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Learn About the Basics of TRICARE

Tricare insurance represents comprehensive and specialized health care support for United States military service members and their families both at home and abroad. Interested parties can conduct a tricare eligibility check online in most cases. With coverage spanning dental, vision, mental health and basic medical care, Tricare provides health plan options that address the needs of any family. Tricare payment is competitive with private sector health markets and no Active Duty sponsor ever pays out of pocket for medical care of any kind.

What are the requirements for TRICARE?

Your Tricare insurance eligibility will be measured and monitored by a database called the Defense Enrollment Eligibility Reporting System (DEERS). A Tricare eligibility check can be conducted at any time utilizing the provider’s online database. All service members on active duty and any spouses or children that have been registered in DEERS will be deemed eligible for benefits. Tricare eligibility is likewise extended to all National Guard/Reserve members and their families in the same fashion.

Retired service members, survivors and Medal of Honor recipients can also choose from a wide array of health care options through the DEERS database. For the purposes of eligibility, there are two categories of beneficiaries that are recognized: sponsors and family members. Champus Tricare recognizes the Active Duty or National Guard/Reserve members as the “sponsors” and the plans available to a beneficiary will depend on what category he or she falls into.

Find Out About TRICARE Coverage and Costs

Tricare benefits encompass a wide-range of basic and specialized health concerns. Tricare coverage extends a percentage of costs for network and non-network providers, and cost is based nearly entirely on the current military status (Active Duty, Guard/Reserve or Retired) of the sponsor and the type of plan chosen. There is no charge for care received at any military treatment facilities outside of a small per diem associated with inpatient care and active duty members never pay for any kind of care.

Tricare cost varies for each of the eleven available plans that are offered: Prime, Prime Remote, Prime Overseas, Prime Remote Overseas, Select, Select Overseas, US Family Health Plan, Reserve Select, Retired Reserve, Young Adult and Continued Health Care Benefit Program. Recipients of Tricare military insurance beneficiaries are also grouped by virtue of whether they entered uniformed service prior to January 1, 2018 (Group A) or after (Group B).

Find out everything you need to know about military health insurance by downloading our free guide.

Learn About TRICARE Dental Plans

Tricare dental has three distinct plans on offer, each with its own dental contractor. The three programs on offer are the Active Duty Dental Program, the Tricare Dental Program and the Tricare Retiree Dental Program. Those participants who are part of the Active Duty plan receive most of their dental care at military dental clinics but if further care is required from a civilian dentist, how that care is provided will depend on where a beneficiary lives. The Tricare dental program for active duty beneficiaries allows for civilian care in:

  • The United States and U.S. Virgin Islands
  • Puerto Rico and Guam
  • The American Samoa and Northern Mariana Islands

International SOS is responsible for all other overseas care. Military dental insurance through Tricare covers oral surgeries, orthodontics, cleanings, extractions, fillings, crowns, dentures, root canals, sealants and all manner of X-rays. Active duty beneficiaries receive referrals from their dental treatment facilities (DTF) for any care that cannot be completed at the DTF and must choose from a United Concordia provider to receive coverage for this care. The Tricare dental program requires Guard and Reserve beneficiaries to complete an annual dental readiness exam in order to retain eligibility.

Get Information on TRICARE Vision Coverage

Tricare vision benefits depend on several factors: age, status and chosen plan. A Tricare eye exam allows for a visit to an optometrist and the immediate receipt of prescriptions eyeglasses if needed. If contact lenses are required, it is necessary to book a separate eye exam in order to have this prescription covered. Tricare vision providers only cover eyeglasses and contacts to treat certain eye conditions for beneficiaries who are not Active Duty, Guard/Reserve or Retired service members, and differences in coverage policy exist for Activated versus Non-Activated Guard/Reserve members.

Tricare medical insurance makes eye exams available on an as-needed basis for Active Duty beneficiaries to maintain readiness for work, on an annual basis for the family members of Active Duty sponsors, annually for diabetic members of Tricare Prime and once every two years for all other members of Tricare Prime. Tricare vision insurance participates in Well-Child Eye Exams for children between the ages of three and six every two years and is free of charge regardless of plan. Most ophthalmic services are included in any plan’s coverage.

Learn About TRICARE Mental Health Coverage

Tricare mental health services encourage all beneficiaries to seek mental health support at any time that help is needed. Tricare mental health providers do not require prior authorization for any outpatient care or substance abuse treatment for any non-emergency mental health needs outside of psychoanalysis. To obtain psychoanalytic care or substance abuse support from a provider outside of the network, prior authorization is needed, and members who choose to seek mental health treatment outside of the network may pay higher costs.

Tricare medical offers immediate and constant support for emergency mental health needs and no prior authorization of any kind is necessary. Any hospital admissions should be reported to the regional contractor within seventy-two hours. Tricare behavioral health rules and regulations are not aimed at discouraging any beneficiary from seeking help when needed, simply to ensure that all conditions that may impede duty are properly addressed.

How to Enroll in TRICARE Health Plans

Tricare enrollment of any kind requires successful completion of an enrollment application and the choosing of your primary care provider. When you sign up for Tricare, you will be assigned a regional contractor through whom you will conduct most of your health plan transactions and who will be responsible for telling you when your enrollment has been processed.

Active Duty service members must enroll in one of the Tricare Prime plans (Prime, Remote, Overseas or Remote Overseas) contingent on the location of the member’s duty station. Tricare enrollment online is possible for beneficiaries who live in designated Prime areas. Once military enrollment is completed, all sponsors and members will receive direct contact information for primary care providers as well as official enrollment cards.

For more detailed information, download our free guide today.