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NAVY ADVANCEMENT SEP 2019 > TRICARE STATESIDE GUIDE > Flashcards

TRICARE STATESIDE GUIDE Flashcards

1
Q

WHAT DETERMINES ELIGIBILITY FOR TRICARE AND WHERE IS IT SHOWN?

A

ELIGIBILITY FOR TRICARE IS DETERMINED BY THE SERVICES AND SHOWN IN THE DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS).

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2
Q

ACCORDING TO TRICARE STATESIDE GUIDE, WHAT IS DEERS?

A

DEERS IS A DATABASE OF SERVICE MEMBERS AND DEPENDENTS WORLDWIDE WHO ARE ELIGIBLE FOR MILITARY BENEFITS.

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3
Q

IN ORDER TO USE TRICARE, YOU MUST FIRST DO WHAT?

A

TO USE TRICARE, FIRST MAKE SURE YOUR DEERS RECORD ISUP TO DATE AT WWW.DMDC.OSD.MIL/MILCONNECT.

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4
Q

WHAT DOES THE TRICARE STATESIDE GUIDE DESCRIBE?

A

THIS HANDBOOK DESCRIBES THE HEALTH CARE, DENTAL, AND PHARMACY OPTIONS TRICARE OFFERS. THESE OPTIONS DIFFER IN TERMS OF THE PROVIDERS YOU SEE, HOW YOU GET CARE, COSTS, AND WHETHER YOU FILE CLAIMS.

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5
Q

WHAT SERVICES ARE GENERALLY COVERED BY ANY TRICARE OPTION? WHAT ABOUT COPAYMENTS?

A

GENERALLY, YOU HAVE TH ESAME COVERED SERVICES, INCLUDING PREVENTIVE, METNAL HEALTH, MATERNITY, AND PHARMACY SERVICES WITH ANY TRICARE PROGRAM OPTION. COPAYMENTS AND/OR COST-SHARES MAY APPLY FOR CERTAIN COVERED SERVICES DEPENDING ON YOUR PROGRAM OPTION AND BENEFICIARY STATUS.

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6
Q

CONCERNING TRICARE, WHERE IS A FULL LIST OF COVERED SERVICES?

A

FOR A FULL LIST OF COVERED SERVICES, GO TO WWW.TRICARE.MIL/COVEREDSERVICES. FOR COSTS, GO TO WWW.TRICARE.MIL/COSTS

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7
Q

HOW DOES TRICARE COMPARE WITH THE MINIMUM ESSENTIAL COVERAGE REQUIREMENT UNDER THE AFFORDABLE CARE ACT?

A

TRICARE MEETS THE MINIMUM ESSENTIAL COVERAGE REQUIREMENT UNDER THE AFFORDABLE CARE ACT.

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8
Q

CONCERNING TRICARE, WHAT HAPPENS BEGINNING JAN. 1, 2019?

A

DUE TO TAX LAW CHANGES, BEGINNING JAN. 1, 2019, MINIMUM ESSENTIAL COVERAGE IS NO LONGER REQUIRED. AN INTERNAL REVENUE SERVICE FORM 1095 FROM YOUR PAY CENTER EACH JANUARY LISTING THE COVERAGE YOU HAD DURING THE PREVIOUS TAX YEAR.

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9
Q

ACCORDING TO THE TRICARE GUIDE, WHAT DOES TEH AFFORDABLE CARE ACT REQUIRE?

A

THE AFFORDABLE CARE ACT REQUIRES THAT INDIVIDUALS MAINTAIN HEALTH INSURANCE OR OTHER HEALTH COVERAGE IN 2018 THAT MEETS THE DEFINITION OF MINIMUM ESSENTIAL COVERAGE. MOST TRICARE PLANS MEET THIS REQUIREMENT. YOU CAN FIND OTHER HEALTH CARE COVERAGE OPTIONS AT WWW.HEALTHCARE.GOV.

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10
Q

WHAT ARE THE TRICARE OPTIONS FOR NATIONAL GUARD AND RESERVE?

A

NATIONAL GUARD AND RESERVE. QUALIFIED NON-ACTIVE DUTY MEMBERS OF THE SELECTED RESERVE ADN RETIRED RESERVE. SPONSOR AND FAMILY MEMBER OPTIONS:
-TRICARE RESERVE SELECT
-TRICARE RETIRED RESERVE
-TRICARE YOUNG ADULT
(SEE THE TRICARE CHOICES FOR NATIONAL GUARD AND RESERVE HANDOOK FOR MORE INFORMATION AT WWW.TRICARE.MIL/PUBLICATIONS).

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11
Q

WHAT ARE THE THREE SPONSOR STATUSES LISTED IN THE TRICARE STATESIDE GUIDE?

A
  • ACTIVE DUTY - INCLUDES NATIONAL GUARD AND RESERVE MEMBERS CALLED OR ORDERED TO ACTIVE DUTY FOR MORE THAN 30 DAYS FOR A PREPLANNED MISSION OR IN SUPPRT OF A CONTINGENCY OPERATION.
  • SEPARATED FROM SERVICE - NON-RETIREMENT
  • RETIRED
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12
Q

WHERE IS UP-TO-DATE COST INFORMATION FOUND?

A

FOR UP-TO-DATE COST INFORMATION FOR ALL TRICARE PROGRAM OPTIONS, SEE THE COSTS AND FEES SHEET AT WWW.TRICARE.MIL/PUBLICATIONS OR GO TO WWW.TRICARE.MIL/COSTS.

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13
Q

WHAT ARE THE TRICARE SPONSOR OPTIONS FOR THE ACTIVE DUTY SPONSOR?

A

TRICARE PRIME AND TRICARE PRIME REMOTE (TPR)

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14
Q

WHAT ARE THE TRICARE FAMILY MEMBER OPTIONS FOR THE ACTIVE DUTY SPONSOR?

A
  • TRICARE PRIME
  • TRICARE PRIME REMOTE
  • US FAMILY HEALTH PLAN (USFHP) (DEPENDING ON LOCATION)
  • TRICARE SELECT
  • TRICARE YOUNG ADULT (TYA)
  • TRICARE FOR LIFE (TFL) (IF ENTITLED TO MEDICARE PART A AND HAVE MEDICARE PART B)
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15
Q

WHAT ARE THE TRICARE SPONSOR OPTIONS FOR THE SEPARATED (NON-RETIREMENT) SPONSOR?

A

SPONSOR AND FAMILY MEMBER OPTIONS:
AFTER SEPARATING FROM SERVICE (NON-RETIREMENT), THE SPONSOR AND FAMILY MEMBERS LOSE TRICARE ELIGIBILITY. HOWEVER, YOU MAY QUALIFY FOR A PERIOD OF CONTINUED COVERAGE UNDER THE:
-TRANSITIONAL ASSISTANCE MANAGEMENT PROGRAM (TAMP)
-CONTINUED HEALTH CARE BENEFIT PROGRAM (CHCBP)

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16
Q

WHAT ARE THE TRICARE SPONSOR OPTIONS FOR THE RETIRED SPONSOR?

A

SPONSOR OPTIONS:

  • TRICARE PRIME
  • USFHP (DEPENDING ON LOCATION AND AGE)
  • TRICARE SELECT
  • TFL (IF ENTITLED TO MEDICARE PART A ANED HAVE MEDICARE PART B)
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17
Q

WHAT ARE THE TRICARE FAMILY MEMBER OPTIONS FOR THE RETIRED SPONSOR?

A

FAMILY MEMBER OPTIONS:

  • TRICARE PRIME
  • USFHP (DEPENDING ON LOCATION AND AGE)
  • TRICARE SELECT
  • TYA
  • TFL (IF ENTITLED TO MEDICARE PART A AND HAVE MEDICARE PART B)
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18
Q

UNDER WHAT CONDITIONS IS A MILITARY MEMBER OR FAMILY MEMBER OF A MILITARY MEMBER AUTOMATICALLY ENROLLED IN A TRICARE PROGRAM?

A

IF YOU ARE AN ADSM, A FAMILY MEMBER OF A NEW ADSM, A NEW FAMILY MEMBER OF A CURRENT ADSM, OR YOUR MILITARY SPONSOR HAS BEEN CALLED TO ACTIVE DUTY, YOU WILL BE AUTOMATICALLY ENROLLED IN TRICARE PRIME IF YOU LIVE IN A PSA. OTHERWISE ADFMS WILL BE AUTOMATICALLY ENROLLED IN TRICARE SELECT. ADSMS MUST REMAIN ENROLLED IN TRICARE PRIME. ALL OTHERS AUTOMATICALLY ENROLLED HAVE 90 DAYS TO CHANGE ENROLLMENT IF ELIGIBLE FOR OTHER TRICARE PLANS. YOU MAY ALSO BE ELIGIBLE TO ENROLL IN THE USFHP IF YOU LIVE IN AN AREA WHERE THE PLAN IS OFFERED.

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19
Q

HOW DOES THE TRICARE STATESIDE GUIDE DEFINE TRICARE PRIME?

A

TRICARE PRIME IS A HEALTH CARE OPTION FOR ACTIVE DUTY SERVICE MEMBERS (ADSM’S), RETIREES, FAMILY MEMBERS, AND CERTAIN OTHERS. IT IS SIMILAR TO A MANAGED-CARE OR HEALTH MAINTENANCE ORGANIZATION OPTION, WHIHC MEANS YOUR ACCESS TO SPECIALTY CARE IS MANAGED BY YOUR PRIMARY CARE MANAGED (PCM).

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20
Q

WHAT ARE THE OTHER TRICARE PRIME OPTIONS?

A
  • TRICARE PRIME REMOTE (TPR) - TPR, A TRICARE PRIME OPTION FOR ADSM’S LIVING AND WORKING IN REMOTE LOCATIONS (OUTSIDE OF A PSA) AND THEIR FAMILY MEMBERS.
  • U.S. FAMILY HEALTH PLAN (USFHP, A TRICARE PRIME OPTION WHERE CARE IS PROVIDED THROUGH NETWORKS OF COMMUNITY-BASED, NOT-FOR -PROFIT HEALTH CARE SYSTEMS IN SIX ARES OF THE U.S. FOR MORE INFORMATION, GO TO WWW.TRICARE.MIL/USFHP..
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21
Q

HOW DOES ONE QUALIFY FOR A TRICARE PRIME OPTION?

A

TO GET TRICARE PRIME, YOU MUST LIVE IN A PSA. YOU MAY ALSO GET TRICARE PRIME IF YOU LIVE WITHIN 100 MILES OF AN AVAILABLE PCM AND WAIVE YOUR DRIVE-TIME ACCESS STANDARDS. TO FIND OUT IF YOU LIVE IN AN AREA WHERE YO UCAN GET TRICARE PRIME, GO TO WWW.TRICARE.MIL/PSA. FOR MORE INFORMATION ABOUT DRIVE-TIME ACCESS STANDARDS, GO TO WWW.TRICARE.MIL/PRIMEACCESS. TPR IS AN OPTION FOR ADSM’S AND ACTIVE DUTY FAMILY MEMBERS (ADFM’S) LIVING AND WORKING IN REMOTE AREAS.

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22
Q

WHAT ACTION MUST BE TAKEN TO ENROLL IN A TRICARE PRIME OPTION?

A
  • ADSM’S MUST USE TRICARE PRIME OR TPR
  • ADFM’S CAN CHOOSE TO ENROLL IN TRCARE PRIME, TPR, OR USFHP, OR TRICARE SELECT.
  • RETIREES AND RETIREE FAMILY MEMBERS MAY ENROLL IN TRICARE PRIME OR USFHP. IF NEITHER IS AVAILABLE, YOU CAN ENROLL IN TRICARE SELECT.
  • **YOU CAN ONLY ENROLL IN OR CHANGE ENROLLMENT TO TRICARE PRIME (IF YOU LIVE IN A PSA) FOLLOWING A QUALIFYING LIFE EVENT (QLE) OR DURING THE ANNUAL FALL TRICARE OPEN SEAASON.
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23
Q

WHAT ARE THE THREE OPTIONS TO ENROLL IN A TRICARE PRIME PROGRAM?

A

YOU HAVE THREE OPTIONS TO ENROLL IN A TRICARE PRIME PROGRAM:

  • USE THE BENEFICIARY WEB ENROLLMENT WEBSITE AT WWW.DMDC.OSDD.MIL/APPJ/BWE
  • CALL YOUR REGIONAL CONTRACTOR
  • SUBMIT A TRICARE PRIME ENROLLMENT, DISNEROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM (DD FORM 2876) TO YOUR REGIONAL CONTRACTOR. YOU CAN FIND THIS FORM AT WWW.TRICARE.MIL/FORMS.
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24
Q

WHAT DOES THE TRICARE STATESIDE GUIDE DEFINE AS A QUALIFYING LIFE EVENT?

A

QUALIFYING LIFE EVENT. A CERTAIN CHANGE IN YOUR LIFE, SUCH AS MARRIAGE, BIRTH OF A CHILD, OR RETIREMENT FROM ACTIVE DUTY, WHICH MAY MEAN DIFFERENT TRICARE OPTIONS ARE AVAILABLE TO YOU . A QLE OPENS A 90 DAY PERIOD FOR YOU TO MAKE ELIGIBLE ENROLLMENT CHANGES. A QLE FOR ONE FAMILY MEMBER MEANS ALL FAMILY MEMBERS MAY MAKE ENROLLMENT CHANGES. TO LEARN MORE, VIST WWW.TRICARE.MIL/LIFEEVENTS.

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25
Q

WHAT DOES THE TRICARE STATESIDE GUIDE DEFINE AS TRICARE OPEN SEASON?

A

TRICARE OPEN SEASON. THE ANNUAL PERIOD WHEN YOU CAN ENROLL IN OR CHANGE YOUR HEALTH CAREE COVERAGFE PLAN FOR THE FOLLOWING YEAR. TO ELARN MORE, VISIT WWW.TRICARE.MIL/OPENSEASON.

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26
Q

WHEN ENROLLED IN A TRICARE PRIME OPTION, FROM WHOM DOES MOST OF YOUR ROUTINE CARE COME FROM?

A

WHEN YOU ENROLL IN A TRICARE PRIME OPTION, YOU WILL GET MOST OF YOUR ROUTINE CARE FROM AN ASSIGNED OR SELECTED PCM.

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27
Q

WHAT DOES THE TRICARE STATESIDE GUIDE DEFINE AS A PCM?

A

-AT A MILITARY HOSPITAL OR CLINIC
-A CIVILIAN TRICARE NETWORK PROVIDER
-A PRIMARY CARE PROVIDER UNDER USFHP
REFERALS AND PRIOR AUTHORIZATIONS MAY BE REQUIRED FOR CERTAIN SERVICES. FOR SPECIFIC INFORMATION, VISIT WWW.TRICARE.MIL/APPOINTMENTS

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28
Q

WHAT DOES THE TRICARE STATESIDE GUIDE DEFINE ENROLLMENT COSTS?

A

ADSM’S, ADFM’S, AND TRANSITIONAL SURVIVORS (SURIVIVING SPOUSES DURING THE FIRST THREE YERS AND SURVIVIING DEPENDENT CHILDREN) HAVE NO ENROLLMENT COSTS. RETIREEES, THEIR FAMILIES, AND OTHERS PAY YEARLY ENROLLMENT FEES. FOR COST DETAILS, GO TO WWW.TRICARE.MIL/COSTS.

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29
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, DO ADSM’S HAVE OUT-OF-POCKET COSTS?

A

ADSM’S HAVE NO OUT-OF-POCKET COSTS FOR COVERED HEALTH CARE SERVICES FROM A PCM, OR WITH THE APPROPRIATE REFERRAL AND PRIOR AUTHORIZATION.

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30
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, DO ADFM’S HAVE OUT-OF-POCKET COSTS?

A

ADFM’S HAVE NO OUT-OF-POCKET COSTS FOR COVERED HEALTH CARE SERVICES FROM A NETWORK PROVIDER IN THEIR ENROLLED TRICARE REGION, OR WITH THE APPROPRIATE REFERRAL AN PRIOR AUTHORIZATION.

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31
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, DO RETIREES HAVE OUT-OF-POCKET COSTS?

A

RETIREES PAY COPAYMENTS OR COST-SHARES FOR COVERED HEALTH CARE SERVICES FROM NETWORK PROVIDERS IN THEIR ENROLLED TRICARE REGION. WHEN FOLLOWING THE RULES OF THE TRICARE PRIME PROGRAM OPTION, OUT-OF-POCKET COSTS ARE LIMITED TO THE CATASTROPHIC CAP AMOUNT FOR THAT CALENDAR YEAR (JAN. 1-DEC. 31). FOR MORE INFORMATION, SEE WWW.TRICARE.MIL/COSTS.

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32
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW DOES THE A NON-ADSM SEE A DIFFERENT, BUT TRICARE-AUTHORIZED, PROVIDER?

A

THE POINT-OF-SERVICE (POS) OPTOIN ALLOWS NON-ADSMS TO SEE ANY TRICARE-AUTHORIZED PROVIDER WITHOUT A REFERRAL. THIS MEANS YOU PAY MORE MONEY UP FRONT TO GET NONEMERGENCY HEALTH CARE FROM ANY TRICARE-AUTHORIZED PROVIDER WITHOUT A REFERREAL. COSTS YOU PAY UNDER THE POS OPTION DON’T COUNT TOWARD YOUR YEARLY CATASTROPHIC CAP. FOR MORE INFORMATION, GO TO WWW.TRICARE.MIL/POINTOFSERVICE.

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33
Q

WITH TRICARE PRIME, HOW DO REFERRALS WORK?

A

WHEN YOUR PRIMARY CARE MANAGER (PCM) SENDS YOU TO ANOTHER PROVIDER FOR CARE. IF YOU HAVE TRICARE PRIME ADN SEE A PROVIDER OTHER THAN YOUR PCM FOR NONEMERGENCY CARE WITHOUT A REFERRAL YOU WILL PAY MORE. CERTAIN, SUCH AS THE COMPREHENSIVE AUTIS CARE DEMONSTRATION, REQUIRE A REFERRAL AND CONTINUED AUTHORIZATIONS.

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34
Q

CONCERNING TRICARE PRIME, HOW IS PRIOR AUTHORIZATION DEFINED?

A

A REVIEW OF A REQUESTED HEALTH CARE SERVICE DONE BY YOUR REGIONAL CONRACTOR TO SEE IF THE CARE WILL BE COVERED BY TRICARE. CHECK FOR SERVICES THAT NEED PRIOR AUTHORIZATION BY GOING TO WWW.TRICARE.MIL OR YOUR REGIONAL CONTRACTORS WEBSITE.

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35
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS THE CATASTROPHIC CAP DEFINED?

A

CATASTROPHIC CAP - THE MOST YOU OR YOUR FAMILY WILL PAY FOR COVERED HEALTH CARE SERVICES EACH CALENDAR YEAR.

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36
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS ENROLLMENT FEE DEFINED?

A

ENROLLMENT FEE - THE YEARLY FEE THAT RETIREES, THEIR FAMILIES, ADN SOME OTHERS PAY WHILE IN TRICARE PRIME.

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37
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS A CALENDAR YEAR DEFINED?

A

A CALENDAR YEAR IS JAN. 1-DEC. 31.

38
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS A TRICARE AUTHORIZED PROVIDER?

A

TRICARE-AUTHORIZED PROVIDER - A PROVIDER APPROVED BY TRICARE TO GIVE HEALTH CARE SERVICES TO BENEFICIARIES. A PROVIDER MUST BE TRICARE-AUTHORIZED FOR TRICARE TO PAY ANY PART OF YOUR CLAIM.

39
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS A NETWORK PROVIDER DEFINED?

A

NETWORK PROVIDER - A PROVIDER WHO HAS AGREED TO ACCEPT THE CONTRACTED RATE AS PAYMENT IN FULL FOR COVERED HEALTH CARE SERVICES AND FILES CLAIMS FOR YOU.

40
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS COST-SHARE DEFINED?

A

COST-SHARE - A PERCENTAGE OF THE TOTAL COST OF A COVERED HEALTH CARE SERVICE THAT YOU PAY.

41
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS COPAYMENT DEFINED?

A

COPAYMENT - THE FIXED AMOUNT THOSE WITH TRICARE PRIME (WHO AREN’T ADSM’S AND ADFM’S) OR TRICARE SELECT PAY FOR A COVERED HEALTH CARE SERVICE OR DRUG.

42
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS TRICARE SELECT?

A

TRICARE SELECT FOR TRICARE-ELIGIBLE BENEFICIARIES WHO AREN’T ABLE TO, OR CHOOSE NOT TO, ENROLL IN A TRICARE PRIME OPTION AND WHO AREN’T ENTITLED TO MEDICARE (WITH THE EXCEPTION OF ADFM’S). THIS PROGRAM LETS YOU MANAGE YOUR OWN HEALTH CARE AND GET CARE FROM ANY TRICARE-AUTHORIZED PROVIDER WITHOUT A REFERRAL. LIKE TRICARE PRIME OPTIONS, ENROLLMENT IS REQUIRED. ADSM’S MAY NOT USE TRICARE SELECT.

43
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW DOES SOMEONE ENROLL IN TRICARE SELECT?

A

YOU MUST TAKE ACTION TO ENTROLL IN A TRICARE SELECT OPTIONS:

  • ADFM’S, RETIREES, AND RETIREEE FAMILY MAMEBERS CAN CHOOS TO ENTORLL IN TRICARE SELECT.
  • **YOU CAN ONLY ENROLL IN OR CHANGE ENROLLMENT TO TRICARE SELECT FOLLOWING A QLE OR DURING THE ANNUAL FALL TRICARE OPEN SEASON.

YOU HAVE THREE OPTIONS TO ENROLL IN TRICARE SELECT:

  • USE THE BENEFICIARY WEB ENROLLMENT WEBSITE AT WWW.DMDC.OSD.MIL/APPJ/BWE.
  • CALL YOUR REGIONAL CONTRACTOR
  • SUBMIT A TRICARE SELECT ENROLLMENT, DISENROLLMENT AND CHANGE FORM (DD FORM 3043) TO YOUR REGIONAL CONTRACTOR. YOU CAN FIND THIS FORM AT WWW.TRICARE. MIL/FORMS.
44
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW DOES ONE GET CARE WTIH TRICARE SELECT?

A

WITH TRICARE SELECT, YOU CAN GET CARE FROM ANY TRICARE-AUTHORIZED NETWORK PROVIDER WITHOUT A REFERRAL OR PRIOR-AUTHORIZATION, IN MOST SITUATIONS. YOU WILL HAVE LOWER OUT-OF-POCKET COSTS IF YOU USE A TRICARE-AUTHORIZED NETWORK PROVIDER VERSUS A TRICARE-AUTHORIZED NON-NETOWRK PROVIDER. IF YOU CHOOS A NON-AUTHORIZED NON-NETWORK PROVIDER, YOU WILL NOT BE REIMBURSED BY TRICARE. TO FIND A TRICARE NETWORK PROVIDER, GO TO WWW.TRICARE.MIL/FINDAPROVIDER OR CALL YOUR REGIONAL CONTRACTOR.

45
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW ARE ENTROLLMENT COSTS DEFINED FOR TRICARE SELECT?

A

THERE IS NO YEARLY ENROLLMENT FEE FOR ADFM’S. FOR RETIREES, THEIR FAMILIES, AND OTHERS, YOU MAY HAVE ENROLLMENT FEES BASED ON WHEN YOU OR YOUR SPONSOR ENTERED ACTIVE DUTY. FOR COST DETAILS, GO TO WWW.TRICARE.MIL/COSTS.

46
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW ARE COSTS FOR COVERED CARE DEFINED FOR TRICARE SELECT?

A

WITH TRICARE SELECT, YOU PAY A YEARLY DEDUCTIBLE AND PER-VISIT COPAYMENTS OR COST-SHARES. YOU’LL FALL INTO ONE OF TWO GROUPS BASED ON WHEN YOU ORYOUR SPONSOR ENTEREED ACTIVE DUTY. THIS GROUP WILL DETERMINE YOUR COSTS. WHEN FOLLOWING THE RULES OF YOUR PROGRAM OPTION, YOUR OUT-OF-POCKET EXPENSES WILL BE LIMITED TO YOUR CATASTROPHIC CAP. NONPARTICIPATING NON-NETWOR PROVICERS MAY CHARGE UP TO 15 PERCENT ABOVE THE TRICARE-ALLOWABLE AMOUNT. YOU’RE RESPONSIBLE FOR THIS AMOUNT, PLUS YOUR DEDUCTIBLE AND COPAYMENTS OR COST-SHARES. FOR COSTS, GO TO WWW.TRICARE.MIL/COSTS.

47
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW ARE CLAIMS FILED UNDER TRICARE SELECT?

A

SUBMIT CLAIMS TO THE REGIONAL CONTRACTOR FOR THE AREA WHERE YOU LIVE. IN THE U.S. ADN U.S. TERRITOREIS (AMERICA SAMOA, GUAM, THE NORTHERN MARIANA ISLANDS, PUERTO RICO, ADN THE U.S. VIRGIN ISLANDS), CLAIMS MUST BE FILED WITHIN ONE YEAR OF THE DATE OF SERVICE OR DATE OF INPATIENT DISCHARGE. YOU’RE RESPONSIBLE FOR CONFIRMING YOUR CLAIMS ARE RECEIVED. FOR ASSISTANCE, CALL YOUR REGIONAL CONTRACTOR.

48
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW CAN A NON-AUTHORIZED PROVIDER BECOME TRICARE-AUTHORIZED?

A

IF YOUR PROVIDER ISNT TRICARE-AUTHORIZED, BUT WANTS TO SEE TRICARE PATIENTS, TELL YOUR PROVIDER HE OR SHE CAN DO SO WITHOUT SIGNING A CONTRACT WITH YOUR EGIONAL CONTRACTOR. MOST PROVIDERS WITH A VALID PROFESSIONAL LICENSE (ISSUED BY A STATE OR A QUALIFIED ACCREDITATION ORGANIZATION) CAN BECOME TRICARE-AUTHORIZED AND THEN TRICARE WILL PAY THEM FOR COVERED SERVICES. GO TO WWW.TRICARE.MIL/FINDAPROVIDER AND CLICK “LEARN MORE.”

49
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS YEARLY DEDUCTIBLE DEFINED?

A

YEARLY DEDUCTIBLE - A FIXED AMOUNT YOU PAY FOR COVERED SERVICES EACH CALENDAR YEAR BEFORE TRICARE PAYS ANYTHING. YOU MAY HAVE A DEDUCTIBLE IF YOU HAVE TRICARE SELECT OR IF YOU HAVE TRICARE PRIME ADN SEE A PROVIDER WITHOUT A REFERRAL.

50
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW CLAIM DEFINED?

A

CLAIM - A REQUEST FOR PAYMENT FROM TRICARE THAT GOES TO YOUR REGIONAL CONTRACTOR AFTER YOU GET A COVERED HEALTH CARE SERVICE.

51
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS PREMIUM DEFINED?

A

PREMIUM - THE AMOUNT YOU PAY FOR A HEALTH CARE PLAN YOU PURCHASED. PREMIUMS APPLY TO THOSE USING TRICARE RESERVE SELECT, TRICARE RETIRED RESERVE, TRICARE YOUNG ADULT, AND THE CONTINUED HEALTH CARE BENEFIT PROGRAM.

52
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT TRICARE PLANS CAN BE PURCHASED?

A

PREMIUM-BASED HEALTH CARE PLANS THAT WORK LIKE TRICARE SELECT WITH THE SAME COPAYMENTS OR COST-SHARES AND A CHOICE OF PROVIDERS CAN BE PURCHASED BY THOSE WHO QUALIFY. THESE PLANS INCLUDE TRICARE RESERVE SELECT (TRS), TRICARE RETIRED RESERVE (TRR), AND THE CONTINUED HEALTH CARE BENEFIT PROGRAM (CHCBP). FOR MORE ON CHCBP, SEE “TRANSITOINAL COVERAGE OPTIONS” IN THE OTHER TRICARE PROGRAM OPTION SECTION.

53
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE ABBREVIATION FOR TRICARE RESERVE SELECT?

A

TRS

54
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE ABBREVIATION FOR TRICARE RETIRED RESERVE?

A

TRR

55
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS TRS AND TRR?

A

TRS AND TRR ARE PREMIUM-BASED, WORLDWIDE HEALTH CARE PLANS FOR CERTAIN QUALIFIED SELECTED RESERVE OR RETIRED RESERVE MEMBERS, THEIR FAMILY MEMBERS, AND SURVIVORS. TRS AND TRR OFFER COMPREHENSIVE HEALTH CARE COVERAGE SIMILAR TO TRICARE SELECT.

  • ENROLLMENT IS REQUIRED.
  • TRICARE OPEN SEASON DOESN’T APPLY TO TRS ADN TRR. THESE PLANS OFFER CONTINUOUS OPEN ENROLLMENT THROUGHOUT THE YEAR.
  • AN INITIAL TWO-MONTH PREMIUM PAYMENT IS DUE WHEN YOU ENROLL.
  • MONTHLY PREMIUMS, A YEARLY DEDUCTIBLE AND COPAYMENTS OR COST-SHARES APPLY.
  • GET CARE FROM ANY TRICARE-AUTHORIZED PROVIDER WITHOUT A REFERRAL
  • CERTAIN SERVICES REQUIRE PRIOR AUTHORIZTION
56
Q

WHAT HAPPENS TO TRS OR TRR IF YOUR NATIONAL GUARD OR RESERVE SPONSOR IS ACTIVATED MORE THAN 30 DAYS FOR A PREPLANNED MISSION OR IN SUPORT OF A CONTINGENCY OPERATION?

A

NOTE: WHEN YOUR NATIONAL GUARD OR RSERVE SPONSOR IS ACTIVATED FOR MOR THAN 30 DAYS FOR A PREPLANNED MISSION OR IN SUPPORT OF A CONTINGENCY OPERATION, THIS COVERAGE STOPS WEHIL YOU GET ACTIVE DUTY BENEFITS.

57
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHERE DOES ONE FIND MORE INFORMATION ON TRICARE RESERVE SELECT AND TRICARE RETIRED RESERVE?

A

FOR MORE INFORMATION, INCLUDING HOW TO PURCHASE TRS OR TRR COVERAGE, GO TO WWW.TRICARE.MIL/TRS OR WWW.TRICARE.MIL/TRR.

58
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT MUST BE DONE WITH MEDICARE IF A PERSON IS TO KEEP TRICARE?

A

IF YOU’RE ENTITLED TO MEDICARE PART A, YOU GENERALLY MUST HAVE MEDICARE PART B TO KEEP TRICARE, REGARDLESSS OF YOUR AGE OR WHERE YOU LIVE. THIS IS A REQUIREMENT BASED ON FEDERAL LAW WITH AND EXCEPTION FOR ADSM’S AND ADFM’S. IF YOU’RE ELEGIBLE FOR TRICARE AND HAVE MEDICARE PART A AND PART B, YOU’RE AUTOMATICALLY COVERED BY TFL.

59
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT DOES MEDICARE PART A COVER?

A

MEDICARE PART A (HOSPITAL INSURANCE):

  • INPATIENT HOSPITAL CARE
  • HOSPICE CARE
  • INPATIENT SKILLED NURSING FACILITY CARE
  • SOME HOME HEALTH CARE
60
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT DOES MEDICARE PART B COVER?

A

MEDICARE PART B (MEDICAL INSURANCE):

  • PROVIDER SERVICES
  • OUTPATIENT CARE
  • HOME HEALTH CARE
  • DURABLE MEDICAL EQUIPMENT
  • SOME PREVENTIVE SERVICES
61
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS COVERED BY TRICARE FOR LIFE?

A

TRICARE FOR LIFE:

  • INPATIENT AND OUTPATIENT WRAPAROUND COVERAGE
  • COVERAGE FOR OVERSEAS CARE
62
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, ARE THERE COSTS ASSOCIATED WITH TRICARE FOR LIFE?

A

THERE ARE NO ENROLLMENT FEES OR FORMS FOR TFL, BUT YOU MUST AHVE MEDICARE PART A AND MEDICARE PART B. MEDICARE PART B HAS A MONTHLY PREMIUM. GO TO WWW.MEDICARE.GOV FOR THE CURRENT PART B PREMIUM AMOUNTS, WHICH VARY BY INCOME LEVEL. FOR MORE INFORMATION ABOU TFL GO TO WWW.TRICARE.MIL/TFL. YOU MAY ALSO CALL WISCONSIN PHYSICIANS SERVICE (WPS) - MILITARY AND VETERANS HEALTH, THE CONTRACTOR THAT ADMINISTERS THE TFL BENEFIT.

63
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE MEDICARE/TRICARE/OUT-OF-POCKET COSTS FOR A TYPE OF CARE COVERED BY TRICARE AND MEDICARE?

A
  • MEDICARE PAYS: MEDICARE-ALLOWED AMOUNT
  • TRICARE PAYS: REMAINING AMOUNT
  • YOU PAY: NOTHING
64
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE MEDICARE/TRICARE/OUT-OF-POCKET COSTS FOR A TYPE OF CARE COVERED BY MEDICARE ONLY?

A
  • MEDICARE PAYS: MEDICARE-ALLOWED AMOUNT
  • TRICARE PAYS: REMAINING AMOUNT
  • YOU PAY: NOTHING
65
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE MEDICARE/TRICARE/OUT-OF-POCKET COSTS FOR A TYPE OF CARE COVERED BY TRICARE ONLY?

A
  • MEDICARE PAYS: NOTHING
  • TRICARE PAYS: TRICARE-ALLOWABLE AMOUNT
  • YOU PAY: TRICARE DEDUCTIBLE AND COST-SHARE
66
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE MEDICARE/TRICARE/OUT-OF-POCKET COSTS FOR A TYPE OF CARE NOT COVERED BY TRICARE OR MEDICARE?

A
  • MEDICARE PAYS: NOTHING
  • TRICARE PAYS: NOTHING
  • YOU PAY: BILLED CHARGES (WHICH MAY BE MORE THAN THE MEDICARE- OR TRICARE-ALLOWABLE AMOUNT)
67
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, IF A PATIENT IS ELIGIBLE FOR BOTH TFL VA BENEFITS, WHICH WILL COST THE PATIENT MORE?

A

IF YOU’RE ELIGIBLE FOR BOTH TFL AND U.S. DEPARTMENT OF VETERANS AFFAIRS (VA) BENEFITS AND CHOOSE TO USE YOUR TFL BENEFIT FOR HEALTH CARE NOT RELATED TO A SERVICE-CONNECTED INJURY OR ILLNESS, YOU WILL PAY MORE TO SEEE A VA PROVIDER THAN YOU WOULD PAY TO SEE A CIVILIAN MEDICARE PROVIDER. TRICARE WILL ONLY PAY UP TO 20 PERCENT OF THE TRICARE-ALLOWABLE AMOUNT FOR CARE YOU GET AT A VA FACILITY AND YOU MAY BE RESPONSIBLE FOR THE REMAINING AMOUNT.

68
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WITH TFL, WHAT IS THE LEAST EXPENSIVE OPTION?

A

WITH TFL, YOUR LEAST EXPENSIVE OPTION IS TO SEE A MEDICARE PARTICIPATING OR MEDICARE NON-PARTICPATING PROVIDER. MEDICARE PARTICIPATING PROVIDERS AGREE T ACCEPT THE MEDICARE-ALLOWED AMOUNT AS PAYMENT IN FULL. MEDICARE NON-PARTICIPATING PROVIDERS DON’T ACCEPT THE MEDICARE-ALLOWED AMOUTN AS PAYMENT IN FULL AND MAY CHARGE UP TO 15 PERCENT ABOVE THE MEDICARE ALLOWED AMOUNT. THIS ADDITIONAL COST MAY BE COVERED BY TFL. IF YOU GET CARE FROM A VA PROVIDER, CHECK WITH WPS TO CONFIRM COVERAGE DETAILS.

69
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT DOES TRICARE OFFER FOR OTHER PLANS?

A

TRICARE OFFERS OTHER COVERAGE OPTIONS FOR THOSE WHO HAVE ELIGIBILITY CHANGES, SUCH AS CHILDREN AGING OUT OF REGULAR TRICARE COVERAGE OR SPONSORS SEPARATING FROM SERVICE. IF YOU HAVE LOST ALL TRICARE ELIGIBILITY, YOU MAY QUALIFY TO BUY COVERAGE UNDER CHCBP (DISCUSSED IN THE TRICARE STATESIDE GUIDE)

70
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS TRICARE YOUNG ADULT (TYA)?

A

TYA IS A PREMIUM-BASED HEALTH CARE PLAN FOR QUALIFIED DEPENDENTS WHO HAVE AGED OUT OF TRICARE. TYA PRIME AND TYA SELECT ARE OFFERD WORLDWIDE. YOUR LOCATIN AND SPONSOR’S STATUS DETERMINE WHETHER YOU QUALIFY FOR TYA PRIME AND/OR TYA SELECT.

71
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS NOT INCLUDED IN TYA?

A

TYA INCLUDES MEDICAL AND PHARMACY BENEFITS, BUT NO DENTAL COVERAGE. COVEAGE, PROVIDER CHOICE, AND COSTS FOR TYA ARE THE SAME AS FORE TRICARE PRIME AND TRICARE SELECT.

72
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE GENERALLY THE CRITERIA FOR BUYING INTO TYA?

A

YOU MAY GENERALLY PURCHASE TYA COVERAGE IF YOUR A DEPENDENT OF A TRICARE-ELIGIBLE SPONSOR; UNMARRIED; AT LEAST AGE 21, BUT NOT YET AGE 26; AND NOT OTHERWISE ELIGIBLE FOR TRICARE OR EMPLOYER-BASED COVERAGE. TRICARE OPEN SEASON DOESN’T APPLY TO TYA. TYA PRIME AND TYA SELECT OFFER CONTINUOUS OPEN ENTROLLMENT THROUGHOUT THE YEAR. FOR MORE INFORMATION, GO TO WWW.TRICARE.MIL/TYA.

73
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE OBJECTIVE OF THE TRICARE TRANSITIONAL COVERAGE OPTIONS?

A

TRICARE OFFERS BENEFITS TO HELP CERTAIN SERVICE MEMBERS AND THEIR FAMILIES TRANSITION TO CIVILIAN LIFE.

74
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE TRANSITIONAL ASSISTANCE MANAGEMENT PROGRAM OPTION?

A

TRANSITIONAL ASSISTANCE MANAGEMENT PROGRAM - TAMP OFFERS 180 DAYS OF PREMIUM -FREE HEALTH CARE AFTER YOUR SPONSOR SEPARATES FROM THE MILITARY. IF YOU’RE ELIGIBLE, TAMP STARTS THE DAY AFTER THE SPONSOR SEPARATES FROM THE SERVICE. FOR MORE INFORMATION GO TO WWW.TRICARE.MIL/TAMP.

75
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE CONTINUED HEALTH CARE BENEFIT PROGRAM?

A

CHCBP IS A PREMIUM-BASED HEALTH CARE PROGRAM MANAGED BY HUMANA MILITARY. THOUGH NOT A TRICARE PROGRAM, CHCBP OFFERS CONTINUED HEALTH COVERAGE (18-36 MONTHS) AFTER TRICARE COVERAGE ENDS. CERTAIN FORMER SPOUSES WHO HAVEN’T REMARRIED BEFORE AGE 55 MAY QUALIFY FOR AN UNLIMITED DURATION OF COVERAGE. IF YOU QUALIFY, YOU CAN PURCHASE CHCBP COVERAGE WITHIN 60 DAYS OF LOSS OF TRICARE OR TAMPE COVERAGE, WHICHEVER IS LATER. TRICARE OPEN SEASON DOESN’T APPLY TO CHCBP. CHCBP OFFERS CONTINUOUS ENPEN ENROLLMENT THROUGHOUT YEAR. FOR MORE INFORMATION, GO TO WWW.TRICARE.MIL/CHCBP. NOTE: YOU’RE NOT LEGALLY ENTITLED TO SPACE-AVAILABLE CARE AT MILITARY HOSPITALS OR CLINICS WHILE IN CHCBP..

76
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE TRICARE PHARMACY PROGRAM?

A

THE TRICARE PHARMACY PROGRAM PROVIDES PRECRIPTION DRUGS THROUGH MILITARY PHARMACIES, TRICARE PHARMACY HOME DELIVERY, TRICARE RETAIL NETWORK PHARMACIES, AND NON-NETWORK PHARMACIES. YOUR OPTIONS FOR FILLING YOUR PRESCRIPTION DEPEND ON TH ETYPE OF DRUG YOUR PROVIDER PRESCRIBES. EXPRESS SCRIPTS, INC. MANAGES THE TRICARE PHARMACY BENEFIT FOR ALL TRICARE-ELIGIBLE BENEFICIARIES. IF YOU’RE IN USFHP, YOU HAVE DIFFERENT PHARMACY COVERAGE. FOR MORE INFORMATION ABOUT THE TRICARE PHARMACY BENEFIT, SEE THE TRICAREPHARMACY PROGRAM HANDBOOK AT WWW.TRICARE.MIL/PUBLICATIONS OR GO TO WWW.TRICARE.MIL PHARMACY.

77
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE THE OPTIONS FOR FILLING PRESCRIPTIONS IN A MILITARY PHARMACY?

A
  • NO COST FOR UP TO A 90-DAY SUPPLY OF MOST COVERED DRUGS.

- USUALLY DON’T CARRY NON-FORMULARY DRUGS

78
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE THE OPTIONS FOR FILLING PRESCRIPTIONS WITH TRICARE PHARMACY HOME DELIVERY?

A
  • NO COST FOR ADSM’S. FOR ALL OTHER BENEFICIARIES, COPAYMENTS APPLY
  • DRUGS ARE MAILED TO YOU WITH FREE STANDARD SHIPPING
79
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE THE OPTIONS FOR FILLING PRESCRIPTIONS WITH TRICARE RETAIL NETWORK PHARMACIES?

A
  • PAY ONE COPAYMENT FOR EACH 30-DAY SUPPLY OF COVERED DRUGS
  • NO NEED TO FILE A CLAIM
  • LOCATED IN THE U.S. AND THE U.S. TERRITORIES OF GUAM, THE NORTHERN MARIANA ISLANDS, PUERTO RICO, AND THE U.S. VIRGIN ISLANDS
80
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE THE OPTIONS FOR FILLING PRESCRIPTIONS WITH NON-NETWORK PHARMACIES?

A
  • PAY FULL PRICE AND FILE A CLAIM TO GET MONEY BACK ON COVERED DRUGS
  • THE AMOUNT OF MONEY YOU GET BACK DEPENDS ON DEDUCTIBLES, OUT-OF-NETWORK COST-SHARES, AND COPAYMENTS.
81
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW MANY CATEGORIES OF DRUGS?

A

FOUR CATEGORIES OF DRUGS - TRICARE GROUPS DRUGS INTO FOUR CATEGORIES. THIS GROUPING. IS BASED ON MEDICAL EFFECTIVENESS AND COST OF A DRUG COMPARED TO OTHER DRUGS OF THE SAME TYPE.

82
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE FIRST CATEGORY OF DRUGS? HOW DOES THE COST COMPARE TO THE OTHER 4?

A

GENERIC FORMULARY DRUGS - $:

  • WIDELY AVAILABLE
  • LOWEST OUT-OF-POCKET COSTS
83
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE SECOND CATEGORY OF DRUGS? HOW DOES THE COST COMPARE TO THE OTHER 4?

A

BRAND-NAME FORMULARY DRUGS - $$:

  • GENERALLY AVAILABLE
  • MODERATE OUT-OF POCKET COSTS
84
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE THIRD CATEGORY OF DRUGS? HOW DOES THE COST COMPARE TO THE OTHER 4?

A

NON-FORMULARY DRUGS - $$$:

  • MAY HAVE LIMITED AVAILABILITY
  • HIGHER OUT-OF-POCKET COSTS
85
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT IS THE FOURTH CATEGORY OF DRUGS? HOW DOES THE COST COMPARE TO THE OTHER 4?

A

NON-COVERED DRUGS - $$$$:

  • NOT COVERED BY TRICARE
  • HIGHEST OUT-OF-POCKET COSTS (YOU PAY 100 PERCENT OF THE DRUG’S COST)
86
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, HOW IS VISION COVERAGE DEFINED?

A

VISION COVERAGE - RETIREES, THEIR ELIGIBILITY FAMILY MEMBERS, AND ACTIVE DUTY FAMILY MEMBERS, AND ACTIVE DUTY FAMILY MEMBERS ENROLLED IN A TRICARE HEALTH PLAN MAY QUALIFY TO PURCHASE VISION COVERAGE THROUGH THE FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM (FEDVIP), OFFERED BY THE U.S. OFFICE OF PERSONNEL MANAGEMENT. FOR INFORMATION ABOUT FEDVIP, VISIT WWW.TRICARE.MIL/FEDVIP.

87
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHAT ARE THE THREE DENTAL OPTIONS THAT ARE SEPARTE FROM TRICARE HEALTH CARE OPTIONS?

A

-TRICARE ACTIVE DUTY DENTAL PROGRAM (ADDP)
-TRCARE DENTAL PROGRAM (TDP)
-FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM (FEDVIP)
ADSM’S GENERALLY GET CARE AT MILITARY DENTAL CLINICS, BUT MAY SOMETIMES USE THE ADDP. FOR MORE INFORMATION AND FOR DENTAL COSTS, GO TO WWW.TRICARE.MIL/DENTAL.

88
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHO IS COVERED BY THE TRICARE ACTIVE DUTY DENTAL PROGRAM?

A

TRICARE ACTIVE DUTY DENTAL PROGRAM (MANAGED BY UNITED CONCORDIA COMPANIES, INC.)

  • ADSM’S
  • NATIONAL GUARD AND RESERE MEMBER CALLED OR ORDERED TO ACTIVE DUTY FOR MORE THAN 30 DAYS FOR A PREPLANNED MISSION OR A CONTINGENCY OPERATION.
  • ADDP - FOR ADSM’S WHO ARE EITHER REFERRED FOR BY A MILITARY DENTAL CLINIC TO A CIVILIAN DENTIST OR HAVE A DUTY LOCATION AND LIVE MORE THAN 50 MILES FROM A MILITARY DENTAL CLINIC.
89
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHO IS COVERED BY THE TRICARE DENTAL PROGRAM?

A

TRICARE DENTAL PROGRAM (MANAGED BY UNITED CONCORDIA COMPANIES, INC.)
-ADFM’S
-NATIONAL GUARD AND RESERVE MEMBERS AND THEIR FAMILY MEMBERS
-INDIVIDUAL READY RESERVE MEMBERS AND THEIR FAMILY
MEMBERS
-SURVIVORS
-TDP:
—VOLUNTARY ENROLLMENT
—SINGLE AND FAMILY PLANS
—MONTHLY PREMIUMS
—COVERAGE FOR MOST PREVENTATIVE AND DIAGNOSTIC SERVICES

90
Q

ACCORDING TO THE TRICARE STATESIDE GUIDE, WHO IS COVERED BY THE FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROG-RAM?

A

FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM (OFFERED BY THE U.S. OFFICE OF PERSONNEL MANAGEMENT)

  • RETIRED SERVICE MEMBERS AND THEIR ELIGIBLE FAMILY MEMBERS
  • RETIRED NATIONAL GUARD AND RESERVE MEMBERS AND THEIR ELIGIBLE FAMILY MEMBERS
  • CERTAIN SURVIVORS
  • MEDAL OF HONOR RECIPIENTS AND THEIR IMMEDIATE FAMILY MEMBERS AND SURVIVORS.
  • FEVIP - FEDVIP IS A VOLUNTARY DENTAL PROGRAM THAT OFFERS ELIGIVLE TRICARE PARTICIPANTS A CHOICE AMONG A NUMBER OF DENTAL CARRIERS, WITH SOME PLANS OFFERING BOTH HIGH AND STANDARD OPTIONS.
91
Q

HOW MANY TRICARE STATESIDE REGIONS ARE THERE?

A

TWO:

  • TRICARE EAST REGION (HUMANA MILITARY)
  • TRICARE WEST REGION (HEALTH NET FEDERAL SERVICES, LLC)

NAVY ADVANCEMENT SEP 2019 (13 decks)

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