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General Medical -- Question & Answer Listing  
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Question / Answer

Question:
Are families of active duty service member who lost their retirement eligibility because they were court martialed and separated still eligible for TRICARE?

Answer:
Families of active-duty service members who lost their retirement eligibility because they were court-martialed and separated for abuse, and spouses and children of NATO representatives under certain circumstances are eligible for TRICARE.

Question:
Are prosthetic services included in the health benefits given to veterans?

Answer:
The Veterans Administration (VA) will cover the cost of prosthetic devices. However, there are certain restrictions and price limitations. Contact your local VA benefits office for more information.

Question:
As a DoD or DA Civilian employee, how do I go about transferring sick leave to my co-worker?

Answer:
The Voluntary Leave Transfer Program (VLTP) permits Federal employees to transfer their unused, accrued annual leave to other employees who have been determined to have a medical or family medical emergency and have been approved as a leave recipient.

Question:
As a Reserve Component member, am I eligible for health care?

Answer:
If a Reserve Component member is ordered to, or extended on, active duty for more than 30 days eligibility begins the day the member commences or is extended on active duty.

Question:
Can a person enrolled in TRICARE Prime still be eligible to receive services under the Program for Persons with Disabilities (PFPWD)?

Answer:
Enrollment in TRICARE Prime does not affect a person’s eligibility to receive services through the PFPWD; however, all requirements of TRICARE Prime, such as using the Primary Care Manager (PCM) for specialty care referral, must also be met.

Question:
Can I use any Military Treatment Facility (MTF)?

Answer:
Individuals authorized to receive care at Military Treatment Facilities (MTFs) may receive treatment at any MTF, regardless of branch of service.

Question:
Do I need to enroll my newborn in TRICARE?

Answer:
TRICARE provides TRICARE Prime coverage for your newborn for the first 120 days of the newborn's life--as long as one additional family member is enrolled in TRICARE Prime. After 120 days, your newborn would be covered under the TRICARE Standard benefit - with lesser benefits and increased costs unless you enroll your newborn in TRICARE Prime. Contact the regional TRICARE contractor to determine if you reside in a TRICARE Prime service area.

Question:
Do I need to obtain a non-availability statement for civilian hospital care?

Answer:
A Non-Availability Statement (NAS) is a certification by a uniformed services medical facility that a specific type of non-emergency care is not available at that facility, at a specific time, to a patient who needs that care, and who lives within a certain radius of the Military Treatment Facility (MTF). Until December 28, 2003, TRICARE Standard beneficiaries were required to obtain an NAS prior to seeking non-emergency treatment at a civilian source as opposed to an MTF. Under the 2002 National Defense Authorization Act, the Department of Defense military health system eliminated the requirement for TRICARE Standard beneficiaries to obtain an NAS on Dec. 28, 2003. An exception in the law continues the requirement for an NAS for non-emergency inpatient mental healthcare services.

Question:
How do formularies impact prescription costs and availability within the defense health system?

Answer:
Military Treatment Facilities are required to stock a DoD specified list of medications. It is DoD’s policy to substitute generic medications for brand-name medications when available to minimize pharmaceutical costs. However, brand-name drugs that have a generic equivalent may be dispensed if the prescribing physician is able to justify medical necessity for its use over the generic equivalent. Co-payments for brand-name prescription drugs obtained through retail pharmacies covered by TRICARE are higher than those for generic prescription drugs.

Question:
How do I file any complaints I have regarding my medical care (TRICARE)?

Answer:
The Patient Bill of Rights and Responsibilities in the Military Health System (MHS) is a directive that outlines the TRICARE beneficiary’s rights and responsibilities in terms of the healthcare they receive. If you have a dispute with certain decisions related to your benefits made by TRICARE Management Activity (TMA) or by a TRICARE contractor, you have the right to appeal - to ask TMA or the TRICARE contractor for another opinion on the decision. The appeals process varies, depending on whether the denial of benefits involves medical necessity determination, factual determination, provider authorization or a provider sanction. Contact your TRICARE Regional Contractor representative for more information.
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