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# BAS Tricare/Champ

# BAS Tricare/Champva

sponsor In the military, this is the person with insurance. Same as the subscriber outside the military
beneficiary person who may receive benefits from an insurance program
MTF Military Treatment facility
PCM Primary Care Manager. The primary doctor in the military. Same as a PCP
Point of Care option (POS) Allows enrollees to select non-network providers for medical care. This is available to those 50miles away from an MTF
catastrophic cap maximum amount of "out of pocket" expense that the insured has to pay. After this amount is reached the insurance pays.
NAS Statement Non-availability statement. Depending upon the type of insurance and/or the benefits this statement may be required if to see a civilian provider if medical treatment is not available at a particular MTF
DEERS Computerized system that maintains records of all beneficiaries of military ins-shareurance
OHI Other health insurance. The insured has another health insurance policy. Coordination of benefits is applied.
Tricare LA Lead Agent for Tricare. A military officer that plans the delivery of care.
"allowed servicers" The services that Tricare will pay for. These are also called "covered charges"
cost-share coinsurance, deductibles and co-pays are all a "cost-share". The beneficiary takes part in paying for a portion of their medical care.
CMAC CHAMPUS maximum allowable charge. The most that Tricare will pay for a medical service.
PAR A participating provider. This provider accepts assignment of the insurance.
nonPAR A non-participating provider. They can charge up to 15% over the allowable charge with Tricare
PPO Preferred provider organization. In this type of insurance the patient can see a specialist without being referred by their primary care physician(PCP)
POS Point of service An option with TRICARE prime that allows the enrollees to see nln-network providers
TPR Tricare Prime Remote. An option for Tricare if the service personnel are 50 miles from an MTF
Tricare prime An HMO . Requires a PCM and use of network providers onlly. There is a POS option that allows seeing civilian providers
Tricare Extra A PPO insurance. Patient can self refer to any provider.\
CHAMPVA beneficiaries can get free care at VA facilities TRUE
With CHAMPVA prescription drugs are free TRUE
CHAMPVA is a federal program for veterans who are permenantly and totally disabled and their families
TRICARE is for Active duty members and their families
CHAMPVA will pay for copays of an HMO if the VET has OHI TRUE
With CHAMPVA the eligible individual must be permanently disabled due to A service connected condidtion.
Created by: rjmtoss