Tricare Prime Remote Handbook

Front 1

What is a worldwide computerized database of uniformed service members (active duty and retired) their family members, and others who are eligible for military benefits, including Tricare?

Back 1

DEERS

Front 2

Who is a person or uniformed services office responsible for coordinating civilian health care for TPR enrolled active duty service members?

Back 2

Service Point of Contact (SPOC)

Front 3

What is distinct from and should not be confused with TPR or TRPADFM stateside?

Back 3

Tricare overseas program (TOP) Prime Remote

Front 4

If you live or work within how many miles of an MTF, you will generally not be eligible for TPR?

Back 4

50

Front 5

Tricare defines a what as a person, business, or institution that provides health care?

Back 5

Provider

Front 6

There are two types of TRICARE authorized providers. What are they?

Back 6

Network and non network

Front 7

There are two types of non network providers. What are they?

Back 7

Participating and non participating

Front 8

If you visit what provider, you may have to pay the provider first and later file a claim with Tricare for reimbursement?

Back 8

Non Participating

Front 9

Who will provide all of your routine (primary) care and refer you for specialty care services?

Back 9

PCM

Front 10

Which providers offer treatment that your PCM can not provide?

Back 10

Specialty care

Front 11

Which providers include ambulances, labs, xrays, and home health care providers?

Back 11

Ancillary services

Front 12

What are medical centers or buildings that offer medical/and or surgical services?

Back 12

Facilities

Front 13

Non- ADSMs may see a network provider for the first how many outpatient behavioral health care visits per fiscal year without a referral or authorization?

Back 13

Eight

Front 14

What web site allows service members and their families in the US to manage their enrollment in Tricare Prime, TPR, TRPADFM, without visiting a TSC or submitting a DD form 2876 to their regional contractor?

Back 14

Beneficiary Web enrollment

Front 15

The 12 month lockout provision does not apply to ADFMs of sponsors of what grades?

Back 15

E1 through E4

Front 16

If your DEERS record is correct and you have lost eligibility, you may qualify for what?

Back 16

Transitional health care

Front 17

You may qualify for a travel reimbursement if referred to specialty care that is more than how many miles from you PCMs office?

Back 17

100 miles

Front 18

YOu should have access to a PCM whose office is within how many minutes of your home, under normal circumstances?

Back 18

30

Front 19

Please be sure to notify your providers office within the appropriate time, usually how many hours prior, if you will not be able to make your scheduled apts?

Back 19

24 to 48

Front 20

If an emergency occurs, call 911 or go to the Er and notify your PCM within how many hours or on the next business day?

Back 20

24

Front 21

What services are medically necessary services required for an illness or injury that would not result in further disability or death if not treated immediately but does require professional attention within 24 hours?

Back 21

Urgent care

Front 22

What care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases, and follow up care for an ongoing medical condition?

Back 22

Routine (primary)

Front 23

Who refers all specialty care requests to your service point of contact (SPOC)?

Back 23

Regional contractor

Front 24

If you seek nonemergency specialty care without first contacting your PCM or regional contractor, you will be using what option, resulting in higher out of pocket cost?

Back 24

POS

Front 25

In some cases, a non medical attendant (NMA) who travels with the patient may also be authorized for travel reimbursement. The NMA must be a parent or guardian or another adult family member age what or older?

Back 25

21

Front 26

What is a review of the requested health care service to determine if its medically necessary at the requested level of care?

Back 26

Prior Authorization

Front 27

Prior Authorizations must be obtained before services are rendered or within how many hours or on the business day following an ER admission?

Back 27

24

Front 28

Individuals at average risk for colon cancer are covered once every how many years beginning the age of 50?

Back 28

10

Front 29

Perform a mamo annually beginning what age?

Back 29

40

Front 30

Cholesterol test: testing is covered for a lipid panal at least once every five years, beginning at what age?

Back 30

18

Front 31

Blood pressure screening is covered annually for children (3-6) and a min of every two years after what age (children and adults)?

Back 31

6

Front 32

Infants eye and vision screening should be given at birth and what age during a well child exam?

Back 32

6 months

Front 33

Active duty service members and active duty family members are covered for how many eye exams per year?

Back 33

One

Front 34

The wait time for an initial urgent, behavioral health care apt shall generally not exceed what time frame?

Back 34

24 hours

Front 35

the wait time for an initial routine, behavioral health care apt shall not exceed what time frame?

Back 35

one week

Front 36

What program uses secure audio visual conferencing to connect eleigible beneficiaries, including TPR and TPRADFM enrollees in the US with offside Tricare network Providers?

Back 36

Telemental Health

Front 37

Which Pharmacy is the least expensive option for filling prescriptions?

Back 37

MTF

Front 38

Express scripts will send your medications directly to your home within about what time frame of receiving your prescriptions?

Back 38

14 days

Front 39

What are usually high cost; self administered; injectable, oral, or infused drugs that treat serious chronic conditions?

Back 39

Specialty medications

Front 40

Tricare does NOT cover what type of ultrasound screening?

Back 40

Routine

Front 41

If you or another Tricare eligible family member is faced with a terminal illness, what care is available from Tricare?

Back 41

Hospice

Front 42

Hospital and anesthesia charges related to routine dental care for children under what age, or those with disabilities, may be covered in addition to dental care related to some medical conditions?

Back 42

5

Front 43

Contact who if you received a negative credit rating or were sent a collection agency due to an issue related to Tricare services?

Back 43

DCAO

Front 44

Your new spouses TPRADFM enrollment is effective based on what rule?

Back 44

20th of the month

Front 45

After a divorce, any children who retain eligibility under the sponsor remain Tricare eligible up to what age?

Back 45

21

Front 46

To remain eligible for Tricare the former spouse must have been married to the same member or former member for at least 20 years, and at least how many of those years must have been creditable in determining the members eligibility for retirement pay?

Back 46

20

Front 47

Tricare benefits end when your college student reaches what age or when full time student status ends, whichever comes first.

Back 47

23

Front 48

TAMP provides how many days of transitional health care benefits to help certain uniformed services members and their families transition to civilian life?

Back 48

180

Front 49

If you qualify, you can purchase CHCBP within how many days of loss of eligibility for either regular Tricare or TAMP coverage?

Back 49

60

Front 50

Your family members who use Tricare Standard and Tricare Extra will see a cost share increase of what percent when you retire?

Back 50

5

Front 51

Surviving spouse: You remain eligible as a "transitional survivor" for how many years following your sponsors death and will have ADFM benefits and costs, including TPRADFM eligibility?

Back 51

Three

Front 52

Appeals must be filed with your regional contractor within how many days from the date that appears on the explanation of benefits or denial notification letter?

Back 52

90

Front 53

Grievances are generally resolved within how many days of receipt?

Back 53

60

Front 54

What is the max out of pocket expenses for which Tricare Beneficiaries are responsible in a given fiscal year?

Back 54

Catastrophic cap

Front 55

What is the rate Tricare network providers and Tricare participating non network providers have agreed to accept for covered services?

Back 55

Negotiated rate

Front 56

What is any non Tricare health insurance that is not considered a supplement?

Back 56

OHI, DD 2569

Front 57

What is an area around military treatment facilities and in other predetermined areas, as defined by Zip codes where Tricare Prime is offered?

Back 57

PSA