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This Power Point is part of an Enlisted Advancement Program training series for US Navy Corpsman rating provided by Naval Medical Center Portsmouth Virginia ...

This Power Point is part of an Enlisted Advancement Program training series for US Navy Corpsman rating provided by Naval Medical Center Portsmouth Virginia

Naval Medical Center Portsmouth is a military treatment facility serving active duty service members, their dependents and retirees in the Hampton Roads community of southeastern Virginia and northeastern North Carolina.

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Tricare Presentation Transcript

  • 1. TRICARETRICARE
  • 2. WHAT IS TRICARE ? • DoD health care program for active duty and retired members of the uniformed services, their families, and survivors. • OBJECTIVE:OBJECTIVE: optimize delivery of health care and services in MTFs and attain the highest level of beneficiary satisfaction through the delivery of world-class health care benefits.
  • 3. ACTIVE DUTY SERVICE MEMBERSACTIVE DUTY SERVICE MEMBERS • All active duty service members are covered under TRICARE Prime or Remote. ADSM must complete enrollment application for each program. • PRIME:PRIME: no health care cost, priority at all MTFs, enrollment required when ADSMs live and work within 50 miles or an hour's drive of MTF. • REMOTE:REMOTE: no health care cost, may access primary care from a non-network provider if network provider unavailable, enrollment required when ADSMs live and work in remote areas usually 50 miles or an hour's drive of MTF.
  • 4. ACTIVE DUTY FAMILY MEMBERSACTIVE DUTY FAMILY MEMBERS • May choose to enroll in TRICARE Prime or Extra or Standard. • PRIME:PRIME: no cost for authorized network care, Point-of Service (POS) charges apply for care received without referral, access to MTF or TRICARE network providers, enrollment required, lowest out-of-pocket costs. • EXTRA:EXTRA: annual deductible and 15% cost-share of negotiated costs, seek care from TRICARE network providers, discounted cost-shares; no claims to file. • STANDARD:STANDARD: annual deductible and 20% cost-share of allowed charges, care from any authorized TRICARE provider, enrollment not required. • REMOTE:REMOTE: no cost, except POS charges apply for non- referred care, access to network and non-network TRICARE providers, enrollment required.
  • 5. RETIREES UNDER AGE 65 AND THEIR FAMILIESRETIREES UNDER AGE 65 AND THEIR FAMILIES • May choose to enroll in TRICARE prime or EXTRA or STANDARD. • PRIME:PRIME: annual enrollment fee of $230/individual or $460/family, $12/network visit co-payment, $0 for MTF care, POS charges apply for non-referral care, enrollment required. • EXTRA:EXTRA: annual deductible fee of $150/individual or $300/family, 20% cost-share of negotiated costs, care from TRICARE network providers, enrollment not required. • STANDARD:STANDARD: annual deductible fee of $150/individual or $300/family, 25% cost-share allowed charges, care from TRICARE authorized provider, enrollment not required.
  • 6. MEDICARE-ELIGIBLE BENEFICIARIESMEDICARE-ELIGIBLE BENEFICIARIES • TRICARE For Life is coverage for TRICARE beneficiaries who become entitled to Medicare Part A due to age, disability, or end-stage renal disease and who purchased Medicare Part B. TRICARE becomes secondary payer to Medicare beginning on the first day of month you turn 65. • TFL:TFL: Medicare part B premiums, no TRICARE enrollment fees on premiums, care from TRICARE provider that accepts Medicare, no TRICARE enrollment required, Purchase of Medicare B is mandatory. • Services covered by both Medicare and TRICARE, Medicare pays first.
  • 7. TRICARE DENTAL PROGRAMTRICARE DENTAL PROGRAM • Available to ADFMs, members of the Individual Ready and Selected Reserve and their families. • Enrollment:Enrollment: Single and family plans available. • Voluntary and portable worldwide, low monthly premiums and cost-shared based on sponsor's pay grade, comprehensive coverage for most dental services; 100% coverage for preventive, diagnostic, and emergency services.
  • 8. TRICARE RETIREE DENTAL PROGRAMTRICARE RETIREE DENTAL PROGRAM • Available to:Available to: retired service members (including medal of honor recipients) regardless of age, retired members of the Reserve Component entitled to retire pay but under 60, current spouses and children of enrolled members, unremarried widow and children of deceased service member. • ENROLLMENT:ENROLLMENT: single, two-party, and family plans available, monthly premiums depend on ZIP code, minimal deductibles and cost-share.
  • 9. TRICARE PHARMACY PROGRAMTRICARE PHARMACY PROGRAM • All beneficiaries including Medicare beneficiaries 65 and older, may fill prescriptions in MTF pharmacy. • MTF:MTF: no cost. • TRICARE Mail Order Pharmacy:TRICARE Mail Order Pharmacy: $3 generic drugs (up to 90-day supply), $9* brand name drugs (up to 90 days). • TRICARE RETAIL NETWORK PHARMACY:TRICARE RETAIL NETWORK PHARMACY: same cost as TMOP, but 30-day supply of drugs. • Non-Network Pharmacy:Non-Network Pharmacy: $9 or 20% of total cost, whichever is greater (up to 30-days supply). • Non-Formulary Drugs:Non-Formulary Drugs: with TMPO or TRRx $22 cost- share, Non-Network Pharmacy $22 cost-share or 20% whichever is greater.
  • 10. TRICARE PHARMACY PROGRAMTRICARE PHARMACY PROGRAM • All beneficiaries including Medicare beneficiaries 65 and older, may fill prescriptions in MTF pharmacy. • MTF:MTF: no cost. • TRICARE Mail Order Pharmacy:TRICARE Mail Order Pharmacy: $3 generic drugs (up to 90-day supply), $9* brand name drugs (up to 90 days). • TRICARE RETAIL NETWORK PHARMACY:TRICARE RETAIL NETWORK PHARMACY: same cost as TMOP, but 30-day supply of drugs. • Non-Network Pharmacy:Non-Network Pharmacy: $9 or 20% of total cost, whichever is greater (up to 30-days supply). • Non-Formulary Drugs:Non-Formulary Drugs: with TMPO or TRRx $22 cost- share, Non-Network Pharmacy $22 cost-share or 20% whichever is greater.