Chapter 3. TRICARE Overview of TRICARE................................................................................................................ 3–1 Active Duty Members and Dependents . ....................................................................................3–2 Retirees and Dependents. .........................................................................................................3–3 TRICARE For Life (TFL). ............................................................................................................3–4 TRICARE Young Adult . .............................................................................................................3–5 Pharmacy Benefits ....................................................................................................................3–6 DEERS ...................................................................................................................................... 3–7 Treatment Priorities at Military Facilities...................................................................................3–8 Dental Care...............................................................................................................................3–9 TRICARE Regions and Contacts. .............................................................................................3–10 TRICARE Cost Table................................................................................................................ 3–11 Medicare/TFL Cost Share Table. .............................................................................................3–12
Prime is a Health Maintenance Organization (HMO) option that is similar to many programs offered by civilian employers across the U.S. In addition to treating you when you are ill, this option focuses on keeping you healthy through preventive care and services such as periodic physical exams, mammograms, and prostate screenings. In order to participate, you must enroll in the TRICARE Prime option. Enrollment is for one year and, depending upon eligibility status, you may be required to pay an annual enrollment fee. While the Prime option does not have an annual deductible, it may require the payment of cost sharing fees for prescription drugs, civilian doctor visits, and other services. You will either choose or be assigned a Primary Care Manager (PCM) who will provide most of the required care. If speciality care is needed, the PCM will refer you to a Health Care Finder (HCF) who will make the necessary
3–1. OVERVIEW OF TRICARE. TRICARE is a regionally based health care program that employs Managed Care Support Contractors (MCSC) to coordinate medical services at both military and civilian treatment facilities. The program offers two main options for health care support: TRICARE Prime and TRICARE Select. Cost comparisons can be found in the table at the end of this chapter. TRICARE Prime. If you are an active duty service member or an activated Guard or Reserve member, you must enroll in TRICARE Prime. Prime is also available to Active Duty Family Members (ADFM), retirees and their families, non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program, and retired Guard/Reserve members receiving retired pay and their families.
CHAPTER 3: TRICARE
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