TRICARE Concepts & Terms
What is Direct Care?
Care and pharmacy services received at a military hospital or clinic
This is the process for a TRICARE Prime Remote Overseas beneficiary to get non-emergency care in their enrolled location.
Contact the Overseas contractor for an authorization
This is a centralized Department of Defense database that lists benefit and eligibility information.
DEERS
This is how long TAMP beneficiaries are eligible for medical care.
180 days.
This is the dental option that retirees and their family members can choose to purchase
Federal Employees Dental and Vision Insurance Program (FEDVIP)
BONUS question for 50 points: Who DOESNT qualify to purchase vision coverage through FEDVIP?
This is a primary care program offered at some military hospitals or clinics
TRICARE Plus
These are the beneficiaries who are part of group A.
Enrollees whose sponsor initially enlisted or commissioned before January 1st, 2018.
These are plans that function similarly to TRICARE Prime.
(Name at least two (2))
TRICARE Prime Remote
TYA Prime
TAMP Prime
USFHP
These are the 2 situations when beneficiaries are able to change their enrollment.
- During Open Season
- Following a QLE (qualifying life event).
BONUS question for 50 points:
Name a QLE!
When their TRICARE eligibility ends, this is how long beneficiaries have to purchase the Continued Health Care Benefit Program (CHCBP).
Within 60 days of when TRICARE eligibility ends.
These are the name of the dental programs for ADSMs and for ADFMs.
ADSM: Active Duty Dental Program (ADDP)
ADFM: TRICARE Dental Program (TDP)
These are plans that function similarly to TRICARE Select.
(Name at least two (2))
TRICARE Reserve Select
TRICARE Retired Reserve
TAMP Select
TYA Select
TRICARE for Life
CHCBP
This is available to National Guard and Reserve Members who get injured during active service for 30 days or less
Line of Duty
BONUS question for 50 points: What is this called for the Coast Guard?
This is the name of the option which lets TRICARE Prime/Prime Remote beneficiaries get non-emergency care without a referral, but at higher cost.
Point of Service (POS)
BONUS question for 50 points: Which beneficiary type can NOT use the Point of Service Option?
These are the beneficiaries who can qualify for ECHO.
Active Duty Family Members with special medical and/or educational needs
BONUS question for 50 points:
If a beneficiary is determined to be ineligible for ECHO, can you appeal this decision?
Name two (2) ways a TRS beneficiary may lose TRICARE eligibility.
Becoming eligible for the Federal Employees Health Benefits (FEHB) program under their own employment
Not paying their premiums
Separating/retiring from the Selected Reserves
Being called to Active-Duty for more than 30 days
This is the maximum supply of medication a beneficiary can obtain at a time using Home Delivery or Military Pharmacies
90-day supply
BONUS question for 50 points:
Where can you check if a particular medication is covered and if there are limitations?
This is the premium-based plan for retired reservists who have not yet turned age 60.
TRICARE Retired Reserve (TRR)
This type of provider did not sign a contract with the TRICARE contractor, but agrees to accept the TRICARE-allowable charge as payment in full
Non-network participating providers
List four (4) facts about TRICARE Prime.
Available to ADSM and ADFM
ADFMs must be command-sponsored overseas
Managed-care option (HMO-like plan)
PCM assigned
50 mile radius of an MTF/Prime Location
Referrals and authorizations required
Network providers
Cashless/Claimless
POS
This is when ADFMs who have Medicare part A should sign up for Medicare Part B to prevent a break in TRICARE coverage.
Before the sponsor retires
Name four (4) eligibility requirements for a service-related condition to be covered under the Transitional Care for Service-Related Conditions (TCSRC) benefit.
The medical condition must be:
- Service-related
- Newly-discovered during TAMP
- Validated by a DoD physician
- Treatable
- Able to be resolved within 180 days of the TCSRC validation date
These are the four (4) TRICARE Pharmacy options.
Military Pharmacies
Home Delivery
Network Pharmacies
Non-network Pharmacies
These are 2 ways you can have TRICARE Plus:
TRICARE Plus with a Select plan
TRICARE Plus with no other TRICARE Eligibility
BONUS question for 50 points:
If you have TRICARE Plus with no other TRICARE Eligibility, are you covered for civilian care?
This is how much Non-Network Non-Participating providers may charge the beneficiary (stateside & U.S. territories).
Up to 15% above the TRICARE-allowable charge
This is the entity who assesses readiness and fitness for duty for remote ADSMs (stateside)
DHA-Great Lakes
This is where new ADFMs, including newborns, must live to be automatically enrolled in TRICARE Prime (stateside)
Prime Service Area (PSA)
These service members ___________ separating from active service under honorable conditions may be eligible for TAMP.
Involuntarily
BONUS question for 50 points:
What if they separate voluntarily?
Name the contractors for the following:
1. ADDP
2. TRICARE Overseas
3. Pharmacy Benefits
4. CHCBP
5. TRICARE West
1. United Concordia
2. International SOS
3. Express Scripts
4. Humana Military
5. TriWest Healthcare Alliance
This is what happens when TRICARE Select beneficiaries receive care from non-authorized, non-network providers. (stateside & Philippines)
TRICARE will not pay their claims