Prime/Prime Remote
The permission needed to have family members accompany the service member to an overseas assignment
Command Sponsorship
What is the difference between copay and cost share?
copay: the fixed dollar amount a beneficiary pays for covered health care services
cost share: % of the total cost of covered health care that a beneficiary pays
What are the two things that would make a young adult not eligible for TYA?
1) if they were married
2)if they were eligible for employer-sponsored healthcare
Beneficiaries show as having this coverage when they aren't enrolled into a TRICARE plan. With this plan they can only get care at an MTF on a space available basis and are not covered for civilian care
Direct Care
A TFL beneficiary must maintain what premiums in order to remain enrolled in TFL?
Medicare Part A and B
This managed care plan is for beneficiaries who live within 40 miles of an MTF. It requires them to obtain referrals and authorizations and this care is cashless/claimless if proper procedures are followed.
Prime
What is the definition of annual deductible?
The amount a beneficiary must pay before TRICARE starts sharing the cost of medical care
Which two T-Program plans can beneficiaries not be eligible or enrolled into FEHB?
TRS and TRR
This program provides 180 days of health care benefits after regular TRICARE benefits end
TAMP
True or False: A Prime for Retired beneficiary in CONUS can not have TFL coverage as well.
False
The option for TRICARE Prime/Prime Remote ADFMs that allows them to receive care from a TRICARE authorized provider without authorization (they will have greater out of pocket expenses)
Point of Service (POS)
What is the catastrophic cap?
The most a beneficiary pays out of pocket annually for TRICARE covered services. Deductibles, co-payments and cost-shares apply toward the CCAP
True or False: A young adult whose Sponsor is Retired overseas can enroll into TYA Prime overseas?
False- Prime for Retired is only available in CONUS, so unless they were living in CONUS they could only be TYA Select
Which contractor is responsible for enrolling beneficiaries and assisting with all queries regarding CHCBP?
Humana Military
This program can give Select beneficiaries higher priority to be seen on base if they are enrolled into it.
TRICARE Plus- if a Select beneficiary isn't enrolled into Plus, they can only be seen on base on a space available basis
This program has International SOS as their PCM when they live outside of the 40 mile radius of an MTF. No referrals are needed, however authorizations are.
Prime Remote
Why are referrals not needed for the care of Select beneficiaries?
-self managed program so no one follows their care; freedom to use any provider of their choosing
What happens when a TRR beneficiary turns 60?
They can no longer have TRR and will have to enroll into TRICARE Select for Retired until age 65 when they become Medicare/TFL eligble
True or False: a beneficiary under the age of 65 can not have TRICARE for Life coverage. Why or why not?
False, if a beneficiary is medically disabled and therefore Medicare eligible, this would allow them to be in TFL coverage
This program provides temporary coverage for 18-36 months when TRICARE eligibility is lost.
CHCBP (Continued Health Care Benefit Program)
Why are ADSM's not allowed to use the Point of Service option?
The government wants ADSMs to be closely monitored to ensure they are getting cashless/claimless care and to ensure they are getting the proper card to allow them to be fit for duty
Name 3 things that Select beneficiaries would be required to obtain pre-authorization for.
adjunctive dental care, home care (CONUS and territories), inpt mental health, organ and stem cell transplants, ECHO Services, ABA Therapy, Genetic testing, Psychanalysis, Skilled Nursing Facility (CONUS and territories), and hospice care
True or False: A TRS beneficiary who switches to Prime because they go on active duty orders for more than 30 days will automatically re-enroll into TRS once they come off orders
False- they must contact us back to re-enroll into TRS after they come off of their active duty orders
This program is for beneficiaries who live in one of the 6 designated areas of the US. It is a Prime option and members are assigned to a PCM at one of these facilities.
USFHP (US Family Health Plan)
Retiring members are NOT eligible for this program
TAMP