The program that offers the most comprehensive and affordable managed care option is TRICARE Prime Program. It is offered in areas where military treatment facilities are located. It is also available in the regions which have TRICARE Prime networks.
Key features of the TRICARE Prime program:
- Participation in the program requires enrollment for the members who are on active duty and their families free of cost
- Enrollment options are flexible
- Can be completed through the Beneficiary Web Enrollment online
- PCM Change Form and a TRICARE Prime Enrollment Form can be mailed to the concerned authorities
- The form for TRICARE Prime Enrollment can even be directly submitted to the service center
- In comparison to other TRICARE programs, fewer additional costs have to be built up
- Enhanced coverage options for clinical, vision, and preventive services
- Priority care access offered at military treatment facilities
- Maximum care options from PCM (Primary Care Manager)
- Referral to specialists from a PCM
- Without requesting for a referral from PCM, point of service option is made available to all
- There is no need to file claims
- When moving from one TRICARE region to another, easy transfer enrollment options are offered
- Distance and time care access which covers routine, specialty care and emergency services
A primary care manager is assigned whenever somebody enrolls in the TRICARE program. This is done regardless of whether or not the enrollment has been completed within a TRICARE network or from a military treatment facility (MTF). The PCM coordinates with the regional contractor to find a specialist when he or she cannot offer the right assistance in certain cases. The PCM even not just helps in finding the specialist in the network, but also helps in filing claims on a member’s behalf.
There are certain distance and time standards for using care services which covers specialty care, emergency care, and routine services. Travel reimbursement for some specialty care, preventive services, and enhanced vision are some other benefits offered under this program.
TRICARE Prime Eligibility
TRICARE Prime is offered to beneficiaries if they aren’t entitled to Medicare Part A & Part B programs. It covers:
- Retired members of the service and their families
- Active members of duty and their families
- Former spouses who are eligible
- Retired Reserve and National Guard members and their families
- Recipients of the Medal of Honor and their families
- National Guard and Reserve members and their families are also eligible if they have remained active for more than 30 successive days
All the eligible beneficiaries are required to live in a PSA (Prime Service Area) zone. PSA areas are the geographical zones that offer TRICARE Prime benefits. These areas are located usually near a military treatment facility. These are even located where there is a heavy concentration of retirees, uniformed services personnel, and their families. A PSA is required to have a proper medical community that can offer support to the beneficiaries of the TRICARE Prime program. If a person isn’t residing in a PSA, then that person becomes eligible for TRICARE Prime Remote program. Servicemembers can also take advantage of the TRICARE Standard program.
If the discharged veterans are disabled, then they can take advantage of the services under CHAMPVA. They are entitled to other special programs if they served in Afghanistan, Iraq, or in the Persian Gulf War.