TRICARE STANDARD HANDBOOK

Question 1

The key difference between TRICARE Standard and TRICARE Extra is in the what that you use for care?

Answer 1

Providers

Question 2

With what program, you choose TRICARE - authorized providers outside of the TRICARE network and pay higher cost-shares?

Answer 2

TRICARE Standard

Question 3

With what program, you choose hospitals and providers within the TRICARE network and receive discounted cost-shares?

Answer 3

TRICARE Extra

Question 4

Prosthetic devices must be approved by the what?

Answer 4

U.S Food and Drug Administration

Question 5

Partial Hospitalization Program (PHP) care is limited to how many treatment days (whether full-or partial-day treatment) per FY or for a single admission?

Answer 5

60

Question 6

What provides extended care for children and adolescents with psychological disorders that require continued treatment in a therapeutic environment?

Answer 6

Residential Treatment Center (RTC) Care

Question 7

Residential Treatment Center (RTC) Care is limited to how many days per FY or for a single admission?

Answer 7

150

Question 8

Residential Treatment Center (RTC) Care is only covered for patients up to what age?

Answer 8

21

Question 9

TRICARE covers emergency and inpatient hospital services for the treatment of what phases of substance use withdrawal (detoxification) when the patient’s condition requires the personnel and facilities of a hospital?

Answer 9

Acute

Question 10

Rehabilitation (residential or partial) is limited to how many days per year, per benefit Period?

Answer 10

21

Question 11

Individual or group therapy is limited to how many visits per benefit period?

Answer 11

60

Question 12

Family therapy is limited to how many visits per benefit period?

Answer 12

15

Question 13

A benefit period begins with the first day of covered treatment and ends how many days later, Stay limits for inpatients services may be waived if determined to be medically necessary?

Answer 13

365

Question 14

What is a Web-based program available to eligible beneficiaries, including TRICARE Standard and TRICARE Extra beneficiaries in the United States?

Answer 14

TRICARE Assistance Program (TRIAP)

Question 15

What may involve live, two-way audio-visual visits between patients and medical professionals?

Answer 15

Telemental Health interaction

Question 16

What is your least expensive option when not using an MTF pharmacy?

Answer 16

Mail Order Pharmacy

Question 17

With the Mail Order Pharmacy, there is only one copayment for each prescription filled (up to a how many-day supply)?

Answer 17

90

Question 18

What makes it easy to reduce your out-of-pocket costs by transferring your current maintenance medication prescriptions to the Mail Order Pharmacy?

Answer 18

Member Choice Center

Question 19

You have access to network of approximately how many retail pharmacies in the United States and U.S. territories?

Answer 19

60,000

Question 20

Currently, there are no TRICARE retail network pharmacies in where?

Answer 20

American Samoa

Question 21

What are medications approved by the U.S. Food and Drug Administration (FDA) and clinically equivalent to brand-name medications?

Answer 21

Generic drugs

Question 22

The DoD Pharmacy and Therapeutics Committee may recommend to the Director of the TRICARE Management Activity that certain drugs be placed in the third, what tier?

Answer 22

“non-formulary”

Question 23

What is a voluntary dental insurance program administered by United Concordia, available to eligible Active Duty Family Member (ADFMs) and National Guard and Reserve and Individual Ready Reserve members and their eligible family members?

Answer 23

TRICARE Dental Program

Question 24

What is a voluntary dental insurance program administered by the Federal Services division of Delta Dental of California (Delta Dental). It offers comprehensive, cost-effective dental coverage for uniformed services retirees and their eligible family members?

Answer 24

TRICARE Retiree Dental Program

Question 25

TRICARE Standard and TRICARE Extra cover all necessary maternity care, from your first obstetric visit through how many weeks after your child is born?

Answer 25

Six

Question 26

A physician is not obligated to perform what on a patient who is at low risk and has no medical indications?

Answer 26

Ultrasonography

Question 27

Some providers offer patients routine ultrasound screening as part of the scope of care after how many weeks of gestation. This is not covered by TRICARE?

Answer 27

16-20

Question 28

Hospice care emphasizes supportive services, rather than cure-oriented treatment, for patients with a life expectancy of what time frame or less?

Answer 28

Six months

Question 29

Respite care is covered when necessary and is limited to no more than how many days at a time?

Answer 29

Five

Question 30

What is not available overseas except in U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands)?

Answer 30

Hospice care

Question 31

What provides financial assistance to qualifying Active Duty Family Member (ADFMs) based on specific mental or physical disabilities, and it offers beneficiaries an integrated set of services and supplies beyond those offered by the basic TRICARE programs?

Answer 31

TRICARE Extended Care Health Option (ECHO)

Question 32

TRICARE ECHO Home Health Care (EHHC) respite care is covered up to eight hours per day, how many days per week (for those who qualify)?

Answer 32

Five

Question 33

The DoD Enhanced Access to Autism Services Demonstration was established to test the feasibility and advisability of permitting TRICARE reimbursement for educational interventions for autism spectrum disorders delivered by paraprofessional providers known as what?

Answer 33

Tutors

Question 34

What are only covered when the life of the mother would be endangered if the pregnancy were carried to term?

Answer 34

Abortions

Question 35

What is covered while the premature infant remains hospitalized during the immediate postpartum period?

Answer 35

Electric breast pump

Question 36

What type of cardiac rehabilitation for lifetime maintenance performed at home or in medically unsupervised settings is excluded?

Answer 36

Phase III

Question 37

What is only covered when used to restore function, correct a serious birth defect, restore body form after a serious injury, improve appearance of a severe disfigurement after cancer surgery, or reconstruct the breast after cancer surgery?

Answer 37

Cosmetic surgery

Question 38

What are excluded for treatment of nonsynostotic positional Plagiocephaly?

Answer 38

Cranial orthotic devices

Question 39

Education and training are only covered under what and diabetic outpatient self-management training services?

Answer 39

TRICARE Extended Care Health Option (ECHO)

Question 40

What may be covered if they are a permanent part of a brace?

Answer 40

Orthopedic shoes

Question 41

If you are using what option, your provider will submit claims on your behalf?

Answer 41

TRICARE Extra

Question 42

If you are using what option, you may be required to submit your own health care claims?

Answer 42

TRICARE Standard

Question 43

Claims must be filed within what time frame of either the date of service or the date of an inpatient discharge?

Answer 43

one year

Question 44

Remember that nonparticipating providers may charge you up to what percent above the TRICARE allowable charge for services, in addition to your cost-share and/or deductible?

Answer 44

15

Question 45

TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs and plans as identified by the what?

Answer 45

TRICARE Management Activity

Question 46

Nonparticipating providers may only bill you up to what percent of the TRICARE-allowable charge?

Answer 46

115

Question 47

What allows TRICARE to be reimbursed for treatment costs if you are injured in an accident caused by someone else?

Answer 47

Federal Medical Care Recovery Act

Question 48

The Statement of Personal Injury Third Party Liability (DD Form 2527) will be sent to you if a claim appears to have what involvement?

Answer 48

Third-party liability

Question 49

Children with what may remain TRICARE- eligible beyond the normal GE LIMITS?

Answer 49

Disabilities

Question 50

Upon loss of TRICARE eligibility, each family member will automatically receive a what?

Answer 50

Certificate of creditable coverage