LRC Health Insurance: Tricare
Coding Classifications & Reimbursement Systems, MDA1305
May 1, 2014
TRICARE formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) is a federal healthcare program implemented in 1967 for active duty military members and their dependent family members. TRICARE is also for retirees of the military and their dependent family members and for survivors of soldiers who died while serving. U.S. uniform services include: Army, Navy, Air force, Marines, Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration (NOAA) (Rowell, J. A. (1997). TRICARE was created to expand health care access, ensure quality of care, control health care costs, and improve medical readiness for soldiers (Rowell, J. A. (1997). There are four regions of TRICARE: North, West, and South in the United States and one for those overseas.
There are three options to TRICARE: TRICARE Prime is a managed care (Fee for Service) option guaranteeing priority access to care at military treatment facilities (ie: base health facilities and the VA) with costly fees if care is sought outside the Prime network. TRICARE Prime is also the most comprehensive of the healthcare benefits of the three with the lowest cost (Rowell, J. A. (1997). Those who are eligible for this option are active-duty military personnel, family to the sponsor who are active-duty, and retirees and their family all whom are under age 65 (Rowell, J. A. (1997). TRICARE Extra allows users of TRICARE Standard save 5 percent while going to any network doctor, hospital or other provider just by presenting their CAC (military personnel’s ID card called common access card). However, there is a lower priority for these users at military treatment facilities on a space availability basis and more expensive than TRICARE Prime but is less costly than Standard alone and there is a choice of any physician within the network and an enrollment fee is not required. Those who are eligible for this TRICARE option are military personnel and their families whose regular physician is a participating provider of TRICARE Extra and those who do not have access to military treatment facilities (example: those in the National Guard, Reserves, or those who do not live on base, those who are retired) and want reduced health care costs with TRICARE Standard (Rowell, J. A. (1997). The last TRICARE option is TRICARE Standard which was originally CHAMPUS. To use Standard, the enrollee must make an appointment at a TRICARE-certified civilian healthcare provider (fee for service) or they must make an appointment at a military treatment facility (Rowell, J. A. (1997). With TRICARE standard it is the highest cost but gives the enrollee more freedom for seeking civilian providers with no enrollment fees. TRICARE Standard is available to those military personnel, their families and retirees.
TRICARES’s three options,...