TRICARE STANDARD HANDBOOK Flashcards
The key difference between TRICARE Standard and TRICARE Extra is in the what that you use for care?
Providers
With what program, you choose TRICARE - authorized providers outside of the TRICARE network and pay higher cost-shares?
TRICARE Standard
With what program, you choose hospitals and providers within the TRICARE network and receive discounted cost-shares?
TRICARE Extra
Prosthetic devices must be approved by the what?
U.S Food and Drug Administration
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?
60
What provides extended care for children and adolescents with psychological disorders that require continued treatment in a therapeutic environment?
Residential Treatment Center (RTC) Care
Residential Treatment Center (RTC) Care is limited to how many days per FY or for a single admission?
150
Residential Treatment Center (RTC) Care is only covered for patients up to what age?
21
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?
Acute
Rehabilitation (residential or partial) is limited to how many days per year, per benefit Period?
21
Individual or group therapy is limited to how many visits per benefit period?
60
Family therapy is limited to how many visits per benefit period?
15
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?
365
What is a Web-based program available to eligible beneficiaries, including TRICARE Standard and TRICARE Extra beneficiaries in the United States?
TRICARE Assistance Program (TRIAP)
What may involve live, two-way audio-visual visits between patients and medical professionals?
Telemental Health interaction
What is your least expensive option when not using an MTF pharmacy?
Mail Order Pharmacy
With the Mail Order Pharmacy, there is only one copayment for each prescription filled (up to a how many-day supply)?
90
What makes it easy to reduce your out-of-pocket costs by transferring your current maintenance medication prescriptions to the Mail Order Pharmacy?
Member Choice Center
You have access to network of approximately how many retail pharmacies in the United States and U.S. territories?
60,000
Currently, there are no TRICARE retail network pharmacies in where?
American Samoa
What are medications approved by the U.S. Food and Drug Administration (FDA) and clinically equivalent to brand-name medications?
Generic drugs
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?
“non-formulary”
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?
TRICARE Dental Program
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?
TRICARE Retiree Dental Program
TRICARE Standard and TRICARE Extra cover all necessary maternity care, from your first obstetric visit through how many weeks after your child is born?
Six
A physician is not obligated to perform what on a patient who is at low risk and has no medical indications?
Ultrasonography
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?
16-20
Hospice care emphasizes supportive services, rather than cure-oriented treatment, for patients with a life expectancy of what time frame or less?
Six months
Respite care is covered when necessary and is limited to no more than how many days at a time?
Five
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)?
Hospice care
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?
TRICARE Extended Care Health Option (ECHO)
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)?
Five
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?
Tutors
What are only covered when the life of the mother would be endangered if the pregnancy were carried to term?
Abortions
What is covered while the premature infant remains hospitalized during the immediate postpartum period?
Electric breast pump
What type of cardiac rehabilitation for lifetime maintenance performed at home or in medically unsupervised settings is excluded?
Phase III
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?
Cosmetic surgery
What are excluded for treatment of nonsynostotic positional Plagiocephaly?
Cranial orthotic devices
Education and training are only covered under what and diabetic outpatient self-management training services?
TRICARE Extended Care Health Option (ECHO)
What may be covered if they are a permanent part of a brace?
Orthopedic shoes
If you are using what option, your provider will submit claims on your behalf?
TRICARE Extra
If you are using what option, you may be required to submit your own health care claims?
TRICARE Standard
Claims must be filed within what time frame of either the date of service or the date of an inpatient discharge?
one year
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?
15
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?
TRICARE Management Activity
Nonparticipating providers may only bill you up to what percent of the TRICARE-allowable charge?
115
What allows TRICARE to be reimbursed for treatment costs if you are injured in an accident caused by someone else?
Federal Medical Care Recovery Act
The Statement of Personal Injury Third Party Liability (DD Form 2527) will be sent to you if a claim appears to have what involvement?
Third-party liability
Children with what may remain TRICARE- eligible beyond the normal GE LIMITS?
Disabilities
Upon loss of TRICARE eligibility, each family member will automatically receive a what?
Certificate of creditable coverage
