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TRICARE Fundamentals Course
Who We Are
& Our History
14Participant Guide
References
TPM 6010.54-M, August 1, 2002, C-19, March 3, 2005
TRICARE Fundamentals Course
14) Who We Are & Our History
Explain the structure of the Military Health System
Identify the TRICARE regions
Define TRICARE and how it has evolved
Explain the purpose of the National Defense Authorization Act (NDAA)
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14) Who We Are & Our History
1.0 The Military Health System (MHS)
The Military Health System is the interconnected and interdependent web of organizations that carry
out the Military Health Care Mission. This includes those employed by the Department of Defense to
deliver care on the battlefield, on ships, in the air and in Military Hospitals, and it includes our partners
in the TRICARE network who deliver care for Department of Defense (DoD) beneficiaries in civilian
hospitals and clinics throughout the world. Supporting health delivery are activities that meet the unique
needs of a military health system—training and education centers for physicians, nurses, technicians
and administrators; research and development centers around the globe; and experts who manage one
of the largest health plans in the world.
1.1 The Mission of the MHS:
To provide optimal Health Services in support of our nation’s military mission—anytime, anywhere.
1.2 The Vision of the MHS:
The provider of premier care for our warriors and their families
An integrated team ready to go in harm’s way to meet our nation’s challenges at home or abroad
A leader in health education, training, research, and technology
A bridge to peace through humanitarian support
A nationally recognized leader in prevention and health promotion
Our nation’s workplace of choice
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2.0 Organizational Structure of the Military Health System (MHS)
SERVICES The President
ARMY SecDef OSD
SG
ASD (HA)
AIR FORCE
SG TMA
NAVY Chairman, JCS
SG J1 J2 J3 J4 J5 J6 J7 J8
USMC The Joint Staff
SG – Surgeon General
OSD – Office of Secretary of Defense
ASD (HA) – Assistant Secretary of Defense (Health Affairs)
SecDef – Secretary of Defense
JCS – Joint Chief of Staff
3.0 TRICARE
TRICARE is the health care program serving active duty service members, retirees, their families,
survivors and certain former spouses worldwide. As a major component of the Military Health System,
TRICARE brings together the health care resources of the uniformed services and supplements them
with networks of civilian health care professionals, facilities, pharmacies and suppliers to provide
access to high-quality health care services, while maintaining the capability to support military
operations.
4.0 TRICARE Management Activity (TMA)
4.1 TMA Charter
The TRICARE Management Activity (TMA) was formally established under Department of Defense
Directive (DoDD) 5136.12 on May 31, 2001. TMA is a field activity of the Undersecretary of Defense
for Personnel and Readiness. Since February 1998, TMA leadership has managed the TRICARE
healthcare program for those entitled to DoD medical care.
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14) Who We Are & Our History
DoDD 5136.12 is the TMA Charter and solidifies TMA's mission, responsibilities, functions,
relationships, authorities, and organizational structure. DoDD 5136.1 and the Defense Federal
Acquisition Regulation Supplement (DFARS) references to the "Office of CHAMPUS" are now
understood to be "TRICARE Management Activity." As a chartered organization, TMA continues to
operate under the authority of the Assistant Secretary of Defense for Health Affairs.
4.2 TMA
Executes health affairs (HA) policy and develops TMA policy
Oversees TRICARE’s managed healthcare program for all uniformed services beneficiaries and
their families worldwide
Manages all financial matters of TRICARE
4.3 TRICARE Management Activity (TMA) organizational chart:
Notes:
The Assistant Secretary of Defense for Health Affairs (ASD/HA):
o Provides and maintains the readiness to provide healthcare services and support to
members of the Uniformed Services healthcare services, and supports members of the
Armed Forces during military operations.
o The Department's healthcare mission provides healthcare services and support to members
of the Armed Forces, their family members, and others entitled to DoD healthcare.
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14) Who We Are & Our History
The TRICARE Regional Offices (TRO) and TRICARE Area Offices (TAO) report directly to the
TMA Deputy Director.
There are six major functional offices within each TRO/TAO:
o Medical Office
o Force Health Protection and Readiness
o Financial Office
o Information Office (information management, technology, and readiness)
o Pharmaceutical Operations
o Health Plan Operations Office (includes Communications and Customer Service)
4.4 TMA Communications and Customer Service (C&CS) organizational chart:
Director
Administrative Staff
Public Customer Beneficiary Beneficiary
Resources &
Affairs Communications Publications Creative
Strategic
Branch Branch Office Communications
Planning Branch
Branch
Staff Customer
Development Service
& Training Branch
Branch
4.4.1 Resources and Strategic Planning Branch
The Resources and Strategic Planning Branch:
o Conducts customer research and market analysis
o Manages the TRICARE Beneficiary Delphi Council, a TMA-chartered worldwide group of
approximately 250 volunteers representing all beneficiary categories serving as a sounding
board for new C&CS communication concepts and products.
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4.4.2 Public Affairs Branch
The Public Affairs Branch uses communications strategies to inform the media and beneficiary
about TRICARE through:
o News releases
o Fact sheets
o The Media Readiness Room: http://www.tricare.mil/pressroom/
o The news media
o Beneficiary associations
o DoD and regional contractor communication professionals
o The annual TRICARE Stakeholders Report
4.4.3 Customer Communications Branch (CCB)
The Customer Communications Branch (CCB) is TMA’s liaison for TRO/TAO and MTF
Beneficiary Counseling and Assistance Coordinators (BCACs) and Debt Collection Assistance
Officers (DCAOs)
CCB also:
o Manages the Assistance Report Tool and the BCAC/DCAO Directory
o Resolves beneficiary questions and concerns
o Writes and updates the TRICARE Web site Frequently Asked Questions
o Develops, delivers, and administers the TRICARE Fundamentals Courses
o Communicates information regarding TRICARE programs and activities to medical, non-
medical, line, and combatant personnel of all uniformed services, including Guard/Reserve
members.
4.4.4 Beneficiary Publications Office
The Beneficiary Publications Office:
o Develops beneficiary and provider educational materials, such as the TRICARE program
handbooks, brochures, beneficiary and provider briefings and flyers
o Develops beneficiary (8 publications/year) and provider (12 publications/year) newsletters
and bulletins
o Coordinates printing and distribution of beneficiary and provider materials
o Develops TRICARE Dental Program educational materials
o Manages the TRICARE Smart Site: http://www.tricare.mil/tricaresmart/
o Oversees development and review of TRICARE-related mailings in coordination with DMDC
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4.4.5 Beneficiary Creative Communications Branch
The Beneficiary Creative Communications Branch:
o Manages the TRICARE Web site: http://www.tricare.mil
o Responds to Congressional inquiries
5.0 The TRICARE Continental United States (CONUS) Regions
TRICARE plan oversight is managed through three geographic health services regions. Each of the
regions has a regional contractor that administers and helps coordinate the health care services
available through military treatment facilities (MTFs) and a network of civilian hospitals and providers.
5.1 West Region
The West region is comprised of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the
Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana,
Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern
corner including El Paso only), Utah, Washington, and Wyoming.
5.2 North Region
The North region is comprised of Connecticut, Delaware, the District of Columbia, Illinois, Indiana,
Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North
Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin, and portions
of Tennessee (Ft. Campbell area), Iowa (Rock Island Arsenal area), and Missouri (St. Louis area).
5.3 South Region
The South region is comprised of Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi,
Oklahoma, South Carolina, Tennessee (except the Ft. Campbell area), and Texas (except the
southwestern corner including El Paso).
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6.0 TRICARE Regional Offices
Each of the three CONUS TRICARE regions is administered by a separate TRICARE Regional Office
(TRO): TRICARE Regional Office-North, TRICARE Regional Office-South, and TRICARE Regional
Office-West. The TROs are government entities that oversee the regional contractors to ensure they
fulfill their contractual responsibilities.
TRICARE Regional Office Organizational Chart
General organizational structure
Regional Director
Senior Executive Service (SES)
or General/Admiral (Flag)
IM/IT Operations Business Ops Program Ops Clinical Ops Contract Ops
CIO and Staff Chief Chief Chief Chief
Information Administration Purchased Care UM/QM/RM Alternate
Assurance Support Contracting Officer
Access Clinical Quality
Analysis and Mgmt Staff
Marketing and
Evaluation
Education Case Mgmt
Finance
Health Benefits Health Program
Counseling Analyst
Customer Service
Reps
Enrollment and
TSC
USCG Liaison
Training
6.1 Regional Director
Each TRO is led by a Regional Director, who reports to and operates under the TMA Deputy Director.
The TRO Director is the regional health plan manager and has visibility of both contract and direct care
assets, and coordinates with the Services to develop integrated health plans for regional military
treatment facilities. Specific responsibilities include:
Management of the TRICARE contracts for all eligible MHS beneficiaries in the region. This
responsibility includes:
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o ensuring network quality and adequacy including provider issues
o monitoring customer satisfaction outcomes
o coordinating referral and authorization policies
o managing enrollment activities
o overseeing contractor credentialing
o ensuring contract support for MTF optimization
o other delegated functions
Provision of the support to the military medical treatment facility (MTF) Commanders in their
delivery of health care services to enrolled and non-enrolled beneficiaries; supporting the MTF
Commanders in their efforts to optimize health care services in the MTFs;
Develop business plans for non-MTF areas (e.g., BRAC sites), remote areas, and those areas in
which a Service Surgeon General requests regional director support.
Integration of MTF and remote business plans into a single, regional business plan for submission
to TMA prior to the start of each fiscal year, and subsequent monitoring of performance against
the business plans.
Funding of regional initiatives to optimize and improve the delivery of health care, through
dedicated resources and a disciplined and open business case planning/approval process.
Opportunities for investment capital can be initiated by the Regional Director, a single MTF
Commander or by a Senior Market Manager on behalf of the MTFs in a multiple service market.
Chair of the TRICARE Regional Advisory Committee
6.2 Other Roles within the TRICARE Regional Office include the following:
Medical Director (referrals, UM/QM/CM)
Managed Care Director (networks, marketing, BCAC)
Business or Finance Director (Resource Sharing/Support, Bid Price Adjustment analysis)
Contracting Director (surveillance, deficiencies)
Operations Director (TRICARE Prime Remote, Reserve component issues)
Information Management Director (DEERS/DOES, ALHTA/CHCS)
6.3 Senior Market Manager
Title applies to the MTF commander designated by the Surgeons General to be the market
manager for each of the 13 multi-service markets. Multi-service markets are major military
treatment facilities and their subordinates that form one unified health system.
Collaborates in a process to develop consolidated business plans and jointly work resource issues
Oversees the single integrated business plan that may include appointing services, resource
sharing, optimization initiatives, and DoD/VA sharing opportunities
Makes recommendations concerning short-term operational decisions
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7.0 The Role of the Regional Contractor
Each of the three CONUS regions has a regional contractor. The regional contractor’s role is to help
support and augment the services available at MTFs by developing a network of civilian hospitals and
providers to meet the healthcare needs of TRICARE beneficiaries and carrying out contractually
required administrative functions.
7.1 Regional Contractor Responsibilities
The regional contractors perform varied functions at the regional level, including the following:
Establishing and maintaining the TRICARE Prime provider network
Delivering customer service
Operating beneficiary information lines
Operating TRICARE Service Centers (TSC)
Providing administrative support such as enrollment, disenrollment, and claims processing
Providing communications and educational information to beneficiaries and providers
Managing the referral and authorization function
Maintaining quality and disease management programs.
Performing utilization and medical review for referrals to the network according to best business
process
7.2 Regional Contractor—West Region
The regional contractor for the West region is TriWest Healthcare Alliance.
Toll-free Phone 1-888-874-9378 (1-888-TRIWEST)
www.triwest.com this redirects to
Web site
https://www.triwest.com/triwest/default.html
West Region Claims, P.O. Box 77028,
Claims Mailing Address
Madison, WI 53707-7028
Toll-free Phone for Claims 1-888-874-9378
Claims Web site www.tricare4u.com
TRO Web site www.tricare.mil/west/default.cfm
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7.3 Regional Contractor—North Region
The regional contractor for the North region is Health Net Federal Services, LLC.
Toll-free Phone 1-877-874-2273 (1-877-TRICARE)
www.healthnetfederalservices.com this is their HN corporate
Web site page – refers to VA and other contracts.We typically link to:
https://www.hnfs.net/bene/home
Health Net Federal Services, LLC c/o PGBA, LLC/TRICARE
Claims Mailing Address
P.O. Box 870140, Surfside Beach, SC 29587-9740
Toll-free Phone for Claims 1-800-930-2929
Claims Web site www.mytricare.com
TRO Web site www.tricare.mil/north/default.cfm
7.4 Regional Contractor—South Region
The regional contractor for the South region is Humana Military Healthcare Services, Inc.
Toll-free Phone 1-800-444-5445
Web site www.humana-military.com
TRICARE South Region, Claims Department
Claims Mailing Address
P.O. Box 7031, Camden, SC 29020-7031
Toll-free Phone for Claims 1-800-403-3950
Claims Web site www.mytricare.com
TRO Web site www.tricare.mil/south/default.cfm
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7.5 MTF Commander role as related to TRICARE
Responsible for managing health care delivery for the active duty personnel and TRICARE
beneficiaries who are seen within their MTF, with access to care higher for those enrolled in Prime
with MTF PCM.
May enter into a Resource Sharing Agreements or have providers refer patients to a network
civilian provider if the MTF cannot or does not have capacity to provide the care to enrollees
directly.
Through a Memorandum of Understanding, coordinated by the Commander, the regional
contractor and the TROs, sets priorities for assignment of MTF PCMs, enrollment activities,
network development and adequacy, resource sharing arrangements, management of referrals
and authorizations, educational outreach, and similar local initiatives.
7.6 Beneficiary Counseling and Assistance Coordinator (BCAC)
Advocates for beneficiaries and provides assistance on TRICARE benefits
Serves at each TRICARE Regional Office and MTF
Works closely with the TMA/TRO/TAO staff, regional contractors, and claims processing staff
Improves customer service and satisfaction, enhances beneficiary education, and reduces
congressional inquiries from beneficiaries
The BCAC directory is available on the TRICARE Web site– www.tricare.mil/BCACDirectory.htm
An official listing of BCAC responsibilities can be found in DOD Instruction 6015.23 at
http://www.dtic.mil/whs/directives/corres/pdf/601523p.pdf
7. 7 Debt Collection Assistance Officer (DCAO)
Program directed by the Under Secretary of Defense (Personnel & Readiness)
Serves at each TRICARE Regional Office and MTF
Becomes involved when beneficiary notified of collection action
Resolves TRICARE related debt collection cases using established policies and guidelines
DCAO directory available on TRICARE Web site—http://www.tricare.mil/bcacdcao/
Roles and responsibilities are outlined in the DCAO Training Guide:
www.tricare.mil/1bcac3263827/1138/reference-guides.cfm
8.0 TRICARE Service Centers (TSCs)
TRICARE Service Centers are usually located with an MTF to serve beneficiaries and provide
information on and assistance with the TRICARE program. The TSCs are staffed by regional contractor
employees and are separate entities from MTF staff.
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8.1 TSCs Provide:
Information about TRICARE Prime, Standard, and Extra
Information on the Point of Service (POS) option
Information on eligibility for the TRICARE Dental Programs
TRICARE Prime enrollment and TRICARE Reserve Select enrollments
Facility PCM selection
Coordination of access to and referral for civilian specialty care
Assistance with claim issues (when the regional contractor is responsible for the claim processing)
TRICARE network providers and pharmacies lists
9.0 The TRICARE Overseas Regions
Outside the Continental United States (OCONUS) there are three separate overseas regions: Europe,
Pacific, and Latin America/Canada. The TRICARE Overseas regions operate in the same way as the
CONUS regions with a few exceptions:
There are no contracted network providers overseas.
TRICARE Area Offices (TAOs), rather than regional contractors, authorize care for beneficiaries.
The Regional Deputy Director manages and administers the TRICARE Overseas Program.
9.1 TRICARE Area Offices
Like the TRICARE Regional Offices (TROs) within the CONUS regions, the three TRICARE Overseas
regions are each managed by a TAO.
9.2 TRICARE Area Offices (TAO):
TAO Europe: Comprised of Europe, Africa, and the Middle East. (120 countries over 3 continents,
and 11 time zones).
TAO Pacific: Comprised of the Western Pacific/Far East, which includes China, Thailand, Korea,
Australia, Japan, and so forth.
TAO TRICARE Latin America/Canada (TLAC): Comprised of the Caribbean, Central and South
America, and Canada.
9.3 TRICARE Area Office Directors
Plan and deliver services to meet the healthcare needs within their area of responsibility, whether
through the available MTFs, contracts, or local host nation providers.
Offers many of the same services offered by a stateside regional contractor or TSC (e.g.
enrollment assistance, claims processing assistance, benefit education).
May contract directly for support services or include this requirement in existing TMA regional
contracts (e.g. TSC staff, translation services).
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Serves as a primary contact to the overseas claims processor, Wisconsin Physician Services
(WPS), and TMA for issues relating to their areas of responsibility.
9.4 OCONUS MTF Commanders
OCONUS MTF Commanders are responsible for providing and managing healthcare delivery for
active duty personnel and TRICARE Overseas Program (TOP) Prime enrollees, as well as other
Military Health System (MHS) beneficiaries who are eligible for care at MTFs on a space available
basis.
OCONUS MTF Commanders work directly with the TAO for network development, and local
initiatives.
9.5 Claims Processor - Overseas
The Claims Processor for the all three overseas regions is Wisconsin Physicians Service (WPS).
Toll-free Phone 1-888-777-8343
Claims Mailing Address WPS—Foreign Claims, P.O. Box 7985,
Madison, WI, USA 53707-7985
TAO Pacific and TLAC
Claims Mailing Address Active Duty:
TAO Europe WPS—Active Duty Claims Processing,
P.O. Box 7968, Madison, WI, USA 3707-7968
Active Duty family members:
WPS—Claims Processing, P.O. Box 8976,
Madison, WI, USA 53708-8976
1-608-301-2310
Commercial Phone for Claims
TAO Europe and Pacific
1-608-301-2311
Commercial Phone for Claims TAO TLAC
Web site TAO Europe www.europe.tricare.osd.mil/
Web site TAO Pacific www.tricare.mil/pacific/tao-pacific.cfm
Web site TAO TLAC www.tricare.mil/tlac/default.cfm
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10.0 MTFs’ Dual Mission
Military Treatment Facilities (MTFs) are responsible for providing both Force Health Protection and
Beneficiary Health Care.
Force Health Protection (FHP) Beneficiary Health Care
Other health care
services not
Individual associated with
Medical FHP training
Readiness
Health Care
Military-Unique
Training for the that
Medical Force
Supports FHP
Clinical care
DNBI*
Prevention Training not associated
with FHP
training
Both FHP and Beneficiary Health Care
*Disease and Non-Battle Injury
10.1 Definition of Force Health Protection
―The medical portion of Force Protection. All measures taken by commanders, leaders, individual
Service members, and the Military Health System to promote, improve, conserve, or restore the mental
and physical well being of Service members across the range of military activities and operations.
These measures enable the fielding of a healthy and fit force, prevention of injuries and illness and
protection of the force from health hazards, and provision of excellent medical and rehabilitative care to
those who become sick or injured anywhere in the world. [1]‖
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11.0 Legislation
11.1 National Defense Authorization Act (NDAA)
The NDAA is under the jurisdiction of the Senate and House Armed Services Committees.
Under the NDAA, Title VII is Health Care.
The NDAA provides statutory direction across all DoD programs by either establishing, changing,
or eliminating programs and activities:
o Example: Preauthorization elimination.
- In NDAA FY 2003, Section 701 prohibits TRICARE preauthorization requirement for
inpatient mental health cases where Medicare has already authorized the care and
Medicare is the primary payer.
- Requires advance authorization for a continuation of inpatient mental health services
when Medicare coverage terminates.
- To implement this, it needs a regulation change.
o Result of the NDAA: Preauthorization is no longer required.
In DoD, a requirement could also be viewed as a new service which is:
o Identified with an assessment of how much the new service will cost.
o Presented to the legislative staffers to develop a bill that goes before Congress for funding.
Changes to TRICARE benefits are presented from Congress through the annual NDAA process.
o Although these changes are listed in the NDAA, the implementation dates are staggered due
to several factors including waiting for the following:
- Public review/comment
- Funding
- Contract awards
- Policies to be written
- Contractor implementation
o The staggered implementation dates allow for staffing of requirements through the TMA
Directorates causing different dates between implementation and execution.
o This fine-tuning is one of the reasons that make it appears that the TRICARE benefits
program has had several changes.
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11.2 Key Points in the FY 2009 NDAA
Section Explanation
Benefit Enhancements
701 One-Year Extension of Prohibition on Increases in Certain Health Care Costs for
Members of the Uniformed Services
702 Temporary Prohibition on Increase in Copayments under Retail Pharmacy System
of Pharmacy Benefits Program
704 Chiropractic Health Care for Members on Active Duty
705 Requirement to Recalculate TRICARE Reserve Select Premiums Based on Actual
Cost Data
711 Waiver of Copayments for Preventative Services for Certain TRICARE Beneficiaries
712 Military Health Risk Management Demonstration Project
713 Smoking Cessation Program Under TRICARE
714 Availability of Allowance to Assist Members of the Armed Forces and their
Dependents Procure Preventive Health Care Services
11.3 Defense Appropriations Act (DAA)
Provides funding or budget authority for authorized agencies, programs, and activities.
Establishes spending levels for programs and activities.
Under the Constitution, all appropriations must originate in the House of Representatives.
Comes under the jurisdiction of the Senate and House Appropriations Committees.
11.4 Code of Federal Regulations (32 CFR) Part 199
After the NDAA and Defense Appropriations Act become Public Law, Executive departments and
agencies implement laws by publishing their rules in the Federal Register.
The rules explain how the statutory mandate/statutory discretion will be implemented by DoD.
Part 199 contains the regulations published in the Federal Register relating to the
CHAMPUS/TRICARE program.
11.5 Title 10
The U.S. Code is divided into 50 titles, and Title 10 dictates Armed Forces matters.
Chapter 55 of Title 10 covers medical and dental care.
When laws are enacted that affect military healthcare, they normally amend Title 10, Chapter 55.
11.6 Title 32
U.S. Code title that covers the National Guard affairs
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12.0 Where it all began
Before 1884 Military Medical Care was for Military Members Only
1775—Congress established a ―hospital‖ (actually a medical department) in Massachusetts with a
Director-General (chief physician of the hospital), four surgeons, an apothecary (pharmacist), and
nurses (usually wives or widows of military personnel) to care for military members.
1818—Secretary of War John C. Calhoun established a permanent medical department.
Military Medical Care for Families
1884—Congressional direction
o ―Medical officers of the Army and contract surgeons shall, whenever possible, attend the
families of the officers and soldiers free of charge‖
1943—Congress authorizes Emergency Maternal and Infant Care Program (EMIC)
o Provided maternity care and care of infants up to one year of age for wives and children of
Service members in the lower four pay grades
o Administered through state health departments
1956—Dependents Medical Care Act
o Amendments to this Act created what would be called CHAMPUS
1966—Civilian Health and Medical Program for the Uniformed Services (CHAMPUS)
o Authorized ambulatory and psychiatric care for active duty family members
1967—Retirees, their family members, and certain surviving family members of deceased military
sponsors were brought into the program
Healthcare under CHAMPUS
1965 to 1993—CHAMPUS, the Civilian Health and Medical Program of the Uniformed Services
o Served the military for over 30 years
o A cost-sharing program used to provide inpatient and outpatient care for:
- Active duty family members from civilian sources when they were unable to get inpatient
and outpatient care through a military hospital or clinic
- Family members of either deceased or retired personnel or retired military personnel and
their family members under the age of 65
o Space available care in MTF was available for all non-active duty.
o Civilian care required:
- Annual deductible
- Cost share for every visit
- Non availability statements for inpatient care
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TRICARE is conceived
1980s—CHAMPUS ―demonstration‖ projects
1988—CHAMPUS Reform Initiative (CRI)
o California and Hawaii
o Offered family members a choice of ways in which they could use their military healthcare
benefits
o Five years of successful operation and high levels of patient satisfaction
TRICARE is Born
1993—Department of Defense officials, along with Congress extend and improve the CRI
The improved program is called TRICARE:
o CHAMPUS becomes TRICARE Standard
o Coverage, deductibles, cost shares, and claim-filing rules stayed the same.
o Essentially the name just changed.
With the switch to the TRICARE name, three options were implemented:
o TRICARE Prime—basically the care received in MTFs
o TRICARE Standard—same as CHAMPUS
o TRICARE Extra—TRICARE Standard with a discount due to negotiated fees with providers
in a network
13.0 TRICARE Evolution
1995
Nurse advice lines toll-free worldwide
Catastrophic cap reduced from $7,500 to $3,000 per year, non-active duty TRICARE Prime
enrollees
1996
TRICARE Web site www.tricare.osd.mil was launched.
1997
TRICARE Prime enrollment portable across regions
TRICARE Selected Reserve Dental Program
National Mail Order Pharmacy
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1998
TRICARE Retiree Dental Program (TRDP)
TRICARE Management Activity (TMA) established as a DoD field activity
Stopped balance billing of TRICARE Prime enrollees by non-participating providers
Limited balance billing by non-institutional providers
The final TRICARE region (Northeast) was put in place
1999
Automatic re-enrollment for TRICARE Prime enrollees
TRICARE Prime Remote for active duty personnel
2000
Designated Beneficiary Counseling & Assistance Coordinators (BCACs) at every Lead Agent and
MTF
Established Debt Collection Assistance Officer (DCAO) Program
Catastrophic cap reduced from $7,500 to $3,000 per year, uniformed services retirees, their family
members, and survivors using TRICARE Standard and TRICARE Extra
2001
TRICARE Dental Program, combined TRICARE Family Member Dental Plan and TRICARE
Selected Reserve Dental Program
TRICARE Senior Pharmacy program was implemented
Eliminated copays for active duty family members enrolled in TRICARE Prime
TRICARE For Life – provides second payer to Medicare coverage to uniformed services retirees,
their family members, and survivors who are age 65 years and over
Chiropractic care benefit for active duty uniformed services members
2002
TRICARE Transitional Healthcare Demonstration Project for 60 to 120 days for family members of
active duty sponsors involuntarily separated from military service under honorable conditions or
family members of Reserve component members separated after serving on active duty for more
than 30 days in support of contingency operations
TRICARE Prime Remote for active duty family members
TRICARE Online (tricareonline.com) implemented with symptom checker, prescription checker,
personal health journal, consumer health information, disease management tools, and online
appointment scheduling with their assigned MTF PCM for TRICARE Prime and TRICARE Plus
enrollees
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Awarded TRICARE Global Remote Overseas contract to International SOS Assistance, Inc., to
standardize the benefit across all remote overseas regions
2003
TRICARE Mail Order Pharmacy contract to Express Scripts, Inc.
TRICARE implements patient privacy standards mandated under the Health Insurance Portability
and Accountability Act of 1996 (HIPAA)
First TRICARE Fundamentals Course taught
TRICARE Retiree Dental Program contract to Delta Dental Plan of California
TRICARE Global Remote Overseas contract begins
2004
Automatic issuance of Certificates of Creditable Coverage for those who lose TRICARE eligibility
Dual-eligible Claims Processing contract to Wisconsin Physician Services Insurance Corp.
New contract to provide healthcare to active duty and their families started in Puerto Rico
Healthcare Services and Support contracts to Health Net Federal Services Inc. (North),
TriWest Healthcare Alliance Corporation (West), and Humana Military Healthcare Services
(South)
TRICARE Retail Pharmacy contract to Express Scripts, Inc.
Transition to 3 stateside regions is completed
2005
TRICARE Reserve Select begins
Extended Care Health Option (ECHO) begins
Permanent Uniformed Services ID cards for beneficiaries age 75 and over
2006
Family members now have a 30-day period to submit a TRICARE Prime enrollment form.
The opportunity to purchase TRICARE Reserve Select (TRS), in one of three premium tiers, was
extended to all qualifying members of the National Guard and Reserves.
Gastric bypass, gastric stapling or gastroplasty, including vertical banded gastroplasty is covered
by TRICARE.
2007
Authorized anesthesia and other costs for dental care for children and certain other patients.
Expanded eligibility of Selected Reserve members under TRICARE program.
Standardization of claims processing under TRICARE program and Medicare program.
Participant Guide June 2009 21
TRICARE Fundamentals Course
14) Who We Are & Our History
Enhanced mental health screening and services for members of the Armed Forces.
2008
Extended prohibition on increases in certain health care costs for the uniformed services.
Temporary prohibition on increase in copayments under retail pharmacy system of pharmacy
benefits program.
Inclusion of mental health care in definition of health care.
Establishment of Joint Pathology Center.
14.0 TRICARE Figures for FY 2008
9.2 million TRICARE Eligible Beneficiaries
o 5.026 million TRICARE Prime Enrollees
o 1.569 million TRICARE For Life
o 167,000 TRICARE Plus
o 96,000 US Family Health Plan
o 57,000 TRICARE Reserve Select
o 2.194 million Non-enrolled Users
o 75,000 Age 65 & older (not TRICARE For Life)
TRICARE Dental coverage
o 1.704 million Active Duty
o 1.794 million Active Duty Family Members
o 1.043 million Retirees
MHS Direct Care Facilities
o 63 Military Hospitals
o 413 Medical Clinics
o 413 Dental Clinics
133,500 MHS Personnel
o 89,400 Military
o 44,100 Civilian
$42.178 billion FY07 Budget (Unified Medical Program)
o $23.694 billion Defense Health Program
o $368 million Medical Military Construction
o $6.958 billion Medical Military Personnel
o $11.158 billion Medicare Eligible Retiree Accrual Fund
Participant Guide June 2009 22
TRICARE Fundamentals Course
14) Who We Are & Our History
Summary
Explain the structure of the Military Health System
Identify the TRICARE regions
Define TRICARE and how it has evolved
Explain the purpose of the National Defense Authorization Act (NDAA)
Participant Guide June 2009 23
TRICARE Fundamentals Course
14) Who We Are & Our History
Appendix
1. Roles and Responsibilities of Debt Collection Assistance Officers (DCAOs)
Refer to the Debt Collection Assistance Officer Implementation & Training Guide, at:
www.tricare.mil/1bcac3263827/1138/reference-guides.cfm
2. Roles and Responsibilities of Beneficiary Counseling and Assistance Coordinators (BCACs)
Refer to DODI Number 6015.23, dated 30 October, 2002, at:
www.tricare.mil/1bcac3263827/1138/reference-guides.cfm
Participant Guide June 2009 24
