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TRICARE Prime
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This section outlines the options for TRICARE Prime, TRICARE Prime Remote (TPR), and TRICARE Prime Remote for Active Duty Family Members (TPRADFM).
TRICARE Prime Annual Enrollment Fees
Retired service members, their families, survivors, eligible former spouses, and others enrolled in TRICARE Prime are required to pay an annual enrollment fee, which is applied to the catastrophic cap. There are no enrollment fees for active duty service members (ADSMs) and active duty family members (ADFMs) enrolled in TRICARE Prime, TPR, or TPRADFM.
Enrollment Fees
| Individual |
Family |
| $230 |
$460 |
The following chart details your enrollment fee payment options.
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Payment Options
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Payment Instructions
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Monthly
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Allotment from Retired Pay |
Complete an Enrollment Fee Allotment Authorization letter. Once authorized, your TRICARE Prime enrollment fee is deducted automatically from your retirement pay on a monthly basis. You must submit an initial three-month payment ($57.50 individual or $115 family) when you submit your Enrollment Fee Allotment Authorization letter to allow time for processing. |
| Electronic Funds Transfer (EFT) |
Provide your correct banking information to Humana Military. Once authorized, your TRICARE Prime enrollment fee is deducted automatically from your bank account on a monthly basis. You must submit an initial three-month payment ($57.50 individual or $115 family) to Humana Military when you begin EFT payments to allow time for processing. |
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Quarterly or
Annually
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Check, Cashier's Check, or Money Order |
A bill for your TRICARE Prime enrollment fee will be sent on a quarterly or annual basis, depending on your selection. Instructions for paying your bill are on the billing statement. |
| Visa® or MasterCard |
Your initial payment will be charged to your credit card, and you will be sent a bill for each subsequent payment. Return the bill to Humana Military along with the credit card authorization for each billing period. For your convenience, you also can pay credit card payments to Humana Military online if you are a registered member. |
TRICARE Prime, TPR, and TPRADFM Health Care Costs
The costs listed are for care received in civilian facilities. These costs are effective for fiscal year 2008 (October 1, 2007–September 30, 2008) and are subject to change each year on October 1.
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Type of
Care
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ADSMs and ADFMs (TRICARE Prime, TPR, or TPRADFM)
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Retirees, Their Families, and All Others (TRICARE Prime)1
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Annual Deductible
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$0 (unless POS option is used) |
$0 (unless POS option is used) |
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Outpatient Visit
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$0 copayment per visit |
$12 copayment per visit |
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Clinical Preventive Services
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$0 copayment per service |
$0 copayment per service |
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Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies
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$0 copayment |
20% of negotiated fee |
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Hospitalization
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$0 per day |
$11 per day ($25 minimum charge) |
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Emergency Services
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$0 copayment per visit |
$30 copayment per visit |
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Outpatient Behavioral Health
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$0 copayment per visit |
$25 (individual visit)
$17 (group visit) |
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Inpatient Behavioral Health
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$0 per day |
$40 per day |
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Inpatient Skilled Nursing
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$0 per day per admission |
$11 per day ($25 minimum charge) |
1 The cost for inpatient care provided at a military treatment facility is $15.15 per day for retiree family members.
Point of Service
The point of service (POS) option allows you to receive nonemergency care from any TRICARE-authorized provider without requesting a referral from your primary care manager (PCM), resulting in higher out-of-pocket costs. The POS deductible applies only to outpatient services and the cost-share applies to both inpatient and outpatient care. Any out-of-pocket expenses you pay under POS do not apply to your annual catastrophic cap. Note: The POS option does not apply to ADSMs, newborns or adoptees deemed to be enrolled in TRICARE Prime in their first 60 days, emergency care, or if you have other health insurance.
| POS Deductible |
POS Cost-Share |
$300/Individual
$600/Family |
50% after POS deductible is met |
Note: Eligible surviving spouses are also covered during the first three years following the ADSM’s death and surviving dependent children until age 21 (or age 23 if enrolled in a full-time course of study in an accredited institution of higher learning and the child was dependent upon the former member for more than one-half of his or her support at the time of the former member’s death).
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