TRICARE
is the uniformed services health care program for: Active Duty Service Members or ADSMs, Active duty family members, or ADFMs, Retirees and their family members & Children.
Reminder: “family
members” refers to dependents of service members who are eligible TRICARE
beneficiaries.
The Defense Enrollment Eligibility Reporting System, or DEERS, is a database of service members
and dependents worldwide who are eligible for military benefits including TRICARE.
Three Common Type of Health Plan Options of TRICARE:
1. TRICARE Prime - Health Maintenance Organization (health plan option)
2. TRICARE Extra - Preferred Provider Organization (health plan option)
3. TRICARE Standard - Fee-For-Service(health plan option)
Active Duty Service Members or ADSMs are eligible for the following Health Plan Options:
The Defense Enrollment Eligibility Reporting System, or DEERS, is a database of service members
and dependents worldwide who are eligible for military benefits including TRICARE.
Three Common Type of Health Plan Options of TRICARE:
1. TRICARE Prime - Health Maintenance Organization (health plan option)
2. TRICARE Extra - Preferred Provider Organization (health plan option)
3. TRICARE Standard - Fee-For-Service(health plan option)
Active Duty Service Members or ADSMs are eligible for the following Health Plan Options:
- TRICARE Prime
- TRICARE Prime Remote
Active Duty Family Members or ADFMs are eligible for the following Health Plan Options:
- TRICARE Standard
- TRICARE Extra
- TRICARE For Life (With Medicare Part A & B Coverage)
- TRICARE Young Adult (Dependent adult children only)
Retirees and their family members are eligible for the following Health Plan Options:
- TRICARE Prime (enrollment fees apply)
- TRICARE Standard and Extra
- TRICARE For Life (with Medicare Part A & B coverage)
Additionally, adult children who "age out" at 21 (or 23 if attending college) may qualify to purchase TRICARE Young Adult.
Social Security Number Removal
In an effort to protect the privacy of
TRICARE beneficiaries, Department of Defense is removing Social Security numbers from military ID cards, including the Common Access
Card.
Your
new ID card will have one or both of the following:
–A 10-digit DoD ID number instead of your
Social Security number or
–A DoD Benefits Number, or DBN, if you are
eligible for DoD benefits
Alert: Your
DBN is required in order to file claims.You
will not need a new ID card until your old card expires.
Note: Not
all ID cardholders are eligible for DoD benefits. For
more information, visit www.tricare.mil/ssn.
Nonavailability Statement (NAS)
Any TRICARE beneficiary who lives within zip code catchment area of a uniformed services hospital must obtain NAS before TRICARE will share the cost of nonemergency inpatient care from civilian source. The zip code catchment area is based on approximately a 40-mile radius surrounding the Military Treatment Facility (MTF).It is the responsibility of the patient to obtain NAS waiver, without it, services could be denied for payment. All civilian hospital admissions require a NAS from MTF before admitting members who live within a catchment area surrounding MTF.
5 Services that requires NAS:
1. Patient is living outside the catchment area.
2. The patient is receiving care from an outside civilian source and it is medically necessary to continue care from a civilian provider.
3. No space available at the MTF.
4. Patient is policyholder of Other Health Insurance (OHI) which is the primary payer to TRICARE.
5. MTF does not have proper facilities and specialist to treat the patient.
Update: TRICARE Standard no longer requires a non-availability statement prior to receiving treatment from a civilian facility. But, members and dependents still need an advance authorization (preauthorization) before receiving certain types of treatment.
Preauthorization - here are the procedures that required prior approval for TRICARE Standard patients:
a. Admission b. Ambulatory Surgical Procedure c. Arthoscopy
d. Breast mass or removal of tumor e. Cardiac Catheterization f. Cataract removal
g. Mental Health Care h. DME purchases i. GI endoscopy
j. Gynecologic laparoscopy k. Hernia repairs l. MRI
m. Ligation of fallopian tube n. Laparoscopic cholecystectomy o. Neuroplasty
p. Dental Care q. Nose repair r. Strabismus repair
s. myringotomy or tympanostomy t. tonsillectomy or adenoidectomy u. other selected procedures that require preauthorization.
When a specialty care or hospitalization is necessary, the MTF must be used if services are available. Now, if services are not available the Health Care Finder can assist referral or preauthorization process.
Always check with TRICARE regional managed care contractors requiring members and dependents to obtain prior approval from a Health Care Finder (HCF).
An HCF is usually a Registered Nurse (RN) who helps patient work with his or her Primary Care Manager (or physician) to locate a specialist and obtain preauthorization for care.
Each region may have their own requirements of preauthorization forms, click the links below for needed forms:
North Region - Health Net Federal Services
South Region - Humana Military Healthcare Services
West Region - UnitedHealthcare Military and Veterans
Click the card image to view CHAMPVA website information
about this new card - - - >
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Internet Resources:
TRICARE WEBSITE
TRICARE FORMS
CHAMPVA (Veterans Health Admisnistration)
CHAMPVA Forms
