Tricare Prime And Tricare Prime Remote Handbook (2014), Tricare Prime Remote Handbook

Question 1

True or False.
Enrollment in TRICARE Prime is continuous—
you do not have to reenroll every year to
maintain coverage.

Answer 1

True

Question 2

True or False.
When disenrolled for nonpayment, you are subject to a
12month lockout during which you will not be
permitted to reenroll in TRICARE Prime.

Answer 2

true

Question 3

True or False.
When you become entitled to premiumfree
Medicare Part A at age 65, you automatically
lose eligibility for TRICARE Prime and
become eligible for TRICARE For Life (TFL)
if you have Medicare Part B coverage

Answer 3

true

Question 4

True or False.
If you are not entitled to premiumfree
Medicare Part A when you become age 65, you
remain eligible for TRICARE Prime, Standard,
and Extra, and you are not required to have
Medicare Part B coverage.

Answer 4

true

Question 5

The wait time for an _____ appointment

should not exceed 24 hours (one day).

Answer 5

Urgent care

Question 6

The wait time for a ______ appointment should

not exceed one week (seven days).

Answer 6

Routine

Question 7

The wait time for a _______ appointment
or wellness visit should not exceed four weeks
(28 days).

Answer 7

Specialty care

Question 8

True or False.
Active duty service members require prior
authorization for all inpatient and outpatient
specialty services.

Answer 8

True

Question 9

When you or another family member become
entitled to premiumfree Medicare A—at age 65
or due to a disability or endstage renal
disease—TRICARE becomes the second payer
after Medicare, if you have Medicare Part B
coverage

Answer 9

Medicare-eligible beneficiaries under age 65
have the option to continue enrollment in
TRICARE Prime or use TRICARE For Life

Question 10

After three years, surviving spouses remain
eligible for TRICARE Prime, Standard, and
Extra at retired family member rates

Answer 10

In overseas locations, TRICARE
Overseas Program (TOP) Prime is available only to ADSMs and
their command-sponsored family members

Question 11

Where you live and military hospital or clinic
capacity levels determine whether you have a military hospital
or clinic or civilian PCM.

Answer 11

For ADSMs located in areas where TRICARE Prime is

available, enrollment in TRICARE Prime is mandatory.

Question 12

ADSMs and their families who do not live in PSAs

may enroll in a TRICARE Prime Remote option.

Answer 12

in all emergencies, your PCM must be
notified within 24 hours or on the next business day following
admission to coordinate ongoing care and to ensure you receive
proper authorization.

Question 13

Medal of Honor recipients and their family members can receive care at MTFs

Answer 13

TRICARE Dental Program or the TRICARE
Retiree Dental Program, depending on their status. Former
spouses and remarried surviving spouses do not qualify to
purchase coverage.

Question 14

In the Philippines, you must use TRICARE-certified

providers. To find a certified provider

Answer 14

There are no enrollment fees for ADSMs and their family
members. Retired service members and their eligible family
members, surviving spouses after the first three years, eligible
former spouses, and others pay TRICARE Prime enrollment
fees, which are applied to the annual catastrophic cap.

Question 15

FY 2016 annual enrollment fees are as follows:
• $282.60 per individual
• $565.20 per family

Answer 15

ADSMs do not pay any out-of-pocket costs for care. ADFMs
generally do not pay out-of-pocket for their care except when
using the POS option.

Question 16

Retired service members, their families, and all others pay

copayments for care from TRICARE network providers.

Answer 16

The POS option gives you the freedom, at an additional
cost, to receive nonemergency health care services from any TRICARE-authorized provider without requesting a referral from your PCM.

Question 17

The POS option does not apply to the following:

Answer 17

ADSMs
•
Newborns or newly adopted children in the first 60 days (120 days overseas) after birth or adoption
•
Emergency care
•
Clinical preventive care received from a network provider within your enrolled TRICARE region
•
Beneficiaries with OHI

Question 18

Beneficiaries under age 65 who become Medicare Part A-eligible may participate in USFHP.

Answer 18

You are encouraged to make initial contact with your new PCM within 30 days to establish yourself as a new patient.

Question 19

There are two types of non-network providers: participating and nonparticipating.

Answer 19

Using a participating provider is
your best option if you are seeing
a non-network provider.

Question 20

If you visit a nonparticipating
provider, you may have to pay
the provider first and later file
a claim with TRICARE for
reimbursement.

Answer 20

There are two types of TRICARE-authorized providers: network and non-network.

Question 21

Non-network providers do not have a signed agreement with your
regional contractor and are considered “out of network.”

Answer 21

Regional contractors have
established networks and you
may be assigned a primary care manager (PCM) who is part of the TRICARE network.

Question 22

All active duty service members (ADSMs) and other TRICARE Prime enrollees who are referred to a VA medical
facility for care must have prior authorization.

Answer 22

an 11-digit DoD Benefits

Number (DBN) is printed on the card.

Question 23

The ID card SSN removal is expected to last 7 years.

Answer 23

You may qualify
for travel reimbursement if referred to specialty
care that is more than 100 miles from your PCM’s
office.