In decades past, the U.S. military discouraged family members from joining loved ones on “unaccompanied” yearlong tours to places such as South Korea, Okinawa, Guam and more-remote tours in “Cold War” Europe.

“Noncommand-sponsored” dependents who traveled to these assignments often were seen as a distraction and strain on support services. Some got the cold shoulder from commands and saw only limited access to medical care, base shopping or other amenities.

The signals sent today to noncommand-sponsored dependents are more positive, though still mixed. The warmest change perhaps is in South Korea, where Army Gen. B.B. Bell runs three major commands, including the 30,000-member U.S. Forces Korea. (Force strength will fall to 25,000 as American bases are consolidated.) Like his predecessor, retired Gen. Leon J. LaPorte, Bell is doing what he can to make both command- and noncommand-sponsored families feel welcomed, said Col. (Dr.) James Gregory Jolissaint, commander of the 18th Medical Command and the 121st General Hospital in Yongsan, South Korea.

The inventory of Army housing dictates how many families receive “command-sponsored” status, Jolissaint said. The number today is about 1,500, he said. Yet several thousand more “noncommand-sponsored” families are also are living in South Korea.

They paid their own travel costs and live on the economy without benefit of “with-dependents” housing or cost-of-living allowances. Some feel they can cope financially because of an extra $300 a month in Assignment Incentive Pay paid in Korea to members who extend their tours another year. After Iraq or Afghanistan, any more time away from family is a harder sell.

“In olden days, if you weren’t command-sponsored, you couldn’t get a ration card,” said Jolissaint. “You couldn’t access other services on post. Now we are treating these folks as if they are command-sponsored. They get their ID cards. They can come on post. They can use the PX. They can use the commissary. They have access to all services. They just can’t get housing on post, and there’s the Tricare Prime issue.”

In April 2005, William Winkenwerder Jr., assistant secretary of defense for health affairs, clarified in a memo to the services that department policy bans enrollment of noncommand-sponsored dependents in Tricare Prime programs overseas. Winkenwerder wrote that, except in a few select circumstances, only active-duty family members who are “command sponsored,” as defined by travel orders, “shall be eligible” for Tricare Overseas Program (TOP) Prime or the Tricare Global Remote Overseas (TGRO) program.

Some commands overseas howled in protest. The policy would disrupt medical benefits to many families, they said, though Winkenwerder noted that these families would remain eligible for Tricare Standard, the military’s fee-for-service insurance; for Tricare Plus, which offers discounts for using network physicians; and for space-available care on base.

Two months later, Winkenwerder agreed to delay the policy crackdown until Oct. 1, 2005, and to allow a “grandfather” clause. Noncommand-sponsored families who enrolled in TOP or TGRO before Oct. 1 can stay enrolled until members complete current overseas assignments.

Tricare officials said the tougher policy isn’t meant to discourage noncommand-sponsored families. It’s to emphasize that families should have their medical needs screened, and matched to available services overseas, before they consider a noncommand move.

Bell, however, is asking Tricare to step in a different direction. Bell learned during recent visits with his troops that when noncommand-sponsored dependents can’t get the medical care they need on post, and have to rely on host-nation facilities or care providers, they typically must pay all medical costs up front before they can get care.

Only later, if enrolled in Tricare Prime stateside, are they reimbursed for the off-base medical costs. The noncommand-sponsored who aren’t even enrolled in Tricare Prime stateside find themselves in the same boat as many retirees living overseas. Again, they must pay host-nation health-care costs up front. But using Tricare Standard, they face higher co-payments, an annual deductible and hefty patient cost-shares on care provided.

Command-sponsored dependents don’t face the same up-front medical costs because they are enrolled in TRICARE Overseas Prime. If they must receive off-base care, because of an emergency or a required specialist isn’t available on base, most host-nation doctors and hospitals have signed a Memorandum of Understanding (MOU) with the U.S. facilities. They know to treat Tricare Prime Korea patients now and to bill Tricare later.

Bell and his medical staff have complained to Tricare officials that noncommand-sponsored dependents in Korea, or elsewhere overseas, should be covered by a so-called “memorandum of understanding” most host-nation doctors and hospitals in the country have signed with U.S. facilities, if enrolled with a Tricare Prime contractor stateside. Bell doesn’t believe families enrolled in Prime coverage stateside should have to pay for care up front, maxing out credit cards in some cases until they get reimbursed, said Jolissaint.

College students of families assigned overseas also get hit. They typically enroll in Prime where they attend school and face up-front charges for host-nation medical care if they become ill during visiting with parents.

Tricare headquarters is “working” the issue, an official explained. A change could impact not only non-command sponsored dependents in Korea but overseas anywhere. Jolissaint said a senior Tricare official told him the problem of up-front medical costs might be solved “with the stroke of a pen.”

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