1. Chapter 10
Military Carriers

2. What is Tricare?
Military healthcare services that utilize medical teams from uniformed services (Navy, Army, Air Force, etc.) AND civilian professionals
Available to active duty and retirees and beneficiaries

3. Who is Tricare for?
Active duty and retired members of uniformed services, their families, and survivors
Unmarried spouse and dependents under 19 of deceased active military

4. Beneficiary—an individual who qualifies for TRICARE
Sponsor—active duty service member
It is the sponsor’s responsibility to report changes in beneficiary status

5. Who is Not Qualified? Anyone on CHAMPVA (veterans)
Parents of active military
Secretarial and civilian positions
Anyone qualified for Medicare

6. DEERS Defense Enrollment Eligibility Reporting System
Computerized Database containing names and numbers of sponsors and beneficiaries
Used to verify eligibility

7. It is a regional program made up of three regions.
We are in the West region.
Additional regions include Canada, Europe, Puerto Rico
Regional Directors oversee each region

8. Military Treatment Facility
MTF-clinic or hospital run by the Department of Defense, located on a military base.
Most services must be performed in an MTF to be covered.

9. Coverage Pays only for allowable services
Pay a portion of allowable charge

10. Tricare Life is Medicare
Three Plan Types
Standard: not for active duty personnel
Extra: not for active duty personnel
Prime: HMO, active duty personnel automatically enrolled
Tricare Life is Medicare
supplemental plan

11. Nonavailability Statement
Used when MTF is not able to provide needed care
Statement from the MTF required for TRICARE extra and standard hospital treatment (not required for outpatient services)
TRICARE may not pay if statement is not sent in

12. Non Par Can bill no more than 115% of allowable charge
Beneficiaries file their own claims
TRICARE pays their portion directly to the provider

13. PAR Accepts Tricare allowable Cannot balance bill
File claims for patient

14. Non-covered Procedures
Benificiary must sign a Waiver of Liability or a Request For Non-Covered Services Form
If not signed:
Provider is responsible for cost of procedure

15. Coordinating Benefits
Priority
Tricare is secondary to:
Worker’s Compensation
Civilian Insurance
Medicare (depending whether procedure is covered by Medicare)
Employee-sponsored HMO
Other liability
Tricare is primary to:
Medicaid
Tricare supplemental insurance

16. CHAMPVA
For Veterans
Veterans with total a permanent disability due to service
Veterans’ survivors
Dependent survivors of those who died while in service
Cannot get CHAMPVA if receiving Tricare or Medicare Part A
No cost if receiving care at VA facility

17. Submitting Claims
Submit as soon as services are provided or within 30 days
Submit no later than one year after service
Do not batch bill—an error on one will hold up all