TRICARE prime Flashcards
What regional contractor does TRICARE north use?
Health net federal services, LLC
What are the three TRICARE regions
North
South
West
What regional contractor does TRICARE south use?
Humana military
What regional contractor does TRICARE west use?
UnitedHealthcare
For ADSM enrollment in what form of TRICARE is mandatory?
TRICARE prime
What is the form used for TRICARE prime enrollment application and PCM change?
DD Form 2876
In order to qualify for TRICARE prime remote your DEERS and work zip code must be how many mile and how long of a drive from the closest mtf?
50 miles
Approximately 1 hour drive
What is the enrollment fee for ADSM and ADFMs?
None
What happens to the enrollment fees for surviving beneficiaries and medically retired members?
Frozen at the rate in effect at the time they become survivors or medically retired
The 12 month lock out from lack of payment does not apply to what pay grades?
E-1 to E-4
If the sponsor is deployed and family member moves they must change from TPRADFM to the appropriate TRICARE for the new location
Note
What is the definition of urgent care?
Medically necessary services for an illness or injury that would not result in further disability or death if not immediately treated, but does require professional attention with in 24 hours
(Sprain, soar throat, rising temp)
Can a specialist refer you to another specialist?
No they must contact your PCM
How many visits can non ADSM have for outpatient behavioral health care services per fiscal year?
8
What are telemental health program?
Uses secure audio-facial conferencing to connect eligible beneficiaries with off site TRICARE network providers
TRICARE covers how many substance use rehabs per lifetime? Per benefit period?
3 life
1 per period
All treatment for substance use disorders requires prior authorization from the regional contractor
Note
TRICARE offers hospice care for personnel with a life expectancy of how long or less?
6 months
What are the four levels of hospice benefit care?
Routine home care
Continuous home care
Inpatient respite care
General hospice care
Hospice care is only available in conus
Note
TRICARE covers all necessary maternity care from your first OB visit till when?
6 weeks after the birth
What type of fetal ultra sounds are not covered by TRICARE?
Not medically necessary
To determine the sex
Is artificial insemination covered by TRICARE?
No
TRICARE DOES NOT COVER ROUTINE ULTRASOUND SCREENINGS, maternal, even if a provider orders them as part of their plan
Important note
If a family member needs to be in the EFMP what type of TRICARE will they need?
ECHO
At an mtf pharmacy you may receive up to how many day supply of most medications at no cost?
90
What is the least expensive option to get medications when not using a MTF pharmacy?
TRICARE pharmacy home delivery
For non ADSM s using the pharmacy home delivery what medications are free at what quantity and which are not free?
90 day supply of generic meds
Brand name and non formulary require a copayment
If upswing express scripts for home delivery of medication you will receive medications within how many days ?
14
Through TRICARE retail network pharmacy you may fill prescription with one copayment for how many days of medication?
30 days
What is the procedure for filling medications at non network pharmacies?
You pay full cost up front
File a claim
Receive partial reimbursement
What is the TRICARE patients request for medical payment?
DD Form 2642
