4. TRICARE CHOICES; TRICARE DENTAL; NAVMEDCOMINST 5360.1; NAVMED P-5132; NMCPHC-TIM 6250.1 Flashcards
What is the Department of Defense’s worldwide health care program available to eligible beneficiaries from any of the seven uniformed services?
TRICARE
Which system is used to maintain Tricare eligibility information?
Defense Enrollment Eligibility Reporting System (DEERS)
How many consecutive days at a minimum must National Guard and Reserve members be called or ordered to active service to be eligible to participate in the Active Duty TRICARE program?
30
Sponsors and family members lose TRICARE eligibility after active duty separation (non-retirement) but can qualify for a period of continued coverage under the Transitional Assistance Management Program along with which other program?
Continued Health Care Benefit Program
Who provides referrals under TRICARE Prime to receive services from specialty care providers and coordinates the referral request with the regional contractor when necessary?
Primary Care Management (PCM)
How many miles must personnel be within an available primary care management (PCM) to enroll in TRICARE Prime?
100
Which TRICARE Prime options are available to Active Duty Service Members (ADSMs) living and working in remote locations and their family members?
Tricare Prime Remote (TPR) and TRICARE Prime Remote for Active Duty Family Members (TPRADFM)
The US Family Health Plan (USFHP) is a TRICARE Prime option in which care is provided through networks of community-based, not-for-profit health care systems in how many areas of the United States?
6
What is the maximum out-of-pocket amount an individual or family pays per FY for TRICARE- covered services?
Catastrophic cap
Up to what age are retirees allowed to enroll in TRICARE Prime or USFHP?
65
What is the fixed amount a TRICARE Prime beneficiary pays for health care services?
Copayment
What is the form number for the TRICARE Prime Enrollment, Disenrollment, and Primary Care Management (PCM) Change Form?
DD Form 2876
Which options allows TRICARE Prime beneficiaries to pay additional out-of-pocket costs to receive nomemergency health care services from any TRICARE - authorized provider without a referral?
Point-of-Service (POS)
The Point-of-Service (POS) option does not apply to newborns or adopted children within the first how many days after birth or adoption?
60
The Point-of-Service (POS) option does not apply to the first how many mental health care outpatient visits per fiscal year to a network provider for a medically diagnosed and covered condition?
8
How many types of TRICARE authorized providers are there?
2
Which type of TRICARE authorized providers have a signed agreement with your regional contractor to provide care and file claims for you?
Network providers
Up to what percent above the TRICARE- allowable charge can non-network providers charge when they don’t participate on a claim?
15%
Which act requires you to have health care coverage that meets a minimum standard called minimum essential coverage?
Affordable Care Act (ACA)
What is the annual amount that a beneficiary must pay for covered outpatient services before TRICARE begins to pay for or reimburse for those services?
Annual Deductible
What is a premium-based, worldwide health care plan that qualified Selected Reserve members and qualified survivors may purchase for themselves and/or their family members?
TRICARE Reserve Select (TRS)
What is the percentage a TRICARE beneficiary must pay for covered inpatient and outpatient services (other than the annual deductible or disallowed amounts)?
Cost-Share
What is a premium-based, worldwide health care plan that qualified Retired Reserve members and qualified survivors may purchase for themselves and/or their family members?
TRICARE Retired Reserve (TRR)
If you are eligible for both TFL and VA benefits and elect to use your TFL benefit for non-service connected care, you will incur significant out-of-pocket expenses when seeing a VA provider. By law, TRICARE can only pay up to what percent of the TRICARE allowable amount?
20%
What can beneficiaries who have lost all TRICARE eligibility purchase to keep coverage if they qualify/
Continued Health Care Benefits Program (CHCBP)
What is the minimum age to be eligible to purchase Tricare Young Adult Coverage?
21
How many days of transitional health care benefits to help certain service members and their families transitions to civilian life is provided by Transitional Assistance Management Program (TAMP)?
180
Up to how many months of continued health coverage can be provided by the Continued Health Care Benefits Program (CHCBP)
36
If personnel qualify they can purchase CHCBP coverage within how many days of loss of TRICARE or TAMP coverage?
60
How many days worth of most medications at no cost can personnel receive from military pharmacies?
90
Over how many TRICARE retail network pharmacies are there?
57,000
The DoD has established a how many tier uniform formulary that groups prescription drugs that may be reimbursed by TRICARE?
Three
Which tier of prescription drugs have the highest out of pocket costs?
Tier 3
What is the TRICARE Dental Program(TDP) administered by?
MetLife
How many geographical service areas is the TRICARE Dental Program (TDP) divided into?
2
Which system is used to confirm TRICARE Dental Program (TDP) eligibility?
Defense Enrollment Eligibility Reporting System (DEERS)
Family members of active duty service members (ADSMs) including unmarried children until reaching which age are eligible to enroll in TRICARE Dental Program (TDP) ?
21
Family members of active duty service members (ADSMs) including unmarried children until reaching which age are eligible to enroll in TRICARE Dental Program (TDP) if enrolled in a full-time course of study at an approved institution of higher learning, and if the sponsor provides over 50 percent of the financial support?
23
A family enrollment is defined as how many or more covered family members?
2
Children under which age may be voluntarily enrolled at any time into the TRICARE Dental Program (TDP)?
4
All beneficiaries must remain enrolled in the TRICARE Dental Program (TDP) for at least how many months?
12
If an Active Duty Service Member (ADSM) transfers with TRICARE Dental Program (TDP) - enrolled family members to a duty station where space-available dental care is available at the local Dental Treatment Facility (DTF), the ADSM may choose to terminate enrollment for his or her family members from the TDP within how many calendar days of the transfer?
90
If you fail to pay your TRICARE Dental Program (TDP) monthly premium(s), your TDP enrollment will be terminated. You will be prohibited from reenrolling in the program, or “locked out”, for how many months following the last month that premiums were paid?
12
When a sponsor dies, the surviving spouse and children are eligible for the TRICARE Dental Program (TDP) Survivor Benefit. Spouses are eligible for how many years beginning on the date of the sponsor’s death?
3
How often does the Department of Defense require all National Guard and Reserve members to undergo dental examinations?
Annually
Which form will be used to assist TRICARE Dental Program (TDP) -enrolled National Guard and Reserve members in documenting dental health?
DD FORM 2813
National Guard and Reserve sponsors are eligible to enroll in the TRICARE Dental Program (TDP) when they are not on active duty for more than how many consecutive days?
30
Which type of dentist has signed a contractual agreement with MetLife to follow TRICARE Dental Program (TDP) rules for providing care and accepting payments?
Preffered Dentist Program (PDP)
When using a Preferred Dentist Program (PDP) dentist, you should never pay more than the applicable cost-share for covered services subject to applicable maximums, limitations, and exclusions. MetLife recommends that you have your dentist submit a predetermination request when the cost is expected to be above which amount?
$300
You will be able to seek care from a non-PDP dentist and MetLife will pay the claim for that particular procedure in a manner that limits your out-of-pocket costs to approximately what they would be from a Preferred Dentist Program (PDP) dentist if MetLife is unable to schedule an appointment within how many days?
21
What is the annual maximum benefit per beneficiary, per plan year for non-orthodontic services?
$1,300
What is the Orthodontic Lifetime Maximum (OLM) benefit per beneficiary for orthodontic treatment?
$1,750
Claims submitted for payment more than how many months after the month in which a service is provided are not eligible for payment?
12
How many oral evaluations (D0120, D0150, or D0180) are covered in a consecutive 12-month period?
3
Comprehensive evaluations (D0150) are only eligible for new patients, on an exception basis, by report, for patients who have had a significant change in health conditions or other unusual circumstances, and for patients who have not had an oral evaluation within the previous how many months from the same office?
36
How many comprehensive periodontal evaluations (DO180s) will be allowed per patient per consecutive 12-month period per office?
1
Panoramic and full mouth X-rays are not routinely covered for patients under which age unless approved by MetLife ?
5
How many routine prophylaxes are covered in a consecutive 12- month period?
2
How many months from the date of finalization are TRICARE Dental Program (TDP) predeterminations valid for?
12
If a patient or participating dentist disagrees with MetLife’s benefit decision may be eligible for an appeal. How many levels of appeal are there?
3
Patients may request a formal review from TRICARE Management Activity (TMA) if they disagree with MetLife’s reconsideration and if the amount remaining in dispute is which amount or more?
$50
A request for a formal review must be postmarked or received by the TRICARE Management Activity (TMA) within how many days from the date of the reconsideration determination?
60
If a patient disagrees with the formal review decision from TRICARE Management Activity (TMA) and the amount in dispute is at least which amount or more, he or she may request a hearing with TMA?
$300
What is an alloy that is typically composed of mercury,silver,tin, and copper along with other metallic elements added to improve physical and mechanical properties used in direct dental restorations?
Amalgam
What is the professional association of dentist committed to the public’s oral health, ethics, science, and professional advancement; leading a unified profession through initiatives in advocacy, education, research, and the development of standards?
American Dental Association (ADA)
Which system serves as a centralized Department of Defense data repository of personnel and health care benefits distributed to uniformed services members?
Defense Enrollment Eligibility Reporting System (DEERS)
Endodontic Exclusions involve the treatment of diseases of the dental pulp (never tissue) or injuries that affect the root tip or nerve of the tooth (apex). What is the most common procedure that you will deal with?
Root canal
What is the relationship between the teeth in the upper and lower arches at rest position?
Occlusion
What is the ideal interval between prophylaxis treatment (prophys)?
Semi-annually
What is MetLife’s fraud and abuse investigation department for reporting suspected fraud if a beneficiary believes a dentist or entity received insurance money through the submission of a false claim?
Special Investigations Unit (SIU)
Which program provides dental care for uniformed services members who are entitled to retirement pay, members of the Retired Reserve under age 60, Congressional Medal of Honor recipients, un-remarried surviving spouses, and certain other eligible family members?
TRICARE Retiree Dental Program (TRDP)
Which program provides for the search, recovery, identification, care, and disposition of remains of deceased persons for whom the Department of the Navy is responsible?
Decedent Affairs Program (DAP)
Under which program are the remains of the deceased shipped to a place designated by the primary next of kin for permanent disposition and ships the decedent’s personal effects to the legal recipient?
Current Death Program
Which program provides for the search, recovery, evacuation, initial identification, disposition of personal effects found with each deceased, and burial of eligible deceased persons in temporary cemeteries?
Graves Registration Program (GR)
Which publication contains operational details incident to graves registrations procedures?
FMFM 4-8 (NOTAL)
Which program is a combination of the Current Death Program and the Graves Registration Program?
Concurrent Return Program
Which program provides for permanent disposition of remains of those persons buried in temporary cemeteries who could not be evacuated under the Concurrent Return Program?
Return of Remains Program
Who in the Navy is responsible for advising field activities of the activation of a Return of Remains Program?
Commander, Naval Medical Command (COMNAVMEDCOM)
Who is responsible for helping the Primary Next of Kin (PNOK) with problems surrounding the death and providing information on disposition of remains?
Casualty Assistance Calls Officer (CACO)
Who administers the Navy Casualty Assistance Calls Program (CACP)?
Commander, Naval Military Personnel Command (COMNAVMILPERSCOM)
Who administers the Marine Corps Casualty Assistance Calls Program (CACP)?
Commandant of the Marine Corps (CMC)
What is the age of majority?
18