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Tricare

QuestionAnswer
TRICARE is available to whom? Eligible beneficiaries from any of the seven uniformed services - Commissioned Corps of the U.S. Public Health Service, NOAA, USN, USMC, USCG, USAF, USA. AD and retirees and their families, and survivors.
How is eligibility for TRICARE determined, and how is the information maintained? By updating DEERS.
The program you are designated to depends on what three things? Beneficiary category, location, entitlement to Medicare.
Which TRICARE programs are members of the National Guard and Reserve members and their family members eligible for? TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Dental Program, TRICARE Retiree Dental Program.
True or false: Anyone covered under TRICARE insurance has access to some type of dental program? TRUE: ADSM - ADDP; ADFM - TDP; Retirees, survivors, Medal of Honor recipients, qualified former spouses - TDRP; National Guard and Reserves - TDP, TDRP.
True or false: The Continued Health Care Benefit Program requires those eligible to pay a premium? TRUE.
How often are you required to pay Continued Health Care Benefit Program premiums? Every 3 months (quarterly).
The Continued Health Care Benefit Program is most similar to which TRICARE program - Prime, Prime Remote, Standard, Extra? Standard.
When can you purchase the Continued Health Care Benefit Program coverage (within how many days)? Within 60 days of losing TRICARE or Transitional Assistance Management Program eligibility.
If you are an ADSM enrolled in TRICARE Prime Remote or you live more than 50 miles from a military dental clinic, what dental plan automatically covers you? Active Duty Dental Program.
How often are you required to pay TRICARE Retiree Dental Program premiums? Monthly.
What two criteria are costs for prescriptions based on? The category under which the drug is classified (non-/formulary, generic vs. brand name); where the script is filled.
True or false: TRICARE will not cover over-the-counter prescription smoking-cessation medications. FALSE
True or false: There are TRICARE Prime enrollment fees for ADSMs or ADFMs set by federal law. FALSE
What is the term for the maximum out-of-pocket amount a beneficiary pays each FY for TRICARE covered services? The catastrophic cap.
What is the term for the percentage a TRICARE beneficiary must pay for covered inpatient and outpatient services? Cost-share.
What are the two types of TRICARE-authorized providers? Network and non-network.
What is the term for a provider billing a TRICARE beneficiary for the remainder of the bill after TRICARE has paid the allowable charge? Balance billing.
There are three TRICARE regions. What are they? West, South, North.
What program is specific to Medicare-eligible beneficiaries age 65 and older? TRICARE for Life
Generally, children under what age can use the ID card of their parent or guardian, so long as they are registered in DEERS? Children under age 10. At 10 years of age the child’s sponsor should obtain an ID card for the child. Children under 10 should also have an ID card of their own when in the custody of a parent who is not eligible for benefits. .
How long is a newborn covered under TRICARE Prime? For the first 120 days. After that, any claim submitted for a newborn will process as TRICARE Standard until the infant is enrolled in DEERS and TRICARE Prime, or the infant’s TRICARE Standard eligibility ends.
If a newborn is not properly registered in DEERS, when will their TRICARE Standard eligibility end? After one year (365 days).
Which TRICARE program offers the least out-of-pocket costs? Prime.
True or false: Active duty service members do not need to complete the TRICARE Prime enrollment form? FALSE: ADSMs are automatically covered under TRICARE Prime but are still required to complete an enrollment form.
What are the four primary means of being disenrolled from TRICARE Prime? Choosing to disenrolled; being disenrolled due to a move to a non-TRICARE Prime service area; non-payment of enrollment fees; any change in status (AD to retired, for example).
Which is not a TRICARE Prime access standard: A) The wait time for an urgent appt shall not exceed 4 hours. B) The wait time for a routine appt shall not exceed 1wk. C) Wait time for a specialty appt or wellness visit shall not exceed 4wks. A) The wait time for an urgent appointment should not exceed 24 hours.
You are eligible to receive “reasonable travel expense” reimbursement if traveling more than how many miles for specialty care? 100 miles.
You will be assigned to TRICARE Prime Remote if you live how many miles or how many hours from the nearest MTF? 50 miles, one hour.
Eligible family members of those in the Reserves may enroll in TRICARE Prime if their sponsor is called to AD for more than how long? For more than 30 consecutive days.
What is the name of the plan or program that allows AD, retirees, eligible family members including those age 65 and older, to receive care through networks of community-based hospitals and physicians? Uniformed Services Family Health Plan.
What is the name of the TRICARE program that benefits ADSM/FMs assigned to designated duty stations in remote overseas locations where MTFs are not available - TRICARE Prime Remote, TOP Prime, TOP Prime Remote, or TRICARE Global Remote Overseas? TRICARE Global Remote Overseas
The Program for Persons with Disabilities was replaced with what? The Extended Health Option (ECHO)
The name of the health care program available to uniformed service members and their families when the sponsor separates from AD is: Transitional Assistance Management Program
What is the name of the health care program that benefits un-remarried former spouses and emancipated children? . The Continued Health Care Benefit Program
True or false: For emergencies, you should go to the nearest treatment facility, and must notify your PCM within 24 hours of any emergency admission. TRUE
TRICARE maternity care covers babies for how long? Up to 6 weeks after birth.
True or false: Prescriptions may be filled up to a 120-day supply for most medications at an MTF pharmacy free of charge. FALSE: Up to 90 days.
Which of the following services is not covered by TRICARE: A) Chiropractic care for an ADSM. B) Reconstructive Sx for a birth defect. C) Smoking cessation for ADFMs. D) Smoking cessation for ADSM meeting certain criteria. C) Smoking cessation for ADFMs.
Which form is sent out in a third party liability claim? DD 2527
How many days do you have to complete and return the DD 2527? . 35 calendar days
The name of the statement sent to you showing what action has been taken on your TRICARE claims is - A TRICARE explanation of benefits (EOB).
Definition of “grievance” A written or formal complaint about service or care.