIWEST useu to have a lot moie iequiiements than any othei aiea of the countiy. I'm not suie if
the new west iegion pioviuei is still asking foi moie.

ECB0 uoes have a monthly cost-shaie baseu on pay giaue.

Pay uiaue Nonthly Cost Shaie Pay uiaue Nonthly Cost Shaie
E-1 to E-S $2S 0-6 $7S
E-6 $Su 0-7 $1uu
E-7, 0-1 $SS 0-8 $1Su
E-8, 0-2 $4u 0-9 $2uu
E-9, W-1, W-2, 0-
S
$4S 0-1u $2Su
W-S, W-4, 0-4 $Su
W-S, 0-S $6S

!"#$ &D 3.)< 2) E$$,.#< F#/2G.+* E)2,4@.@ 9EFE: 7*+8*2-
Applieu Behavioi Analysis is the only autism theiapy that TRICARE coveis.
Theie aie TBREE options foi ABA theiapy:
H#8C,2* IHJ=EH( 7*+8*2-
The iegulai TRICARE piogiam itself only allows a Boaiu Ceitifieu Behavioi Analyst (BCBA) to see
youi chilu to uo the hanus-on woik. BCBAs can iun fiom $12S-$2Suhoui. A BCBA has a mastei's
uegiee anu has successfully passeu the baiu exam. BCBAs aie usually supeivisois anu uo not see
kius, but you may be lucky to finu some that will see kius.
(=>? K#-+)@"*2".+) 7*+8*2-
The seconu option is to finu a pioviuei paiticipating in the Autism Seivices Bemonstiation Pioject,
usually just iefeiieu to as the "Bemo". The Bemo pays foi a BCBA supeivisoi anu tutois that aie
supeiviseu by the BCBA who actually uo the woik with youi chilu. You can get a lot moie houis of
ABA with the Bemo piogiam.
EFE 7.,+" B+* L+)ME1".G#MKC"4
This pilot is only available thiough }uly 2u14 unless ieneweu thiough legislation. The piogiam
coveis seivices pioviueu by a BCBA. It iequiies moie testing anu assessments than the othei ABA
options. Foi uetails please see the TRICARE website
http:tiicaie.milWelcomeSpecialPiogiamsABAPilot.aspx. Seivices aie coveieu up to
$S6,uuuyeai with a 1u% cost shaie. The TRICARE annual anu catastiophic caps uo not apply to
the cost shaie.

A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



7
IHJ=EH( =+G#*28# +B EFE =+-$2*#<N
Last upuateu Feb. S, 2u14
?@<;"@A B.2%3 A;CD "$-%21
>'1)92-*.-%)9
"B" E%,)-
A,%=%4%,%-/ All Active uuty Non-active uuty
@'F$%*'& -'2-%9= None None ! AB0S-2 foi baseline assessment
! vinelanu II - eveiy 18u uays
! Active uuty families eniolleu in
ECB0 tiansitioning to non-active uuty
status thiough ietiiement aie alloweu
uiiect entiy to the ABA Pilot anu a 1
yeai giace peiiou will be gianteu to
meet uiagnosis, iefeiial, anu
assessment iequiiements (the
vinelanu II is still iequiieu eveiy 18u
uays)
A;CD '9*),,1'9-
*'F$%*'&
No Yes No
;)G./H3)2- 2I.*' ABA is consiueieu
"specialty caie." Cost
shaie is baseu on uuty
status anu TRICARE plan
(Piime, Stanuaiu, etc.)
Active uuty family out-of -
pocket maximum =
$1,uuuyi.
Non-active uuty family
out-of- pocket maximum
= $S,uuuyi.
$2S to $2Sumonth
uepenuing on iank (cost
shaie uoes not acciue to
out-of- pocket maximum)
1u% cost-shaie
(cost shaie uoes not acciue to out-of-
pocket maximum)
C)$*2 G'* J''K H
.99$., 3.G
No limitation Seivices ueliveieu unuei
the ECB0 Autism Bemo
aie baseu on annual
$S6,uuu cap. Seivices can
be combineu with the
houis ueliveieu unuei the
TRICARE Basic Piogiam.
Seivices ueliveieu unuei the ABA
Pilot Bemo aie baseu on annual
$S6,uuu cap. Seivices can be
combineu with the houis ueliveieu
unuei the TRICARE Basic Piogiam.
;):'*'& 2'*:%3'2 All uiiect seivices must
be ueliveieu by Boaiu
Ceitifieu Behavioi
Analyst, Boaiu Ceitifieu
Behavioi Analyst -
Boctoial, oi othei
TRICARE qualifieu
pioviuei licenseu oi state
ceitifieu to uelivei ABA.
Boaiu Ceitifieu Assistant
Behavioi Analysts aie
specifically excluueu
ABA Technicians
(commonly iefeiieu to as
"tutois" by TRICARE) aie
coveieu. ABA Technicians
must be supeiviseu by a
qualifieu bacheloi's level
Boaiu Ceitifieu Assistant
Behavioi Analyst oi a
mastei's level oi above
Boaiu Ceitifieu Behavioi
Analyst. Piogiam costs
incluue supeivision time.
Boaiu Ceitifieu Assistant Behavioi
Analysts anu ABA Technicians
(commonly iefeiieu to as "tutois" by
TRICARE) aie coveieu when woiking
unuei the supeivision of a mastei's
level oi above Boaiu Ceitifieu
Behavioi Analyst. Piogiam costs
incluue supeivision time.
"=' .9& >$*.-%)9
L%1%-2
None None Yes. Waivei necessaiy foi
beneficiaiies ovei age 16 anu foi
tieatment beyonu 2 yeais
*Chait fiom Autism Speaks
http:www.autismspeaks.oigsitesuefaultfilesuocsgitiicaie_aba_S_plans_siue_by_siue_u2.uS.2u14.puf



A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

8
!"#$ &O P#" +) Q+C* !"2"#R@ 5#<.12.< S2.".)8 T.@"
Each state is uiffeient. Check out TACA's links at http:www.tacanow.oigfamily-iesouicesstate-
meuicaiu. Even if you uo not expect to evei get to the top of the waiting list foi ABA oi attenuant
seivices, the state neeus to see the neeu oi they will not funu auuitional spots.

ECB0 is an excellent oppoitunity to ieceive ABA benefitsmost insuiance plans in the 0S uo not
covei ABA. (Though many states manuate it, theie aie a lot of loopholes foi employeis to not
pioviue it). TRICARE is N0T an insuiance planit is an entitlement. When useu in conjunction
with self-pay anu state Neuicaiu waivei piogiams, youi chilu can ieceive the 2S-4u houis
iecommenueu of ABA.

Check youi chilu's eligibility foi Supplement Secuiity Income (SSI). E-6 anu below shoulu apply. In
aieas wheie theie is not a heavy militaiy population, you may have a casewoikei who uoes not
know how to calculate youi income. Nake suie that housing is not counteu as a special pay, but as
iegulai pay.
M.:%=.-%9= ?@<;"@A
About TRICARE Plans
TRICARE Piime is the best option foi the piice. It is most like a piivate BN0 plan. It will most likely
consist of caie at a Nilitaiy Tieatment Facility (NTF) with militaiy uoctois anu specialists. Theie is
an option to use a Point-of-Seivice (P0S) within Piime to see specialists without a iefeiial, but it
will cost much moie. TRICARE Stanuaiu is the most flexible, not iequiiing any iefeiials, but also
the most expensive at up to $1uuuyeai. In many cases you will have to submit youi own claims.
TRICARE Extia is like the Piefeiieu Pioviuei 0ption (PP0) of TRICARE. You can use pioviueis in
the netwoik, wheieas Stanuaiu is outsiue of the netwoik.
=+-$2*.@+) I26,#
http:www.tiicaie.milWelcomeCompaiePlans.aspx

Table with most peitinent info only
?@<;"@A E*%1' ?@<;"@A N-.9&.*& .9& AO-*.
PI.- %2 %-Q
TRICARE Piime is a manageu caie option
offeiing the most affoiuable anu
compiehensive coveiage.
TRICARE Stanuaiu anu Extia is a fee-foi-seivice
plan available to all non-active uuty beneficiaiies
thioughout the 0niteu States.
PI.- .*'
-I' 1.%9
('.-$*'2Q
! Eniollment iequiieu
! Enhanceu vision coveiage anu clinical
pieventive seivices
! Nost caie ieceiveu fiom youi piimaiy caie
managei
! Time anu uistance access stanuaius
! Fewei out-of-pocket costs
! No claims to file (in most cases)
! Eniollment not iequiieu
! Nay seek caie fiom any TRICARE-authoiizeu
pioviuei, netwoik oi non-netwoik
! Refeiials aie not iequiieu, but some caie may
iequiie piioi authoiization
! You may have to pay foi seivices when they aie
ieceiveu anu file youi own claims foi
ieimbuisement
C)J &) < ='-
3.*'Q
You'll get most caie fiom youi assigneu
piimaiy caie managei (PCN). Youi PCN will
give you a iefeiial foi caie he oi she cannot
You may seek caie fiom any TRICARE-authoiizeu
pioviuei, netwoik oi non-netwoik. Refeiials aie
not iequiieu, but some seivices may iequiie piioi
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



9
pioviue. authoiization 9!$##1/U ?I 2)< 7I *#VC.*# $*.+*
2C"/+*.W2".+):X
P%,, < I.:'
-) (%,' 1/
)J9 3,.%12Q
Youi pioviuei will file claims foi you (in
most cases).
If you ieceive caie fiom a netwoik pioviuei, youi
pioviuei will submit claims on youi behalf. If you
ieceive caie fiom a non-netwoik pioviuei, you
may be iequiieu to submit youi own health caie
claims.
>) < I.:' -)
'9*),,Q
PI.- %2 -I'
.99$., (''Q
LnrollmenL ls requlred. 1here ls no enrollmenL
fee for acLlve duLy famllles. 8eLlrees, Lhelr
famllles and all oLhers musL pay annual
enrollmenL fees Lo parLlclpaLe.
Eniollment is not iequiieu.
PI.- %2 -I'
.99$.,
&'&$3-%4,'Q
Theie is no annual ueuuctible unless you aie
using the point-of-seivice option:

! $SuuInuiviuual
! $6uuFamily
!"#$% '(#)*$ +,#- .$/*)($ 0$01$/. 02- 3"#
,.$ #4$ 5")3#6"76.$/*)($ "5#)"38
The annual outpatient ueuuctible vaiies
uepenuing on the sponsoi's militaiy status anu
iank:

Active uuty family membeis (sponsoi iank E-4
anu below):
! $SuInuiviuual
! $1uuFamily
AcLlve duLy famlly members (sponsor rank L-3 and
above)
$130/lndlvldual
$300/lamlly
All oLhers:
$130/lndlvldual
$300/lamlly
!"#$% 94$ 233,2: +$+,(#)1:$ ). ;2)*$+ 7"/ 720):-
0$01$/. "7 !2#)"32: <,2/+=>$.$/*$ 0$01$/.
,.)3? 9>@A'>B C#23+2/+ 23+ BD#/2 ;4".$ .5"3."/
;2. 2(#)*2#$+ )3 .,55"/# "7 2 ("3#)3?$3(-
"5$/2#)"38
C)J 1$3I
&) < G./ ()*
.9
)$-G.-%'9-
:%2%-Q
Netwoik Pioviuei

! Active uuty seivice membeis: $u
! Active uuty family membeis: $u
! All otheis: $12 pei visit
non-neLwork rovlder
! With PCN iefeiial: Same as netwoik
pioviuei costs
! Without PCN iefeiial: Point-of-seivice
fees apply (Su% of allowable chaige, aftei
the P0S annual ueuuctible is met.**)
neLwork rovlder (LxLra opLlon)
AcLlve duLy famlly members: 13 of negoLlaLed
fee afLer Lhe annual deducLlble ls meL
All oLhers: 20 of negoLlaLed fee afLer Lhe annual
deducLlble ls meL

non-neLwork rovlder (SLandard opLlon)
AcLlve duLy famlly members: 20 of allowable
charges afLer Lhe annual deducLlble ls meL
All oLhers: 23 allowable charges afLer Lhe annual
deducLlble ls meL

PI.-R2 -I'
1.O%1$1
The catastiophic cap vaiies uepenuing on
the sponsoi's militaiy status:
?our caLasLrophlc cap varles dependlng on Lhe
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

1u
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! Active uuty families: $1,uuu pei family, pei
fiscal yeai
! National uuaiu anu Reseive families:
$1,uuu pei family, pei fiscal yeai
! Retiieu families (anu all otheis): $S,uuu
pei family, pei fiscal yeai
sponsor's mlllLary sLaLus:
! Active uuty families: $1,uuu pei family, pei
fiscal yeai
! National uuaiu anu Reseive families: $1,uuu pei
family, pei fiscal yeai
! Retiieu families (anu all otheis): $S,uuu pei
family, pei fiscal yeai
PI'*' %2 -I'
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In the 0niteu States in Piime Seivice Aieas. 0niteu States
C)J 3.9 <
,'.*9 1)*'Q
Co Lo Lhe 18lCA8L rlme page Lo learn more.
Co Lo Lhe 18lCA8L SLandard and LxLra page Lo learn
more.
** ,-.+/ 01.%2+ 3).# &+42%1+ 5+5"+4 5'# 6-. )&+ .7+ *-%6.8-98&+42%1+ -*.%-6:

Theie will be moie examples with specific costs latei in this aiticle.
TRICARE Supplemental Plans
Piivate companies offei supplemental insuiance plans to lowei the costs associateu with TRICARE
Stanuaiu anu Extia. uoogle foi a companies offeiing supplements oi look at the aus in youi
bianch's "Times" newspapei. Also see www.militaiy4life.comtiicaie.

Nany civilian uoctois chaige moie than the TRICARE alloweu uollai amount foi a uoctoi's visit.
TRICARE will ieimbuise only the allowable amount anu a supplement may make up some of the
uiffeience.

I believe that TRICARE Stanuaiu with a supplement is the best way to go. You may move with it
anu not have to woiiy if you will have a goou TRICARE Piime PCN at youi next uuty station.

Effective 0ctobei 2u12, the Nilitaiy 0fficeis Association of Ameiica (N0AA) TRICARE supplement
changeu its policy on paying moie than 1S% of chaiges ovei the TRICARE alloweu amount. This
useu to be a gieat ueal, now it is not. We chose to keep N0AA anyway as the supplement piice was
not veiy expensive anu it still pays co-pays foi speech anu occupational theiapy.
Costs Compaieu
Let us consiuei that a NAPS (http:www.meumaps.oig) uoctoi chaiges $Suu foi an initial two
houi visit anu the TRICARE appioveu iate is $166.

Let's assume that the uoctoi uoes not accept insuiance at all anu that you have to file it. (Nost NAPS
uoctois uo not accept insuiance because it costs them money to have to file it anu keep up with
claims). So, in eveiy instance you will be paying $Suu at the time of the appointment. The
uiffeiences will be in how much you aie ieimbuiseu which is shown at the bottom of each column.
The table is baseu on a $Suu new patient uoctoi's office visit with a TRICARE appioveu amount of
$166. Reimbuisement is assuming the ueuuctible of $Suu has alieauy been met.




A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



11
Plan Refeiial Nath Reimbuisement
Piime with P0S option no iefeiial Su% of $166= $8S
Piime iefeiial 1uu% of $Suu= $Suu*
Stanuaiu no iefeiial 8u% of $166= $1SS
Stanuaiu with Supplement no iefeiial 1uu% of $166 + 1S% ovei $166 =
$19u.9u**
*this is what TRICARE will tell you, but this is not likely to be youi ieimbuisement iate. Rate
uepenus on the uoctoi's agieement with TRICAREwhethei they aie netwoik, non-netwoik oi uo
not accept assignment (uo not accept insuiance). Bo not expect to be fully ieimbuiseu with this
option. Nake suie you uiscuss this with youi uoctoi's office befoie youi fiist appointment.
**Eveiy supplement is uiffeient, you will neeu to check with youis.

An option not listeu in the chait is if youi chilu's NAPS uoctoi is also his in-netwoik PCN. You
woulu pay nothing. We manageu to uo that on both coasts; while unusual, it is not impossible.
Piesciiptions
Theie aie foui ways to get piesciiptions filleu.
1. If you take youi piesciiption to an NTF, theie is no cost.
2. 0se a BoB TRRx (TRICARE ietail netwoik phaimacy, like youi local Walgieens), co-pays aie
$S foi geneiics anu $17 oi $44 foi bianu name (new iates effective }anuaiy 2u1S). You can
only get a Su-uay supply at each time.
S. 0se the TRICARE mail oiuei phaimacy, the co-pay foi foimulaiy uiugs is $1S anu non-
foimulaiy is $4S, but you can get a 9u-uay supply, ueliveieu to you at home foi a single co-
pay.
4. 0se a non-netwoik phaimacy- such as a compounuing phaimacy.

Theie aie some autism-fiienuly compounuing phaimacies that will bill TRICARE foi you. Lee Silsby
anu Puie Compounuing will bill TRICARE. So, if paying foi youi piesciiptions up fiont is a pioblem,
they aie a goou option. You will only have to pay shipping anu that is not ieimbuisable, anu you
can only get one month at a time.

Submitting a claim foi a piesciiption is not uifficult. 0se BB Foim 2642; attach youi ieceipt with
amount paiu. Bosing infoimation must also be on the ieceipt oi a sepaiate foim anu the NBC neeus
to be on the claim also. Nost phaimacies will give you a geneiic claim foim so that you can file
youiself. }ust ask foi it. Nake a copy anu mail it to:

Expiess Sciipts
Attn: TRICARE Claims
P.0. Box 66S18
St. Louis, N0 6S166-6S18

Copayments (effective }anuaiy 2u1S)
?/G' )( >*$= W6 >./ N$GG,/ @'-.%, EI.*1.3/ X6 >./ N$GG,/ C)1' >',%:'*/
ueneiic * $S $u
Foimulaiy $17 $1S
Non-Foimulaiy $44 $4S
*0ccasionally, some geneiic meuications may be consiueieu non-foimulaiy. Non-foimulaiy
geneiics will be subject to the non-foimulaiy copayments listeu above - $4S foi Bome Beliveiy anu
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

12
$44 foi ietail phaimacy. Youi uoctoi can submit eviuence of meuical necessity foi these uiugs. If
eviuence of meuical necessity is appioveu, the foimulaiy copayment - $1S foi Bome Beliveiy anu
$17 foi ietail phaimacy - will apply.

Expiess Sciipts (the TRICARE Phaimacy) has a nice website that allows you to oiuei, set iefill
ieminueis oi auto iefill. You may also piice a uiug on the website befoie senuing in youi Rx fiom
the uoctoi.

Ny TRICARE supplement pays foi my BoB TTRx co-pays.

Not all meuications oi tieatments that may be piesciibeu by youi uoctoi aie coveieu.

In 2u1S TRICARE announceu it woulu no longei covei some compounueu meuications. They have
since changeu theii stance anu the official statement (as of }an 2u14) is "TRICARE has uelayeu the
implementation of any change in piactice on compounueu piesciiptions until fuithei notice." Foi
the most cuiient news on compounueu meuications see the Expiess-Sciipts page http:expiess-
sciipts.comTRICAREcompounueumeuicationsinuex.shtml.

Lab Tests
Nost lab foims I have seen give you the option of billing youi insuiance company oi piepaying at a
lowei cost. I have nevei hau a lab iefuseu when I piepaiu it anu submitteu a claim. 0se that option
whenevei you can as you aie most likely to get youi money back. Youi uoctoi shoulu fill in the
uiagnosis anu othei coues on the foim. If he uiu not, call anu make suie you have the iight coues on
youi foim befoie senuing in the lab test.

Lab tests aie ieimbuiseu the same way as uoctoi's office visits useu in the compaie costs examples
above.

Claims
!C6-."".)8 2 =,2.-
0se BB Foim 2642. This foim can be filleu out online anu piinteu with youi infoimation in itit
piints a copy foi you to keep anu one to senu in.

I use a "shoitcut". I fill out the foim except foi the conuition (8a) anu the signatuie anu uate (12a
anu b) anu piint seveial copies of page 4 (I only piint page 4) that I keep in my "claims penuing"
foluei. When I neeu to submit a claim, I pull one out, wiite the conuition in 8a, sign anu uate anu
make a copy. I make a lot of claims in TRICARE Stanuaiu, so this is less time consuming foi me.

You uo not neeu to wiite in meuical teims foi the conuition box. In fact I have founu you uon't have
to say much at all, the coues on youi suppoiting uocument (uoctoi's office bill, lab test) have all the
official meuical infoimation coueu (if you neeu a coue - check out the list of coues on TACA
http:www.tacanow.oigfamily-iesouicesbilling-coues-that-woik). Foi example, foi methyl-
B12 shots I wiite "vitamin B12 ueficiency" on a uiine toxins test I wiite "lab test foi toxic metals".

A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



1S
I*21A.)8 Q+C* =,2.-@
Keep a copy foi youiself (a flatbeu piinteicopieiscannei is veiy useful) anu inuicate at the top of
youi copy - the uate of seivice, what it was foi, the uollai amount of the claim anu when you maileu
it. Both sites have a mailbox featuie foi coiiesponuence. This is veiy useful when you woik on
claims aftei business houis.

www.mytiicaie.com is an excellent way to tiack youi Explanation of Benefits (E0B). I tuin off
ieceiving all of mine by papei - I'u get too many. I'u iathei save the tiees. Because I have TRICARE
Stanuaiu, they tell me what the checks aie foi when sent, so I enu up ieceiving many E0Bs by mail
anyway. It is slow anu clumsy, but it is faiily simple to see what has been paiu anu what hasn't. You
uo have to change youi passwoiu often, so uon't foiget to wiite it uown.

www.expiess-sciipts.com is the site foi piesciiption meuication tiacking. Each family membei
neeus a uiffeient login.
Financial Assistance
Check out TACA's Scholaiship page http:www.tacanow.oigabout-tacataca-scholaiships.

The Bypeibaiic Neuical Centei of New Nexico will tieat any chilu with ceiebial palsy oi autism,
who establishes themselves as a patient in theii vitaeiis Bypeibaiic 0xygen chambei, at no cost.

Integiative Bypeibaiics (Wisconsin & Califoinia) also offeis financial assistance foi Bypeibaiics
anu biomeuical tieatments. Contact 6u8-278-4268 foi moie infoimation.

If you want to see a NAPS uoctoi anu cannot get a iefeiial anu uo not have the iesouices to pay the
co-pays, fiist get some auvice fiom a family that has uone it, then consiuei applying foi a
scholaiship.

Scholaiships aie available foi militaiy families fiom ACT! Foi Nilitaiy Families
http:www.acttouayfoimilitaiyfamilies.oigapply_autism_giant.aspx.

Scholaiships open to all families with a chilu with autism aie available thiough the Autism Caies
piogiam http:www.autismcaies.oig.

ueneiation Rescue also offeis family giants www.geneiationiescue.oig.
+'&%3., @'3)*&2
Nilitaiy 0neSouice offeis the BoB Special Neeus Toolkit anu the Special Caie 0iganizational
Recoiu (SC0R). The SC0R is available foi uownloau online anu both may be iequesteu in haiu copy
with a binuei fiom Nilitaiy 0ne Souice by calling 1-8uu-S42-9647.
http:www.militaiyonesouice.milefmpfamily-suppoit.content_iu=267764. Fiom the website:
The SC0R is an oiganizing tool that helps families keep infoimation about theii chilu's health anu
caie oiganizeu anu in one place. The SC0R also makes it easiei foi you to finu anu shaie key
infoimation with otheis who aie pait of youi chilu's caie team.

A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

14
When you get ieauy to PCS, make suie you get copies of all of youi chilu's (even youi own) meuical
iecoius to caiiy with you. Some civilian clinicsuoctois may chaige you foi copies. Let them know
you aie militaiy anu moving, sometimes they may waive theii usual fees. If not, it is woith the small
piice to have those iecoius with you. Nevei give anyone the only set of iecoius you have. It's 0K to
hanu them ovei at the beginning of an appointment so they can make copies, but uon't leave them
behinu. You may nevei see them again.
<11$9%Y.-%)92
The militaiy is veiy stiaight foiwaiu on this. If you aie oiueieu to be immunizeu you only have two
options to avoiu it - a meuical, ieligious (see S-6 of www.apu.aimy.milpuffilesi6uu_2u.puf) oi
auministiative exemption. Aimy Regulation 4u-S62 iegaiuing the Nilitaiy vaccine 0ffice may be
founu at www.apu.aimy.milpuffilesi4u_S62.puf .

Requiiements foi a family membei aie uiffeient. Family membeis aie civilians anu may iefuse
vaccines. Bowevei, if youi chilu is at a BoB chilucaie oi school you may have to go thiough the
same exemption piocess as noteu foi the sponsoi above.

When PCSing oveiseas, you may be tolu that you uo neeu immunizations. The only immunizations
you aie iequiieu to have aie the ones manuateu by the countiy to which you aie moving. 0ften the
foiwaiu commanu has the final woiu in this. If you aie looking foi oveiseas immunization
infoimation foi militaiy, theie aie some veiy knowleugeable moms on the www.motheiing.com
foium.

I suggest having youi cuiient uoctoi sign the meuical exemption foim foi youi chilu's new school
befoie you move. You can usually call aheau anu get eniollment foims maileu to you, oi even
uownloau them off the inteinet. Fewei meuical exemptions aie questioneu.
C)$2%9=
Choosing wheie to live can often be the biggest heauache in a move since youi school almost always
is baseu on wheie you live. Living on base, if housing is available, is the easiest anu often most cost
effective option. Ask if they allow families with special neeus to be placeu highei in the waiting list.
When you live in base housing you uo not ieceive youi housing allowance (it gets paiu to the
housing company) anu youi utilities aie also paiu (watei, gas, electiic).

In the last 1u yeais, the Navy (anu othei biaches) have been piivatizing housing. This means many
housing aieas acioss the countiy have been iebuilt anu look gieat. But, the piivate fiim is not in
the BoB chain of commanu. They uo not have to altei anything foi youi chilu oi youi family. If, foi
example, caipeting is going to be a pioblem foi youi chilu with seveie alleigies, think twice about
choosing base housing.

Theie aie always places to ient in the community foi militaiy families. Buying in some maikets is a
nice option as well (especially is you expect to stay). Bon't buy just because piices aie low. You
will have to sell again when you leave anu may take a loss uepenuing on the maiket. To check youi
monthly housing allowance see http:www.militaiy.combenefitsmilitaiy-paybasic-allowance-
foi-housing-iates .
A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



1S
L'=., <22$'2
Legal uocuments that you neeu piepaieu aie a Last Will anu Testament, Lettei of Intent, Buiable
Powei of Attoiney, anu a Special Neeus Tiust.

}Au attoineys can piepaie youi will anu powei of attoiney. While the Lettei of Intent is not a legal
uocument, it shoulu be placeu with youi othei legal uocuments.

Some Aimy bases have civilian attoineys that aie qualifieu to piepaie Special Neeus Tiusts. Check
with youi base's }Au office fiist, then neaiby Aimy bases. If you cannot finu a militaiy office to
piepaie it, check with local suppoit gioups foi an attoiney iecommenuation. The cost is $2uuu-
$Suuu.

See also http:www.talkaboutcuiingautism.oigiesouicesauult-legal-planning.htm.
NG'3%., A&$3.-%)9
If youi chilu is school age this is the aiea in which you neeu to be a big auvocate. You neeu to
ieseaich schools, have a goou IEP in hanu befoie getting to the new school, anu know what youi
chilu neeus anu how to get it at the new school.

Befoie moving to the aiea, euucate youiself on the aiea schools. Check the Ameiican Nilitaiy
Family Autism Suppoit website (http:www.amfas.oig )Facebook page
http:www.facebook.commilitaiyautism , ask on yahoo gioups (militaiy, TACA, Autism Society oi
othei local lists) anu contact youi base's EFNP Cooiuinatoi to see if theie aie any goou contacts in
the aiea that can talk about schoolsespecially how they woik (oi uon't) with a chilu like youis.
Review youi chilu's IEP to see that it incluues eveiything. If youi cuiient school has mouifieu class
woik foi youi chilu, given him an aiue, auueu extia speech seivices, oi anything that has helpeu
him, make suie it is auueu to youi IEP. In oui last IEP befoie a move, I make suie eveiything is
explicitly wiitten out. If his IEP uoes not say he has a full-time aiue, but he uoes, I will make suie
that is wiitten out in oui last IEP.

Eveiy school uistiict oui son has been in has hau a uiffeient IEP wiiting piogiam anu uiffeient iules
goveining IEPs. If possible, view an IEP fiom the school youi chilu will be attenuing befoie youi
IEP meeting. It is also veiy helpful to the new school if youi chilu's cuiient teachei will wiite
tiansition notes that explain moie about an aveiage uay than testing scoies anu goals uo. The notes
shoulu incluuing toileting ioutines, lunch ioom ioutines, types of scheuules useu, piefeiieu
iewaius oi bieak time activities, type of class he is in (how many teacheisstuuentsaiues) anu the
type of suppoit he has.

uet copies of youi chilu's entiie euucation filenot just the uocuments you aie piesenteu with, but
all of the uata taken on youi chilu (anu sometimes you) uuiing the time you weie in that school oi
uistiict. Nost schools will not just hanu ovei this infoimation. The iaw uata taken on some
evaluations may be a big clue to youi new school of some stiengths oi ueficits in youi chilu. Not all
school psychologists aie equal anu some may inteipiet the uata uiffeiently.

A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)

16
Know the law. Theie aie seveial goou books available on special euucation law. The Wiight's Law
website is a goou iesouice. Finu a TACA Law Bay seminai www.tacanow.oig oi buy the confeience
CB of the session fiom Autism 0ne. I finu it convenient to listen while packing oi making a cioss
countiy uiive to iefiesh my memoiy.

A couple of Naiine Coips bases have hiieu special euucation auvocates to help oui families!
@'2G%-' N'*:%3'2
Being a paient is haiu enough sometimes, but being a paient to a special neeus chilu AL0NE while
youi spouse is ueployeu can be tough. Nake suie that you have suppoits in placefamily, fiienus,
tiusteu babysitteis. Nany people want to help, but may not be ieauy to babysit. Naybe you can use
them to help othei ways such as taking youi othei uaughtei to hei ballet lessons, picking up
something at the gioceiy stoie, etc. Eveiy little bit will help when you woulu otheiwise have to uo
it all youiself.

Respite pioviueis give families a much neeueu bieak. Look foi a pioviuei with expeiience woiking
with chiluien with autism. If you aie not using all youi ECB0 money foi ABA, you can use some foi
iespite also thiough a TRICARE-authoiizeu pioviuei.

Some bianches of seivice anu some bases have iespite piogiams of theii own. Youi EFNP
cooiuinatoi on base shoulu be able to tell you about special piogiams on youi base. If not - stait
asking aiounu on base anu on list-seives.

Youi state may also offei iespite seivices as pait of Neuicaiu. Nake suie you have applieu foi them.
>'G,)/1'9-2
Paienting a Special Neeus Chilu When Youi Spouse is Beployeu fiom Nilitaiy 0ne Souice
http:www.militaiyonesouice.comN0SFinuInfoimationCategoiyTopicIssueNateiial.aspx.
NateiialTypeIB=9&NateiialIB=1SS28
L'=%2,.-%:' A(()*-2

TRICARE uoes give us some excellent coveiage, but it stills falls shoit when it comes to houis
iecommenueu foi ABA.

TRICARE cieateu the ECB0 piogiam in oiuei to auu the ABA seivices on to TRICARE. This ieally
cieates a sepaiate insuiance piogiam foi the uisableu chilu. ABA is an eviuence-baseu, meuically
necessaiy tieatment foi autism anu it shoulu be a iegulai benefit unuei the basic TRICARE meuical
piogiam. If it weie a iegulai basic benefit, theie woulu be no uollai limit anu it woulu be accessible
by ietiiees.

A uuiue foi Nilitaiy Families Affecteu by Autism (Febiuaiy 2u14)



17
Anothei big pioject that militaiy families shoulu stait woiking on is Neuicaiu poitability. If you
have been somewheie long enough to get off the waiting list anu ieceive seivices, the next time you
move you will lose those seivices anu stait at the bottom of anothei state's waiting list.

Know who youi state congiessman anu senatois aie, as well as those fiom youi legal state of
iesiuence. When issues aiise neeuing youi auvocacy as a militaiy paient of a chilu with autism you
can wiite to both states' electeu officials.
@'2)$*3'2
ACT! Touay foi Nilitaiy Families http:www.acttouayfoimilitaiyfamilies.oig (they offei giants)

Ameiican Nilitaiy Family Autism Suppoit www.amfas.oig (ieseaich youi new base)

Autism Reseaich Institute www.autism.com (viueo piesentations)

Autism Society http:www.autism-society.oig anu http:www.autismsouice.oig (local iesouices)

Autism0ne www.autismone.oig (viueo piesentations anu annual confeience)

Nilitaiy B0NEFR0NT http:www.militaiyhomefiont.uou.mil

Nilitaiy 0ne Souice www.militaiyonesouice.oig

Specializeu Tiaining of Nilitaiy Paients (ST0NP) www.stomppioject.oig (gieat listseiv anu paient
tiainings)

Talk About Cuiing Autism www.tacanow.oig (a wealth of autism iesouices fiom uiet to auvocacy
anu iegional confeiences)
"4)$- -I' "$-I)*
Lisa Rupe is a Navy wife with thiee chiluien. Bei oluest son is 1S anu was
uiagnoseu with autism in San Biego when he was 28 months olu. Bei 11-
yeai-olu uaughtei is a gieat theiapist anu "big" sistei. The Rupes auopteu
theii youngest son fiom Russia in 2u1u. Be is 9 yeais olu anu also in EFNP.
Lisa's husbanu is a Navy chaplain who has seiveu with Naiine, Coast uuaiu
anu Naval units. Lisa woiks pait-time foi a softwaie uevelopei on BoB
piojects ielateu to uocument publishing anu eBooks. The Rupes enjoy
militaiy life anu aie paiticulaily fonu of beaches. You may contact Lisa at
lisaiupeyahoo.com.





S82u14-2