When an active duty service member arrives at a new duty station, he or she must update their DEERS and update their enrollment in TRICARE Prime. Active duty personnel have TRICARE Prime and are assigned their own primary care manager team based on their work location. This guarantees that active duty service members receive medical care in military clinics and hospitals, and the care is near their workplace. Once you have done that, you are encouraged to go to www.TRICAREOnline.com and register to allow you to book your primary care appointments online.
If the service member has family members, their DEERS and TRICARE information must also be updated. Family members and retirees under 65 may choose among three TRICARE options based on which plan best fits their needs. If family members choose TRICARE Prime and are assigned a Fort Lee primary care manager, then they may also register and book their appointments at www.TRICAREOnline.com.
TRICARE is a managed health care program managed by the military in conjunction with civilian contractors. Managed care means that you have a doctor or health care professional who serves as your personal health care manager. They can arrange referral appointments for specialty care when you need a specialist.
TRICARE serves active duty and retired members of the uniformed services, their families and survivors. Reservists and their family members are also covered by TRICARE, although coverage depends upon the length of the Reservist’s orders. TRICARE uses Army, Navy and Air Force health care with supplemental care from the civilian sector. This combination provides the best access and highest quality service for its beneficiaries.
WHO IS ELIGIBLE FOR TRICARE?
Active duty and retired members and their families, and survivors of all uniformed services who are not eligible for Medicare are all eligible for TRICARE. Reservists on active duty are covered by TRICARE (amount of coverage is based on length of orders), and their family members are covered when their Reservist’s orders are for more than 30 days.
Active duty service members (including Reservists) must update their DEERS information and enroll in TRICARE upon arrival at each new duty station, and they receive their TRICARE Prime benefit at the military clinic or hospital near where they work. For other beneficiaries, TRICARE offers three options for health care: TRICARE Prime, TRICARE Extra and TRICARE Standard. Call HealthNet at 1-877-TRICARE to learn which TRICARE option is best for you or your family. Service members are also encouraged to register at www.TRICAREOnline.com, which allows them to make appointments online 24/7. The Health Net Web site at www.healthnetfederalservices.com under the beneficiary portal also provides a wealth of health care information when it may be inconvenient to contact the Primary Care Manager, such as WebMD and ways to improve to a Healthy Living lifestyle.
When on military duty, Reservists are covered for any injury, illness or disease contracted or aggravated in the line of duty. This includes traveling directly to or from the place where they perform military duty. When ordered to active duty for more than 30 consecutive days, Reservists have comprehensive health care coverage under TRICARE. Family members of Reservists with orders for more than 30 days are eligible for all TRICARE options, including TRICARE Prime if they live within an hour’s drive of an MTF (they may enroll in Prime upon the sponsor’s activation). Upon demobilization, some Reservists and family members are eligible for an additional 120 days of TRICARE coverage under the Transitional Health Care Benefit. Contact our local TRICARE network contractor at 1-877-TRICARE for more information, or visit the beneficiary portal at www.healthnetfederalservices.com.
Military retirees and family members who are over 65 and have Medicare Part B have TRICARE For Life (TFL). TFL is the last payer after Medicare and other health insurance.
With this option, most health care is provided by a military treatment facility (MTF), and supplemented by our TRICARE Network civilian providers around the MTF. (All Active Duty Service Members and activated reservists/National Guardsmen must enroll in TRICARE Prime when they report to a new duty station.)
There is no enrollment fee for TRICARE Prime for Active Duty Family Members (ADFMs), but they must complete an enrollment form. Family members of reservists with orders for more than 30 days may enroll in TRICARE Prime upon activation.
Beneficiaries choosing TRICARE Prime have a Primary Care Manager who coordinates your health care needs and refers you to a specialist when you need one.
The Primary Care Manager also:
• Provides and coordinates your routine health care;
• Maintains your health records;
• Refers you to specialists, if necessary (specialty care must be arranged and approved by your Primary Care Manager).
• No enrollment fee for active duty and families;
• No cost shares for active duty family members (except for pharmacy, the Point-of-Service feature and the Extended Care Health Option); no costs for active duty member;
• Guaranteed appointments;
• Primary Care Manager supervises and coordinates care;
• Away-from-home emergency coverage.
If you have other health care insurance, TRICARE Prime may not be your best option. Call HealthNet at 1-877-TRICARE for more information, or contact the Fort Lee Health Benefits office at (804) 734-9447/9448 to discuss your options. Or you may visit the Fort Lee TRICARE Service Center at Kenner Army Health Clinic Monday – Friday, 0730-1630hrs.
Under this option, you choose a doctor, hospital or other medical provider listed from the Managed Care Support Contractor Provider Directory Listings. If you need help, contact HealthNet at 1-877-TRICARE. Anyone who is eligible for TRICARE Standard may use TRICARE Extra. TRICARE Extra offers savings over TRICARE Standard because the doctors and health care providers are in the TRICARE network.
• Co-payment is 5 percent less than TRICARE Standard;
• No balance billing;
• No enrollment fee;
• No forms to file; and
• You may also use TRICARE Standard.
• Annual deductible must be met;
• 0% cost share when seen by civilian network provider; and
• Care is only on a space available basis at a military facility.
With this option, you have the most flexibility to see the authorized provider of your choice. People who are happy with coverage from a current civilian provider often choose this plan. But having this flexibility means that care generally costs more out of your pocket. Any needed treatment may be available at a military facility, if space allows and after TRICARE Prime patients have been served. This option may be used by beneficiaries who have other health insurance (TRICARE Standard becomes the last payer).
• Broadest choice of providers;
• Widely available;
• No enrollment fee; and
• You may also use TRICARE Extra.
• Annual deductible must be met;
• 25% cost share when seen by civilian non-network provider;
• You may have to file your own claims;
• Care may not be available at military facility; and
• Highest cost
The Pharmacy benefit has four options to meet your needs. Your best option is the Military Treatment Facility or Clinic Pharmacy where there is no cost to you for prescriptions.
With the TMOP (TRICARE Mail Order Pharmacy), you can receive up to a 90-day supply of your medication – generics for $3, or name-brand for $9. Your medication is delivered postage-paid to your door through the U.S. Mail. This option works well for maintenance medications (including birth control pills) that are used on a regular basis. TMOP cannot be used by individuals with Other Health Insurance.
TRICARE Network Pharmacies are pharmacies in town that have contracted with TRICARE to fill your prescriptions. The co-pay for a 30-day supply is $3 for generics and $9 for name-brand drugs. The TRICARE Pharmacy Network now extends coast to coast, so if you are traveling and need to use a network pharmacy, it is no longer necessary to pay the full price upfront and seek reimbursement.
If these options are not available, you may use a non-Network Pharmacy, but your out-of-pocket costs will be higher. There is an annual deductible for this option plus a $9 or 20 percent cost share (whichever is greater). You may have to pay the bill upfront and then file a claim for reimbursement.
If you are seeking a prescription for a drug that is not on the TRICARE formulary, then your out-of-pocket expenses are increased to $22 through either a 30-day supply at a local network pharmacy or a 90-day supply through TMOP. As always, you and the government save money when you use the MTF and TMOP options to fill your prescriptions.