Tricare Choices

Front 1

What is a managed care for health maintenance organization (HMO) option available in specific geographic areas?

Back 1

Tricare Prime

Front 2

What is a Tricare Prime like benefit for active duty families living and working in remote locations?

Back 2

Tricare Prime Remote

Front 3

What is a Fee for service option available worldwide?

Back 3

Tricare Standard

Front 4

What is a preferred provider option (PPO) in areas with established Tricare networks?

Back 4

Tricare Extra

Front 5

What is a Premium based health plan that qualified National Guard and Reserve members may purchase?

Back 5

Tricare Reserve Select (TRS)

Front 6

What is a Medicare wraparound coverage available to all Medicare eligible Tricare beneficiaries regardless of age, provided they have Medicare Part A and Medicare Part B?

Back 6

Tricare for Life (TFL)

Front 7

What is a tricare prime managed care option available through networks of community based, not for profit health systems in six areas of the US?

Back 7

US Family Health Plan (USFHP)

Front 8

For what will you receive most care from primary care manager (PCM) at a MTF or within Tricare network?

Back 8

Tricare Prime

Front 9

For what will you receive care from Tricare network providers (or a Tricare authorized provider if network provider is unavailable)?

Back 9

Tricare Prime Remote

Front 10

For what will you receive care from Tricare authorized, non-network provider?

Back 10

Tricare standard

Front 11

For what will you receive care from Tricare network providers>

Back 11

Tricare Extra

Front 12

For what will you receive care from any Tricare authorized provider (network or non-network)?

Back 12

TRS

Front 13

For what will you receive care from Medicare Providers?

Back 13

Tricare for Life (TFL)

Front 14

For what will you receive care from primary care physician in the health care system to which you are enrolled?

Back 14

US Family Health Plan (USFHP)

Front 15

Authorized providers who are not part of the Tricare network of civilian providers may charge beneficiaries using Tricare Standard up to what percent above the Tricare allowable charge for service?

Back 15

15%

Front 16

If you enroll in what, you may not access care at an MTF, including MTF pharmacies?

Back 16

USFHP

Front 17

Who are not required to have Medicare Part B to remain eligible for Tricare?

Back 17

ADFMs

Front 18

Changes to Tricare programs are continually made as what is amended?

Back 18

Public Law

Front 19

Upon's sponsor's retirement, what must be in effect no later than the sponsor's retirement date to avoid a break in Tricare coverage?

Back 19

Medicare Part B

Front 20

National Guard and Reserve members who may have retired from their Service are not eligible for Tricare coverage until they reach what age?

Back 20

Traditional Retirement Age

Front 21

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

Back 21

DEERS

Front 22

What is a distinct form and should not be confused with TPR or TPRADFM stateside?

Back 22

Tricare Overseas Program (TOP) Prime Remote

Front 23

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

Back 23

50 miles

Front 24

Tricare defines a what as a person, business, or installation that provides healthcare?

Back 24

Provider

Front 25

There are two types of Tricare authorized providers, what are they?

Back 25

Network & Non-Network

Front 26

There are two types of non-network providers, what are they?

Back 26

Participating & Non-participating

Front 27

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

Back 27

Nonparticipating

Front 28

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

Back 28

PCM

Front 29

Which providers offer treatment that you PCM cannot provide?

Back 29

Specialty Care

Front 30

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

Back 30

8 visits

Front 31

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

Back 31

E1 - E4

Front 32

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

Back 32

Transitional health care

Front 33

You may qualify for a travel reimbursement if referred to specialty care that is more than how many miles from your PCM's office?

Back 33

100 miles

Front 34

You should have access to a PCM whose office is within how many minutes of you home, under normal conditions?

Back 34

30 minutes

Front 35

What care includes general office visits for the treatment of symptoms for an on-going medical condition?

Back 35

Routine (primary)

Front 36

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

Back 36

Prior Authorization

Front 37

Prior authorization needs to obtained before services are rendered how long in advance?

Back 37

24 hours

Front 38

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

Back 38

10 years

Front 39

Perform a mammography annually beginning at what age?

Back 39

40 years old

Front 40

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

Back 40

18 y/o

Front 41

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

Back 41

6 y/o

Front 42

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

Back 42

6 months

Front 43

ADSMs and ADFMs are covered for how many eye exams per year?

Back 43

One

Front 44

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

Back 44

24 hours

Front 45

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

Back 45

One week

Front 46

What program uses secure audio-visual conferencing to connect eligible beneficiaries, including TPR and TPRADFM enrollees in the US, with offsite Tricare network providers?

Back 46

Telemental Health

Front 47

Which pharmacy is the least expensive for filling prescriptions?

Back 47

MTF

Front 48

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

Back 48

14 days

Front 49

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

Back 49

Specialty Medications

Front 50

Tricare does not cover what type of ultrasound screenings?

Back 50

Routine

Front 51

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

Back 51

Hospice

Front 52

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 52

5 y/o

Front 53

Your new spouse's TPRADFM enrollment is effective based on what rule?

Back 53

"20th of the month"

Front 54

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

Back 54

21 y/o

Front 55

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 member's eligibility for retirement pay?

Back 55

20 years

Front 56

Tricare benefits end when your college student reaches what age or when full-time student status ends; whichever comes first?

Back 56

23 y/o

Front 57

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

Back 57

180 days

Front 58

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

Back 58

5%

Front 59

Surviving Spouse: You remain eligible as a "transitional survivor" for how many years following your sponsor's death and will have ADFM benefits and cost, including TPRADFM eligibility?

Back 59

3 years

Front 60

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 60

90 days

Front 61

Grievances are generally resolved within how many days of receipt?

Back 61

60 days

Front 62

What is the maximum out-of-pocket expenses for which Tricare beneficiaries are responsible in a given fiscal year?

Back 62

Catastrophic Cap

Front 63

Upon loss of Tricare eligibility, each family member will automatically receive a what?

Back 63

Certificate of Creditable Coverage

Front 64

The Statement of Personal Injury Third Party Liability (DD Form 2527) will be sent to you if a claim appears to have what involvement?

Back 64

Third-Party Liability

Front 65

What allows Tricare to be reimbursed for treatment cost if you are injured in an accident caused by some else?

Back 65

Federal Medical Care Recovery Act

Front 66

Nonparticipating providers may only bill you up to what percent of the Tricare allowable charge?

Back 66

115%

Front 67

Remember that nonparticipating providers may charge you up to what percent above the Tricare allowable charge for services, in addition to your cost-shares and or deductible?

Back 67

15%

Front 68

Claims must be filed within what time frame of either the date of service or the date of an impatient discharge?

Back 68

1 year

Front 69

If you are using what option, you may be required to submit your own health care claims?

Back 69

Tricare Standard

Front 70

If you are using what option, your provider will submit claims on your behalf?

Back 70

Tricare Extra

Front 71

What type of cardiac rehabilitation for lifetime maintenance performed at home or in medically unsupervised settings in excluded?

Back 71

Phase III

Front 72

With what program, you chose Tricare-authorized providers outside of the Tricare network and pay higher cost-shares?

Back 72

Tricare Standard

Front 73

With what program, you chose hospitals and providers within the Tricare network and receive discounted cost-shares?

Back 73

Tricare Extra

Front 74

Residential Treatment Center (RTC) Care is only covered for patients up to what age?

Back 74

21 y/o

Front 75

Rehabilitation is limited to how many days per year, per benefit period?

Back 75

21 days

Front 76

Individual or group therapy is limited to how many visits per benefit period?

Back 76

15 visits

Front 77

What is a voluntary dental insurance program administered by United Concordia, available to eligible ADFMs and National Guard and Reserve and Individual Ready Reserve members and their eligible family members

Back 77

Tricare Dental Program

Front 78

What is a voluntary dental insurance program administered by the Federal Services division of Delat Dental of California (Delta Dental)

Back 78

Tricare Retiree Dental Program

Front 79

Tricare Standard and Tricare Extra cover all necessary maternity care, from your first ob vist through how many weeks after your child is born?

Back 79

6 weeks