Beneficiary Counseling and Assistance Coordinator (BCAC)
Persons at military treatment facilities and TRICARE Regional Offices who are available to answer questions, help solve health care-related problems and assist beneficiaries in obtaining medical care through TRICARE. To locate a BCAC, visit
www.tricare.mil/bcacdcao.
Catastrophic Cap
The maximum out-of-pocket expenses for which TRICARE beneficiaries are responsible for deductibles and cost-shares based on allowed charges for the services and supplies received in a given fiscal year (October 1–September 30).
Continued Health Care Benefit Program (CHCBP)
A premium-based health care program you may purchase after loss of TRICARE eligibility if you qualify. The CHCBP offers temporary transitional health coverage and must be purchased within 60 days after TRICARE eligibility ends.
Debt Collection Assistance Officer (DCAO)
Persons located at military treatment facilities and TRICARE Regional Offices to assist you in resolving health care collection-related issues. Contact a DCAO if you have received a negative credit rating or have been sent to a collection agency due to an issue related to TRICARE services.
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.
Explanation of Benefits (EOB)
A statement sent to beneficiaries showing that claims were processed and the amount paid to providers. If denied, an explanation of denial is provided.
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. National Guard and Reserve Includes the Army National Guard, the Army Reserve, the Navy Reserve, the Marine Corps Reserve, the Air National Guard, the Air Force Reserve, and the U.S. Coast Guard Reserve.
Negotiated Rate
The rate network providers and participating non-network providers have agreed to accept for covered services.
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 nonparticipating.
Nonparticipating Non-network Provider
Nonparticipating providers have not agreed to accept the TRICARE allowable charge or file your claims. When you self-refer using the point of service (POS) option, nonparticipating providers may charge you up to 15 percent above the TRICARE allowable charge for services in addition to your POS deductible and cost-shares. This amount is your responsibility and will not be paid by TRICARE.
Other Health Insurance (OHI)
Any non-TRICARE 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 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 copayment 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.
Point of Service (POS) Option
The POS option allows you to receive non-emergency care from any TRICARE-authorized provider without requesting a referral from your PCM. However, POS has higher out-of-pocket costs for care.
Prime Service Area
A geographic area where TRICARE Prime benefits are offered. Regional contractors are required to establish a TRICARE Prime network in TRICARE Prime Service areas.
Prior Authorization
A review determination made by a licensed professional nurse or paraprofessional for requested services, procedures or admissions. Prior authorizations must be obtained prior to services being rendered or within 24 hours of an admission.
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).
Transitional Assistance Management Program (TAMP)
Transitional health care for certain uniformed services members (and eligible family members) who separate from active duty.
TRICARE Allowable Charge
The maximum amount TRICARE will pay for services.
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 and can never be certified, you are responsible for the full cost of care. TRICARE-authorized providers include doctors, hospitals, ancillary providers (such as laboratory and radiology providers), and pharmacies. There are two types of authorized providers: network and non-network.
TRICARE Supplement
A health plan you may purchase specifically to supplement your TRICARE Prime coverage. It will pay second after TRICARE. A TRICARE supplement is not employer-sponsored health insurance.
