TRICARE Choices in the United States at a Glance 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%
