Personalized marriage certificate

Message from the Assistant Secretary of Defense for Health Affairs

THE best military in the world deserves the best healthcare in the world. The military family--the extended family you see at each visit to a military treatment facility--knows the sacrifices you make. I am as committed to caring for military families as I am my own.

Military families are often far from home and their social-support networks of family and friends. Tricare is the only healthcare program that is founded on respect for your emotional well-being, while ensuring that you and your family get the best possible coordinated care.

When duty places families far from a military treatment facility, Tricare provides the same quality healthcare through civilian network providers. The new Tricare contracts with these civilian providers are making a strong healthcare program even better.

You and your family's needs and best interests are the focus of my decisions. Tricare's unique healthcare delivery system, using military and civilian facilities, gives you the best access to quality healthcare providers. Tricare monitors healthcare delivery in both systems to ensure that you are completely satisfied with the healthcare you receive. You are the most important part of Tricare's mission.

Currently, the separation aspects of military life are being felt throughout the armed forces. I want you to know that whenever healthcare is needed, whether it is for the service member serving overseas or the family member at home facing a difficult diagnosis alone, I am committed to providing personalized and responsive care.

You are the best military in the world, and serving you is the most important thing I do.

DR. William WINKENWERDER JR., M.D. Assistant Secretary of Defense for Health Affairs

What is Tricare

TRICARE is the health care program for active-duty Soldiers, National Guard and Army Reserve members who are activated for more than 30 days, retirees, family members and survivors of service members. Additionally, until Dec. 31, 2004, members of the Selected Reserve of the Ready Reserve, members of the Individual Ready Reserve and their families may be eligible for Tricare (see page 12.)

Managed by the military in partnership with civilian hospitals and clinics, Tricare is designed to increase patients' access to care, assure quality care and promote medical readiness. All military hospitals and clinics are part of the Tricare program.

Quality is the cornerstone of Tricare, which uses the National Practitioner Data Bank to verify education, board certification, disciplinary and other information on civilian providers. Qualified professionals and military physicians oversee the civilian credentialing process.

DEERS: Your Key to Health Benefits

THE Defense Enrollment Eligibility Reporting System is a computerized database of military sponsors, families and others who are entitled by law to Tricare benefits. DEERS registration is required for Tricare eligibility.

Active-duty, National Guard, Army Reserve and retired service members are automatically registered in DEERS, but they must take action to register their family members and ensure they're correctly entered into the database. Mistakes in the DEERS database can cause problems with Tricare claims.

Sponsors or registered family members may make address changes, but only the sponsor can add or delete a family member from DEERS, and such documents as a marriage certificate, divorce decree and/or birth certificate are required.

DEERS information can be verified by contacting the regional Tricare Managed Care Support Contractor, the local Tricare Service Center or the nearest uniformed services personnel office.

Enroll Your Newborn

ENROLLING your newborn in DEERS establishes the baby's eligibility to receive essential well-baby and pediatric care through Tricare.

A newborn is covered as a Tricare Prime beneficiary in DEERS for the first 120 days after birth as long as one additional family member is enrolled in Tricare Prime or Tricare Prime Remote. After the initial 120 days, any claim submitted for a newborn not registered in DEERS will be processed under Tricare Standard until the infant's eligibility for Tricare Standard ends 365 days after birth.

To establish Tricare eligibility for newborns in DEERS, parents or legal guardians must submit a certificate of "live birth" from a hospital or Tricare-approved birthing center. They must also provide a copy of a verified and approved DD Form 1172, "Application for Uniformed Services Identification and Privilege Card."

Where to Get Care

TRICARE is divided into regions, each with its own Managed Care Support Contractor. The MCSC combines the services available at military treatment facilities and those offered by a network of local civilian hospitals and providers to meet beneficiaries' health needs.

MCSCs provide such administrative support as enrollment, disenrollment and billing. They offer customer service and educational information, and establish local provider and retail pharmacy networks. MCSCs link beneficiaries with local Tricare Service Centers.

A "provider" is the person, institution, or other provider of services or supplies that administers health care. Examples include doctors, hospitals and ambulance companies.

Authorized providers accept Tricare regulations and are given authorized status by their Regional Managed Care Support Contractor. Authorized providers meet Tricare regulatory requirements for state licensure, accreditation by national organizations, and agree to sign a participation agreement if they become network providers.

Tricare Standard does not help pay for care from providers who are not authorized.

Who Gets Priority Care?

1. Active-duty service members and eligible National Guard and Army Reserve members.

2. Active-duty family members enrolled in Tricare Prime. Active-duty family members enrolled in Tricare Plus fall into this category for primary care appointments only. Family members of National Guard and Army Reserve members have the same priority as active-duty families.

3. Retirees, their family members and survivors who are enrolled in Tricare Prime.

4. Active-duty, National Guard and Army Reserve family members who are not enrolled in Tricare Prime. These beneficiaries may enroll in the Tricare Plus Program to receive primary care at a military treatment facility.

5. Retirees, their family members and survivors who are not enrolled in Tricare Prime. These beneficiaries may enroll in the Tricare Plus Program.

6. All other eligible persons.

The Options

ACTIVE-duty Soldiers are required to enroll in Tricare Prime by completing a Tricare Prime enrollment form. Active-duty Soldiers receive free priority care at all military treatment facilities. They pay no deductibles, premiums or co-pays for authorized medical visits and prescriptions. (See page 12 for information on National Guard and Army Reserve benefits under the Emergency Supplemental Appropriations Act for Defense and for the Reconstruction of Iraq and Afghanistan.)

Active-duty family members may choose from three Tricare plans: Prime, Extra and Standard.

Tricare Prime

Tricare Prime is the most popular option in the Tricare Program. It guarantees beneficiaries to free, priority care in military hospitals and clinics. Your health care is guided by a single primary care manager or by a team of medical professionals who work together, similar to a civilian HMO, or Health Maintenance Organization. Tricare Prime also includes such preventive cheeks as pap smears, mammograms and prostate screenings. Enrollment is required.

Beneficiaries of Tricare Prime may still choose to see a civilian doctor by enrolling in Prime and requesting a Primary Care Manager from the civilian Tricare network. Requests for a change of PCMs are normally honored if resources are available. Check with the contracting Tricare Service Center.

Prime beneficiaries with medical emergencies should seek care at the nearest military or civilian hospital. For non-emergency care, call your PCM for authorization before seeking civilian care. Non-emergency, civilian care that hasn't been authorized will not be fully paid by Tricare.

Tricare Prime enrollees also have what's called a point-of-service option that allows them to get Tricare-covered, non-emergency services outside the Tricare Prime network of providers without a referral from their PCM, and without authorization from a Health Care Finder. However, there's an annual deductible of $300 for individuals and $600 for families. After the deductible is satisfied, a cost-share of 50 percent of the Tricare allowable charges will be applied.

Tricare Plus