Choices Enrollment Handbook

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US Family Health Plan
TRICARE Standard and TRICARE Extra
TRICARE For Life

Step 2: Explore Your Options

The US Family Health Plan (USFHP) is an additional TRICARE Prime-like option available to ADFMs, retirees, and their eligible family members (including those age 65 and over), through networks of community-based hospitals and physicians in six areas of the country.

If you enroll in USFHP, you may not access care at an MTF or use MTF pharmacies. Furthermore, you are not eligible to use the other program options listed in this section. If you move or disenroll from USFHP, you may choose any TRICARE program that you are eligible for and that is available in your area. See Figure 3.3 for a list of USFHP enrollment areas.

USFHP Enrollment Areas                                                                                                                        Figure 3.3

Call 1-800-74-USFHP (1-800-748-7347) or visit www.usfamilyhealthplan.org for more information or to enroll.

If you do not enroll in one of the TRICARE Prime options, you are covered by TRICARE Standard and TRICARE Extra as long as you remain eligible in DEERS. TRICARE Standard and TRICARE Extra have higher out-of-pocket costs than TRICARE Prime. But, there is no enrollment process for TRICARE Standard and TRICARE Extra, which means there are no forms to fill out and no annual enrollment fees for retirees, their families, and others.

TRICARE Standard and TRICARE Extra give you the freedom to manage your own health care—you don’t have an assigned PCM and you don’t need referrals for care. Prior authorization is required for certain services, such as adjunctive dental care and inpatient behavioral health care, so you’ll need to check with your regional contractor to learn about each region’s prior authorization requirements. Because you have the freedom to seek care from any TRICAREauthorized provider in or out of theTRICARE network, you can only seek care from MTFs on a spacea-vailable basis.

While the options can be used interchangeably together, it’s important to understand the key differences between TRICARE Standard and TRICARE Extra.

• If you seek care from a non-network, TRICARE-authorized provider, you’re using the TRICARE Standard option. Because you’re using a non-network provider, you’ll have higher costs than with TRICARE Extra and you may be required to file your own claims.
•  If you seek care from a TRICARE network provider, you’re using the TRICARE Extra option. Because you’re using a network provider, you’ll pay less than with TRICARE Standard and your provider will file claims for you.
• TRICARE Standard is available worldwide, while TRICARE Extra is not available overseas.

TRICARE For Life (TFL) offers Medicare wraparound coverage to TRICARE beneficiaries regardless of age, provided they are entitled to Medicare Part A and also have Medicare Part B coverage.* Under the TFL program, your provider will file the claims with Medicare. Medicare will pay its portion and automatically forward the claim electronically to TRICARE for processing.

Here are some features of TFL:

• Must have Medicare Part B coverage*
• May receive care from any Medicare provider
• Claims processed as follows:
  • For services covered by both Medicare and TRICARE, Medicare pays first and TRICARE pays second. You pay nothing out of pocket.
  • For services covered by TRICARE, but not by Medicare, TRICARE will pay its portion and you are responsible for applicable TRICARE deductibles and cost-shares.
  • For services covered by Medicare, but not by TRICARE, Medicare will pay its portion and you are responsible for applicable Medicare deductibles and cost-shares.
  • For services not covered by Medicare or TRICARE, you are responsible for the entire bill.
  • For all Medicareeligible ADFMs, claims for inpatient services will be processed as described above. For outpatient services, if an ADFM is not enrolled in Medicare Part B, TRICARE will pay its portion and you are responsible for any applicable TRICARE deductibles and costshares (like any ADFM not entitled to Medicare).

TFL is administered by Wisconsin Physicians Service (WPS). If you are eligible for TFL, visit TRICARE4U or contact WPS at 1-866-773-0404. Additional steps may be required to coordinate benefits if you have other health insurance in addition to TRICARE and Medicare.

*With the exception of ADFMs and USFHP enrollees, all beneficiaries entitled to Medicare Part A must have Medicare Part B coverage to maintain their TRICARE eligibility.

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