Tricare

If you're a member of an active-duty military family living overseas, you have two options for receiving health care: TRICARE Europe Prime and TRICARE Standard. There are important differences between the two.

TRICARE EUROPE PRIME

Active Duty Members. All active duty members will be enrolled in TRICARE Europe Prime upon assignment to the theater. Active duty members will see military physicians primarily and most referrals will be made to military medical facilities.

Active Duty Family Members. Family members must make a choice between the two TRICARE options (Prime and Standard). If you choose TRICARE Standard, no action is necessary. To obtain coverage under TRICARE Europe Prime you must be command sponsored and complete an enrollment form at the local TRICARE Service Center. Normally, the enrollment for both active duty members and their families is done during inprocessing.

There are several reasons why a family member should consider enrolling in TRICARE Europe Prime:

Primary Care Manager. If you enroll in TRICARE Europe Prime you will know your Primary Care Manager (PCM) by name. A PCM is a provider who will take care of you on a regular basis and manage your care even when referred to a specialist.

Priority for Care. If you choose to enroll in TRICARE Europe Prime you will be provided the highest priority for care in military medical facilities.

Enhanced Preventive Medicine Benefits. You will enjoy access to specific preventive medicine benefits. The philosophy and focus behind TRICARE Prime is to keep you healthy and encourage you to live a healthy lifestyle, not to simply treat diseases and conditions when they occur.

Preferred Provider Networks (PPN). Prime enrollees will have access to both military medical facilities and networks of local civilian providers put together by the commanders of military medical facilities. Wherever possible or available, most of your care will be provided by the PCM to whom you are assigned. When necessary, you will have access to specialized care recommended by the PCM. Members of the PPN are quality providers who agree to see you and to file TRICARE claims for Prime patients. In most cases, these providers will speak English, but when they don't, bilingual patient liaisons are available in most locations to serve as interpreters.

Access to Care Standards. The Department of Defense has published access standards for you: one day for urgent care, whether primary or specialty; one week for a routine primary visit; four weeks for a health prevention visit (e.g., pap smear), and four weeks for routine specialty care. Military medical facilities in Europe either meet these access standards at their facilities or send enrollees to a preferred provider.

TRICARE EUROPE STANDARD

Family members who choose not to enroll in TRICARE Europe Prime will be automatically eligible for TRICARE Standard. Under TRICARE Standard, you are responsible for deductibles and cost-shares for care obtained from civilian facilities and providers. If you make this choice you will have no primary care manager, will have reduced priority for access to care in a military treatment facility, and will not receive the preventive medicine benefits that come along with Prime.

Yet even with its increased costs and reduced benefits, TRICARE Standard may be the right choice for you if you prefer to get your care directly from host-nation providers. By choosing TRICARE Standard, you retain the full freedom to choose from any provider you wish for outpatient care.

What Do You Need To Do? If you need more information or wish to enroll in TRICARE Europe Prime, you should simply contact the closest TRICARE Service Center. After enrolling you will receive an enrollment confirmation package with the TRICARE Europe Health Care Passport and the name of your Primary Care Manager.

Persons seeking medical care in Europe may well have many healthcare related questions. For this reason, TRICARE Service Centers have been established at all military treatment facilities. These are the first places for you to turn for answers.

TRAVELING WITH TRICARE

Family Members. When you are covered by TRICARE Standard or enrolled in TRICARE Europe Prime, your TRICARE benefit is always available to you, whether you are traveling or on vacation, whether you stay in Europe, travel to another overseas area or head back to the states. However, your Prime enrollment protects you even further by ensuring priority care at all military medical facilities and prevents you from incurring high-cost medical bills when you're away from home.

Traveling In Europe or Other Overseas Locations. As a TRICARE Europe Prime family member, your medical benefit covers you whenever you travel overseas. If you require emergency medical care while on vacation, seek care at the nearest military medical facility if possible. If you aren't certain where to go, contact the nearest TRICARE Service Center for referral to a local national civilian doctor or seek care at the nearest emergency room, hospital or clinic (the TRICARE Europe Health Care Passport lists all service centers and their phone numbers). In all cases, you must contact your servicing TRICARE Service Center, preferably before care is rendered but at least immediately afterward, in order to have your claims processed correctly.

Preauthorization is required for any non-emergency civilian care received overseas. Claims submitted without an authorization will be paid at the point-of-service rate, which includes a high cost share and deductible. If you incur a charge for civilian medical care, retain the itemized statement and any medical documentation and submit the claim to Wisconsin Physician Services (WPS). (See box.) If you are referred to a member of the preferred provider network, the physician may submit your medical bills to WPS. Claims for authorized civilian care will be paid 100%, with no cost-shares, co-pays or deductibles for covered, authorized services.

Traveling in the USA. If you need emergency or urgent medical care when traveling in the USA, you are not required to seek authorization for care. However, if you are near a military medical facility with emergency facilities, go there first for care; otherwise, take the following steps:

• Call the applicable toll-free number for the region in which you are seeking care to find out if there is a TRICARE network provider located near you (the TRICARE Europe Health Care Passport has a list of all US regional toll free numbers);
• If there is no network provider, make sure the civilian provider accepts the TRICARE/CHAMPUS allowable charges as payment in full. Otherwise, you may be responsible for some additional charges above the CHAMPUS allowable;
• The provider may file the claim for you, or you may be expected to pay first and then file the claim for yourself. In either event, all claims for family member care in the US should be mailed to Wisconsin Physician Services.

Traveling Outside the Region for Over 60 Days. If you will be traveling to the states for an extended visit that exceeds 60 days, you should contact your servicing European TRICARE Service Center to request a transfer of your Prime enrollment to the region in which you will be staying. When you arrive at your destination, you must contact the gaining TRICARE Service Center to ensure your enrollment is transferred. The TRICARE representative will provide you with an information packet, which will include where to send your claims and information on the local civilian network of providers. If you return to Europe, you will again contact your TSC to ensure your Prime enrollment is transferred.

Children Attending School in the USA. Children of active duty members assigned overseas who attend school or college in the USA must transfer their Prime enrollment to the region that services the area in which they are attending school, if Prime is available. If TRICARE Prime is not available in their area, they must disenroll from Prime, but will be covered by TRICARE Standard. Students or other family members may enroll in TRICARE Europe Prime if they live with their active duty sponsor assigned overseas during periods that exceed 60 days. When they return to school in the US, they will process out with their servicing European TRICARE Service Center and return to the coverage they had in the states, whether Prime or Standard. Note: Children of retirees who are enrolled in TRICARE Prime in the states but spend their summers (over 90 days) in Europe with their retired sponsor should have their sponsor notify their regional TRICARE Office.

CONUS Prime Family Members Visiting in Europe. If a family member is enrolled in TRICARE Prime in a CONUS region and will be staying in Europe for less than 60 days, they may remain enrolled in Prime in their current region. However, they must have authorization from their PCM for anything other than emergency care or face a point-of-service charge for any civilian medical care.

Active Duty. Active duty members needing emergency medical care while traveling should obtain care from the nearest medical facility and follow parent service reporting procedures. Active duty members must obtain routine civilian and host-nation medical care according to policies established by their parent service. Medical bills should be submitted according to parent service policy.

RETIREES

Overseas retirees under 65 enjoy many of the same TRICARE healthcare options as retirees living in the states, but there are differences. The biggest is that TRICARE prime is not available to retirees living overseas. The type of TRICARE benefits you choose may depend on where you live, what type of Military Treatment Facility is near you (if any), and your own personal healthcare choices. With Standard you will also pay deductibles and cost-shares. You will normally be required to do your own paperwork and file your own claims. See your Benefits Counseling and Assistance Coordinator (BCAC) at your local TRICARE Service Center if you need assistance and guidance.

Over-65 Retirees. Over-65 retirees have TRICARE for Life. There are no enrollment fees for it, but you are required to enroll in Medicare Part B and pay Medicare Part B monthly fees. Check with the Social Security Administration on line at www.ssa.gov, toll-free at 1-800-772-1213 or visit Medicare online at www.medicare.gov, for more information about enrolling in Medicare Part B and monthly fees that will apply to you. You may also contact your closest U.S. Embassy/Consulate Federal Benefits Unit for assistance.

Using Military Medical Facilities. Treatment may be available at a military treatment facility if there is space available after TRICARE Prime patients have been served. You may ask why Prime members get preferential treatment at military Medical Treatment Facilities (MTFs) here. It's because the number one priority of MTFs overseas is to maintain the mission readiness of active duty people. Maintaining this readiness means taking care of active duty personnel and their family members first, and there are simply not that many military clinics and hospitals here to do this.

Military hospital and clinic commanders in Europe work hard to ensure you have access to military facilities as often as possible. In fact, depending on where you live, you may even be able to enroll in a program that provides you with access to a MTF and a Primary Care Manager there. It's called TRICARE Plus.

TRICARE Plus is a military treatment facility primary care enrollment program that is offered at select military treatment facilities around Europe. If you are eligible for care in a military treatment facility, you may seek enrollment for primary care at military treatment facilities where enrollment capacity exists.

Bear in mind that this applies for overseas retirees. If you are enrolled in TRICARE Prime or a Medicare HMO in the continental U.S. you are not eligible. If you can't enroll or choose not to enroll in Tricare Plus, it does not affect TRICARE For Life benefits or other existing programs you may be signed up for. Eligible beneficiaries with existing relationships with primary care providers at military treatment facilities will have the first opportunity to enroll as long as the facility has the space and resources.

TRICARE Senior Pharmacy Program. The over-65 TRICARE-eligible beneficiaries are also eligible to receive pharmacy benefits. This benefit also applies to overseas retirees, who will be able to submit claims to TRICARE for their prescription drugs. Beneficiaries may also use the TRICARE Mail Order Pharmacy if they have an APO/FPO address. The pharmacy benefit is a substantial one, meaning drastically reduced out-of-pocket costs for all 65 and over retirees.

If you turned 65 prior to April 1, 2001, you automatically qualify for the benefit whether or not you have purchased Medicare Part B. (However, you still must have Medicare Part B to be eligible for the TRICARE for Life Benefit.)

If you turned 65 after April 1, 2001, you must be enrolled in Medicare Part B to receive the Senior Pharmacy Benefit.

Retiree Catastrophic Cap. Another significant benefit for the retiree population is the TRICARE Standard Catastrophic Cap of $3,000. A "catastrophic cap" is the upper limit on what must be paid for health care. This applies to the family's annual deductibles and cost-shares for covered medical care received in any one fiscal year. Once the "cap" has been reached, TRICARE Standard will pay the full billed charges for covered care provided during the rest of the fiscal year. This can drastically reduce your out-of-pocket medical care costs.