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Beneficiary Counseling and Assistance Coordinator (BCAC)
Persons at military treatment facilities and TRICARE Regional Offices who are available to answer
questions, help solve health carerelated problems, and assist beneficiaries in obtaining medical care
through TRICARE. To locate a BCAC near you, visit TRICARE's Web site.
Catastrophic Cap
The maximum outofpocket expenses for which TRICARE beneficiaries are responsible for deductibles
and costshares based on allowed charges for services and supplies received in a given fiscal year(October 1-September 30).
Cost-share
A costshare is the percentage or portion of costs that the beneficiary will pay for inpatient or outpatient care.
Defense Enrollment Eligibility Reporting System (DEERS)
A database of uniformed services members (sponsors), family members, and others worldwide who are entitled under law to military benefits, including TRICARE. Beneficiaries are required to keep DEERS
updated.
Military Treatment Facility (MTF)
A medical facility (hospital, clinic, etc.) owned and operated by the uniformed services—usually located on or near a military base.
Network Provider
Network providers have a signed agreement with Humana Military to provide care at a negotiated rate. Network providers handle claims for you.
Non-network Provider
Non-network providers do not have a signed agreement with Humana Military and are therefore
“out of network.” There are two types of non-network providers: participating and non-participating.
Nonparticipating Non-network Provider
Non-participating providers have not agreed to accept the TRICARE allowable charge or file your claims. Non-participating providers may charge you up to 15 percent above the TRICARE allowable charge for services. This amount is your responsibility and will not be shared by TRICARE.
Other Health Insurance (OHI)
Any nonTRICARE health insurance that is not considered a supplement acquired through an employer, entitlement program, or other source. TRICARE pays second after all other health plans except for Medicaid, TRICARE supplements, the Indian Health Service, or other programs or plans as identified by the TRICARE Management Activity.
Participate on a Claim
When providers participate on a claim, also known as “accepting assignment,” they agree to file the claim for the patient, to accept payment directly from TRICARE, and to accept the amount of the TRICARE allowable charge, less any applicable patient costshare paid by you, as payment in full for their services.
Participating Non-network Provider
Participating providers have agreed to file claims for you, to accept payment directly from TRICARE, and to accept the TRICARE allowable charge, less applicable cost-shares paid by you as payment in full for their services. Providers may participate on a claim by claim basis.
Regional Contractor
A TRICARE civilian partner who provides health care services and support in the TRICARE regions Health Net Federal Services, Inc.; Humana Military Healthcare Services, Inc.; and TriWest Healthcare Alliance).
TRICARE-authorized Provider
A provider who meets TRICARE’s licensing and certification requirements and has been certified by
TRICARE to provide care to TRICARE beneficiaries. If you see a provider who is not TRICARE authorized or can never be certified, you are responsible for the full cost of care. TRICARE authorized providers include doctors, hospitals, ancillary providers (such as laboratories and radiology centers), and pharmacies. There are two types of TRICARE-authorized providers: network and non-network.
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