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TRICARE Overseas Program:
Summary of Beneficiary Costs
This flyer is not intended to be all-inclusive. For additional information, please contact your local military treatment facility or TRICARE Area Office.
This flyer summarizes beneficiary costs for TRICARE Overseas Program (TOP) options. These costs are effective October 1, 2008,
and are subject to change each fiscal year (FY) on October 1. Visit www.tricare.mil/costs for more information.
OVERSEAS TRICARE PRIME PROGRAM OPTIONS
There are no enrollment fees or copayments for TOP Prime, TRICARE Global Remote Overseas (TGRO), or TRICARE Puerto Rico
Prime beneficiaries unless they use the point of service (POS) option. Note: TRICARE-eligible retired service members and their
family members are not eligible for overseas TRICARE Prime options.
Point of Service Option
The POS option allows active duty family members (ADFMs) enrolled in an overseas TRICARE Prime
POS Deductible
program option* to receive nonemergency care from any TRICARE-authorized provider without a referral
from their primary care manager or TGRO Alarm Center, resulting in higher out-of-pocket costs. The POS $300/Individual
annual deductible applies only to outpatient services; the cost-share applies to both inpatient and outpatient $600/Family
care. POS out-of-pocket expenses do not apply to your annual catastrophic cap. Note: The POS option is not POS Cost-Share
available to active duty service members (ADSMs) and does not apply to newborns or adoptees deemed to 50% of the allowed
be enrolled in an overseas TRICARE Prime option during their first 60 days (TRICARE Area Office directors charges after POS
have extended this period up to 120 days), beneficiaries who have other health insurance (OHI), or for deductible is met
emergency care.
* For the TRICARE Pacific area, POS applies only to TGRO ADFMs (all locations) and TOP Prime ADFMs enrolled in Guam, Japan, and Korea. For the
TRICARE Latin America and Canada area, POS applies everywhere except Canada. For the TRICARE Europe area, POS applies to all locations served
by TGRO.
TOP STANDARD
This section highlights TOP Standard costs. Note: ADSMs may not use TOP Standard.
Annual Outpatient Deductible Beneficiary Category Outpatient Deductible
When using TOP Standard, you must meet an annual ADFMs (sponsor rank E-4 and below) $50/Individual $100/Family
deductible each FY for outpatient services before cost-sharing
ADFMs (sponsor rank E-5 and above) $150/Individual $300/Family
begins. The annual deductible varies based on your beneficiary
category and type of coverage (individual or family). Retired Service Members, Their
$150/Individual $300/Family
Families, and All Others
TOP Standard Health Care Costs*
The costs listed are for care received at host nation facilities.
* For ADFMs and all others receiving care in the Philippines and Panama, the allowable amount TRICARE will reimburse is the lesser of the actual billed
charges or the TRICARE maximum-allowable charge for covered services, once applicable deductibles and cost-shares are met.
Type of Care ADFMs1 Retirees, Their Families, and All Others1
Outpatient Visit 20% of covered costs after the annual
25% of covered costs after the annual deductible is met
(including behavioral health care) deductible is met
Durable Medical Equipment, Prosthetic 20% of covered costs after the annual
25% of covered costs after the annual deductible is met
Devices, and Medical Supplies deductible is met
25% of billed charges for institutional services, plus 25%
Hospitalization $15.65 per day ($25 minimum charge)2
of covered costs for separately billed professional services
25% of billed charges for institutional services, plus 25%
Inpatient Skilled Nursing $15.65 per day ($25 minimum charge)2
of covered costs for separately billed professional services
25% of billed charges for institutional services, plus 25%
Inpatient Behavioral Health $20 per day ($25 minimum charge)2
of covered costs for separately billed professional services
1. The cost for inpatient care provided at a military treatment facility (MTF) is $15.65 per day for TOP Standard ADFMs and retiree family members.
2. Example: If your hospital stay lasts one day, your charge for the stay will be $25. If your hospital stay lasts more than one day, your charge will be
$15.65 (or $20 for inpatient behavioral health care) multiplied by the number of days of your stay.
February 2009
TRICARE RESERVE SELECT
TRICARE Reserve Select (TRS) is a premium-based health care plan that qualifying National Guard and Reserve members may
purchase. TRS monthly premium amounts are determined by type of coverage (TRS member-only or TRS member-and-family), are
adjusted annually effective January 1, and are not applied to the catastrophic cap. The 2009 monthly premiums are $47.51 (TRS
member-only) and $180.17 (TRS member-and-family). Note: Cost-shares and deductibles are the same as those listed for TOP
Standard ADFMs.
Humana Military Healthcare Services, Inc. handles TRS for beneficiaries residing outside the U.S. For more information, visit
www.tricare.mil/trs or www.humana-military.com, or call 1-877-298-3408.
TRICARE fOR LIfE
To be eligible for TRICARE For Life (TFL), you must be entitled to Medicare Part A and have Medicare Part B. Visit
www.medicare.gov for current Medicare Part B premium amounts. Medicare covers health care received in U.S. territories
(American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). In these locations, Medicare
pays first and TFL pays second, or last if you have OHI. For more information, visit www.tricare.mil/tfl. Because Medicare generally
does not cover health care received overseas, in overseas areas TFL works like TOP Standard, with the same annual deductible and
cost-shares as those listed for TOP Standard retirees. To seek reimbursement for care received overseas, you must submit a paper
claim to Wisconsin Physicians Service along with a copy of your provider’s itemized bill and, if applicable, your OHI’s explanation of
benefits. For more information, visit www.TRICARE4u.com or call 1-866-773-0404 (stateside), 1-608-301-2310 (Europe and Pacific
areas), or 1-608-301-2311 (Latin America and Canada area).
TRICARE PhARMACy PROGRAM COSTS
Pharmacy costs are summarized in the following table. For more information, visit www.tricare.mil/pharmacy or call 1-866-ASK-4PEC
(1-866-275-4732) for mail-order pharmacy overseas, 1-866-DoD-TMOP (1-866-363-8667) for mail-order pharmacy stateside, or
1-866-DoD-TRRX (1-866-363-8779) for retail network pharmacy.
Formulary Costs
Type of Pharmacy Non-Formulary Costs (Tier 3)
Generic (Tier 1) Brand Name (Tier 2)
MTF (up to a 90-day supply) $0 $0 Not available
Mail Order1 (up to a 90-day supply) $3 $9 $22 (unless medical necessity is established)
Network Retail2 (up to a 30-day supply) $3 $9 $22 (unless medical necessity is established)
Non-Network Retail2 TOP Standard, TFL, or TRS: TOP Standard, TFL, or TRS:
(up to a 30-day supply) $9 or 20% of total cost (whichever is greater) after $22 or 20% of total cost (whichever is greater)
the annual deductible is met after the annual deductible is met
Overseas TRICARE Prime Options: Overseas TRICARE Prime Options:
POS option applies POS option applies
1. Mail-order prescriptions must be written by a U.S.-licensed physician and are only available for delivery to APO or FPO addresses.
2. The retail pharmacy program is available outside the U.S. only in Guam, Puerto Rico, and the U.S. Virgin Islands.
Host Nation Pharmacy Costs
There are no copayments or cost-shares for overseas TRICARE Prime enrollees (ADSMs and ADFMs). Note: Overseas host nation
pharmacy costs apply to pharmacies in American Samoa.
Beneficiary Category Cost-Share
ADFMs Using TOP Standard or TFL 20% cost-share after deductible is met1
Retired Service Members, Their Families, and All Others Using TOP Standard, TFL, or TRS 25% cost-share after deductible is met1
1. Annual deductible amounts are listed in the “Annual Outpatient Deductible” chart.
CATASTROPhIC CAP
The catastrophic cap is the maximum out-of-pocket expense you will pay each FY for TRICARE-covered services. You are not
responsible for any amounts above the catastrophic cap in a given FY, except for services that are not covered, POS charges, or
any amounts nonparticipating host nation providers may charge that exceed the TRICARE-allowable charge. The catastrophic cap
amount is based on your beneficiary category and is not affected by the program option you are using.
ADFMS Retirees, Their Families, and All Others TRS Enrollees and Their Families
$1,000 per family, per FY $3,000 per family, per FY $1,000 per family, per FY
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TRICARE DENTAL PROGRAM
The TRICARE Dental Program (TDP) is available to ADFMs and National Guard and Reserve members and/or their families. The
TDP is administered by United Concordia Companies, Inc. (United Concordia). Note: This section only highlights dental costs for
the overseas program. Limitations apply to certain services based on your beneficiary category and there are exceptions to when the
Government pays cost-shares overseas. For details, visit www.TRICAREdentalprogram.com or call 1-888-418-0466 (overseas) or
1-800-866-8499 (stateside).
TDP Monthly Premiums
Enrollment Year
Beneficiary Category Type of Plan
February 1, 2009–January 31, 2010 February 1, 2010–January 31, 2011
ADFM Single (one family member) $12.12 $12.69
ADFM Family (more than one family member) $30.29 $31.72
National Guard or Reserve
Single (sponsor only) $12.12 $12.69
Member1
National Guard or Reserve Single (one family member,
$30.29 $31.72
Family Member1 excluding sponsor)
National Guard or Family (more than one family
$75.73 $79.29
Reserve Family Member1 member, excluding sponsor)
IRR Member1 Single (sponsor only) $30.29 $31.72
Single (one family member,
IRR Family Member1 $30.29 $31.72
excluding sponsor)
Family (more than one family
IRR Family Member1 $75.73 $79.29
member, excluding sponsor)
1. These amounts are only applicable when the sponsor is not on active duty orders for a period of more than 30 days. If sponsors and family members
enroll together, the amounts listed are added together to determine the total premium amount.
TDP Cost-Shares and Maximums
Type of Service Your Cost-Share (Amount you Pay) TDP Maximums
Diagnostic 0% The TDP limits how much it will pay
Preventive 0% for dental benefits per enrollee.
Sealants 0% Dental Program Annual
Consultation/Office Visit 0% Maximum Benefit
Post-Surgical Services 0% $1,200 per enrollee per enrollment year
Basic Restorative 0% for non-orthodontic services. Many
Endodontic 0% diagnostic and preventive services are
not applied to the annual maximum.
Periodontic 0%
Oral Surgery 0% Orthodontic Lifetime
General Anesthesia 0% Maximum Benefit1
Intravenous Sedation 0% $1,500 per enrollee during your lifetime
for orthodontic services. Orthodontic
Miscellaneous Services (occlusal
0% diagnostic services are applied to the
guard, athletic mouthguard)
$1,200 annual maximum.
Other Restorative 50%
Implant Services 50% 1. Age limitations apply to orthodontic
services.
Prosthodontic 50%
Orthodontic1 50%
1. Age limitations apply to orthodontic services.
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TRICARE RETIREE DENTAL PROGRAM
The Enhanced-Overseas TRICARE Retiree Dental Program (TRDP) is available to eligible retired service members and their family
members who live outside the 50 United States, the District of Columbia, American Samoa, Canada, Guam, the Northern Mariana
Islands, Puerto Rico, and the U.S. Virgin Islands. The TRDP is administered by Delta Dental of California (Delta Dental).
TRDP Monthly Premiums
Enhanced-Overseas TRDP monthly premiums vary according to the enrollment option you choose (single person, two persons, or
family of three or more persons). To find your premium rate, visit the “Prospective Enrollees” section at www.trdp.org. Premium
rates are effective October 1–September 30 and are subject to annual adjustments. If you move or change your enrollment option,
your monthly premium rate may increase or decrease accordingly. Federal law mandates that monthly TRDP premiums be deducted
automatically from your uniformed services retired pay. Delta Dental will directly bill retirees whose pay is determined by the
appropriate finance center as being insufficient to cover premium allotment amounts. For more information, visit www.trdp.org or call
Delta Dental by dialing the AT&T USADirect® Access Number followed by 866-721-8737 (overseas)* or 1-888-838-8737 (stateside).
* For access numbers and assistance with overseas dialing instructions, visit www.usa.att.com/traveler/index.jsp.
TRDP Cost-Shares, Annual Deductible, and Maximums
Benefits Available during First 12 Months Annual Deductible and Maximums
Amount You Pay1
of Enrollment Annual Deductible
Diagnostic Services (e.g., exams) 0% (per person, per benefit year; $50
Preventive Services (e.g., cleanings) 0% $150 cap per family)
Basic Restorative Services (e.g., fillings, including Annual Maximum
20% $1,200
tooth-colored fillings on back teeth) (per person, per benefit year)
Endodontics (e.g., root canals) 40% Orthodontic Maximum
$1,500
Periodontics (e.g., gum treatments) 40% (per person, per lifetime)
Oral Surgery (e.g., extractions) 40% Dental Accident Maximum
$1,000
(per person, per benefit year)
Emergency Services (e.g., treatment for minor pain) 20%
Dental Accident Coverage 0%
Additional Benefits Available after 12 Months
of Continuous Enrollment or if Enrolled within Amount You Pay1
Four Months after Retirement
Cast Crowns, Onlays, and Bridges 50%
Partial/Full Dentures 50%
Orthodontics 50%
Dental Implants 50%
1. The percentage paid is based on the allowed amount for each procedure. Your out-of-pocket
costs may be higher if care is received from a nonparticipating provider.
fOR MORE INfORMATION
TRICARE Area Office (TAO)—Europe TAO—Latin America and Canada TAO—Pacific
Stateside: 1-888-777-8343, option 1 Stateside: 1-888-777-8343, option 3 Stateside: 1-888-777-8343, option 4
Comm.: 011-49-6302-67-7433/7434 Comm.: 1-706-787-2424 Comm.: 011-81-6117-43-2036
DSN: 496-7433/7434 DSN: 773-2424 DSN: 643-2036
E-Mail: teurope@europe.tricare.mil E-Mail: taolac@tma.osd.mil E-Mail: TPAO.CSC@med.navy.mil
www.tricare.mil/europe www.tricare.mil/tlac www.tricare.mil/pacific
Europe TRICARE Global Remote Overseas Latin America and Canada TGRO Alarm Center Pacific TGRO Alarm Centers
(TGRO) Alarm Center Stateside: 1-800-834-5514 Singapore:
Comm: 011-44-20-8762-8133 E-Mail: tricarephl@internationalsos.com Comm.: 011-65-6-338-9277
E-Mail: tricarelon@internationalsos.com E-Mail: sin.tricare@internationalsos.com
Puerto Rico Call Center: 1-800-700-7104
Sydney:
Comm.: 011-61-2-9273-2760
E-Mail: sydtricare@internationalsos.com
An Important Note about TRICARE Program Information
At the time of printing, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law and federal regulation.
Changes to TRICARE programs are continually made as public law and/or federal regulation are amended. Military treatment facility guidelines and policies
BR1231BEG02095
may be different than those outlined in this publication. For the most recent information, contact your TRICARE Area Office, TRICARE Service Center, or local
military treatment facility.
Please provide feedback on this flyer at www.tricare.mil/evaluations/feedback.
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