EMERGENCY and URGENT CARE:

TRICARE provides coverage for medically necessary emergency and urgent care to all TRICARE-eligible benficiaries. If you have an emergency, call 911 or go to the nearest emergency room. Prior authorization is not required before receiving emergency care. However, in all emergencies, your PCM or regional contractor must be notified within 24 hours or the next business day following admission.

Urgent care services are medically necessary services required for an illness or injury that would not result in further disability or death if not treated immediately, but does require professional attention within 24 hours. Contact your PCM or regional contractor for help coordinating urgent care.

TRICARE is a regionally managed health care program for Uniformed Service members and their families that blends the direct care system of military hospitals and clinics (known as Military Treatment Facilities, or MTFs) with civilian providers. Members of the Commissioned Corps of the Public Health Service and their dependents are eligible for enrollment.

1. TRICARE Prime Tricare Prime operates as an HMO for active duty members and their families with no enrollment fee. It gives you access to a regional network of providers who manage your healthcare. Active duty servicemembers MUST use this option.

2. TRICARE Extra and TRICARE Standard TRICARE Extra is a plan that allows family members to select their health care providers from the TRICARE Provider Directory. TRICARE Standard is the new name for the former CHAMPUS fee-for-service program. Members of this plan have the broadest choice of providers, but pay more for this flexibility. Although dependents pay no enrollment fee for either plan, they do pay annual deductibles and a share of the cost.

3. TRICARE Prime Remote (TPR) TPR serves those on remote assignments by providing access to quality, convenient health care as well as other benefits of TRICARE Prime. Active Duty Members of the PHS who live AND work more than 50 miles (or approximately an hour’s drive) from the closest MTF are eligible for TRICARE Prime Remote. You may be able to obtain a waiver.

4. TRICARE Young Adult (TYA) TYA is a plan that qualified adult children can purchase after eligibility for “regular” TRICARE coverage ends at age 21 (or 23 if enrolled in college). TYA is available in Prime and Standard Options. TYA requires a monthly premium. If purchased, TRICARE Young Adult is minimum essential coverage under the Affordable Care Act.

5. TRICARE For Life TRICARE For Life is Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B.

Health Net Federal Services is the TRICARE contractor for the North Region, which includes Ohio, Indiana, and Kentucky (except Fort Campbell). The TRICARE SMART site allows you to view, print or download copies of TRICARE briefings, fact sheets, handbooks and other materials.

Dental Care

1. U.S. Public Health Service Active Duty Dental Program is administered by the Federal Government Programs division of Delta Dental of California through its subsidiary, Delta Dental Insurance Company (DDIC).

2. United Concordia is the contractor for the TRICARE Dental Program (TDP) for active duty family members

Pharmacy

Information about the TRICARE Pharmacy program can be found here. Prescriptions can be filled at military pharmacies, through the prescription home delivery program, at network pharmacies, and at non-network pharmacies.

New rules for select maintenance drugs for dependents became effective October 1, 2015. Do you take drugs regularly for a chronic condition like high cholesterol or high blood pressure? These are select maintenance drugs. You have to refill select maintenance drugs through home delivery or at military pharmacies. This doesn’t apply to active duty service members. Beneficiaries who keep using a retail pharmacy for these drugs will have to pay the full cost. Beneficiaries can contact Express Scripts at 1-877-363-1303 to see if they are affected.

E-prescribing is another choice if you want to avoid the co-pay at the retail pharmacy. Electronic prescribing is now accepted at many military pharmacies in the United States, Puerto Rico and Guam. This change allows your civilian providers to send prescriptions electronically to military pharmacies near you, reducing the need for handwritten prescriptions.

Beginning Sept. 1, 2017, Express Scripts will need annual consent from patients who want to receive automatic refills of their maintenance medications enrolled in TRICARE Pharmacy Home Delivery. This means that just before one of your prescriptions runs out of refills, Express Scripts will reach out to you to know if you would like your doctor to be contacted to renew the prescription and if you’d like to continue in the Automatic Refill program. If not, Express Scripts will not refill your prescription.

Contact information for the TRICARE Service POC at DCCPR can be found on this page.

Looking ahead

The Military Health System is modernizing TRICARE. Most provisions will go into effect on January 1, 2018, with full implementation occurring on January 1, 2019. See https://www.tricare.mil/About/Changes for more information and how to prepare. The changes are summarized below.

Health Plans

TRICARE Standard and TRICARE Extra will become the new TRICARE Select plan.
TRICARE Prime and other TRICARE plans will undergo additional changes.
TRICARE For Life (Medicare wrap-around coverage) won’t change.

Costs

You may need to pay an enrollment fee, depending on your plan and when you became eligible for TRICARE.
Some costs will change annually starting on Jan. 1, 2018.

Enrollment

You will be automatically enrolled on Jan. 1, 2018 if you already have a plan or are eligible for TRICARE on Dec. 31, 2017.
After Jan. 1, 2018, you must enroll in a TRICARE plan to get or change coverage.

Regions and Contractors