Active duty service members and activated National Guard and Reserve members* must enroll in TRICARE Prime or TRICARE Prime Remote. Active duty family members, retired service members and their families, survivors, and others have the choice of enrolling in TRICARE Prime or using TRICARE Standard and TRICARE Extra.
Enrollment is not required for TRICARE Standard and TRICARE Extra—there are no enrollment forms to fill out and no enrollment fees. You may use TRICARE Standard and TRICARE Extra interchangeably as often as you like, but it’s important to understand the differences between the two.
The key difference between TRICARE Standard and TRICARE Extra is in the providers that you use for care. With TRICARE Extra, you choose hospitals and providers within the TRICARE network and enjoy discounted costshares. With TRICARE Standard, you choose TRICARE-authorized providers outside of the TRICARE network and pay higher cost-shares.
Figure 1.1 provides a quick comparison of the two options. We’ll discuss specific provider types later in this handbook. For detailed cost information, see the TRICARE: Summary of Beneficiary Costs flyer or contact Humana Military.
* Activated National Guard and Reserve members will enroll in one of the TRICARE Prime options at their final duty station.
Not in network, but still a TRICARE-authorized provider
In network
Outpatient cost-share after deductible is met
Active Duty Families:
20% of the TRICARE allowable charge Retirees, Their Families, and All Others:
25% of the TRICARE allowable charge
Active Duty Families: 15% of the negotiated rate
Retirees, Their Families, and All Others:
20% of the negotiated rate
Claims
You may be required to file your own TRICARE claims.
Network providers file claims for you.
1 Nonparticipating providers may also charge up to 15% above the TRICARE allowable charge. You are responsible for paying this amount. TRICARE will not pay it.
