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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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