TRICARE ®
Your Military Health Plan
Introduction to TRICARE
Presenter Name
Month DD, YYYY
Complete Version
Updated February 2011
Today’s Agenda
• What Is TRICARE?
• TRICARE Eligibility
• Medical Coverage
• Other Important Information
• For Information and Assistance
Photo courtesy of The National Guard
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What Is TRICARE?
TRICARE is…
… the health care program for active duty service members
(ADSMs), active duty family members (ADFMs), National Guard
and Reserve members and their family members, retirees and
retiree family members, survivors, and certain former spouses
worldwide.
… a network of military and civilian health care professionals
working together to foster, protect, sustain, and restore health for
those entrusted to their care.
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What Is TRICARE?
TRICARE Stateside Regions (50 United States & Washington, DC)
TRICARE is available worldwide and managed regionally
Health Net
Federal
Services, LLC
TriWest
Healthcare Humana
Alliance Corp. Military
Healthcare
Services, Inc.
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What Is TRICARE?
TRICARE Overseas Region
The TRICARE Overseas Region is managed through three geographic areas
Latin America and Canada Eurasia-Africa Pacific
Central and South America, Europe, Africa, and Asia, Guam, Australia,
the Caribbean Basin, Canada, Puerto the Middle East New Zealand, and remote
Rico, and the U.S. Virgin Islands Western Pacific countries
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TRICARE Eligibility
Take Action! Register Your Family in DEERS
Registration in DEERS is key to TRICARE eligibility
Register your family members in the Defense Enrollment Eligibility
Reporting System (DEERS)
– In person at a uniformed services identification (ID)
card-issuing facility: www.dmdc.osd.mil/rsl/owa/home
– By sending changes and required documentation to:
Defense Manpower Data Center Support Office (DMDC)
400 Gigling Road
Seaside, CA 93955-6771
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TRICARE Eligibility
Take Action! Register Your Family in DEERS
• Proper documentation is required
– Marriage certificate
– Divorce decree
– Adoption papers
– Birth Certificate
• You can verify eligibility in one of three ways:
– Go to www.mydodbenefits.dmdc.mil
– Visit your local MTF’s Patient Administration Office
– Contact your Service’s personnel office
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TRICARE Eligibility
Updating DEERS
• Remember to register/update DEERS whenever there is a change in
the family (marriage, birth, adoption, divorce, death, etc.) or when you
move
• Keep your contact information up to date:
– Online: www.dmdc.osd.mil/appj/address/
– By Phone: 1-800-538-9552
– By Fax: 1-831-655-8317
– Visiting an ID card-issuing facility:
www.dmdc.osd.mil/rsl/owa/home
• More information: www.tricare.mil/DEERS
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How Can I Get TRICARE?
Family Members Entitled to TRICARE
Relationship Benefits
Spouses • Entitled to TRICARE benefits
Unmarried • Entitled until age 21, or 23 if a full-time student
Dependent • Extended entitlement for children incapable of self-support
Children
• Retain entitlement after parents divorce or remarry
(except stepchildren)
Dependent • Not entitled to most civilian TRICARE benefits
Parents • Eligible for care at military treatment facilities (MTFs) on a
space-available basis
• May fill prescriptions at MTF pharmacies and use TRICARE
Pharmacy Home Delivery and retail network pharmacies under
certain circumstances
Former • Eligibility based on years of marriage
Spouses • Use personal Social Security number (SSN) for eligibility
• For more information, contact the Defense Manpower Data
Center (DMDC) Support Office at 1-800-538-9552.
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How Can I Get TRICARE?
Survivors Entitled to TRICARE
Relationship Benefits
Surviving • Entitled to TRICARE benefits until remarriage
Spouse • First three years: ADFM coverage
• After three years: same coverage as a retiree family member
Surviving • Entitled as ADFMs until they reach eligibility age limit, marry,
Children or otherwise lose TRICARE entitlement
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How Can I Get TRICARE?
Beneficiary Categories
The TRICARE program options available to you are based on
where you live and your beneficiary category. TRICARE has five
main beneficiary categories:
• Active duty service members (ADSMs)
• Active duty family members (ADFMs)
• Retired service members and their families
• National Guard and Reserve members and their families
• Survivors, certain former spouses, and others
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TRICARE Program Options
Depending on your location and beneficiary category, there are
multiple program options available to you:
• TRICARE Prime options
– TRICARE Prime
– TRICARE Prime Remote (TPR)
– TRICARE Prime Remote for Active
Duty Family Members (TPRADFM)
– US Family Health Plan (USFHP)
• TRICARE Standard and TRICARE Extra
• TRICARE For Life (TFL)
• TRICARE Reserve Select (TRS)
• TRICARE Retired Reserve (TRR)
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Program Options
TRICARE Prime
Topic Description
Eligibility • ADSMs, ADFMs, retirees and their families, survivors, certain
former spouses, and others in Prime Service Areas (PSAs)
Enrollment • Enroll via the BWE site or by filling out the TRICARE Prime
Enrollment Application and PCM Change Form (DD Form 2876)
• Submit initial enrollment fee with application (if required)
• Choose a primary care manager (PCM)
Costs ADSMs and ADFMs All others
• No enrollment fees/deductibles • Annual enrollment fee required
• ADFMs have cost-shares • Copayments for health care
for some prescriptions services and some prescriptions
Getting • Your PCM delivers most routine care, coordinates all other care
Care and referrals, and files claims on your behalf.
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Program Options
TRICARE Prime Remote (TPR) and TPRADFM
Topic Description
Eligibility • Available to ADSMs and ADFMs only
• ADSMs must live and work in a TRICARE Prime Remote area (check
the status of your location at www.tricare.mil/tpr/default_zip.cfm).
• ADFMs must live with their TPR-enrolled sponsor, except when an
ADSM moves away for a follow-on unaccompanied assignment or
when a National Guard and Reserve member is called to active duty.
Enrollment • Same as TRICARE Prime
Costs • Same as TRICARE Prime ADSMs and ADFMs
Getting • If possible, you will have an assigned PCM.
Care • If there are no network PCMs available, you can choose any
TRICARE-authorized provider for your routine health care services.
• To coordinate specialty care, work with your PCM or primary care
provider and regional contractor.
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Program Options
US Family Health Plan (USFHP)
Topic Description
Eligibility • ADFMs, retired service members
and their families, survivors, certain
former spouses, National Guard US Family Health
and Reserve family members, and Plan Service Areas
others (does not include ADSMs)
• Must live in one of six service areas
located across the country
• Medicare-eligible beneficiaries do
not need to have Medicare Part B to be eligible for USFHP.
Enrollment • Beneficiaries must enroll through the USFHP sponsoring
organizations. Go to www.usfhp.com and click “Enroll Now” for more
information.
Costs • Same as TRICARE Prime
Getting • A USFHP primary care provider delivers all routine care and provides
Care referrals for specialty care. If you are enrolled in USFHP, you are not
eligible to receive health care or pharmacy benefits from MTFs or
other TRICARE programs.
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Program Options
TRICARE Standard and TRICARE Extra
Topic Description
Eligibility • ADFMs, retirees and their families, survivors, certain former spouses,
and others
Enrollment • No enrollment necessary; eligible beneficiaries should be covered
when they update their information in DEERS.
Costs • There are no enrollment fees, but annual deductibles and cost-
shares apply.
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Program Options
TRICARE Standard and TRICARE Extra (Continued)
Topic Description
Getting • Beneficiaries can see any TRICARE-authorized provider for care.
Care – Network Provider = TRICARE Extra (lower costs)
– Non-network Provider = TRICARE Standard (higher costs)
• No referrals are necessary, but prior authorizations are required
for certain services.
• TRICARE Standard and TRICARE Extra beneficiaries may receive
services at a military hospital or clinic on a space-available basis.
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Program Options
TRICARE For Life (TFL)
Topic Description
Eligibility • Beneficiaries who are entitled to premium-free Medicare Part A
coverage and have Medicare Part B coverage.
Enrollment • No enrollment necessary; DEERS is updated monthly with Medicare
enrollment data received directly from the Centers for Medicare and
Medicaid Services.
Costs • No enrollment fees. Beneficiaries avoid deductibles and copayments
when health care services are covered under both Medicare and
TRICARE.
Getting • TFL beneficiaries may see any Medicare participating,
Care non-participating or opt-out provider in the United States.
• TFL beneficiaries may see any host nation provider while living or
traveling overseas.
• Care is available at military hospitals and clinics on a space-
available basis.
• For customer service questions, contact Wisconsin Physicians Service
(WPS) at 1-866-773-0404.
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Program Options
TRICARE For Life (TFL) (Continued)
Topic Description
Getting • TFL beneficiaries may see any Medicare participating,
Care non-participating, or opt-out provider in the United States.
• TFL beneficiaries may see any host nation provider while living or
traveling overseas.
• Care is available at military hospitals and clinics on a space-
available basis.
• For customer service questions, contact Wisconsin Physicians Service
(WPS) at 1-866-773-0404.
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Program Options
TRICARE Reserve Select (TRS)
Topic Description
Eligibility • Qualified members of the Selected Reserve who are not eligible
for or enrolled in the Federal Employees Health Benefits program and
their eligible family members.
Enrollment • Visit the Web-based Defense Manpower Data Center (DMDC)
Reserve Component Purchased TRICARE Application at
https://www.dmdc.osd.mil/appj/trs/, follow the instructions, and print
and sign the Reserve Component Health Coverage Request form
(DD Form 2896-1).
• Fax or mail the completed form to the appropriate address along
with the first month’s premium.
Costs • TRS is a premium-based health care plan with monthly premiums,
an annual deductible, and cost-shares.
Getting • Beneficiaries can see any TRICARE-authorized provider for care.
Care • No referrals are necessary, but prior authorizations from your
regional contractor are required for certain services.
• TRS beneficiaries may receive services at a military hospital or clinic
on a space-available basis.
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• For more information, visit www.tricare.mil/trs.
Program Options
TRICARE Retired Reserve (TRR)
Topic Description
Eligibility • Qualified Retired Reserve members, their family members, and
qualified survivors.
Enrollment • Visit the Web-based Defense Manpower Data Center (DMDC)
Reserve Component Purchased TRICARE Application at
https://www.dmdc.osd.mil/appj/reservetricare, follow the instructions,
and print and sign the Reserve Component Health Coverage Request
form (DD Form 2896-1).
• Fax or mail the completed form to the appropriate address along
with the minimum of two months’ premiums.
Costs • TRR is a premium-based health care plan with monthly premiums,
an annual deductible, and cost-shares.
Getting • Beneficiaries can see any TRICARE-authorized provider for care.
Care • No referrals are necessary, but prior authorizations from your
regional contractor are required for certain services.
• TRR beneficiaries may receive services at a military hospital or clinic
on a space-available basis.
• For more information, visit www.tricare.mil/trr.
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Other Important Information
TRICARE Pharmacy Program
Formulary
Pharmacy Option Non-Formulary
Generic Brand Name
MTF Pharmacy $0 $0 N/A
(up to a 90-day supply)
TRICARE Pharmacy $3 $9 $22
Home Delivery
(up to a 90-day supply)
Retail Network $3 $9 $22
Pharmacy
(up to a 30-day supply)
Non-Network Retail TRICARE Prime: 50% cost- TRICARE Prime: 50% cost-
Pharmacy share after point-of-service share after point-of-service
(up to a 30-day supply) deductible is met deductible is met
Other Programs: $9 or 20% Other Programs: $22 or 20%
of total cost (whichever is of total cost (whichever is
greater) after the annual greater) after the annual
deductible is met deductible is met
Express Scripts, Inc. website: www.express-scripts.com/TRICARE
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Other Benefit Information
Dental Program Options
• Active Duty Dental Program (ADDP)
– Available to ADSMs
– Care through military dentist referrals and remote access
– For more information, visit www.addp-ucci.com.
• TRICARE Dental Program (TDP)
– Available to eligible ADFMs and National Guard and Reserve
members and their families
– For more information or to enroll online, visit
www.TRICAREdentalprogram.com.
• TRICARE Retiree Dental Program (TRDP)
– Available to retired service members and their families, retired
National Guard and Reserve Members, survivors, and others
– For more information or to enroll online, visit www.trdp.org.
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Other Benefit Information
Overseas Dental Options
• TRICARE Dental Program (TDP)
– Available to ADFMs and National Guard and Reserve members
and their families (Command sponsorship not required, but higher
cost-shares apply).
– For more information or to enroll online, visit
www.TRICAREdentalprogram.com
• Enhanced-Overseas TRICARE Retiree Dental Program (TRDP)
– Available in certain areas for retired service members and their
families, retired National Guard and Reserve members, survivors,
and others
– For more information or to enroll online, visit www.trdp.org
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Other Important Information
TRICARE Dental Program (TDP)
• Voluntary, premium-based program
• Premiums depend on sponsor’s status
One Family More Than One Sponsor
Service Sponsor
Member Family Member and Family
Active Duty N/A $12.69 $31.72 N/A
National Guard
$12.69 $31.72 $79.29 $91.98
and Reserve
Individual Ready
$31.72 $31.72 $79.29 $111.01
Reserve
TDP website: www.TRICAREdentalprogram.com
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Other Benefit Information
Annual Catastrophic Cap
• Limits the amount of out-of-pocket expenses a family will
have to pay for TRICARE-covered medical services
• Applies to all covered services, including annual deductibles,
pharmacy copays, TRICARE Prime enrollment fees, and other
cost-shares based on TRICARE-allowable charges
• $1,000 total for active duty families and $3,000 per family
for all other beneficiaries
• After you meet the catastrophic cap, TRICARE will pay your
portion of the TRICARE-allowable amount for all covered
services for the rest of the fiscal year
• Point of service charges and additional non-network provider
charges do not count toward the cap.
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Other Important Information
Priority for Access to Military Treatment Facility Care
Active duty service members, including National Guard and
1
Reserve members on active duty status
Active duty family members enrolled in a TRICARE Prime
2
option
Retired service members, their dependents, and all others
3
enrolled in a TRICARE Prime option
Active duty family members not enrolled in a TRICARE Prime
4
option, and TRICARE Reserve Select beneficiaries
Retired service members and their dependents not enrolled in
a TRICARE Prime option, TRICARE Retired Reserve
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beneficiaries, and all other eligible beneficiaries not enrolled
in a TRICARE Prime option
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Other Important Information
TRICARE and Other Health Insurance
• TRICARE serves as the secondary payer.
• If you have other health insurance (OHI):
– Fill out a TRICARE Other Health Insurance Questionnaire
(www.tricare.mil/mybenefit/Forms.do)
– Follow the referral and authorization rules for your OHI
– Tell your provider about your OHI and TRICARE
– Show him or her your insurance card
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For Information and Assistance
Stateside Regional Contractors Overseas Regional Contractor
TRICARE North Region International SOS Assistance, Inc.
Health Net Federal Services Eurasia-Africa:
1-877-TRICARE (1-877-874-2273) +44-20-8762-8384
www.hnfs.com Latin America & Canada:
+1-215-942-8393
TRICARE South Region Pacific:
Humana Military Healthcare Services Singapore: +65-6339-2676
1-800-444-5445 Sydney: +61-2-9273-2710
www.humana-military.com www.tricare-overseas.com
TRICARE West Region
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378) Connect with TRICARE Online!
www.triwest.com
General Contact Information
TRICARE Website: www.tricare.mil www.tricare.mil/mediacenter
Contacts: www.tricare.mil/contacts
MMSO: www.tricare.mil/tma/mmso
PP4111BEC05101W
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