1. ATTENTION PRESENTER: To ensure that those using TRICARE get the most up-to-date information about their health benefit, you must go to for the latest version of this briefing before each presentation. Briefings are continuously updated as benefit changes occur.
Presenter Tips:
Review the briefing with notes prior to your presentation.
Remove any slides that don’t apply to your audience.
Review the Other Important Information briefing slides and the Costs briefing slides at to identify any additional slides to include in your presentation.
Launch the briefing in “slide show” setting for your presentation.
Estimated Briefing Time: 45 minutes
Target Audience: Wounded, ill and injured service members and their families.
TRICARE Resources: Go to to view, print or download copies of TRICARE educational materials. Suggested resources include Resources for Service overview, Transitional Assistance Management Program fact sheet, Transitioning From Active Duty to Retirement fact sheet and Costs and Fees sheet.
Briefing Objectives:
Help service members and their family members understand their TRICARE benefit and navigate TRICARE, Medicare and Department of Veterans Affairs benefits
Prevent eligible service members from losing their TRICARE benefit
Optional Presenter Comments: Welcome to the Wounded, Ill and Injured Service Members briefing. The goal of today’s presentation is to give you a general understanding of your TRICARE benefit so you and your family can get the health care services you need.

2. During today’s briefing, we will discuss:
What TRICARE is
The Integrated Disability Evaluation System, or IDES, and the impact it has on your TRICARE benefit based on the determination to return to active duty, separate from active duty or retire
Dual eligibility between TRICARE and the Department of Veterans Affairs, or VA, and TRICARE and Medicare
TRICARE benefit information, such as pharmacy and dental benefits
Important resources for more information
To learn more about TRICARE options, go to
To get TRICARE news and publications by , sign up at
To sign up for s about your eligibility and enrollment changes, go to
Note: We will give an overview of IDES and some basic information on VA and Medicare benefits; however, the information provided is not all-inclusive. Resources will be provided throughout the presentation to help you find the additional benefit information you need.

3. Optional Presenter Comment: First we will discuss what TRICARE is.

4. What Is TRICARE? Uniformed services health care program
Worldwide network
Military hospitals and clinics
Civilian health care providers
TRICARE is the uniformed services health care program for active duty service members, or ADSMs, active duty family members, or ADFMs, certain National Guard and Reserve members and their family members, retirees and retiree family members, survivors and certain former spouses worldwide.
Note: Throughout this presentation, the term “family members” refers to dependents of service members who are eligible to use TRICARE.
TRICARE brings together the health care resources of the Military Health System—such as military hospitals and clinics—with a network of civilian health care professionals, institutions, pharmacies and suppliers to foster, protect, sustain and restore health for those entrusted to their care.

5. TRICARE Stateside Regions
Health Net Federal Services, LLC
UnitedHealthcare
Military & Veterans
TRICARE is available worldwide. There are three TRICARE regions in the U.S.—TRICARE North, TRICARE South and TRICARE West.
Your TRICARE benefit is the same regardless of where you live, but there are different customer service contacts for each region.
TRICARE partners with civilian regional contractors to manage the TRICARE health benefit in the three regions. Health Net Federal Services, LLC administers the benefit in the North Region, Humana Military administers the benefit in the South Region and UnitedHealthcare Military & Veterans administers the benefit in the West Region.
Your regional contractor is your primary resource for information and assistance about your TRICARE benefit.
Each regional contractor maintains a website and toll-free customer service call center to assist you with your questions and concerns about issues, such as eligibility, referrals and prior authorizations, claims, appeals and fraud.
Contact information for each region will be provided at the end of this presentation.
Separate contractors administer TRICARE’s dental and pharmacy benefits. You can go to and for more information.
Humana Military

6. TRICARE Overseas Program
International SOS Government Services, Inc., or International SOS, administers the TRICARE Overseas Program, or TOP, benefit.
There is one overseas region divided into three geographic areas: Latin America and Canada, Eurasia-Africa and the Pacific.
Contact information for your area will be provided at the end of this presentation. If you are relocating overseas, keep the contact information for your area close at hand.

7. Keep DEERS Information Up To Date
Go to an ID card office. Find an office at
Note: You must use this option to add family members in DEERS.
Log on to
Call
You must be registered in the Defense Enrollment Eligibility Reporting System, or DEERS, to use TRICARE. DEERS is a database of service members and dependents worldwide who are eligible for military benefits. After you are registered in DEERS, you can get a uniformed services ID card.
Sponsors are automatically registered in DEERS.
Sponsors must add their family members in DEERS for them to use TRICARE. If a sponsor is not available, a person with power of attorney from the sponsor may add family members to DEERS.
To add family members, go to an ID card office. You can find an office at
You must have appropriate paperwork, such as a marriage certificate, birth certificate and/or adoption papers.
Once added, family members age 18 and older may update their own contact information.
You must update DEERS when you have life changes, such as moving, getting married or divorced or adopting or having a child.
Go to to check your eligibility and update your contact information. You can also update your information by phone or fax or by going to an ID card office. Log in using your Common Access Card, or CAC, Defense Finance and Accounting Service, or DFAS, myPay PIN, or DoD Self-Service, or DS Logon.
For more information, go to
Fax

8. Optional Presenter Comment: Next we will discuss the Integrated Disability Evaluation System.

9. Overview
Integrated Disability Evaluation System (IDES): A system for determining if service members coping with wounds are able to continue to serve. Upon referral and examination, it consists of the following:
Phase 1: Medical Evaluation Board–Medical officers review examination summaries within your IDES case file and determine the appropriate diagnosis and whether you may return to full, unrestricted duty. Questionable determinations proceed to the Physical Evaluation Board.
Phase 2: Physical Evaluation Board–A formal fitness-for-duty board determines your continuation of service or recommends separation or temporary or permanent retirement.
Phase 3: Transition–You transition to civilian life or reintegrate into military service.
The Integrated Disability Evaluation System, or IDES, is a system for determining if service members coping with wounds are able to continue to serve. Upon referral and examination, it consists of the following:
Phase 1: Medical Evaluation Board–Medical officers review examination summaries within your IDES case file and determine the appropriate diagnosis and whether you may return to full, unrestricted duty within a reasonable amount of time. If medical retention standards are met, then you can return to full duty in your current job. If medical retention standards are determined to be questionable, your case is forwarded to the Physical Evaluation Board.
Phase 2: Physical Evaluation Board–A formal fitness-for-duty board determines your continuation of service and return to duty or the percentage of your disability compensation and recommends separation or temporary or permanent retirement.
Phase 3: Transition–You transition to civilian life or reintegrate into military service based upon the recommendation from the Physical Evaluation Board.
For more information on IDES, contact your military primary care manager, or PCM.

10. Optional Presenter Comment: Next we will discuss your TRICARE benefit during active duty.

11. TRICARE Standard and TRICARE Extra TOP options
ADSMs must remain enrolled or reenroll in TRICARE Prime, TRICARE Prime Remote (TPR), TOP Prime or TOP Prime Remote
ADFM options:
TRICARE Prime, TRICARE Prime Remote for Active Duty Family Members and the US Family Health Plan (where available)
TRICARE Standard and TRICARE Extra
TOP options
If the Physical Evaluation Board determination is for you to return to active duty, you must stay enrolled or reenroll in TRICARE Prime or TRICARE Prime Remote, or TPR. Overseas, you must enroll in TOP Prime or TOP Prime Remote.
Note: To be eligible for TPR, the active duty sponsor must live and work 50 miles from the nearest military hospital or clinic in a TPR-designated ZIP code. ADFMs must live with the TPR-enrolled sponsor in a designated stateside TPR location.
Your family members may be eligible for TRICARE Prime, TRICARE Prime Remote or TRICARE Standard and TRICARE Extra stateside, or TOP Prime, TOP Prime Remote and TOP Standard overseas.
Family members living in certain areas are also eligible for the US Family Health Plan, or USFHP, which is a TRICARE Prime option available in six designated areas across the U.S. For more information, go to
Note: In most cases, only command-sponsored family members who accompany their active duty sponsor on his or her orders overseas may be enrolled in TOP Prime options.

12. Additional Benefits for Injured Service Members
Home health care supplies and services
Training, rehabilitation, special education and assistive technology and services
Institutional care and associated transportation (when appropriate)
Respite care for the primary caregiver
Note: Certain services may be limited or unavailable overseas.
Additional benefits may be available to injured homebound service members and their caregivers. These benefits include:
Inpatient, outpatient and comprehensive home health care supplies and services
Training, rehabilitation, special education and assistive technology and services
Long-term care in private, not-for-profit, public and state institutions and facilities and transportation to and from such institutions and facilities (when appropriate)
Respite care, or temporary relief, for the primary caregiver of the injured service member
Note: Certain services may be limited or unavailable overseas.
For more information, contact your PCM, care coordinator or benefits adviser about services that may be available to you. Overseas, contact your TOP Regional Call Center for more information.

13. ADSM Respite Care
Short-term care to provide rest for the primary caregiver
Provided when the care plan includes frequent interventions
Benefit limitations:
Forty hours per calendar week
Five days per calendar week
Eight hours per calendar day
Must be provided by a TRICARE-authorized home health agency
ADSM respite care covers respite care for ADSMs who are homebound as a result of a serious injury or illness they got while serving on active duty. Respite care is short-term care that provides rest for the people who care for the patient at home and help with activities of daily living. Although this is usually the patient’s family, it may be a relative or friend.
The service member’s case manager or another authority may approve respite care when the care plan includes frequent primary caregiver interventions, which is generally more than two specific actions during the eight-hour period per day that the primary caregiver would normally be sleeping.
Respite benefits are limited to:
Forty respite hours in a calendar week
No more than five days per calendar week
No more than eight hours per calendar day
Care must be provided by a TRICARE-authorized home health agency and requires prior authorization from your regional contractor and the ADSM’s approving authority, which is the Defense Health Agency—Great Lakes or the referring military hospital or clinic. The ADSM doesn’t have to be registered in the Extended Care Health Option to get the respite benefit.

14. Optional Presenter Comment: Next we will discuss your TRICARE benefit while separating from active duty.

15. Transitional Health Care Coverage
Helps with the transition to civilian life
Programs available for those who qualify:
Transitional Assistance Management Program (TAMP)
Continued Health Care Benefit Program (CHCBP)*
Those transitioning to National Guard or Reserve:
May qualify for TRICARE Reserve Select (TRS)
More information, go to
Active duty coverage ends on your last day of active duty service
Possible VA benefit eligibility
If the Physical Evaluation Board determination is for you to separate from military service, you should be aware of TRICARE’s transitional coverage options. TRICARE provides transitional health care coverage to protect you and your family between military and civilian health care coverage.
You may be eligible for or qualify to purchase the following programs:
The Transitional Assistance Management Program, or TAMP
The Continued Health Care Benefit Program, or CHCBP
Note: The full-cost, premium-based CHCBP provides continued health coverage for beneficiaries who lose TRICARE eligibility.
We will discuss both programs in greater detail later in this presentation.
If you are transitioning to the National Guard or Reserve, you may qualify for TRICARE Reserve Select, or TRS. For more information about TRS, go to
If you are not eligible for TAMP and don’t purchase TRS or CHCBP, TRICARE benefits end for you and your family members on your last day of active duty service—even if you are getting ongoing treatment and/or have a valid authorization dated later than your last day of active duty service.
You may become eligible for VA benefits. We will discuss how to apply for VA benefits later in this presentation.
* The full-cost, premium-based CHCBP provides continued health coverage for beneficiaries who lose TRICARE eligibility.

16. TAMP provides 180 days of transitional health care benefits to help certain uniformed service members and their families transition to civilian life.
The services determine TAMP eligibility and DEERS reflects that status. If you have questions about your eligibility, contact your personnel office and/or command unit representative.
If eligible, the 180-day TAMP period begins the day after you separate from active duty.
Under TAMP, you and your eligible family members are covered as ADFMs. You are automatically covered by TRICARE Standard and TRICARE Extra and may choose to enroll or reenroll in TRICARE Prime if you live in a Prime Service Area, or in TOP Prime, if available. You may also choose to enroll in USFHP, if available.
Note: TPR and TOP Prime Remote are not available under TAMP.
For more information, go to

17. TRICARE Prime® Enrollment During TAMP
Enroll in TRICARE Prime:
Online: Enroll on the Beneficiary Web Enrollment (BWE) website:
Phone: Call your regional contractor
Mail: Download and submit a TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (DD Form 2876) at
Overseas information:
If you and your family members were enrolled in a TRICARE Prime or TOP Prime option while you were on active duty and want TRICARE Prime coverage during the TAMP period, you must reenroll.
As long as your enrollment form is received before the TAMP period expires, TRICARE Prime coverage will continue without interruption.
If you don’t reenroll, your coverage will convert to TRICARE Standard and TRICARE Extra or TOP Standard.
If your dependents were not previously eligible for enrollment in TRICARE Prime, they are not eligible to enroll in TRICARE Prime during the TAMP period.
Note: TPR and TOP Prime Remote are not available during TAMP.
There are three ways to enroll in TRICARE Prime.
To enroll online, use the Beneficiary Web Enrollment, or BWE, website at
To enroll by phone, call your regional contractor using the contact information provided at the end of this briefing.
To enroll by mail, download the TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form, which is DD Form 2876, and submit it to your regional contractor at the mailing address provided on the form.
To enroll in TOP Prime, call your regional contractor or submit DD Form 2876 by mail. For more information, go to
Note: Remember to verify eligibility in DEERS anytime there is a change in sponsor or family status.

18. Transitional Care for Service-Related Conditions
Extends TAMP coverage for 180 days for individual conditions
The condition must be:
Service-related
First discovered or diagnosed during the TAMP period
Validated by a Department of Defense (DoD) health care provider  
Able to be resolved within 180 days
Submit the request and justification to the Defense Health Agency—Great Lakes
More information:
The Transitional Care for Service-Related Conditions program, or TCSRC, extends TRICARE coverage for individual service-related conditions that are identified during the 180-day TAMP period.
Note: TCSRC is not available for ADFMs.
To qualify for TCSRC, you must be eligible for TAMP and have a medical condition that is:
Service-related
First discovered or diagnosed during the 180-day TAMP period
Validated by a DoD health care provider
Able to be resolved within 180 days from the date the condition is validated
If your DoD provider identifies a service-related condition during your TAMP period, send a TCSRC request letter and application worksheet along with justification to the Defense Health Agency—Great Lakes.
For more information, or to download a sample letter and the application worksheet, go to
If the request is accepted, you will get medical care for that specific condition as if you were an ADSM for up to 180 days, even if it extends beyond your TAMP period.

19. Continued Health Care Benefit Program
Full-cost, premium-based continued health care coverage
Available immediately after TRICARE coverage ends
Available for up to 18–36 months after previous coverage ends
Similar to TRICARE Standard but with premium payments
Administered by Humana Military
Once regular TRICARE eligibility ends, you may qualify for participation in the full-cost, premium-based CHCBP, which provides continued health coverage for beneficiaries who lose TRICARE eligibility. CHCBP is administered by Humana Military.
If you qualify, CHCBP provides you and your family with continued health care coverage for 18 to 36 months after you lose your military health care benefits.
CHCBP is not a TRICARE program, but it offers coverage comparable to TRICARE Standard with similar benefits, providers and program rules. The main differences are that premium payments are required, and those with CHCBP are not legally entitled to routine, urgent or specialty care at military hospitals and clinics or to military pharmacy services.
CHCBP is available to former uniformed service members, their qualified family members, former spouses who haven’t remarried before reaching age 55 and dependent children.
Participation is optional and must be purchased in 90-day increments.
For more information, go to

20. Enrolling in CHCBP
You must enroll in CHCBP within 60 days of qualifying for coverage.
To enroll, submit:
A completed Continued Health Care Benefit Program (CHCBP) Application (DD Form 2837):
Download the form at HumanaMilitary.com
Call Humana Military at
Full payment for the first 90 days of coverage from the date of eligibility
Certificate of Release or Discharge from Active Duty (DD Form 214) (if applicable)
To be covered under CHCBP, you must enroll within 60 days of qualifying for coverage.
Note: CHCBP premiums must be paid from the date of initial eligibility—not the date of enrollment.
To enroll, fill out the Continued Health Care Benefit Program (CHCBP) Application (DD Form 2837), which you can get by going to HumanaMilitary.com or calling Individual coverage is available to sponsors, certain former spouses who haven’t remarried and adult children. Family coverage is only available to former service members and their dependents. Dependents can’t enroll unless the sponsor enrolls.
Make a premium payment for the first 90 days of coverage from the date of initial eligibility.
Go to for information on costs.
If applicable, include in your enrollment submission a Certificate of Release or Discharge from Active Duty (DD Form 214).

21. Transitional Coverage Timeline
TAMP-Eligible
Last day of active duty
Last day of TAMP (day 180)
TAMP period begins (day 1)
CHCBP qualification begins (day 181)
Not TAMP-Eligible
This chart shows the timeline for transitional health care benefits.
If eligible, the 180-day TAMP period begins the day after you separate from active duty service.
For continuous TRICARE Prime coverage during TAMP, you must reenroll in TRICARE Prime before the end of the TAMP period.
If you qualify to purchase CHCBP, your qualifying period for purchasing CHCBP begins the day after you separate from active duty service, or if applicable, the day after your TAMP period ends.
Remember, enrollment in CHCBP must occur within 60 days of qualifying for coverage.
Last day of active duty
CHCBP qualification begins (day 1)

22. TRICARE Reserve Select®
Selected Reserve members may qualify for TRS if they are not eligible for or enrolled in the Federal Employees Health Benefits (FEHB) Program.
Log on to the Defense Manpower Data Center (DMDC) Reserve Component Purchased TRICARE Application:
If qualified, print and sign the completed Reserve Component Health Coverage Request form (DD Form ).
Mail the completed form to the TRICARE contractor address listed.
Make an initial premium payment as indicated on the form. The initial payment required is two months of premiums.
Note: For continuous coverage, purchase TRS up to 60 days before TAMP ends, but no later than 30 days after TAMP ends.
If you transition to the Selected Reserve, you may qualify to purchase TRS. TRS is a premium-based health plan available for purchase by qualified members of the Selected Reserve and their families.
TRS is a comprehensive health plan similar to TRICARE Standard and TRICARE Extra (in the U.S.) or TOP Standard (overseas). You may purchase member-only or member-and-family coverage.
You won’t qualify for TRS if you are eligible for the Federal Employees Health Benefits, or FEHB, Program based on civilian employment or if enrolled in FEHB through a family member.
Note: Contact your Reserve component personnel office with any questions on qualifying for TRS.
To determine qualification and purchase coverage, go to the Defense Manpower Data Center, or DMDC, Reserve Component Purchased TRICARE Application at Use one of the following to access the website:
CAC
DFAS myPay PIN
DS Logon
Follow the instructions to complete, print and sign the Reserve Component Health Coverage Request form, which is DD Form
Mail the completed and signed form along with the premium payment amount indicated on the form. The initial payment required is two months of premiums.
Note: For TRS, to ensure continuous coverage for members who become eligible for benefits under TAMP, submit a TRS application up to 60 days before or no later than 30 days after TAMP ends.

23. Optional Presenter Comment: Next we will discuss your TRICARE benefit during retirement.

24. Retiring from Active Duty Service
Terminal leave
Retiree program options:
TRICARE Prime (if in a Prime Service Area), including USFHP
TRICARE Standard and TRICARE Extra
TRICARE For Life (TFL)
If your Physical Evaluation Board determination results in retirement, you will become eligible for retiree benefits.
If you have accrued leave during your military career, you may take terminal leave prior to retirement.
You must remain enrolled at your final duty station and get referrals and prior authorizations from your PCM and regional contractor where you are enrolled.
Your family members can remain enrolled in their current program and location, transfer enrollment to a new location or switch to another available program option.
You and your family members will be automatically covered by TRICARE Standard and TRICARE Extra when your status changes to “retired” in DEERS, unless you enroll or reenroll in TRICARE Prime. Note: This may not apply to Medicare-eligible beneficiaries.
Under TRICARE Standard and TRICARE Extra, you can see any TRICARE-authorized provider for care.
Referrals aren’t required, but prior authorizations may be needed for certain services.
When you retire and are under age 65, you may enroll in TRICARE Prime even if you are Medicare- eligible. You may enroll in TRICARE Prime if you live in a Prime Service Area in the U.S. or, if you waive your drive-time access standards, within 100 miles of an available PCM.
TRICARE Prime for retirees and family members is similar to TRICARE Prime for active duty beneficiaries, but you will be responsible for a yearly enrollment fee and copayments.
If you choose to enroll in TRICARE Prime, you will have a PCM dedicated to your care and you must follow TRICARE Prime referral and prior authorization requirements. Note: Retirees can’t enroll in TOP Prime or TPR options.
You may also enroll in USFHP. For more information, go to
If you or a family member is or becomes entitled to premium-free Medicare Part A and has Medicare Part B, you will be covered by TRICARE For Life, or TFL, TRICARE’s Medicare-wraparound coverage. We will talk more about this later.

25. TRICARE Prime Enrollment
You must reenroll to be covered by TRICARE Prime.
To reenroll:
Use the BWE website at
Call your regional contractor (once your retired status is showing in DEERS).
Download and submit a TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (DD Form 2876) available at
While you are automatically covered by TRICARE Standard and TRICARE Extra when your status is changed to retired in DEERS, you must reenroll to be covered by TRICARE Prime.
You must reenroll in TRICARE Prime before or within 30 days after your retirement date to have continuous TRICARE Prime coverage. The effective date of coverage will be the date of your retirement. If you sign up more than 30 days after your retirement, your request will be considered an initial enrollment in TRICARE Prime and the 20th-of-the-month rule applies. The 20th-of-the-month rule is as follows:
For an initial enrollment in TRICARE Prime received on or before the 20th of the month, your coverage will begin the first day of the following month (for example, coverage for an initial enrollment received Jan. 20 or before would begin Feb. 1). For an initial enrollment received after the 20th of the month, your coverage will begin the first day of the month following the next month (for example, coverage for an initial enrollment received Jan. 21 would begin March 1).
There are three ways to reenroll in TRICARE Prime:
Use the BWE website at
Call your regional contractor using the contact information provided at the end of this briefing. The sponsor’s retirement date must be showing in DEERS before enrolling by phone.
Download a TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (DD Form 2876) and submit it to your regional contractor at the mailing address provided on the form.
Note: The service member doesn’t have to be enrolled for a family member to enroll. Some family members can use TRICARE Standard and TRICARE Extra while others enroll in TRICARE Prime. TRICARE Extra is not available overseas.
For more information, go to

26. TRICARE For Life
TFL is available to TRICARE beneficiaries who have Medicare Part A and Medicare Part B, regardless of age or where they live.
Get care from any Medicare provider. You may seek military hospital or clinic care on a space-available basis.
TRICARE is the last payer after Medicare (and other health insurance [OHI], if applicable).
The TFL benefit is administered by Wisconsin Physicians Service (WPS)—Military and Veterans Health.
TFL is Medicare-wraparound coverage for TRICARE beneficiaries who have Medicare Part A and Medicare Part B, regardless of age or where they live.
With TFL, you can get care from any Medicare-participating or nonparticipating provider. Care is also available at military hospitals and clinics on a space-available basis. For overseas locations outside of the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands) see any purchased care sector provider for care. A purchased care sector provider is a TRICARE-authorized civilian provider in your overseas area.
There are no enrollment fees for TFL.
Medicare-participating providers file your claims with Medicare. After Medicare pays its portion, Medicare forwards the claim automatically to TRICARE and TRICARE pays the provider directly (unless you have OHI).
Wisconsin Physicians Service—Military and Veterans Health, or WPS, is the contractor for TFL claims processing and customer service in the U.S. and U.S. territories. If you are using TFL, WPS is your primary contact for TRICARE-related customer service needs. We will discuss TFL in more detail later in the briefing.
WPS Information 

27. Using TFL Overseas
For overseas locations outside the U.S. and U.S. territories, TFL works like TRICARE Standard and you may visit any purchased care sector provider for care.*
Claims are filed with the TOP claims processor.
For more information, go to
Overseas, when getting health care from purchased care sector providers, expect to pay for your care at the time of service. You are responsible for filing claims with the TOP claims processor for reimbursement. For more information, go to
Since Medicare can’t make any payments on overseas claims, the TOP claims processor can process the claim without evidence of processing by Medicare.
Note: If you live or travel in the Philippines, you are required to see a certified provider for care. Additionally, TOP Standard beneficiaries who live in the Philippines and who seek care within designated Philippine Demonstration areas must see approved demonstration providers to ensure TRICARE cost-shares your claims, unless you request and get a waiver from Global 24 Network Services. For more information, go to
For more information, go to
* If you live or travel in the Philippines, you are required to see a certified provider for care. Additionally, TOP Standard beneficiaries who live in the Philippines and who seek care within designated Philippine Demonstration areas must see approved demonstration providers to ensure TRICARE cost-shares your claims, unless you request and get a waiver from Global 24 Network Services. For more information, go to .

28. Optional Presenter Comment: Next we will discuss dual eligibility.

29. TRICARE and VA Benefits
To submit an application for VA benefits:
Download the form at
Request an application by calling VETS ( )
If you’re in TRICARE Prime, get care from your PCM unless your PCM is located at a VA facility.
If not enrolled in TRICARE Prime, get care from any VA facility using TRICARE Standard and TRICARE Extra.
Care for service-connected conditions must be received under VA benefits.
If you are entitled to Medicare Part A and have Medicare Part B, you are eligible for TFL and are advised to seek care for non-service connected conditions from Medicare-participating or nonparticipating providers.
If your Physical Evaluation Board determination results in separation or retirement, you may be eligible for VA benefits or dual eligible for TRICARE and VA benefits.
To begin receiving your VA benefits, fill out and submit the Application for Health Benefits, which is VA Form 10-10EZ.
Fill out and submit the form online, download a paper form and mail or fax it to the VA or request an application by calling the VA.
Note: Some service members may not be required to submit an application to get care, depending on the disability rating and the services sought. However, it is recommended that all beneficiaries fill out the form for the best possible coordination of care.
The VA will determine your eligibility status as a veteran by reviewing your active duty determination and length of active duty service.
If you are eligible for care under TRICARE and VA benefits, you may use your TRICARE benefit at a VA facility if you’re in TRICARE Prime and your PCM is located at a VA facility.
If you aren’t in TRICARE Prime, you may get care from any VA facility using TRICARE Standard and TRICARE Extra.
VA providers can’t bill Medicare and Medicare can’t pay for services you get from the VA. If you are eligible for both TFL and VA benefits and choose to use your TFL benefit for non-service-connected care, you will incur significant out-of-pocket expenses when seeing a VA provider. By law, TRICARE can only pay up to 20 percent of the TRICARE-allowable amount. If you get care at a VA facility, you may be responsible for the remaining amount. When using your TFL benefit, your least expensive options are to see a Medicare-participating or Medicare-nonparticipating provider.
Care you get at the VA for service-connected conditions must be received under VA benefits.

30. Social Security Disability Benefits
You may qualify for Social Security benefits if:
You are unable to do the work you did before your disability.
You are unable to adjust to other work because of your medical condition(s).
Your disability has lasted or is expected to last for at least one year or is terminal.
Apply for disability benefits:
Online:
Request an application by phone:
If your medical condition prevents you from working, is expected to last for at least one year, or is considered terminal, you may qualify for Social Security disability benefits.
You can apply for Social Security disability benefits online or request an application by calling the Social Security Administration.

31. TRICARE and Medicare
You should start getting Social Security disability benefits the sixth full month after the date your disability began.
You will be entitled to Medicare in the 25th month of getting disability benefits.
You should get a Medicare Initial Enrollment Package about 3½ months before Medicare benefits begin.
You must actively enroll and/or keep Medicare Part B to stay eligible for TRICARE benefits under TFL.
Medicare becomes your primary payer, unless you see an opt-out provider.
If your Physical Evaluation Board determination results in retirement, you may be dual eligible for TRICARE, Medicare and/or VA benefits.
If you are approved for disability benefits, your first Social Security benefit will be paid the sixth full month after the date your disability began.
You will become eligible for Medicare in the 25th month of getting disability benefits.
You should get a Medicare Initial Enrollment Package about three-and-a-half months before your Medicare benefits begin. The package will include a welcome letter, a Medicare booklet, a Medicare card showing you have Medicare Part A and Medicare Part B and a return envelope.
If you are on temporary or permanent disability retirement and eligible for Medicare, you must keep Medicare Part B to remain eligible for TRICARE benefits, regardless of your age.
If you have Medicare Part A and Part B, you will be covered by TFL, TRICARE’s Medicare- wraparound coverage. When you are covered by TFL, Medicare is your primary health care payer, and you should follow Medicare’s rules for getting care.
When seeing an opt-out provider for services covered by Medicare and TRICARE, TFL will process the claim as the second payer unless you have OHI. TFL pays the amount it would have paid if Medicare had processed the claim, which is normally 20 percent of the TRICARE-allowable charge. You are responsible for the remainder of the billed charges, including care you get from VA providers, who are not Medicare providers and can’t bill Medicare.

32. TRICARE For Life: Getting Care
With TFL, Medicare provides coverage only in the U.S., U.S. territories and aboard ships in U.S. territorial waters.
To find a Medicare provider, go to
Military hospital and clinic care is provided on a space-available basis (space is limited).
Overseas, TFL:
Is the primary payer (unless you have OHI)
Works like TOP Standard with the same cost-shares and deductibles for beneficiaries who live or travel overseas
For more information, contact WPS at or
With TFL, you can get care from any Medicare provider in the U.S. and U.S. territories and aboard ships in U.S. territorial waters.
Medicare does not pay for health care services overseas, except aboard ships in U.S. territorial waters.
Go to the Medicare website to find a provider.
Care is also available at military hospitals and clinics, but only on a space-available basis. Space can be very limited.
TFL is your primary payer for health care in all other overseas locations, unless you have OHI.
TFL provides the same coverage as TOP Standard and has the same cost-shares and deductibles for beneficiaries who live or travel overseas.
WPS is the contractor for TFL claims and customer service in the U.S. Overseas, International SOS administers the TFL benefit.
For more information, contact WPS at or
Note: If you are under age 65, you may choose to enroll in a TRICARE Prime option. Beneficiaries under age 65 who are in TRICARE Prime and have Medicare Part A and Part B may get care at military hospitals and clinics with priority access to their PCM. These appointments are not on a space-available basis. 32

33. Optional Presenter Comment: We will now discuss TRICARE benefit information.

34. Pharmacy Options Military Pharmacy
Usually inside military hospitals and clinics
Get up to a 90-day supply
TRICARE Pharmacy Home Delivery
Must use this option for some drugs
Get up to a 90-day supply
TRICARE Retail Network Pharmacy
Fill prescriptions without submitting a claim
Get up to a 30-day supply
TRICARE offers prescription drug coverage and many options for filling your prescriptions. Your options depend on the type of drug your provider prescribes. The TRICARE pharmacy benefit is administered by Express Scripts. To learn more, go to or call
You have the same pharmacy coverage with any TRICARE program option. If you have USFHP, you have separate pharmacy coverage.
To fill a prescription, you need a prescription and a valid uniformed services ID card or CAC.
This slide shows the options that may be available for filling your prescriptions:
Military pharmacies are usually inside military hospitals and clinics. Call your local military pharmacy to check if your drug is available. Go to for more information.
The TRICARE Pharmacy Home Delivery option must be used for some drugs. You will pay one copayment for each 90-day supply. For more information on switching to home delivery, go to or call
You may fill prescriptions at TRICARE retail network pharmacies without having to submit a claim. You will pay one copayment for each 30-day supply. Go to to find a TRICARE retail network pharmacy.
At non-network pharmacies, you pay the full price for your drug up front and file a claim to get a portion of your money back.
Your pharmacy will most often fill your prescription with a generic drug. If you need a brand-name drug, your provider can send a request to Express Scripts.
For more information and costs, go to
Pay full price up front and file a claim to get a portion of your money back
Get up to a 30-day supply
Non-Network Pharmacy

35. Dental Program Options
Active duty dental care:
Available to ADSMs
Get care through military dental clinics or, in remote overseas locations, dental care will be coordinated by the TOP contractor
Active Duty Dental Program (ADDP):
Available to ADSMs in the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands)
For more information:
Active duty dental care is available to ADSMs.
Get care through military dental clinics. In remote overseas locations, your dental care will be coordinated by the TOP contractor.
The Active Duty Dental Program, or ADDP, provides civilian dental care to ADSMs in the U.S. and U.S. territories, which consists of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands, who are unable to get required care from military dental care providers.
The ADDP is a DoD dental program. The benefit is administered by United Concordia Companies, Inc. (United Concordia).
Care is provided to ADSMs who get referrals from their military dental care providers or prior authorization from UCCI, or who live and work in remote locations, that is, 50 miles from the nearest military dental clinic.

36. TRICARE Dental Options (continued)
TRICARE Dental Program (TDP):
Available to eligible ADFMs and National Guard and Reserve members and their families
For more information, go to
TRICARE Retiree Dental Program (TRDP):
Available to retired service members and their families, retired National Guard and Reserve members, survivors and others
For more information or to enroll online, go to
The TRICARE Dental Program, or TDP, is a voluntary, premium-based DoD dental program available to eligible ADFMs and National Guard and Reserve members and their families. The TDP benefit is administered by United Concordia.
Care is provided by TDP-participating dental care providers. You may also get services from a nonparticipating dental care provider, which may result in higher costs.
The TRICARE Retiree Dental Program, or TRDP, is a premium-based DoD dental program, administered by Delta Dental of California. It is available to retired service members including retired National Guard and Reserve members and their eligible family members, and others.
Care is provided by TRDP network dental care providers. Remember, obtaining services from a non-network dental care provider may result in higher costs.

37. Line of Duty (LOD) Care Care needed after orders expire
If a National Guard or Reserve member resides 50 miles or less of a military hospital or clinic, LOD determination requests go to the military hospital or clinic.
If a National Guard or Reserve member resides more than 50 miles from a military hospital or clinic, LOD requests go to the Defense Health Agency—Great Lakes (DHA-GL).
Find instructions and forms at or call , option 2
Note: Authorized LOD care is limited to the specific injury, illness or disease that was incurred or aggravated while in a qualified duty status (for example, if your left arm was injured and an LOD determination was approved for that condition, then care for a right knee issue is not authorized under the same LOD).
If further medical care is needed relating to an injury, illness or disease that was incurred or aggravated while in a qualified duty status and after orders expire, an LOD determination must be initiated by your command unit.
If you need care during the LOD review and investigation, it can be preauthorized by the military hospital or clinic (for National Guard and Reserve members residing 50 miles or less of a military hospital or clinic) or by Defense Health Agency—Great Lakes, or DHA-GL, (for National Guard and Reserve members residing more than 50 miles from a military hospital or clinic).
An LOD condition requiring care must be incurred or aggravated while in a qualified duty status (performing military service).
For example, if your left arm was injured and an LOD determination was approved for that condition, then care for a right knee issue is not authorized under the same LOD
Medical conditions not incurred or aggravated while in a qualified duty status are not authorized for treatment and claims payment under LOD.
Clinical documentation of the condition must accompany the LOD form and preauthorization requests.
If you are remote, DHA-GL uses the DHA-GL Worksheet-02 for general medical care and DHA-GL Worksheet- 06 for surgical care as the preauthorization request forms.
Visit for the worksheets or call , and choose option 2.
Army National Guard and Reserve members should submit LOD documentation through eMMPS (LOD module).
Other National Guard and Reserve members should fax LOD documentation to DHA-GL at
Note: National Guard and Reserve members who don’t have ongoing TRICARE eligibility may qualify for LOD care. 37

38. In Summary
Your options vary depending on the type of transition you are making in your career:
Returning to active duty service:
ADSMs: TRICARE Prime, TPR, TOP Prime or TOP Prime Remote
ADFMs: TRICARE Prime, USFHP, TRICARE Standard and TRICARE Extra or TOP program options
Separating from active duty service: TAMP, CHCBP or TRS
Retiring from active duty service: TRICARE Prime, USFHP, TRICARE Standard and TRICARE Extra or TFL
Keep information in DEERS up to date
In summary, your TRICARE benefits will depend on your Physical Evaluation Board determination.
If your determination is to return to active duty service, you and your family members remain eligible for TRICARE benefits as ADSMs and ADFMs.
If your determination is separation with or without severance pay, you and your family may be eligible for transitional benefits. Your service personnel branch determines eligibility.
If your determination is temporary or permanent retirement, you may become eligible for retiree benefits.
Depending on your condition, you may also become eligible for VA or Medicare benefits. Be sure to follow the guidelines for each program to get the best possible care.
Remember to keep your DEERS information up to date when personal eligibility information changes, including military career status and family status. 38

39. The Affordable Care Act
TRICARE meets the minimum essential coverage requirement under the Affordable Care Act (ACA).
The Affordable Care Act, or ACA, requires most Americans to maintain basic health care coverage, called minimum essential coverage. The TRICARE program meets the minimum essential coverage requirement under the ACA.
If you don’t have minimum essential coverage, you may have to pay a penalty for each month you are not covered. The penalty will be collected each year with federal tax returns.
Each tax year, you will get an IRS Form 1095 from your pay center. It will list your TRICARE coverage status for each month.
If your military pay is administered by DFAS, you can opt in to get your tax forms electronically through your DFAS myPay account. For more information, go to
For more information about the IRS tax forms, go to
Note: The IRS will use information from DEERS to verify your coverage. It is important for sponsors to keep their information and their family members’ information up to date in DEERS, including Social Security numbers. It is also important to update DEERS when personal eligibility information changes, including military career status and family status (for example, marriage, divorce, birth or adoption).
If you are losing TRICARE or are not TRICARE-eligible, you can find other health care coverage options through the Health Insurance Marketplace at
Premium assistance or state Medicaid coverage may be available based on income, family size and the state you live in.
For more information, go to
Each tax year, you will get an Internal Revenue Service (IRS) Form 1095 from your pay center. It will list your TRICARE coverage for each month.
Your Social Security number (SSN) and the SSNs of each of your covered family members should be included in DEERS for your TRICARE coverage to be reflected accurately.

40. Optional Presenter Comment: The following slide provides contact information that may be helpful to you for using your TRICARE benefit.

41. Remember, your regional contractor is based on where you live.
This slide shows contact information for stateside and overseas regional contractors, as well as other important information sources.
Remember, your regional contractor is based on where you live.
PP41613BET05170W