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Medical Insurance -- Question & Answer Listing  
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Question / Answer

Question:
Does TRICARE still cover my medical expenses if I have supplemental medical insurance?

Answer:
When a beneficiary has other health insurance (OHI), a claim must be filed with the OHI before TRICARE pays. After the OHI processes the claim, you or your provider must file a DD Form 2642 claim with TRICARE and include with the claim, copies of what the other health plan paid and the itemized charges from the provider.

Question:
How do I obtain a referral from my Primary Care Provider (PCP)?

Answer:
If the medical care or treatment you require is not something your current Primary Care Provider (PCP) can provide, he/she will issue a referral to allow you to seek treatment from another source.

Question:
How do I select a Primary Care Provider?

Answer:
If enrolled in TRICARE Prime, your health care is arranged and coordinated by a Primary Care Manager (PCM) at the Military Treatment Facility (MTF), which may be augmented by a network of civilian doctors and clinics, who agree to treat TRICARE Prime enrollees, to charge the allowable fee for treatment, and to file claims forms for the beneficiary. TRICARE maintains a listing of Service Providers from which to choose for the other TRICARE plans. Contact your TRICARE Regional Contractor for a list of providers or visit TRICARE’s website for more information.

Question:
How do pre-existing conditions impact health care coverage?

Answer:
In many cases, pre-existing medical conditions will increase the cost of civilian health care coverage and may, in some cases, prevent an individual from getting health insurance.

Question:
How do the annual outpatient deductibles for TRICARE Standard compare to TRICARE Extra?

Answer:
The annual outpatient deductibles for TRICARE Extra are the same as for TRICARE Standard (CHAMPUS): for the families of active-duty E-4s and below, $50 for one person or $100 for a family per fiscal year. For all others, the deductible is $150 for one person or $300 for a family.

Question:
How is Medicaid different from Medicare?

Answer:
Medicaid, like Medicare, is a Federal health insurance program (run by the individual states) that provides health care for select low-income families.

Question:
How long does my enrollment in TRICARE Prime last?

Answer:
One you have enrolled in TRICARE Prime, you will be enrolled for 12 months at which time, your enrollment will automatically be renewed unless you disenroll.

Question:
If I am eligible for benefits under CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), am I still eligible for TRICARE?

Answer:
Although similar, CHAMPVA is completely separate with a totally different beneficiary population than TRICARE - a Department of Defense healthcare program formerly called CHAMPUS. CHAMPVA is a health care benefits program for the spouse or widow(er) and for the children of a veteran who: is rated permanently and totally disabled due to a service-connected disability by a VA regional office; was rated permanently and totally disabled due to a service-connected condition at the time of death; died of a service-connected disability; died on active duty; and the dependents who are not otherwise eligible for DoD TRICARE benefits. While the benefits are similar, the programs are administered separately with significant differences in claim filing procedures and preauthorization requirements.

Question:
If I am enrolled in TRICARE Prime, can I get medical attention from a civilian resource outside my TRICARE Prime service area?

Answer:
TRICARE Prime will only pay for emergency services unless a civilian resource is authorized in advance.

Question:
Is there a dental plan for military retirees?

Answer:
The TRICARE Retiree Dental Program (TRDP) is a voluntary dental benefits program that first began in February 1998 offering limited basic and preventive dental coverage to Uniformed Services retirees and their family members. The scope of coverage has since been enhanced. Current features of the Delta Dental of California program (Delta Dental of CA is the contractor who manages the TRDP) include a shortened enrollment commitment, a waiting period of only 12 months for the full scope of covered services, and an increase in the annual maximum and lifetime orthodontic maximum amounts to $1,200. The TRDP is a fee-for-service program funded entirely by enrollee-paid premiums. Enrollees in the TRDP may receive dental services from any licensed dentist they choose, but are advised that there are advantages to receiving treatment from a participating network dentist.
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