The Tricare program enables Ireland Army Community Hospital to use our resources most efficiently and gives our beneficiaries more health care options. As always, active duty soldiers receive first priority for health care services at IRACH under Tricare, while active duty family members, retirees and their family members who are not Medicare-eligible now have three options for their health care:
- Tricare Prime
- Tricare Standard
- Tricare Extra
New to TRICARE
You've just become eligible for military benefits, including TRICARE because you are either a:
New uniformed services member
New spouse of an active duty or retired uniformed services member
Recently activated National Guard or Reserve member
Family member of a recently activated National Guard or Reserve member
Basically, TRICARE is your military health plan. TRICARE offers several convenient health care options to meet your unique needs wherever you are living and provides coverage to approximately 9.4 million beneficiaries around the world.
As a uniformed services member or family member you're entitled to TRICARE benefits, but you have to take specific steps to make sure you're eligible.
Tricare Prime is a managed-care option, similar to a civilian HMO (health maintenance organization).
Prime is for active duty service members: Active duty service members (ADSM) are required to be enrolled in Prime; They must take action to enroll, by filling out the appropriate enrollment form and submitting it to the regional contractor. There is no cost to the service member.
Active duty family members must also enroll if they wish to be covered under Tricare Prime, but they do not pay an enrollment premium.
Retirees and their families who are under age 65 are eligible for Tricare Prime and must pay an annual enrollment premium of $230 per individual or $460 for the entire family. Prime is available to other Tricare Beneficiaries. To see who is eligible click here.
Prime enrollees receive most of their health care at IRACH. Their case is coordinated by a primary care manager (PCM).
Prime enrollees must follow the rules: Prime employees must follow some well-defined rules and procedures, such as seeking care, first, from IRACH. For specialty care, the Prime enrollee must receive a referral from his/her PCM and authorization from the regional coordinator, Healthnet. Failure to do so could result in costly Point of Service (POS) option charges. Emergency care is not subject to Point of Service option charges. (See the Point of Service Fact Sheet)
IRACH offers the following Prime Clinics as your Primary Care Manager.
- Primary Care Clinic #1 and Pediatric Clinic, located on the basement level of Ireland Army Community Hospital near the Pharmacy. PCC#1 is open for enrollment to all beneficiary children from birth through age 12 years.
- Primary Care Clinic #2, is also located on the basement level of Ireland Army Community Hospital near the Pharmacy and enrollment is open to all adult family members and retirees.
- Internal Medicine Clinic is located on the first floor of Ireland Army Community Hospital and enrollment is open to all adult family members and retirees. If you are in an older adult or have chronic health problems, the Internal Medicine Clinic may be the best choice.
Formerly known as CHAMPUS.
No Enrollment: Tricare Standard is the basic Tricare health care program, offering comprehensive health care coverage, for people not enrolled in Tricare Prime. Standard does not require enrollment.
Fee-for-service flexibility: Standard is a fee-for-service plan that gives beneficiaries the option to see any Tricare-certified / authorized provider (doctor, nurse-practitioner, lab, clinic, etc.). Standard offers the greatest flexibility in choosing a provider, but it will also involve greater out-of-pocket expenses for you, the patient. You also may be required to file your own claims.
Costs: Standard requires that you satisfy a yearly deductible before Tricare cost sharing begins, and you will be required to pay co-payments or cost shares for outpatient care, medications, and inpatient care.
Extra can be used by any Tricare-eligible beneficiary, who is not active duty, not otherwise enrolled in Prime, and not eligible for Tricare for Life.
Extra goes into effect whenever a Standard beneficiary chooses to make an appointment with Tricare network provider. Extra, like Standard, requires no enrollment and involves no enrollment fee.
Extra is essentially an option for Tricare Standard beneficiaries who want to save an out-of-pocket expenses by making an appointment with a Tricare Prime network provider (doctor, nurse practitioner, lab, etc.).
The appointment with the in-network provider will cost 5% less than it would with a doctor who is a Tricare authorized or participating provider.
Also, the Extra option-user can expect that the network provider will file all claims forms for him. (The Standard beneficiary might have claims filed for him, but the non-network provider can decide to file on his behalf or not, on a case by case basis.)
When using the Extra option, the Standard beneficiary must meet the same requirements to satisfy a deductible and pay a cost share for treatment.
Under Tricare Extra, because there is no enrollment, there is no Extra identification card. Your valid uniformed services ID card serves as proof or your eligibility to receive health care coverage from any Tricare Prime provider.
Your uniformed services ID card is, in effect, your insurance card, and you should have it with you whenever you seek medical care. It is your proof of eligibility and it should always be kept current-that is, you should check the expiration date and have it renewed before it expires, and you should make sure that all your personal information is correct and up to date in the Defense Enrollment Eligibility Reporting System (DEERS).