Tricare Prime And Tricare Prime Remote Handbook (2014), Tricare Prime Remote Handbook Flashcards
True or False.
Enrollment in TRICARE Prime is continuous—
you do not have to reenroll every year to
maintain coverage.
True
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.
true
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
true
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.
true
The wait time for an _____ appointment
should not exceed 24 hours (one day).
Urgent care
The wait time for a ______ appointment should
not exceed one week (seven days).
Routine
The wait time for a _______ appointment
or wellness visit should not exceed four weeks
(28 days).
Specialty care
True or False.
Active duty service members require prior
authorization for all inpatient and outpatient
specialty services.
True
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
Medicare-eligible beneficiaries under age 65
have the option to continue enrollment in
TRICARE Prime or use TRICARE For Life
After three years, surviving spouses remain
eligible for TRICARE Prime, Standard, and
Extra at retired family member rates
In overseas locations, TRICARE
Overseas Program (TOP) Prime is available only to ADSMs and
their command-sponsored family members
Where you live and military hospital or clinic
capacity levels determine whether you have a military hospital
or clinic or civilian PCM.
For ADSMs located in areas where TRICARE Prime is
available, enrollment in TRICARE Prime is mandatory.
ADSMs and their families who do not live in PSAs
may enroll in a TRICARE Prime Remote option.
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.
Medal of Honor recipients and their family members can receive care at MTFs
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.
In the Philippines, you must use TRICARE-certified
providers. To find a certified provider
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.
FY 2016 annual enrollment fees are as follows:
• $282.60 per individual
• $565.20 per family
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.
Retired service members, their families, and all others pay
copayments for care from TRICARE network providers.
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.
The POS option does not apply to the following:
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
Beneficiaries under age 65 who become Medicare Part A-eligible may participate in USFHP.
You are encouraged to make initial contact with your new PCM within 30 days to establish yourself as a new patient.
There are two types of non-network providers: participating and nonparticipating.
Using a participating provider is
your best option if you are seeing
a non-network provider.
If you visit a nonparticipating provider, you may have to pay the provider first and later file a claim with TRICARE for reimbursement.
There are two types of TRICARE-authorized providers: network and non-network.
Non-network providers do not have a signed agreement with your
regional contractor and are considered “out of network.”
Regional contractors have
established networks and you
may be assigned a primary care manager (PCM) who is part of the TRICARE network.
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.
an 11-digit DoD Benefits
Number (DBN) is printed on the card.
The ID card SSN removal is expected to last 7 years.
You may qualify
for travel reimbursement if referred to specialty
care that is more than 100 miles from your PCM’s
office.
