Health Benefits for AD & ADSMs


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Health Benefits for AD & ADSMs

  1. 1. Health Benefits for AD & ADSMs<br />MEDICAL: As an active duty member, the military provides you and your family with comprehensive medical care. This care may be available at the military treatment facility (MTF) on the base where you are assigned, or via a network of civilian medical providers in the community through a program called TRICARE. TRICARE is the name of the Department of Defense’s regional managed health care program. Under TRICARE, there are three health plan options: TRICARE Prime (which covers all active duty members and those family members that choose to enroll in this HMO-style plan); TRICARE Standard (an indemnity plan formally called CHAMPUS) and TRICARE Extra (a Preferred Provider Organization plan). Under TRICARE Prime, you will have an assigned military or civilian primary care manager who will oversee all aspects of your care, including referrals to specialists. As of 1 Oct 2001, active duty families that enroll in Prime will have no deductibles, cost-shares, or co-payments except for a nominal co-payment for prescriptions filled outside the (MTF). In addition to providing top quality health care, TRICARE Prime also guarantees access for all your health needs: urgent appointments available within 24 hours, routine appointments within seven days and referral for specialty care within 30 days. Emergency care is offered 24 hours a day. Furthermore, TRICARE Prime includes preventative health screening services such as periodic eye examinations, mammograms, cholesterol screening and a health risk assessment appraisal that many civilian health plans may not cover. Family members who wish to enroll in TRICARE Prime must complete an enrollment form. TRICARE Standard offers a greater choice of providers, but more out-of-pocket costs. Enrollment is not required, so there is no paperwork to complete. TRICARE For Life has expanded benefits for retirees or other beneficiaries who are Medicare eligible and have both Medicare Parts A & B. The following table provides a general comparison of the rates associated with TRICARE Prime, Extra and Standard for active duty and their family members.<br />Tricare PrimeTricare Standard & ExtraEnrollment fee$0 No enrollment fee.You do not have to enroll in TRICARE Standard and Extra to participate.  Coverage is automatic, as long as you remain eligible in the Defense Enrollment Eligibility Reporting System.Annual Deductible$0**If you are using the point-of-service (POS) option, which allows you to see any provider without a referral from your primary care manager, the following deductibles apply:POS outpatient annual deductible:$300/Individual $600/Family Note:  Active duty service members may not use the POS option. Active duty family members (sponsor rank E-4 and below):   $50/Individual $100/Family Active duty family members (sponsor rank E-5 and above)    $150/Individual $300/Family Note:  There is no annual deductible for care received in military treatment facilities.Outpatient Co-paymentsMilitary Treatment FacilityNo charge TRICARE Network Provider$0* Non-network ProviderWith PCM referral: $0 Without PCM referral: POS fees apply *POS Option: 50% of the TRICARE allowable charge, after the POS annual deductible is met. Active duty service members may not use the POS option.Military Treatment FacilityNo charge TRICARE Network Provider (Extra option)15% of negotiated fee after the annual deductible is met Non-network Provider (Standard option)20% of allowable charges after the annual deductible is met Inpatient HospitalizationMilitary Treatment FacilityNominal charges may apply Check with your local facility for details TRICARE Network Provider (Extra option)$15.65/day ($25 minimum charge) Non-network Provider (Standard option)$15.65/day ($25 minimum charge) <br />Additional information regarding your medical and dental benefits may be obtained by contacting the Patient Administration office at your base MTF, or your TRICARE Service Center. <br />Helpful Links:<br /><br /><br />DENTAL: The Air Force provides high quality, no-cost dental care for all active duty members. However, most active duty dental treatment facilities do not have the resources or manning to see family members, especially at stateside (CONUS) bases. The TRICARE Dental Program (TDP), currently administered through United Concordia, is available to family members of active duty and to National Guard/Reserve members and/or their families. Family members are strongly encouraged to enroll in the TDP as a means of having their annual dental needs met by a network of more than 64,000 participating dentists. Family members who are stationed overseas (OCONUS) are also encouraged to keep their TDP enrollment active in the event dental care is not readily available on base due to the mission requirements, manning/resource shortages or other reasons.<br />Active duty members who live and work greater than 50 miles from a military dental treatment facility (DTF) are considered “remote” members and will receive their dental care utilizing the remote Active Duty Dental Plan (ADDP), which is also currently operated through United Concordia. Remote active duty service members can personally coordinate their routine dental care (exams, cleanings and fillings) as long as the treatment is less than $500 per procedure/appointment or the cumulative total is less than $1,500 for treatment plans completed within a consecutive 12 month period. An explanation of the steps required to get an appointment control number from United Concordia for initiating dental care can be found on the ADDP website at and clicking on the “Active Duty Service Members” link.<br />National Guard/Reserve members who complete an initial sign up for the TDP will automatically be enrolled in the plan when not on active duty orders for >30 days and then re-enrolled upon their deactivation. Guard/Reserve family members are eligible for continuous dental coverage through the TDP even if their sponsor does not enroll. Retirees are not eligible for the TDP; however, Delta Dental manages a dental plan that allows retired military members to enroll for their dental care.<br />Monthly TDP premiums are cost-shared by the Department of Defense with the government paying 60% and the sponsor paying 40%. Currently, the active duty family member TDP monthly single premium for one family member is $12.69 and the monthly family premium is $31.72. The plan covers 100% of the cost for basic preventative and emergency services. Most specialty care fees are covered between 50-80% through the plan with the remaining cost share being paid by the members requiring the service. In addition, cost shares for periodontal, endodontic and oral surgery are lower for E-1’s to E-4s.<br />Additional information regarding your dental benefits may be obtained by talking to team members at your nearest DTF or at the resources listed below:<br />Helpful Links:<br /> <br /> <br />Delta Dental - 1-888-838-8737<br />