Disclaimer


An Overview of the TRICARE Standard and Extra Service Plan

The TRICARE Standard and Extra service plan is available for military beneficiaries with a non-active duty status in the entire United States. An additional fee is to be paid for this particular service but you don’t need to enroll for this service.

The coverage under this service is continued until all of your information in the Defense Enrollment Eligibility Program is current. When you use this service, you can visit any authorized TRICARE provider who is within the network or even not in the network. Care is also provided at the military facilities, but is only on the basis of space availability. Any type of referral is not required for the care coverage, but in some cases, authorization might be required.

Your choice of care provider will determine the options available for you and will also determine the amount that you need to pay for out-of-pocket expenses. While visiting a provider who is not in the TRICARE network, you are choosing the Standard option. Alternatively, if you are visiting a provider who is in the TRICARE network, you are choosing the Extra option. While using the Extra option, you will pay less out-of-pockets and the filing of the claims will be completed by the provider.

Your military status is an additional factor that determines the cost of the services (retirees and family members versus the active-duty members’ family members). Once the annual deductible is met, you need to pay the cost share as dependent on the basis of the percentage required.

Beneficiary Category Cost Share of Outpatient Care Cost Share of Inpatient Care
Family Member of an Active Duty Personnel Member Network Providers: 15% of all the rate that is negotiated $16.85 per day

($25 minimum charge)

Non-network Providers: 20% of the total allowable charge of the TRICARE Non-network Facilities: $535 per day or 25% of the institutional services (you need to pay the one that is less). Additionally, 25% for every professional charge that is billed separately.
Retired Duty Personnel and their Family Members Network Providers: 20% of all the rate that is negotiated Network Facilities: $250 per day or 25% of the institutional services (you need to pay the one that is less). Additionally, 20% for every professional charge that is billed separately.
Non-network Providers: 25% of the total allowable charge of the TRICARE

TRICARE Overseas Standard

The TRICARE Overseas Standard service offers comprehensive coverage to the family members of the active duty servicemembers, retired service personnels and their families, and also the people that cannot or did not enroll in TRICARE Overseas Prime. The TRICARE Extra plan is not designed for those who are at an overseas location. You don’t need to enroll yourself for the service and the coverage will be provided until all your information in the reporting system is current.

When using the TRICARE Overseas Standard services, you can receive health care from providers in the host-nation. You may also receive care at military facilities on the basis of space-availability. No referral is required for care, however, you might need authorization for some services. You may be required to pay the complete amount when you file claims for reimbursement with TRICARE for the care that you’ve received. The military status of the sponsor will determine the cost (retiree family members versus active-duty members’ family members). Once the annual deductible is met, you need to pay the cost share as based on the percentage of the total cost.

Beneficiary Category Cost Share of Outpatient Care Cost Share of Inpatient Care
Family Member of Active Service Personnel 20% of the total allowable charge of the TRICARE Charge of per diem, (minimum of $25)
Retired Duty Personnel and their Family Members 25% of the total allowable charge of the TRICARE A cost of 25% of the institutional services. Additionally, 25% for every professional charge that is billed separately.

The contractor of the Overseas Program of the TRICARE program is International SOS. International SOS is responsible for providing you with all of the information and assistance that you may need for the purpose of filing claims, authorization, searching for a health care provider, etc.

TRICARE Reserve Select

TRS (TRICARE Reserve Select) is a health plan that is premium-based and can only be purchased by qualified members of the National Guard and Reserve. The TRS program requires you to pay premiums on a monthly basis and offers coverage which is like the TRICARE Standard and Extra coverage services.

Some of the key features of this coverage plan include:

  • Worldwide availability to almost all of the selected members of the Reserve, as well as their families, even when they are not on active orders or covered by the Transitional Assistance Management program
  • You need to be qualified and purchase the TRS plan for the purpose of participation
  • Payment of the premiums should be done on a monthly basis and failure to do so can result in disenrollment or lockout of enrollment
  • As there is no assigned care manager, you’re free to manage your own health care
  • The ability to visit any TRICARE-certified provider or any provider who is in the host-nation of an overseas location
  • The amount that you need to pay out-of-pocket is reduced when you choose a provider that is in the TRICARE network
  • No referral requirement needed, but you might need authorization for some services
  • Freedom to receive care in a military care facility based on the availability of space
  • Comprehensive coverage which also includes prescription coverage through TRICARE

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