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Beneficiary Online Handbook
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TRICARE Program Options
TRICARE Prime
Eligibility for TRICARE Prime
Enrollment
TRICARE Prime Access Standards |
TRICARE PROGRAM OPTIONS |
| TRICARE’s family of programs offers comprehensive health and dental benefits to every TRICARE beneficiary category. It’s important to understand the choices available to choose the best option for you and your family. |
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TRICARE PRIME |
| TRICARE Prime offers fewer out-of-pocket costs than any other TRICARE option. TRICARE Prime beneficiaries receive most of their care from a military treatment facility (MTF), supported by the Humana Military provider network, and are guaranteed access to care. When an MTF is not available due to distance or enrollment limitations you may enroll in Humana Military’s extensive network of primary care providers. To enroll in TRICARE Prime, you will complete an enrollment form and select, or will be assigned, a primary care manager (PCM) who provides and coordinates your care, maintains your patient health records, refers you to specialists, and files claims for you. Specialty care must be arranged by your PCM and approved by your MTF or Humana Military to be covered under TRICARE Prime. TRICARE Prime also offers enhanced coverage for vision and clinical preventive services. Specialty care received without a referral will be covered under the TRICARE Prime point-of-service (POS) option, which includes a deductible, higher co-payments, and cost-shares. |
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| Eligibility for TRICARE Prime |
| TRICARE Prime is available to active duty service members, family members, survivors, and eligible former spouses of active duty personnel; retirees, their family members, and survivors under age 65; and members of the Reserve Component and their families if the sponsor is activated for more than 30 consecutive days. All eligible beneficiaries must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and reside in a service area where TRICARE Prime is offered. |
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| Enrollment |
| To participate in TRICARE Prime, you must complete a TRICARE Prime enrollment form and submit it to Humana Military. Access Prime enrollment forms electronically or call the Humana Military TRICARE Service Line at 1-800-444-5445. Active duty service members are automatically covered under the TRICARE Prime benefit but are still required to complete an enrollment form. There is no enrollment fee for active duty family members. Retirees and their family members must pay an annual enrollment fee of $230 for an individual or $460 for a family to enroll in TRICARE Prime. Payments can be made in annual or quarterly installments if paying by check, credit card, or money order. If paying by allotments or electronic funds transfer, the installments may be made monthly. |
Enrollment in TRICARE Prime is continuous. You may choose to disenroll, or you may be disenrolled due to a move to a non-TRICARE Prime area or for nonpayment of enrollment fees. If you choose to disenroll from TRICARE Prime, or are disenrolled for nonpayment, you may be subject to a one-year lockout. The lockout provision does not apply to active duty family members of E-1 through E-4. Please note that any change in status (e.g. active duty to retired or demobilization) will cause a disenrollment from TRICARE Prime. When there is a status change you MUST re-enroll in TRICARE Prime to maintain your coverage. |
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| TRICARE Prime Access Standards |
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Another advantage of enrolling in TRICARE Prime is the TRICARE Prime access standards. You are guaranteed an appointment within the following standards:
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- An urgent care appointment shall not exceed 24 hours.
- A routine appointment shall not exceed one week.
- A specialty care appointment or wellness visit shall not exceed four weeks (28 days).
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| Additionally, under normal circumstances, your travel time may not exceed 30 minutes from your home to your PCM’s office for primary care, and you should not have to travel more than one hour from your home for referred specialty care. |
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