Choices Enrollment Handbook

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TRICARE Prime Options
Enrollment in Non-Prime Service Areas
TRICARE Prime Split Enrollment Feature

TRICARE Prime Options
Active duty service members (ADSMs), including National Guard and Reserve members called to active duty for more than 30 consecutive days, must enroll in TRICARE Prime or TRICARE Prime Remote (described below)—proceed to Step 4 for information about how to enroll.

Here are some general features of the TRICARE Prime options:
  • Enrollment required
  • Enhanced benefits and services
  • Priority access for care at MTFs
  • Most care received from an assigned PCM (or approved TRICARE-authorized provider if
    enrolled in TPR/TPRADFM and network providers are not available)
  • PCM referrals required for specialty care
  • No claims to file (in most cases)
Figure 3.2 and the following information are some additional features of the TRICARE Prime options that you should take into consideration.

             Tricare Prime Options                                                                                                     Figure 3.2
TRICARE Prime TRICARE Prime is a managed care option offering the most affordable and comprehensive coverage. TRICARE Prime is available in TRICARE Prime service areas (PSAs)—areas near an MTF and where regional contractors have established TRICARE Prime networks. While ADSMs must enroll in TRICARE Prime where available, ADFMs, retired service members and their family members, survivors, certain former spouses, and other eligible beneficiaries may choose to enroll in TRICARE Prime or remain covered by TRICARE Standard and TRICARE Extra.
TRICARE Prime Remote (TPR)

TPR offers a TRICARE Prime benefit for ADSMs who live and work more than 50 miles or an hour’s drive from an MTF. Visit the TRICARE Prime Remote Web Portal and type in your residential and work ZIP codes or call your regional contractor to determine your eligibility.

If you live or work within 50 miles of an MTF, you will generally not be eligible for TPR.

However, you may submit a TPR Determination of Eligibility Enrollment Request form if you believe geographic boundaries cause you to drive more than one hour to an MTF. The request must be directed through your unit commander to the TRICARE Regional Office (TRO) in your area. Visit TRICARE's Prime Remote Web Portal to submit your request online.

TRICARE Prime Remote for Active Duty Family Members(TPRADFM)

TPRADFM is available to eligible ADFMs residing with their TPRenrolled sponsors. Your DEERS address information is used to determine residency, and accurate address information in DEERS is essential to determine your eligibility for TPRADFM. In most cases, you can remain enrolled in TPRADFM if your sponsor received unaccompanied orders to another location, if you don’t move from the TPR ZIP code location where you are enrolled.

 
Enrollment in Non-Prime Service Areas 
If enrolled in TPR or TPRADFM (available only to ADSMs and ADFMs), you will choose a network PCM in a nonPrime service area, when available. If a network provider is not available,you may choose any approved TRICARE- authorized, non-network provider as your PCM.All other beneficiaries (retirees, their families, or
others) residing in a non-Prime service area who want to enroll in TRICARE Prime must choose a PCM within a PSA, even if a network provider is available outside of the PSA. When you select a PCM outside of the PSA, you are agreeing to waive your TRICARE Prime access standards and travel longer distances to receive care from a network provider. All other beneficiaries cannot enroll in Prime outside of a PSA. Note: If you live within 100 miles of an MTF, you may be able to waive your access standards to enroll in TRICARE Prime at the MTF.

 
TRICARE Prime Split Enrollment Feature

Split enrollment allows families living in separate TRICARE regions to enroll in TRICARE Prime together. To use split enrollment, you must notify each family member’s regional contractor of the split enrollment status. The region where the enrollment fee payment is made is determined by the sponsor’s TRICARE Prime enrollment location. If the sponsor is not enrolled, the region where payment is made is determined by the next eldest TRICARE Prime family member enrolled. The regional contractors will coordinate enrollment fees and send the statements to the designated payer. An enrollment fee left unpaid causes the entire family to be disenrolled.

Key points to remember with split enrollment:
  • Families with college students, children living with a custodial parent or guardian, or families
    otherwise separated can enroll together in separate regions.
  • Active duty families are not required to pay enrollment fees, but they can still enroll in
    separate regions.
  • Retiree families have only one enrollment fee.There is no limit to the number of family
    members that can enroll.
Note: While split enrollment is not available with TPR and TPRADFM, family members residing in separate locations may enroll in TRICARE Prime, if it is available where they reside.

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Last Reviewed: February 29, 2008