Tricare Patient Services
You've just become eligible for military benefits, including TRICARE because you are either a:
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.
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.
Formerly known as CHAMPUS.
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).