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OCR for page 357
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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