TRICARE Programs and Options
Explain the process for a TRICARE Prime Remote Overseas beneficiary to get specialty 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
Complete the blanks with the relevant durations:
When injured while on active service for ________, National Guard and Reserve members may be covered for Line of Duty coverage for ___________.
Less than 30 days.
Up to a year.
This is how long TAMP beneficiaries are eligible for medical care.
180 days.
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 the two parts of the MHS.
-Direct Care
-Civilian Care = TRICARE
Bonus: What is Direct Care? (50 points)
List two (2) self-managed healthcare options.
TRICARE Select
TRICARE Reserve Select
TRICARE Retired Reserve
TAMP Select
CHCBP
These are the 2 situations when beneficiaries are able to change their enrollment.
-During open enrollment season
-or during a QLE (qualifying life even).
Bonus: For 50 points name a QLE!
This is the premium-based plan for retired reservists who have not yet turned age 60.
TRICARE Retired Reserve (TRR)
Continued Health Care Benefit Program must be purchased within __ days of when TRICARE eligibility ends.
60 days
These are the drugs that beneficiaries need to pay 100% for.
Over the counter and not covered medicine
Bonus: Where can I check the coverage of medication? (50 points)
These are the beneficiaries who are part of group A.
Enrollees whose sponsor initially enlisted or commissioned before January 1st, 2018.
This is a primary care program offered at some military hospitals or clinics but NOT available to TRICARE Prime enrollees.
TRICARE Plus
This is when ADFMs should sign up for Medicare Part B to prevent a break in TRICARE coverage.
Before the sponsor retires
List 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
Retiring from the Selected Reserves
List three (3) healthcare options available under TAMP.
Prime / Prime Overseas
USFHP
Select / Select Overseas
This is how a TRICARE Prime Remote Overseas ADSM gets routine dental care overseas?
Contact the Dental Contractor and get an ACN (appointment control number)
Or get an instant ACN online
Bonus: What kind of services are included in 'routine' dental care? (50 points)
This type of provider agrees to accept the TRICARE-allowable charge as payment in full, but did not sign a contract with the TRICARE contractor.
Non-network participating
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
40 mile radius of an MTF/Prime Location
Referrals and authorizations required
Network providers
Cashless/Claimless
POS
List two (2) types of beneficiaries that can enroll in TRICARE Plus.
TRICARE Select beneficiaries (including ADFMs)
Retirees
TFL beneficiaries
Retiree family members
Parents/Parents in law
List two (2) healthcare options available to National Guard/Reserve members separating from active service.
TAMP
TRS
CHCBP
TDP (dental)
List 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
It must be 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
This type of provider can charge up to 15% above the TRICARE allowable charge.
Non-Network Non-Participating providers
This is the name of the option which lets TRICARE Prime enrollees get non-emergency care from any overseas provider without a referral, but at higher cost.
Point of Service (POS)
Newborn children of active duty service members are automatically enrolled in TRICARE Prime (stateside) when they live in a....
Prime Service Area (PSA)
Describe the process of getting LOD care: who is eligible? what do they need to qualify for it? and how long can they get care?
National Guard/Reserve members who incur or aggravate an injury while on the line of duty
They need an LOD determination/NOE
They can get care for up to one (1) year
These service members ___________ separating from active service under honorable conditions may be eligible for TAMP.
Involuntarily
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
Explain how TRICARE for Life works with Medicare stateside when a beneficiary gets care.
TFL beneficiary can see any Medicare provider.
If the provider participates with Medicare, they will file claims with Medicare.
Then, Medicare will send the claim to TRICARE For Life.