20th of the Month Rule
Under the “20th of the month rule,” applications for benefits received by Humana Military by the 20th of the month will become effective at the beginning of the following month (e.g., an enrollment received by December 20 would become effective January 1). If your application is received after the 20th of the month, your coverage will become effective on the first day of the month following the next month (e.g., an enrollment received on December 27 would become effective February 1).
Beneficiary Counseling and Assistance Coordinator (BCAC)
BCACs are 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. BCACs were previously known as Health Benefits Advisors. To locate a BCAC, visit
TRICARE's BCAC Directory.
Catastrophic Cap
The catastrophic cap is the maximum out-of-pocket expenses for which TRICARE beneficiaries are responsible in a given fiscal year (October 1–September 30). Point-of-service (POS) cost-shares and the POS deductible are not applied to the catastrophic cap.
Continued Health Care Benefit Program (CHCBP)
CHCBP is 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)
DCAOs are 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)
DEERS is 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. DEERS is the official record system for TRICARE eligibility.
Explanation of Benefits (EOB)
An EOB is a statement sent to a beneficiary showing that a claim was processed, and it indicates the amount paid to the provider. If denied, an explanation of denial is provided.
Military Treatment Facility (MTF)
An MTF is a medical facility (hospital, clinic, etc.) owned and operated by the uniformed services and usually located on or near a military base.
National Guard and Reserve
The 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 Coast Guard Reserve.
Negotiated Rate
The negotiated rate is the rate TRICARE network providers and TRICARE participating non-network providers have agreed to accept for covered services.
Network Provider
A TRICARE network provider is a professional or institutional provider who has a contractual relationship with a TRICARE regional contractor to provide care at a contracted rate. A network provider agrees to file claims and handle other paperwork for TRICARE beneficiaries and typically administers care to TRICARE Prime and TRICARE Standard beneficiaries using TRICARE Extra (the preferred provider option). A network provider accepts the negotiated rate as payment in full for services rendered.
Non-Network Provider
A non-network provider is one who has no contractual relationship with a TRICARE regional contractor but is authorized to provide care to TRICARE beneficiaries. There are two types of non-network providers—participating and nonparticipating.
Nonparticipating Non-Network Provider
A nonparticipating non-network provider is a TRICARE-authorized hospital, institutional provider, physician, or other provider that furnishes medical services and supplies to TRICARE beneficiaries but who has not signed a contract and does not agree to accept the TRICARE-allowable charge or file claims for TRICARE beneficiaries.
Other Health Insurance (OHI)
OHI is any non-TRICARE health insurance that is not considered a supplement. This insurance is acquired through an employer, entitlement program, or other source. Under federal law, TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, or other programs or plans as identified by the TRICARE Management Activity.
Participate on a Claim
When TRICARE-authorized providers participate on a claim, also known as “accepting assignment,” they agree to file the claim for you, to accept payment directly from TRICARE, and to accept the amount of the TRICARE-allowable charge, less any applicable patient cost-share paid by you, as payment in full for their services.
Participating Non-Network Provider
A participating non-network provider agrees to file claims for TRICARE beneficiaries, accept payment directly from TRICARE, and accept the TRICARE-allowable charge as payment in full for services delivered. Non-network providers may participate on a claim-by-claim basis. Providers may seek payment of applicable copayments, cost-shares, and deductibles from the beneficiary.
Point of Service (POS) Option
The POS option allows a TRICARE Prime beneficiary to obtain medically necessary services—inside or outside the TRICARE network—from someone other than his or her primary care manager without first obtaining a referral or authorization. Using the POS option results in a deductible and greater out-of-pocket expenses for the beneficiary. The POS option is not available to active duty service members.
Primary Care Manager (PCM)
A PCM is a TRICARE civilian network provider or military treatment facility provider who provides routine (primary) care to TRICARE beneficiaries. A PCM is either selected by the beneficiary or assigned by an MTF commander or his or her designated appointee.
Prime Service Area (PSA)
A PSA is an area around military treatment facilities and in other predetermined areas as defined by ZIP codes where TRICARE Prime is offered.
Prior Authorization
Prior authorization is a process of reviewing certain medical, surgical, and behavioral health services to ensure medical necessity and appropriateness of care before services are rendered or within 24 hours of an emergency admission. View the
prior authorization list for the South Region.
Regional Contractor
A regional contractor is a TRICARE civilian partner who provides health care services and support in the TRICARE regions. Health Net Federal Services, LLC, is the regional contractor for the North Region; Humana Military Healthcare Services, Inc., is the regional contractor for the South Region; and TriWest Healthcare Alliance Corp. is the regional contractor for the West Region.
Transitional Assistance Management Program (TAMP)
Tamp provider transitional health care for certain uniformed services members (and their eligible family members) who separate from active duty.
TRICARE Allowable Charge
The TRICARE-allowable charge (also called allowable charge) is the maximum amount TRICARE will pay for services.
TRICARE-authorized Provider
A TRICARE-authorized provider 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 (laboratories and radiology centers), and pharmacies. There are two types of TRICARE-authorized providers: network and non-network.
TRICARE Supplement
A TRICARE supplement is a health care plan you may purchase specifically to supplement your TRICARE Prime coverage. It pays after TRICARE pays. A TRICARE supplement is not employer-sponsored health insurance.
