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 IACH
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
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
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
Prime enrollees receive most of their health care
at IACH. Their case is coordinated by a primary care manager
Prime enrollees must follow the rules: Prime
employees must follow some well-defined rules and procedures, such as
seeking care, first, from IACH. 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)
IACH 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
- 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
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.
Program Details: For more information about
the Standard benefit, see the
Tricare Standard Handbook.
- 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
- 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
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
Enrollment Eligibility Reporting System (DEERS).