TRICARE:
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TRICARE is the name of the Defense Department’s new regional managed health care program for service families. Under TRICARE, you’ll generally have three choices of ways in which to get your health care: Here’s a brief look at each of the three options:
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TRICARE Prime:
This is a voluntary health maintenance organization-type (HMO) option. If you decide to get your health care through TRICARE Prime, you’ll pay an annual enrollment fee (except for active-duty families, who may enroll free) and enroll for a year at time. Normally, you’ll receive your care from within the Prime network of civilian and military providers. You’ll either choose or be assigned a Primary Care Manager (PCM) from within the contractor’s network or at your nearest uniformed services medical facility, who will furnish most of your care and will manage all aspects of your care, including referrals to specialists. The Health Care Finder (HCF) assists in finding the appropriate specially care for you. Covered services will be like those of regular CHAMPUS (now known as TRICARE Standard), plus additional preventive and primary care services that aren’t covered under TRICARE Standard or TRICARE Extra. For example, period health promotion/disease prevention surveillance screenings (most people think of them as routine physical exams) are covered at no charge under TRICARE Prime. Prime also covers certain immunizations, as well as examinations for various cancers and infectious and cardiovascular diseases, and other screenings, with certain age and frequency limitations.
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TRICARE Extra:
In this option, you don’t have to enroll or pay an annual fee. You do have to satisfy an annual deductible for outpatient care, just as you do under TRICARE Standard. (See the section on TRICARE Standard below. The deducible and cost-sharing works the same way under TRICARE Extra. On a visit-by visit basis, you can seek care from a provider who’s part of the TRICARE Extra network, get a discount on services, and have reduced cost-shares-five percent less than under TRICARE Standard. Also, you generally won’t have to file any claim forms. You pay annual deductibles for outpatient care before government cost-sharing starts, as you do under TRICARE Standard. You can get a list of the TRICARE Extra providers by contacting one of the TRICARE service-centers.
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Eligibility: Applicants must have a good credit rating, have an income sufficient to support mortgage payments, and agree to live in the property. To obtain a VA certificate of eligibility, complete VA Form 26-1880, "Request for Determination of Eligibility and Available Loan Guaranty Entitlement," and submit it to the nearest VA regional office.
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TRICARE Standard:
This option is the regular CHAMPUS program with a new name. It pays a share of the cost of covered health care services that you obtain from an authorized non-network civilian health care provider. There’s no enrollment in TRICARE Standard. You’ll pay the normal TRICARE Standard deductibles for outpatient care, and your cost-sharing percentages will be the same as for regular CHAMPUS. |
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