A Brief Explanation of TRICARE Select. TRICARE Select is an option military family members (but not the active duty service member, where applicable) can choose when TRICARE Prime doesn’t quite meet the needs of the patient(s). TRICARE Select allows coverage for military members themselves when they meet the following criteria.
- Tricare Select Specialist Copay
- Tricare Select Specialist Copay Center
- Tricare Standard Copay
- Tricare Select Specialty Copay
Q. My Air Force retiree husband and I use Tricare Standard. We are considering going with another policy through his employer, which would make Tricare our secondary insurance. If we take this step, is there anything we need to do to make it official, or does the fact that we are already on Tricare Standard simply make it so? I do understand that Tricare is always last payer.
A. Yes, you would need to take a couple of relatively simply actions.
First, you'd have to tell your Tricare regional contractor that you have other health insurance, referred to as OHI.
The Tricare Reserve Select Program (TRS) is run like any other insurance program, you make monthly premium payments which authorizes you certain types of care at a discounted or free rate. Tricare Select is a fee-for-service insurance plan that lets you see any doctor. This plan is available to family members, veterans, and retirees. TRICARE Select fees. If you wish to reinstate your TRICARE Select Group A coverage, you must now call us before June 30 at (800) 444-5445.
The form that you would need to fill out and send to your regional contractor can be downloaded here: http://tricare.mil/Resources/Forms/OHI.aspx
Tricare Select Specialist Copay
Then whenever you are in need of health care, you would have to tell your health care provider that you have both OHI and Tricare Standard.
Toll-free contact information for all Tricare regional contractors is here: www.tricare.mil/ContactUs/CallUs.aspx
You can get more information on how Tricare works with OHI here: www.tricare.mil/ohi
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Q. I just got married to a Marine at Camp Pendleton, California, but have not yet interacted with DEERS. Am I automatically enrolled in Tricare, or do I have to do it manually after going through DEERS?
A. Before you can use any Tricare benefits, your husband — your 'military sponsor' — must register you in the Defense Enrollment Eligibility Reporting System and get you a family member military ID card.
Once that's squared away, how you access your Tricare benefits will depend on which Tricare plan you intend to use. Your husband, as an active-duty Marine, must use Tricare Prime, the military's version of Health Maintenance Organization. But you are free to use Prime or Tricare Standard, the military's version of a fee-for-service plan.
Tricare Select Specialist Copay Center
Prime requires enrollment; Standard does not. Prime normally requires you to coordinate your care through a primary care manager, who would make any referrals for specialty care as necessary. Under Standard, you may see any Tricare-authorized provider without a referral whenever you need care, simply by showing your military family member ID card and telling the provider you are covered by Tricare Standard.
Tricare Standard Copay
However, Standard tends to carry higher out-of-pocket costs than Prime in terms of co-pays and cost shares.
You can read more about the features and costs of the various Tricare options here: www.tricare.mil/Plans/HealthPlans.aspx
You can also get more information from the managed-care contractor for the Tricare region in which you live, which is Tricare West.
The contractor for that region is UnitedHealthcare Military & Veterans; call their customer service line toll-free at 877-988-9378.
Tricare Select Specialty Copay
| In-Network (PPO benefit) - You pay: | Out-of-Network (Non-PPO benefit)* - You pay: | |
|---|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services | 35% of our allowance† |
| Physician Care | $25 for primary care | 35% of our allowance† |
| Virtual Doctor Visits by Teladoc® | $0 for first 2 visits | N/A |
| Urgent Care Center | Accidental Injury: $0 Medical Emergency: $30 copay | Accidental Injury: $0 Medical Emergency: 35% of our allowance† |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $7.50 copay1 Tier 2 (Preferred brand): 30% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30% of our allowance Tier 5 (Non-preferred specialty): 30% of our allowance Mail Service Pharmacy: Tier 1 (Generics): $15 copay1 Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy2: Tier 4 (Preferred specialty): $65 copay Tier 5 (Non-preferred specialty): $85 copay | Retail Pharmacy: 45% of our allowance Mail Service Pharmacy: Not covered Specialty Pharmacy: Not covered |
| Maternity Care | $0 copay | Pre-/postnatal professional care: 35% of our allowance† Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Outpatient facility care: 35% of our allowance† |
| Hospital Care | Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance† | Inpatient (Precertification is required): $450 per admission copay, plus 35% of our allowance Outpatient: 35% of our allowance† |
| Surgery | 15% of our allowance† | 35% of our allowance† |
| ER (accidental injury) | $0 within 72 hours | Nothing for covered services |
| ER (medical emergency) | 15% of our allowance† | 15% of our allowance† |
| Lab work (such as blood tests) | 15% of our allowance† | 35% of our allowance† |
| Diagnostic services (such as sleep studies, X-rays, CT scans) | 15% of our allowance† | 35% of our allowance† |
| Chiropractic Care | $25 per treatment; up to 12 visits per year | 35% of our allowance†; up to 12 visits per year |
| Dental Care | The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) | 35% of our allowance† |
| Rewards Program | Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3 | Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3 |