Disclaimer


Various Coverage Plans Under the TRICARE Health Care Program

TRICARE is a health care program offered to the retirees and service members as well as their families and surviving beneficiaries. TRICARE health benefits are also offered to the members of the United States National Guard and Reserve and their families when they are called to perform active duty for more than 30 days. Additional health care programs are also offered to retired military members and active servicemembers which include TRICARE Dental, TRICARE for Life, and TRICARE Pharmacy. Though it may seem difficult to understand the TRICARE program, it isn’t as  complicated when it is broken down so you understand the numerous ways in which you can access the benefits.

Three main coverage plans are offered by TRICARE. The servicemember may not be enrolled under all three plans, but the family and the service member may be enrolled under one of the categories under TRICARE.

  1. TRICARE Prime is offered to active National Guard members, Reserve members and active duty personnel. Enrollment options are offered to their family members as well. Under the TRICARE program, the principal health care providers are available through military treatment facilities (MTFs), outpatient clinics, and military hospitals. TRICARE Prime Remote services are offered to people who live 50 miles away from a military treatment facility location.
  1. TRICARE Standard refers to a health care program that helps to pay for copayments and deductibles. Fees that need to be paid for service options offers flexibility when it comes to choosing health care providers. All military families are automatically enrolled under this health care plan though it does require for patients to file claims to receive coverage for medical care treatment.
  1. TRICARE Extra provides the military families medical care from the health care professionals that are listened within the preferred network. There isn’t any annual or enrollment fee charged under this healthcare program.

For most family members, the savings in deductible and cost-shares generally make TRICARE Prime the best choice. However, if money is not a concern and if preference is to obtain care from civilian providers, then TRICARE Standard will be the right choice for such people. TRICARE Extra is the right choice if one wishes to see civilian doctors and to avoid the filing of claims.

A “provider” refers to the institution, business, or person offering health care services. Ambulance transportation services, labs, hospitals, and doctors are all considered as providers.  Here are some providers and the links to their websites:

  1. TRICARE My Benefits

            Website: www.tricare.mil/mybenefit

  1. DEERS Registration

Website:http://www.military.com/benefits/tricare/defense-enrollment-eligibility-reporting-system-deers.html

  1. Military Treatment Center Locator

            Website: www.tricare.mil/mtf/

  1. TRICARE Customer Service Locator

           Website: www.military.com/benefits/content/tricare/trservice-centers.html

Providers must be authorized through TRICARE and their status has to be certified by the regional contractor under the TRICARE program. This implies that these providers possess the license and the accreditation by an organization, proving that they meet standard medical needs. TRICARE Standard doesn’t pay for services offered by an unauthorized provider. Most doctors and hospitals possess authorization under TRICARE. It is best to consult a TRICARE Service Center or a Beneficiary Counseling and Assistance Coordinator before using services from ambulance transportation services, doctors, hospitals, and labs. It is wise to know this information so that it is available to you in the case of an emergency.

People who aren’t servicemembers qualify for outpatient and inpatient care services via TRICARE provided they fall into one of the following categories:

  • Individuals who involuntarily or voluntarily separated from a servicemember, e.g. divorce
  • Family members of servicemembers and uniformed services retirees who died during retirement or while on active duty
  • Family members of Reserve memberes, Activated Guard members, or active duty servicemembers

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2 comments

  1. We have a patient coming in this after noon and has Tricare insurance. We know we are a provider but do not have any information on reimbursement and copays for patients. We also would like to know where to send claims and do we send a HICA for? Urgency is of the utmost since patient has apt this afternoon. Thank you.

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