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TRICARE
In response to the challenge of maintaining
medical combat readiness while providing the best health care for all eligible
personnel, the Department of Defense introduced TRICARE. TRICARE is a regionally managed health
care program for active duty and retired members of the uniformed services,
their families, and survivors. TRICARE brings together the health care resources of the Army, Navy and
Air Force and supplements them with networks of civilian health care
professionals to provide better access and high quality service while
maintaining the capability to support military operations. TRICARE is being
implemented throughout the U.S., Europe, Latin America and the Pacific as a way
to:
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Improve overall access to health care for beneficiaries;
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Provide faster, more convenient access to civilian health care;
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Create a more efficient way to receive health care;
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Offer enhanced services, including preventive care;
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Provide choices for health care; and
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Control escalating costs.
Who is
Eligible for TRICARE?
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Active duty
members and their families;
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Retirees and
their families; and
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Survivors of
all uniformed services that are not eligible for Medicare.
If you have other primary health care
insurance, TRICARE Prime may not be your best option. Health Benefits Advisors
are available at your local TRICARE Service Center (TSC) or Military Treatment
Facility to help you decide which option is best for you.
TRICARE
offers three options: TRICARE Prime, TRICARE Standard, and
TRICARE Extra. Additionally,
TRICARE Prime Remote is
the Prime benefit extended to those service members and their families who work
and reside fifty (50) miles or more from a military treatment
facility.
You should understand the difference
between Standard, Extra, Prime and Prime Remote to determine whether you will
use your TRICARE benefit or maintain your Employer-Sponsored Health Plan. You
should also k
now where to locate more information on the Web site.
TRICARE STANDARD
You choose your authorized TRICARE
provider. You may be able to
keep your current provider. The
medical provider does not need to be a part of the TRICARE civilian network but
must be a TRICARE authorized provider. You pay an annual deductible and 20 percent cost shares. Enrollment is not required to
participate.
TRICARE EXTRA
You choose your medical provider from the
list of TRICARE civilian providers who are part of the TRICARE network. You will be responsible for an annual
deductible and 15 percent cost shares. The cost shares in TRICARE Extra are
less than TRICARE Standard. There
are no claim forms to file. You
just pay your reduced cost share after satisfying the deductible. You may use a combination of the
TRICARE Extra and TRICARE Standard programs at any time, depending on whether you choose
providers inside or outside the network. Enrollment is not required.
The annual TRICARE Standard/Extra
deductible, depending upon your status, is $50 – $300. If you are called in support of certain
operations, your family’s deductible may be waived. For more information call
your TRICARE Service Center (TSC).
TRICARE PRIME
This option is available to family members
whose sponsor is on active duty for 179 consecutive days or more. Requires
enrollment and grants exclusive access to the MTF. If enrollment is received
between the first and 20th of the month, the effective date is the first of the
following month. If received after the 20th, the effective date will be the
first day of the subsequent month. Enrollment can be mailed or completed at your
TSC. Under this plan, you may select or be assigned a Primary Care Manager (PCM)
to provide or arrange for your family’s healthcare needs. You will also have
access to additional wellness and preventive care services. (Family members
living with their sponsor outside an MTF catchment area may be eligible for
TRICARE Prime Remote Benefits.)
The main challenge for most eligible
beneficiaries is deciding which TRICARE option, Prime, Extra or Standard, is best for them. Active Duty personnel are enrolled in TRICARE Prime and pay no fees. Active duty family members pay no
enrollment fees, but they must choose a TRICARE option and apply for enrollment
in TRICARE Prime. There are no enrollment fees for active duty families in TRICARE
Prime.
If you do not know your region number,
view the regional map to find your
region number and phone number for more TRICARE information. You can link to current news releases
with detailed information about changes to TRICARE coverage at http://www.tricare.osd.mil/NewsReleases/.
TRICARE Offers Benefits to Activated National Guard
Members and Reservists
A full explanation of benefits can be found
at http://www.tricare.osd.mil/. Demobilized members of the
Reserve component and their dependents, who were activated in support of a
contingency operation are eligible for the TRICARE transitional health care
demonstration project. (Does not include full-time National Guard duty.)
Members of the reserves and National Guard who are called to active
duty will be eligible for health care benefits under TRICARE, just as
other active-duty service members are. Their families will also become eligible
for TRICARE benefits, if the military sponsor’s active-duty orders are for
a long-enough period of time.
Families
of members called to active duty in response to the Sep 11, 2001 terrorist
attacks are eligible for enhanced benefits under the TRICARE Reserve Family Demonstration Project.
TRICARE eligibility for the military sponsor
begins on the effective date of their orders to active duty. Needed care will be
provided by uniformed services medical treatment facilities, and by authorized
civilian health care providers.
Families
of activated reservists and National Guard members become eligible for health
care benefits under TRICARE
Standard or TRICARE
Extra on the first day of the
military sponsor’s active duty, if his or her orders are for a period of more
than 30 consecutive days of active duty, or if the orders are for an indefinite
period.
TRICARE Standard is the former CHAMPUS program
with a new name. Benefits under TRICARE Standard are the same as they were for
CHAMPUS.
For
active-duty families, TRICARE Standard pays 80 percent of the TRICARE allowable
charge for covered health care services that are obtained from authorized,
non-network, civilian health care providers. Those who receive the care are
legally responsible for the other 20 percent of the allowable charge, plus other
charges billed by “non-participating” providers, up to the legal limit of 15
percent above the allowable charge. Providers who “participate” in TRICARE
accept the TRICARE allowable charge as the full fee for the care they
provide.
You’re Covered
When on military duty you are covered for any injury,
illness or disease incurred or aggravated in the line of duty. This includes traveling directly to or from
the place where you perform your military duty. When on active duty for more
than 30 days, you have comprehensive health care coverage under TRICARE
Prime.
Your Family Is Covered
When you are
on active duty for more than 30 days, your family’s health and dental care needs
are covered under several TRICARE options, all of which are designed to meet
their needs.
Access To Care
The first step is to enroll
or update you and all eligible family members in the Defense Enrollment
Eligibility Reporting System (DEERS). DEERS is your key to all
benefits. For more information, call
DEERS, Monday-Friday, 9 a.m.-6:30 p.m. Eastern Time, at 1-800-538-9552
(California, 1-800-344-4162), or visit DEERS.
Reserve Component Members
Reserve component
members (includes
National Guard members on active duty under 32 U.S.C. 502 (f)) on active duty for more than 30
consecutive days, must enroll in TRICARE Prime. TRICARE Prime enrollment means
on the effective date of your orders, you are eligible for medical and dental
care at any Military Treatment Facility.
Family Members
Your family should decide now about health care
coverage options if and when you are called to active duty. Family members are eligible for health
care under either TRICARE Standard or TRICARE Extra when you are on active duty
for more than 30 days. There is no
need to enroll, just show your Military ID card. Make sure your family members’ DEERS records
are up-to-date to prevent delays in treatment and claims processing. If you are
on active duty for 179 consecutive days or more, your family members have the
option to enroll in TRICARE Prime.
Before Receiving Deployment
Notification
Enroll family members in DEERS and/or update
information as needed. Get military
ID cards for eligible family members. Get your will and other legal documents in order. Contact your command or
unit family readiness representative for help with completing your family care
plan. Review your TRICARE
options. Review your civilian
employer’s health and dental coverage options while on active duty. Determine costs and benefits of both
TRICARE and civilian options before choosing one or the other.
Upon
Receiving Deployment Orders
Confirm that your family’s DEERS information
is current. Ensure that eligible
family members have current ID cards. Give your family copies of your orders. Contact unit commander or reserve center
for information on TRICARE. Contact
your civilian employer to continue or discontinue your employer health and/or
dental coverage. Contact your
military legal assistance office to appoint your power of attorney and update
your will. Contact your command or
unit family readiness representative for help in updating your family care
plan. Contact finance office to set
up an allotment, if applicable. Make other financial arrangements as required. Review life insurance for spouse and
yourself.
TRICARE Handbook
The
TRICARE HANDBOOK provides
TRICARE benefit information. Users can search for information on the TRICARE
benefit either by subject search, or general search. In addition, you can go
right to sections in the Handbook using the interactive Table of Contents (TOC),
as well as print out the online version in its entirety.
Benefits Available During
Demobilization
Reserve
component members ordered to active duty for more than 30 days in support of a
contingency operation (does not include full-time National Guard Duty) are
entitled to transitional health care and dental benefits upon separation. Family
members are not eligible for transitional dental benefits because they are
eligible for dental benefits under the TDP. Members separated with less than six
years of total active federal military service (as indicated on the DD 214) and
eligible family members, are eligible for 60 days of transitional health care.
Members separated with six years or more of total active federal military
service and their eligible family members are eligible for 120 days of
transitional health care.
Reserve
component members are eligible for the Continued Health Care Benefit Program
(CHCBP) when they lose military health benefits and their transitional health
care benefit period has expired. They also may enroll their family members for
this coverage. CHCBP provides benefits similar to TRICARE Standard for a
specific period of time (up to 18 months for members and their family members).
They must enroll within 60 days of the date that their transitional benefit
period expires and pay quarterly premiums ($933 per individual, $1966 per
family). For more information about CHCBP, individuals may call toll free:
1-800-444-5445, visit online at www.humana-military.com or write to
Humana Military Healthcare Services Inc., Attn: CHCBP, P.O. Box 740072,
Louisville, KY 40201.
When a Reserve Component Sponsor
Retires
When reserve component
members retire, they do not become eligible for TRICARE or space-available care
in an MTF until they reach age 60 or are receiving retired pay. At that time,
they and their family members may enroll in TRICARE Prime or they may use
TRICARE Extra or TRICARE Standard. Retired reserve component members also become
eligible for TRICARE For Life when they become eligible for Medicare at age 65
and enroll in Medicare Part B. In addition, retired reserve component members,
and their spouses and dependent children are eligible for the TRICARE Retiree
Dental Program, regardless of the sponsor’s age and whether the sponsor is
receiving retired pay.
For more
information about medical care, dental care and other benefits for reserve
component members, and their eligible family members, interested parties may
visit the TRICARE Web site. More information about the TRICARE Dental Programs is
available on the TRICARE Dental Program Web
site, and the TRICARE
Retiree Dental Program Web site.
TRICARE DENTAL PROGRAM
The
TRICARE Dental Program
(TDP) is a voluntary dental insurance program for the Selected
Reserve, Individual Ready Reserve, and all eligible uniformed services family
members. To be eligible, you must have at least 12 months of service commitment
remaining and participate in the program for at least 12 months after which
enrollment is month to month.
Selected Reserve members
are responsible for just 40 percent of the monthly premium; the government pays
the rest. Other Reserve component members are responsible for the full premium.
When called to active duty for more than 30 days, you are eligible for dental
care at military treatment facilities free of charge, and thus are disenrolled
from the TRICARE Dental Program.
Eligible family members are
invited to enroll, even if the sponsor does not. Family members are responsible
for the full premium, except when you are called to active duty for more than 30
days, which reduces the premium share to 40 percent; the government pays the
rest. Although family members enroll under the sponsor’s Social Security number,
there will be two separate premium payments – one for you, the sponsor, and one
for family members. NOTE: Family members are not bound by the 12-month minimum
enrollment commitment if the sponsor is ordered to active duty for a contingency
operation as defined in law. In this case, you have 30 days from activation to
submit the enrollment application. Family members must remain enrolled during
the entire active duty period in support of the contingency operation.
Additional information on the TRICARE Dental Program is available at the
United Concordia Companies, Inc. Web site at www.ucci.com, or
call toll free 1-800-866-8499 for general information, or 1-888-622-2256 to
enroll. To contact the Managed Care Support Contractor for your region, go the
regional
map.
Upon
mobilization, reserve members become eligible for the same health care benefits
that active duty service members receive, including dental benefits. As a
result, Reserve Component members enrolled in the TDP who are activated for more
than 30 days automatically are removed from the program and become eligible for
dental care from military dental providers. Family members of mobilized
reservists become eligible for the same lower premiums that active duty family
members enjoy. Please visit the United Concordia’s Web site (the administrator of the program) for more information.
Active-duty, uniformed service family
members, Selected Reserve and Individual Ready Reserve members and/or their
family members are eligible for the TRICARE Dental Plan if the sponsor has at
least 12 months remaining on his or her service commitment with the parent
service at the time of enrollment. If the Defense Enrollment Eligibility Reporting System (DEERS) indicates
less than 12 months remaining, United Concordia will validate the intent of
those active duty, Selected Reserve or IRR members to continue their service
commitment. The contractor for the
TRICARE Dental Program is United Concordia. United Concordia’s toll free number is
(800) 866-8499. You can also check out their web page by visiting them at
http://www.tricare.osd.mil/dental/.
The Department of Defense has developed the TRICARE Selected Reserve
Dental Program to provide low cost dental coverage. The DOD covers 60% of the premium and
the soldier pays 40%. This means
the soldier pays $4.36 per month for his/her dental coverage. The $4.36 can be
deducted per month from his IDT Drill check.
To enroll the soldier can
call 1-800-669-6614 for a form or Website:
www.humana-military.com
Eligible individuals are family members of
active duty, Selected Reserve and Individual Ready Reserve service members,
including spouses and unmarried children (natural, step, adopted and wards)
under the age of 21 (eligibility ends at the end of the month in which they turn
21). Eligibility may be available after age 21 if:
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The dependent is enrolled full time at an
accredited college or university and is more than 50 percent dependent on the
sponsor for financial support. Eligibility continues until the end of the
month in which the dependent turns 23 or the end of the month in which
education terminates, whichever occurs first.
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The dependent has a disabling illness or
injury that occurred before his or her 21st birthday, or between the ages of
21 and 23 while enrolled as a full time student, and was more than 50 percent
dependent on the sponsor for financial support.
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Select Reserve and IRR service
members.
The TDP
is administered by United Concordia Companies Inc. (UCCI). For more information
about the TDP, beneficiaries may access the benefit handbook online at www.ucci.com or by calling toll free
1-800-866-8499, 24 hours a day. Members residing outside the continental United
States (OCONUS) should call 1-888-418-0466 (toll free). This telephone number is
available in the following countries: Australia, Bahrain, Belgium, Bolivia,
Columbia, Egypt, Germany, Greece, Iceland, Italy, Japan, Netherlands, Norway,
Panama, Portugal, Saudi Arabia, South Korea, Spain, Switzerland, Turkey and the
United Kingdom. At all other locations, members should call 1-717-975-5017.
Representatives are available to assist members in English, German and Italian
24 hours a day, Monday through Friday.
Brochure for Reserve Component Members and Their
Families
A new brochure is available for download:
“Healthcare Benefits for Reserve Members on Active Duty for More than 30
Days and Their Families.” Members of
the reserve component who are called to active duty for more than 30 days are
eligible for TRICARE, the same as any active duty service member. Families of
these individuals also may become eligible for TRICARE if the sponsor is called
to active duty for more than 30 days. To ensure family members are eligible for
TRICARE upon activation, sponsors should register their family members in the
Defense Enrollment Eligibility Reporting System (DEERS).
For
More Information
TRICARE is there for your family’s needs – in a variety of
situations, including when traveling away from home or away at college. For more
information about eligibility and benefits, or to enroll in TRICARE Prime or
TRICARE Prime Remote, contact your local TRICARE Service Center.
See Also
Transitional Health Care Benefits for Service Members and
Their Families
TRICARE Eligibility For Guard and Reserve Family
Members
Reserve Component Personnel Need to Know About Medical
Benefits
Slide Show
Briefing: Health Benefits for Reserve Component
Members and Their Families. (2Mb
PPS file)
Download New
brochure: “Healthcare Benefits for Reserve Members
on Active Duty for More than 30 Days and Their Families”
Order brochures for
your unit at the TRICARE Store. Just select the brochure and complete the mailing
information.
POST-DEPLOYMENT HEALTH A DOD PRIORITY
DoD officials believe
caring for service members after a deployment should be a national priority.
They have taken the lessons learned since the Gulf War and devised a set of
guidelines for healthcare professionals to care for service members with
deployment-related health concerns.
Beginning March 1, 2002, healthcare providers will ask service members
who seek medical care if their visit is related to concerns stemming from a
deployment. If the service
member answers, “yes,” the new guidelines require the provider to take certain
steps, including a specific evaluation and arrange follow-up visits. Patients
receiving routine check-ups or wellness visits would not be asked the deployment
question.
After the 1990-1991 Gulf War, DoD realized veterans were suffering from
unexplained health problems, typified by fatigue, diffuse pain, and sleep and
memory problems. DoD officials
realize deployment-related health conditions may not show up during or
immediately after a deployment. DoD
medical professionals are trying to do a better job of acknowledging patients’
concerns than has been done in the past. That is where the Clinical Practice
Guideline for Post-Deployment Health Evaluation and Management comes in. The guidelines do not contain a
strict definition of “deployment” since there are countless situations in which
military service members might experience hazardous exposures — be they
psychological, industrial or environmental. This is an evaluation for people who have been
to what essentially amounts to a hazardous workplace — a deployment of some
sort — in service to their country.
For more
information on post-deployment healthcare, visit http://www.pdhealth.mil/.
STATE HEALTH DEPARTMENTS
State Health Departments can be accessed at:
STATE INSURANCE COMMISSIONS/DEPARTMENTS
State Insurance Commissions/Departments can
be accessed at:
MEDICARE
Medicare is a Health Insurance Program for people
65 years of age and older, some disabled people under 65 years of age, and
people with End-Stage Renal Disease (permanent kidney fa ilure treated with
dialysis or a transplant). You can
access the official Medicare website at http://www.medicare.gov/ where you can obtain information for health plans, nursing
homes, dialysis facilities, Medigap policies, contacts, Medicare events,
participating physicians, suppliers, and prescription assistance programs in your
area.
SPECIAL VA HEALTH CARE ELIGIBILITY FOR COMBAT
VETERANS
Effective immediately, the Department of Veterans
Affairs (VA) has implemented policies and procedures for providing free health
care services and nursing home care to combat veterans for a period of two years
beginning on the date of separation from active military
service.
What’s covered?
This benefit covers all illnesses and injuries except
those clearly unrelated to military service; for example, a common cold,
injuries from accidents that occurred after discharge, and disorders that
existed before joining the military. Care may not be provided for any disability found to have resulted from a
cause other than the military service in combat operations. Combat veterans seeking treatment for
health conditions claimed to be related to combat operations are evaluated
clinically by means of a physical examination and appropriate diagnostic
studies. In making this
determination, the physician must consider that the following types of
conditions are not ordinarily considered to be due to occupational or military
service: (1) Congenital or developmental conditions, for example, scoliosis, (2)
Conditions which are known to have existed before military service, and (3)
Conditions have a specific and well-established cause and that began after
military combat service. Coverage
extends for a two-year period following separation from active military
service. Dental services are not
included.
Who’s
eligible?
Veterans are eligible if they served on active duty in
a theater of combat operations during a period of war after the Gulf War or in
combat against a hostile force during a period of “hostilities” after November
11, 1998 and have been discharged under other than dishonorable conditions. National Guard and Reserve members are
also eligible for VA health care if they were ordered to active duty by a
federal declaration, served the full period for which they were called or
ordered to active duty, and have separated from active military service under
other than dishonorable conditions. Active duty, National Guard and Reserve members who were activated to a
combat mission and then separated from active duty receive a DD Form 214, which
should show an award of the Armed Forces Expeditionary Medal. Individuals
seeking services under this authority should bring their DD Form 214 when
reporting to a VA health care facility.
What’s meant by
“hostilities?”
“Hostilities” is defined as conflict in which Armed
Forces members are subjected to the danger comparable to that faced in a period
of war.
What’s
changed?
Unlike other veterans who do not have VA-adjudicated
service-connected conditions, veterans who qualify under this special
eligibility authority are not subject to VA means testing or co-payment
requirements. There is no burden placed on these veterans to prove that their health problems are related to
their military service or prove that they have low income to qualify for
cost-free VA health care.
What happens after the two
years?
The co-payment status will depend on whether the
veteran’s illness or injury is found to be service-connected or whether the
veteran is otherwise qualified for VA health care. Each veteran will be enrolled for VA
health care in the appropriate priority group. Some veterans – those in the lowest
priority group – whose income is above the means test threshold must agree to
make required co-payments. If the
veteran does not agree to make co-payments, the veteran will be ineligible for
VA care.
Where can a veteran get additional
information?
Additional information is available at the nearest VA
medical facility. The telephone
number can be found in the local telephone directory under the “U.S. Government”
listings. Veterans can also call
toll-free: 1-800-827-1000 or
1-877-222-8387.
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