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Health

 

The Department of Defense (DOD) has developed a world class health care system for servicemembers and their families. It encourages total health fitness, delivers top quality health care, and focuses on medical readiness.

Tricare

In response to the challenge of maintaining medical combat readiness while providing the best health care for all eligible personnel, the Department of Defense introduced TRICARE (TRI-Army, Navy and Air Force and CARE-health care). TRICARE is a regionally managed health care program. TRICARE brings together the health care resources of the Army, Navy, and Air Force and supplements them with networks of civilian health care professionals to provide better access and high quality service while maintaining the capability to support military operations. TRICARE offers soldiers and their families affordable health care when they need it the most. Registration is important-be sure to enroll your family members in the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE affects soldiers and retirees in the US, Europe, Latin America, and the Pacific. Those eligible for TRICARE are-

  • Active duty soldiers (including reserve component soldiers on active duty under Title 10) and their families.
  • Retirees and their families (see Section VIII).
  • Survivors of all uniformed services who are not eligible for Medicare.

TRICARE offers eligible beneficiaries three choices for their health care:

  • TRICARE Prime-where military treatment facilities (MTFs) are the principal source of health care.
  • TRICARE Extra-a preferred provider option that saves money.
  • TRICARE Standard-a fee-for-service option (the old CHAMPUS program).

The main challenge for most eligible beneficiaries is deciding which TRICARE option; Prime, Extra or Standard is best for them. Active duty soldiers are enrolled in TRICARE Prime and pay no fees. Active duty family members pay no enrollment fees, but they must choose a TRICARE option and apply for enrollment in TRICARE Prime. There are no enrollment fees for active duty families in TRICARE Prime.

Tricare Prime

With TRICARE Prime, most of your health care will come from an MTF, augmented by the TRICARE contractor's Preferred Provider Network (PPN). All active duty personnel are enrolled in TRICARE Prime. Soldiers receive most of their care from military medical personnel. Family members and survivors of active duty personnel may enroll. For active duty families, there is no enrollment fee for TRICARE Prime, but they must complete an enrollment form. Reserve component soldiers (and their family members) called to active duty for 30 days or more may enroll in TRICARE Prime or may be eligible for TRICARE Prime Remote.

Your primary care manager or team of providers will see you first for your health care needs. The primary care manager-

  • Provides and/or coordinates your care.
  • Maintains your health records.
  • Refers you to specialists, if necessary. To be covered, specialty care must be arranged and approved by your primary care manager.

Advantages of TRICARE Prime:

  • No enrollment fee for active duty and families.
  • Small fee per visit to civilian providers and no fee for active duty members.
  • Guaranteed appointments.
  • Primary care manager supervises and coordinates care.
  • Away-from-home emergency coverage.

Disadvantages of TRICARE Prime:

  • Enrollment fee for retirees and their families.
  • Provider choice limited.
  • Specialty care by referral only.
  • Not universally available.

Tricare Standard

TRICARE Standard is the new name for CHAMPUS. Under this plan, you can see the authorized provider of your choice. Those who are happy with coverage from a current civilian provider often opt for this plan. However, this flexibility generally means that care costs more. Treatment may also be available at an MTF if space allows and after TRICARE Prime patients have been served. Furthermore, TRICARE Standard may be the only coverage available in some areas.

Active duty family members, family members of reserve component soldiers ordered to active duty for more than 30 days, and retirees drawing retired pay are eligible for TRICARE Standard. Active duty soldiers are enrolled in TRICARE Prime and not eligible for TRICARE Standard. The RC soldier ordered to active duty for more than 30 days is entitled to the TRICARE Prime benefit as soon as he is activated.

Advantages of TRICARE Standard:

  • Broadest choice of providers.
  • Widely available.
  • No enrollment fee.
  • TRICARE Extra is an available option.

Disadvantages of TRICARE Standard:

  • No Primary Care Manager.
  • Patient pays a deductible, co-payment and the balance of the medical bill if the provider does not participate in TRICARE Standard.
  • Nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs.
  • Beneficiaries may have to do their own paperwork and file their own claims.

Tricare Extra

With TRICARE Extra, you will choose a doctor, hospital, or other medical provider listed in the TRICARE Provider Directory. If you need assistance, call the health care finder at your nearest TRICARE service center (TSC). Anyone who is eligible for TRICARE Standard may use TRICARE Extra.

Advantages of TRICARE Extra:

  • Co-payment 5% less than TRICARE Standard.
  • No balance billing.
  • No enrollment fee.
  • No deductible when using retail pharmacy network.
  • No forms to file.
  • You may use also TRICARE Standard.

Disadvantages of TRICARE Extra:

  • No primary care manager.
  • Provider choice is limited.
  • Patient pays a deductible and co-payment.
  • Nonavailability statement may be required for civilian inpatient care for areas surrounding MTFs.
  • Not universally available.

Tricare Overseas

The TRICARE Overseas programs are designed to provide health care to eligible beneficiaries who reside overseas, not in the 50 United States. TRICARE has three overseas regions: Europe, Pacific and Latin America & Canada.

The main difference for overseas prime enrollees is that the copayment for civilian care is waived and no pre-authorization is required for TRICARE covered benefits received outside of Puerto Rico, even when traveling in CONUS. TRICARE Prime enrollees in Puerto Rico who are enrolled to an MTF must have authorization from their primary care manager to see a civilian provider for other than emergency care.

Other TRICARE options:

  • TRICARE Prime Remote-designed for active duty family members in remote locations. This is similar to TRICARE Prime.
  • TRICARE for Life-for Medicare-eligible beneficiaries age 65 and over.
  • TRICARE Plus. Enrolled beneficiaries have priority access to care at military treatment facilities; however, beneficiaries who choose to use TRICARE Extra, TRICARE Standard or TRICARE for Life may also continue to receive care in an MTF as capacity exists.

The best source of information on current health care benefits is your health benefits advisor available at your local TSC or MTF. Look for additional information on the TRICARE website, www.tricare.osd.mil.

Dental

The Tricare Dental Program (TDP) is a voluntary, comprehensive dental program offered worldwide for family members of all active duty soldiers. It may also be available to selected reserve and individual ready reserve (IRR) soldiers and/or their family members. Active duty soldiers get dental care through their servicing dental activity.

Dental Enrollment Basics

The TDP offers two plans: a single plan and a family plan. New enrollees must continue in the TDP for at least 12 months. Anyone failing to pay premiums or who disenrolls for other than a valid disenrollment reason may not re-enroll in the program for 12 months.

Under the single plan, one eligible member is covered. This can be one active duty family member, a selected reserve or IRR member, or one selected reserve or IRR family member. A family enrollment consists of two or more covered family members, either active duty, selected reserve or IRR. Under the TDP, however, all eligible family members of a sponsor must be enrolled if any are enrolled, except for the following:

  • Sponsors may voluntarily enroll children under four years old. Upon their 4th birthday, they are automatically enrolled.
  • If a sponsor has family members living in geographically separated locations, he may enroll only those family members residing in one location (e.g., children living with a divorced spouse).
  • Selected reserve and IRR sponsors can enroll independently of their family members and family members can enroll independently of the sponsor.
  • Two soldiers cannot enroll the same family members. If both husband and wife are soldiers, they cannot enroll each other in the plan.

Dental Eligibility

Active duty family members, selected reserve, and IRR members and/or their family members are eligible for the TDP if the sponsor has at least 12 months remaining on his or her service commitment at the time of enrollment. Family members of active duty, selected reserve and IRR soldiers, including spouses and unmarried children (natural, step, adopted and wards) under the age of 21, are eligible.

Child eligibility may be available after age 21 if-

  • The dependent is a full time student at an accredited college or university and is more than 50% dependent on the sponsor for financial support.
  • The dependent has a disabling illness or injury that occurred before his or her 21st birthday, or between the ages of 21 and 23 while enrolled as a full time student, and was more than 50% dependent on the sponsor for financial support.

Upon mobilization, RC soldiers become eligible for the same health care benefits as active duty soldiers, including dental benefits. As a result, RC soldiers enrolled in the TDP who are activated for more than 30 days automatically are removed from the program and become eligible for dental care from military dental providers. Family members of mobilized reservists become eligible for the same lower premiums that active duty family members enjoy.

Remotely Stationed Active Duty Soldiers

The Tri-Service Remote Dental Program (RDP) is for military personnel serving on active duty in remote CONUS locations (50 miles or more from a military base). Soldiers enrolled in TRICARE Prime Remote (medical) are automatically eligible for the RDP. RDP eligible active duty soldiers can receive emergency dental care any time they are in an active duty status. RDP is not for family members.

Soldiers that leave the Army with transitional assistance health care benefits may receive dental coverage for emergency care only. Soldiers that have served 180 days of continuous active duty or more may be eligible for dental care as a veteran's benefit following separation from active duty. The laws governing veteran's benefits change frequently. See current information on the Department of Veterans Affairs website at www.va.gov or visit your local VA office.

Survivor Benefits

When an enrolled soldier dies while on active duty for a period of more than 30 days, the enrolled family members will continue to receive benefits for 3 years from the month following the month of the soldier's death. This applies only to family members enrolled at the time of death.

This benefit also applies to enrolled family members of selected reserve and IRR-special mobilization category (IRR-SMC) sponsors who die while in selected reserve and IRR-SMC status regardless if the sponsor was enrolled at the time of death. Family members must be enrolled at time of death to receive these benefits. In these cases the government pays the entire TDP premium. The family members will be notified of coverage termination prior to disenrollment.

For additional information regarding the Tricare Dental Program, visit your local TRICARE office or the website through the Army homepage.

Supplemental Insurance

If you receive medical care outside the military system, and you don't have any other health insurance (or a supplemental policy) to help pay your cost-shares or co-payments, you'll face out-of-pocket expenses. Even though TRICARE pays a generous share of the cost of civilian medical bills, your share of the cost might be substantial.

Many associations, organizations, and insurance companies provide supplemental insurance. Supplemental insurance may cover co-payments and costs TRICARE does not pay. The TRICARE website has a list of some of the associations and organizations that offer supplemental insurance. Neither TRICARE nor the Department of Defense endorses any specific company, organization, or plan. Likewise, neither DOD nor the TRICARE Management Activity promotes any specific policy for purchase, nor recommends retention or cancellation of any coverage you may have. The decision to purchase supplemental insurance is yours and yours alone.

Most TRICARE supplemental insurance policies are designed to reimburse patients for the civilian medical care bills they must pay after TRICARE pays the government's share of the cost. Before you buy any supplement, carefully consider which plan is best suited to your individual needs. Each TRICARE supplemental policy has its own rules concerning acceptance for pre-existing conditions, eligibility requirements for the family, deductibles, mental health limitations, long-term illness, well-baby care, care provided to persons with disabilities, claims under the diagnosisrelated group payment system for inpatient hospital charges, and rules concerning allowable charges. In some soldiers' situations, supplemental insurance may be appropriate while others may not need or want it. Look at your own circumstances and decide if the additional cost of supplemental insurance is something you think necessary. Either way, it is your decision.