Appendix E

Features of TRICARE and Related Purchased Care Plans

TRICARE Prime

  • Health maintenance organization
  • Active duty service members automatically enrolled
  • Some other beneficiary groups can choose to enroll
  • Some groups have annual enrollment costs
  • Based on a managed care model with an assigned primary care manager and referrals for specialty care
  • Limited co-payments for some beneficiary groups

TRICARE Standard

  • Fee-for-service for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary has most options for provider selection
  • Provider can charge usual fees
  • Benefit is a percentage of billed charges after an annual deductible
  • No referrals, some preauthorization
  • Does not require use of network

TRICARE Prime Remote

  • Similar to TRICARE Prime
  • For beneficiaries 50 miles or an hour’s drive from a military treatment facility
  • Primary care manager selected from TRICARE civilian provider network
  • Referrals for specialty care
  • Limited to active duty service members and their dependents

TRICARE Extra

  • Preferred provider organization
  • Fee-for-service plan for non–active duty beneficiaries
  • Does not require pre-enrollment
  • No annual enrollment costs
  • Beneficiary chooses authorized TRICARE provider
  • Benefit is a percentage of allowable charges after an annual deductible
  • No referrals, some preauthorization


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Appendix E Features of TRICARE and Related Purchased Care Plans TRICARE Prime TRICARE Standard •  Health maintenance organization •  Fee-for-service for non–active duty •  Active duty service members beneficiaries automatically enrolled •  Does not require pre-enrollment •  Some other beneficiary groups can •  annual enrollment costs No choose to enroll •  Beneficiary has most options for provider •  Some groups have annual enrollment selection costs •  Provider can charge usual fees •  Based on a managed care model with •  Benefit is a percentage of billed charges an assigned primary care manager and after an annual deductible referrals for specialty care •  referrals, some preauthorization No •  Limited co-payments for some beneficiary •  Does not require use of network groups TRICARE Prime Remote TRICARE Extra •  Similar to TRICARE Prime •  Preferred provider organization •  For beneficiaries 50 miles or an hour’s •  Fee-for-service plan for non–active duty drive from a military treatment facility beneficiaries •  Primary care manager selected from •  Does not require pre-enrollment TRICARE civilian provider network •  annual enrollment costs No •  Referrals for specialty care •  Beneficiary chooses authorized TRICARE •  Limited to active duty service members provider and their dependents •  Benefit is a percentage of allowable charges after an annual deductible •  referrals, some preauthorization No 357

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358 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES TRICARE Prime Overseas TRICARE for Life •  Similar to TRICARE Prime when near an •  Medicare “wraparound” overseas military treatment facility •  Authorized in 2001 for Medicare •  Requires enrollment beneficiaries who also were eligible for •  Limited to active duty service members TRICARE benefits (generally retirees and and their Command-sponsored their dependents) dependents who are living together in •  Requires Medicare Parts A and B a nonremote overseas location (near a •  Generally no out-of-pocket expenses military treatment facility) •  Primary care managers are assigned and make referrals for specialty care TRICARE Prime Remote Overseas TRICARE Plus •  Provides TRICARE-like benefits for •  New program that allows TRICARE active duty service members and their Extra and TRICARE for Life dependents living in remote overseas beneficiaries to enroll at a military locations (distant from a military treatment facility and receive their treatment facility) primary care there •  Requires enrollment to participate •  enrollment fees No •  Divided into Eurasia-Africa, Latin •  Not all military treatment facilities America, and Pacific regions participate •  Requires primary care managers who also makes referrals •  Coordinated by International SOS, a civilian corporation that coordinates overseas health care for DoD U.S. Family Health Plan for TRICARE Young Adult Non–Active Duty Beneficiaries •  Program for eligible dependents aged •  TRICARE Prime managed care option 21 (or 23 if enrolled in college full time) that evolved from the old Marine to 26 originating in the 2010 Patient Hospital System/Public Health Service Protection and Affordable Care Act Hospitals in the early 1980s •  Managed by six health care organizations •  Available to beneficiaries in selected areas of the northeast United States, Washington State, southeast Texas, and southwest Louisiana TRICARE Reserve Select Civilian Health and Medical Program of the Uniformed Services •  Premium-based health plan available to Selected Reserve members of the Ready •  Predecessor of TRICARE; began in 1966 Reserve (and their dependents) who are •  DoD secretary was authorized to not eligible for or enrolled in the Federal contract with civilian providers to Employee Health Benefits program provide health care, primarily to non– •  Requires cost sharing active duty beneficiaries •  referrals, some preauthorization No

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APPENDIX E 359 TRICARE Reserve Retired Federal Employee Health Benefits Program •  For certain retired Reserve members •  Overall health insurance program under age 60 available to federal civilian employees •  Premium-based worldwide health plan •  Includes various options with a number that may be purchased by qualified of insurance carriers Reserve members and survivors •  Premium-based •  Covers member and dependents •  Provides choice of providers although out-of-pocket costs vary •  referrals, some preauthorization No

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