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Tricare Presentation

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1.TRICARE and their subsidiaries are a form of insurance coverage for members and their families of uniformed services. The coverage is available to those of the Army, Navy, Air Force, Marine Corp, Coast guard, Public Health service, the National Oceanic and Atmospheric Administration and the National Guard as long as eligibility requirements are met (ValeriusBayesNewbySeggern, 2008). This presentation will focus on the eligibility requirements, covered and non-covered services, network and non-network providers, participating and non-participating provider charges along with reimbursements of TRICARE and their four subsidiaries.

2.The first topic is eligibility. Each insured individual must meet a set of requirements to be deemed eligible or not. Even though most insurance companies decide who is eligible and who is not here is where TRICARE is different. TRICARE does have requirements but they do not make those decisions; they are made by various branches of the military (ValeriusBayesNewbySeggern, 2008). Eligibility information can be obtained by the insured from a system called DEERS (defense enrollment eligibility reporting system), but providers may not access this system because of patient privacy (ValeriusBayesNewbySeggern, 2008). TRICARE Standard is a fee-for-service program as with its subsidiaries that covers medical services provided by civilian physician or by MTF (military treatment facilities) and most members pay annual deductibles.

Members and their families of all branches of the military may be eligible for TRICARE Standard the only exception is the National Guard they become eligible after performing on active duty for a minimum of 30 days or when they retire at age 60 (ValeriusBayesNewbySeggern, 2008). Services covered under TRICARE Standard are similar to those of Medicare. They include surgeries, diagnostic testing, durable medical equipment, medications, and family planning. Care services are offered such as hospice, maternity, well-child, inpatient and outpatient. Other services included under this coverage are laboratory, pathology, and X-ray. Preventive services are provided like immunizations and screening examinations. Services not covered under TRICARE are cosmetic and experimental treatments, foot care, and routine physicals. Some procedures may require consent before being administered these would include arthroscopy, MRIs, cataract

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