TRICARE

TRICARE is the United States military's health care plan for military personnel, military retirees, and their dependents. The TRICARE benefit is also available to some members of the Selected Reserve and their dependents. The TRICARE program is managed by TRICARE Management Activity (TMA) under the authority of the Office of the Assistant Secretary of Defense for Health Affairs (OSD/HA). TRICARE is the civilian care component of the Military Health System although historically, it also included health care delivered in the military medical treatment facilities.

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History

In 1956, the U.S. Congress passed the Dependents Medical Care Act, allowing the Department of Defense to provide civilian health care to dependents of military service members.

Following several amendments to the Dependents Medical Care Act, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) was established; first for Active Duty family members on October 1, 1966, and later for retired service members and their dependents, on January 1, 1967. This was a federally-funded health benefits program which provided supplemental care to that available in military and Public Health Service facilities, for retired U.S. military personnel, as well as dependents of active-duty, retired and deceased military. It provided authorized in-patient and out-patient care from civilian sources, when medically necessary, on a cost-sharing basis, and was administered by private parties under government contracts. All CHAMPUS beneficiaries moved over to Medicare at age 65.

After several demonstration projects in the 1980s, Congress and the DoD made numerous changes to the CHAMPUS program. The revised program became known as TRICARE in 1993. Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare-eligible, and "TRICARE Reserve Select" in 2005.

TRICARE's Options

TRICARE Standard

TRICARE Standard provides a similar benefit to the original CHAMPUS program. Under TRICARE Standard, beneficiaries can use any civilian health care provider that is payable under TRICARE regulations. The beneficiary is responsible for payment of an annual deductible and coinsurance, and may be responsible for certain other out-of-pocket expenses. There is no enrollment in TRICARE Standard.

TRICARE Extra

TRICARE Standard beneficiaries can elect to use the TRICARE Extra option by using a civilian health care provider from within the regional contractor's provider network. In this way, TRICARE Extra represents a preferred provider organization (PPO). When using TRICARE Extra, the beneficiary's coinsurance amount is reduced by at least five percentage points. There is no fee for use of the TRICARE Extra benefit other than the coinsurance.

TRICARE Prime

TRICARE Prime is a health maintenance organization (HMO) style plan. Under TRICARE Prime, beneficiaries must choose a primary care physician and obtain referrals and authorizations for specialty care. In return for these restrictions, beneficiaries are responsible only for small copayments for each visit. There is an annual enrollment fee for TRICARE Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members.

US Family Health Plan

US Family Health Plan, a TRICARE Prime-sponsored health plan option, is made available by nonprofit health care providers in the Northeast U.S., Southeast Texas/Southwest Louisiana, and the Puget Sound region of Washington state.

TRICARE Reserve Select [TRS]

TRICARE Reserve Select is a premium-based health plan that qualified National Guard and Reserve members may purchase. It requires a monthly premium and offers coverage similar to TRICARE Standard and Extra.

Program Administration

TRICARE Management Activity contracts with several large health insurance corporations to provide claims processing, customer service and other administrative functions to the TRICARE program. Currently, there are three regional Managed Care Support Contractors (MCSCs), a Medicare/TRICARE Dual Eligible Fiscal Intermediary Contractor (TDEFIC) and a TRICARE Pharmacy contractor, who administers both Mail Order Pharmacy (TMOP) and Retail Pharmacy (TRRx) programs. In addition several administrative contractors provide quality management, auditing and statistical services. TMA also oversees the TRICARE Dental Program (TDP) and TRICARE Retiree Dental Program (TRDP).

Regional Contractors

In 2004, TRICARE Management Activity re-aligned the previous twelve regions into three large regions, known as TRICARE North, TRICARE South, and TRICARE West. Services in these regions are provided by:

• North - Health Net Federal Services
• South - Humana Military Healthcare Services
• West - TriWest Healthcare Alliance

All medical claims are processed by the following claims processing sub-contractors:

• North and South - Palmetto Government Benefits Administration, or PGBA (a subsidiary of Blue Cross-Blue Shield of South Carolina}
• West and overseas claims - Wisconsin Physicians Service

National Contractors

• TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC) - Wisconsin Physicians Service
• TRICARE Mail Order Pharmacy (TMOP), TRICARE Retail Pharmacy (TRRx) - Express Scripts, Inc.

See also

• Military Health System
• Assistant Secretary of Defense for Health Affairs
• Extended Care Health Option

Secretary of the Army •  Secretary of the Navy •  Secretary of the Air Force