drugs through home delivery or at military pharmacies. Maintenance drugs are those that you take regularly for a chronic condition (i.e., drugs to control blood pressure or cholesterol). The table on the previous page outlines your cost under each of the pharmacy programs. Medicare Prescription Drug Program . Medicare offers a drug insurance program that is designed to reduce the out–of– pocket costs associated with prescription drug treatments (see Chapter 12). Since TRICARE beneficiaries already have a comprehensive pharmacy benefit, there is generally no added value in purchasing a Medicare drug prescription plan. 3–7. DEERS. DEERS is an acronym for the Defense Enrollment Eligibility Reporting System. The system is a computerized data bank maintained by the DoD. Its purpose is to serve as the official record of eligibility for individuals receiving uniformed service benefits. Active and retired members are listed automatically, but sponsors must initially report their dependents and any subsequent changes to dependent status (for example: newborn children, divorce or remarriage by a sponsor, marriage of a dependent, etc.). This is particularly important because if an ineligible family member improperly receives medical care, the government is required by law to seek reimbursement for the care provided. Registration in DEERS is absolutely critical to maintaining your official record of eligibility for health care treatment under TRICARE. If you are not registered under DEERS, contact your nearest military installation or the DEERS telephone center at 1–800–538–9552. You may also update your information online at milconnect.dmdc.osd.mil. The following categories of individuals qualify as dependents for health care purposes: a. Spouses and unmarried children under the age of 21; b . Spouses and unmarried children under the age of 21 of reservists who are ordered to active duty for more than 30 consecutive days (coverage is only available during the reservist’s active duty tour); c. Unmarried children over 21 who have a severe mental or physical handicap and rely on their parents for at least one–half of their support; d. Unmarried children under the age of 23 who are full time students at an accredited college and rely on their parents for over one–half of their support;
e. Widows and widowers of active and retired members who have not remarried; f. Spouses, widows, and eligible family members of Medal of Honor recipients; and, g. Former spouses of active or retired members, provided they were married for at least 20 years during a sponsor’s period of credible service, have not remarried, and are not covered by an existing employer sponsored health plan. 3–8. TREATMENT PRIORITIES AT MILITARY FACILITIES. Current DoD policy has established the following priorities for health care service at Military Treatment Facilities (MTF): 1. Active duty service members. 2. Active duty family members who are enrolled in TRICARE Prime (for the purpose of determining access priority, survivors of military sponsors who died on active duty and are enrolled in TRICARE Prime are included in this priority group). 3. Retirees, their family members, and survivors who are enrolled in TRICARE Prime. 4. Family members of active duty service members who are not enrolled in TRICARE Prime (for the purpose of determining access priority, survivors of military sponsors who died on active duty who are not enrolled in TRICARE Prime are in this priority group). 5. Retirees, their family members, and survivors who are not enrolled in TRICARE Prime. 6. All other eligible persons (including retirees and family members not enrolled in TRICARE Prime). 3–9. DENTAL CARE. Complete dental care is provided to all active duty members under the Active Duty Dental Program. However, dental care is generally not authorized for either retirees or the dependents of active duty or retired members at military facilities within the United States. Routine treatment may be available at overseas locations and emergency dental care is authorized worldwide. Dental care may also be authorized in certain situations when it is considered to be a necessary part of a medical or surgical treatment program.
CHAPTER 3: TRICARE
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