How Does Tricare Prime Point Of Service Work

2012 Benefits Handbook

Pay and Benefits
- Pay and Allowances
- Other Allowances
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Support Services
- Military Services
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Education
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- Military - Personal
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Health Care
- Tricare Options
- Tricare - Other
- Tricare Glossary
- Other Medical
Housing
- Allowances
- Base Housing
- Off-Base Housing
Recreation
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Moving
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Retirement
- Bones Plans
- Other Benefits

Health Care

TRICARE OPTIONS

TRICARE PRIME

Prime is similar to a health maintenance organization, which has lower out-of-pocket costs merely requires enrollees to use network providers and coordinate care through a primary care manager – a doctor, nurse practitioner or medical team.

Prime requires enrollment. It'south costless for active-duty members and their families, but retirees must pay an annual enrollment fee. In financial 2013, those fees are $269.28 for an individual and $538.56 for a family.

Prime number limits out-of-pocket expenses; it has no deductibles, and co-payments for health care visits are lower than for the other programs. Co-pays for outpatient noncombatant md visits are $12 for enrolled retirees and their family members. Active-duty family members don't pay for civilian medical care if they follow the Prime rules. They practise pay for noncombatant pharmacy services.

The catastrophic cap – the ceiling on how much a family must pay annually for Tricare-covered health care services – is $1,000 for active-duty families and $3,000 for retirees' families.

A Tricare Prime option is available overseas for active-duty troops and their command-sponsored family unit members. Prime number is non available to retirees or noncommand-sponsored families overseas.

Costs rising substantially if a Prime enrollee goes outside the Tricare network without dominance from the primary intendance provider using the betoken-of-service option. In such instances, deductibles are $300 for an individual or $600 for a family unit. After the deductible is met, Tricare will pay only 50 pct of what it establishes every bit the Tricare allowable charge.

Contact: www.tricare.mil/prime

TRICARE PRIME REMOTE

Service members who live and piece of work more than 50 miles or an hour'southward drive from the nearest military handling facility must enroll in Tricare Prime Remote. Family unit members are eligible if they live with an enrolled service member in a qualifying location. Family members may opt for Prime Remote or choose Tricare Standard or Extra.

Contact: www.tricare.mil/tpr

TRICARE Prime number REMOTE AND STANDARD OVERSEAS

The Tricare Overseas Programme is managed by contractor International SOS Assistance and includes Prime number, Prime number Remote and Standard options. Tricare Prime Overseas is a managed-intendance option for active-duty members and their command-sponsored family members living in nonremote locations. They take assigned main care managers at a military handling facility who provide most care and refer for and coordinate specialty care.

Tricare Prime Remote Overseas is bachelor in remote locations for active-duty personnel and their command-sponsored family members. Similar Prime number Overseas, those enrolled have an assigned main care manager who provides nearly care.

Tricare Standard Overseas provides comprehensive coverage to active-duty family members, retirees and their families and all others who can't enroll in Tricare Prime Overseas. Enrollment is not required and coverage is automatic as long as the beneficiary is in the Defense Enrollment Eligibility Reporting System. Beneficiaries receive care from host-nation providers. They may seek care at a military treatment facility on a space-available basis only. No referrals are needed for care only some services may require prior authorization. Beneficiaries may accept to pay the provider in total when they get care and file for reimbursement.

Contact: world wide web.tricare.mil/overseas

TRICARE STANDARD

Standard is modeled afterward a traditional fee-for-service health plan. Authorized doctors, hospitals and other providers are paid a Tricare allowable charge for each service performed.Individuals may use only Tricare authorized providers, and they pay more under other Tricare plans. Certain procedures likewise crave pre-authorization. For civilian physician visits, cost shares are a percentage of the allowable charge. Retirees and other eligible beneficiaries pay 25 percent; active-duty family members pay twenty percent.

Standard patients must run into outpatient deductibles earlier the government shares costs. Deductibles, which depend on rank and family status, range from $50 to $150 for an individual and $100 to $300 for a family. The annual catastrophic cap on allowable charges is $i,000 for active-duty families and $3,000 for retirees.

Cost shares are waived for preventive screenings for colorectal, breast, cervical and prostate cancers as well as immunizations and well-child visits for children under half dozen years of age.

The Pentagon'south proposed 2013 upkeep calls for new almanac enrollment fees for working-age retirees and their families to employ Standard or Extra – $70 for an individual and $140 for a family. At press time, the proposal was awaiting in Congress.

Contact: www.tricare.mil/standardextra

TRICARE EXTRA

Actress is a preferred-provider selection, a variation of Tricare Standard that allows Standard/non-Prime enrollees to lower their costs past using a Tricare network provider.

Extra does not require enrollment or charge premiums, only users must come across deductibles earlier government toll shares are covered. For paygrades E-4 and below, deductibles are $50 for an individual and $100 for a family; other active-duty members and retirees pay $150 for an individual and $300 for a family unit.

Users also must pay a portion of the costs associated with receiving intendance. For civilian doctor visits, active-duty families pay 15 percent of the allowable price; retirees pay xx pct.

Contact:www.tricare.mil/standardextra

TRICARE FOR LIFE

Medicare and Tricare play a role in health coverage for older retirees and their family unit members. Medicare Office A, which is gratis, covers hospitalization. Medicare Office B outpatient insurance, which requires monthly premiums, is necessary for retirees to exist eligible for Tricare For Life.

Medicare-eligible beneficiaries who are entitled to Office A and buy Medicare Function B employ Tricare equally a secondary payer under Tricare for Life. Those eligible for Medicare Part A who do not enroll in Part B lose Tricare eligibility, with one exception: Medicare-eligible active-duty family members are non required to purchase Part B until the sponsor retires.

Tricare For Life works as a wraparound supplement to Medicare only in the U.S. and its territories because Medicare does non cover health care away. Overseas, Medicare-eligible beneficiaries are covered past Tricare Standard if they take Medicare Role B insurance.

The Pentagon's proposed 2013 upkeep calls for new enrollment fees for all Medicare-eligible beneficiaries except dependents of active-duty personnel. The annual fee would be based on military retirement income: $35 per private for those making up to $22,589; $75 for those making between $22,590 and $45,178; and $115 for those making $45,179 and more.

Contact: www.tricare.mil/tfl

TRICARE RESERVE SELECT

Selected reserve members tin can buy Tricare coverage when they are in drilling condition –not mobilized– provided they are eligible for Tricare Reserve Select.

The plan, which offers coverage like to Tricare Standard and Extra, is available to drilling reservists who are not eligible for or enrolled in the Federal Employee Health Benefits program.

Monthly premiums in 2012 are $54.35 for an individual and $192.89 for family coverage. This includes medical, behavioral wellness and prescription drug benefits. For office visits, patients pay xv per centum of the allowable charge if the wellness care professional providing the service is in the Tricare network, 20 percent if not.

Annual deductibles use to outpatient services. For paygrades E-4 and below, they are $50 for an individual and $100 for a family unit. For college ranks, they are $150 for an individual and $300 for a family unit. The catastrophic cap is $1,000 a year.

Contact: www.tricare.mil/trs

TRICARE PLUS

Tricare Plus allows beneficiaries who are not in a civilian or Medicare HMO to enroll at a military dispensary or infirmary on a space-available footing for primary care but. They do not pay an enrollment fee and cannot be guaranteed specialty care, only they are seen according to the same access standards as Prime patients inside military handling facilities that offering Tricare Plus. Enrollment availability and capacity varies by dispensary or infirmary, so enrollment is not portable.

Contact: world wide web.tricare.mil/plus

TRICARE RETIRED RESERVE

This plan is for so-called "gray area" National Guard and reserve retirees who accept accumulated enough service to qualify for armed services retirement benefits, simply have not still reached the historic period at which they can brainstorm drawing those benefits (unremarkably age 60).

Retired reservists tin purchase TRR, which offers coverage similar to Tricare Standard, if they are under age threescore and are not eligible for or enrolled in the Federal Employee Health Benefits program.

For 2012, monthly premiums are $419.72 for an individual and $1,024.43 for a family.

Contact: world wide web.tricare.mil/trr

TRICARE YOUNG Developed

Unmarried dependent children who do non accept private-sector wellness insurance through an employer may remain in Tricare until age 26 under a parent's coverage as part of the Tricare Young Adult programme, created to bring Tricare in line with the broader national health intendance reform police force.

Ii plans are offered in 2012: TYA Standard, with a monthly premium of $176, and TYA Prime, conveying a monthly premium of $201.

To qualify, a beneficiary must be an adult child of an eligible sponsor at least 21 and not older than 26, must non qualify for his own employee-sponsored wellness care coverage and must exist single.

Contact: www.tricare.mil/tya

UNIFORMED SERVICES Family unit HEALTH Plan

Some beneficiaries – including active-duty family members, retirees and their family members, can use an boosted Tricare Prime selection available through networks of customs-based, non-for-profit health care systems in six areas of the U.Southward. through the Uniformed Services Family Health Programme. These facilities are "designated providers," offer a range of coverage at little out-of-pocket cost.

Enrollment is required and can be on an private or family basis. Participants must live within the designated provider's surface area. USFHP enrollees must agree non to apply other military or government wellness care facilities except for emergencies or if USFHP refers the patient to such a facility.

Active-duty service members cannot enroll in USFHP.

Under the 2012 Defense force Authority Deed, USFHP is prohibited later on Sept. 30, 2012, from accepting new members age 65 and older. Until then, persons of whatsoever historic period can enroll and remain for life. New members who join later the deadline must leave the plan when they turn 65.

Beneficiaries living in a USFHP location must choose either Tricare or USFHP. Eligible beneficiaries enrolled in Tricare Prime at a military facility or with a noncombatant Prime provider can withdraw at any time and enroll in the Prime number plan offered past USFHP, and vice versa.

If beneficiaries are transferred to an surface area without a USFHP facility, they tin can withdraw and resume using war machine facilities, Medicare or Tricare.

Dissimilar in Tricare, retirees over historic period 65 already in the plan or who enroll before Sept. 30, 2012, exercise not need to take Medicare Function B to participate in USFHP. However, the Defence Department highly encourages beneficiaries to enroll in Part B when they first go eligible, to avoid Part B premium surcharges if they subsequently move away.

If beneficiaries practise not enroll in Medicare Part B when first eligible, and want to practise so after, they will pay (in addition to the normal Medicare Part B monthly premium) an almanac 10 percent penalty for each year they were eligible to enroll but did not. In addition, they will be able to enroll in Medicare Part B merely during the general enrollment menses, Jan. 1-March 31 of each twelvemonth, and Part B benefits/Tricare coverage will not go constructive until July ane of that year.

USFHP operating areas:

♦Maine, New Hampshire, Vermont, upstate and western New York and the northern tier of Pennsylvania: Martin's Betoken Health Care, 888-241-4556

♦Maryland, Washington, D.C., and parts of Virginia, West Virginia, Pennsylvania and Delaware:
Johns Hopkins Medicine, 800-808-7347

♦Massachusetts, Rhode Island, northern Connecticut: Brighton Marine Health Center, 800-818-8589

♦New York City, Long Island, southern Connecticut, New Jersey and Philadelphia and surface area suburbs:
St. Vincent Cosmic Medical Centers, 800-241-4848

♦Southeast Texas, southwest Louisiana: CHRISTUS Health, 800-678-7347

♦Puget Sound region of Washington state: Pacific Medical Centers, 888-958-7347

Contact: www.usfhp.org; www.tricare.mil/mybenefit/habitation/overview/Plans