Thursday, April 7, 2011

Tri-Care Tips

Quick Tips from TRICARE® and Health Net Federal Services, LLC

Keep Your DEERS Information Up To Date!
It is essential to keep your information in the Defense Enrollment Eligibility Reporting System (DEERS) current for you and your family. Proper and current registration in DEERS is the key to receiving timely, effective TRICARE benefits, including doctors’ appointments, prescriptions, and payments of health care expenses. Below are several ways to update your information in DEERS.

Maximize Your TRICARE Prime Benefit

TRICARE Prime is a managed care option offering the most affordable and comprehensive coverage in Prime Service Areas (i.e., geographical areas where TRICARE Prime is offered). It is available to all beneficiaries who are not entitled to Medicare due to age (i.e., having turned 65). When you enroll in TRICARE Prime, you select or are assigned a primary care manager (PCM) who may be either at a military treatment facility (MTF) or may be a civilian TRICARE network provider. Your PCM provides most of your care and will refer you to a specialist for care he or she cannot provide.

If you are a TRICARE Prime beneficiary, avoid using the point-of-service (POS) option. The POS option allows TRICARE Prime beneficiaries to obtain medically necessary, TRICARE-approved services—inside or outside the TRICARE network—from someone other than his or her PCM without first obtaining a referral. Using the POS option results in higher deductibles and greater out-of-pocket expenses. Prior authorization requirements apply even if you are using the POS option. POS does not apply to:

Active duty service members
Beneficiaries with other health insurance
Emergency care

First eight behavioral health outpatient visits to a network provider for a medically diagnosed and covered condition per fiscal year (October 1–September 30)
Newborns or newly adopted children in the first 60 days after birth or adoption (as long as one other family member is enrolled in TRICARE Prime)

Maximize Your TRICARE Standard and TRICARE Extra Benefit
TRICARE Standard provides the most flexibility to eligible beneficiaries by allowing beneficiaries to see any TRICARE-authorized provider. There are no enrollment fees, but cost-shares and deductibles apply. Cost-shares for active duty family members (ADFMs) and TRICARE Reserve Select (TRS) members are 20 percent; for retirees, their families, and all others, cost-shares are 25 percent. Additionally, non-network providers may charge up to 15 percent above the TRICARE-allowable charge (by law), which is not reimbursed by TRICARE.

TRICARE Standard beneficiaries can use the TRICARE Extra option to see network providers and save 5 percent on cost-shares (reducing cost-shares to 15 percent for ADFMs and TRS members and 20 percent for retirees, their families, and all others). Network providers file claims on the beneficiary’s behalf and accept the TRICARE-allowable charge as payment in full. To locate a TRICARE network provider in the North Region, search the online provider directory at or contact Health Net Federal Services, LLC (Health Net) at 1-877-TRICARE (1-877-874-2273). You can also call providers’ offices to ask if they accept TRICARE and are part of the TRICARE network. TRICARE Standard beneficiaries now save money with cost-share waivers for many preventive health services, such as immunizations and screenings, including those for colorectal, prostate, breast, and cervical cancers.

Avoid Using the Emergency Room for Nonemergency Situations

In many cases, using the emergency room is unnecessary and can result in longer wait times and higher costs. You can often be treated more quickly at an MTF, your PCM, family doctor, or an urgent care center. The explanations of emergency and urgent care below can help you seek the most appropriate level of service. Emergency Care:
TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a “prudent layperson” (someone with average knowledge of health and medicine) to believe that a serious medical condition exists;
that the absence of immediate medical attention would result in a threat to life, limb, or sight; when a person has severe, painful symptoms requiring immediate attention to relieve suffering;
or when a person is at immediate risk to self or others. If you need emergency care, go to the nearest military or civilian emergency room, or call 911.Urgent Care:

TRICARE defines urgent care as medically necessary treatment for an illness or injury that would not result in further disability or death if not treated immediately, but that requires professional attention within 24 hours. Note: In most cases, TRICARE Prime beneficiaries can receive urgent care from their PCMs. If you are enrolled in TRICARE Prime and do not coordinate urgent care with your PCM or Health Net, the care will be covered under the POS option, resulting in higher out-of-pocket costs.

Avoid Denied Claims: Tell Us about Your Other Health Insurance

If you have other health insurance (OHI), you or your health care provider must file health care claims with your OHI before filing with TRICARE. A copy of your OHI’s payment determination and a copy of the itemized bill must be sent with your TRICARE claim.

Report Suspected Health Care Fraud or Abuse

Review your bill and TRICARE explanation of benefits carefully. If you have any questions or concerns, or if you suspect fraud or abuse, notify Health Net immediately by phone at 1-800-977-6761 or by e-mail at
Using Your TRICARE Pharmacy Home Delivery Benefit

TRICARE Pharmacy Home Delivery is your least expensive option for filling prescriptions when not using an MTF pharmacy. Home delivery allows you to receive up to a 90-day supply of your maintenance medications for the same price as a 30-day supply filled at your local retail network pharmacy. If you have a prescription and are a TRICARE-eligible beneficiary, you may order by mail, phone, fax, or online, and prescriptions are delivered with free standard shipping. Not all persons with Common Access Cards or uniformed services identification cards are eligible. If you would like to convert a current maintenance prescription to mail order, call the Member Choice Center at 1-877-363-1433, or use the online tool on the TRICARE Pharmacy Program Web site at

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