Chapter 11 - TRICARE and CHAMPVA Flashcards

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Questions and Answers

What is a Military Treatment Facility (MTF)?

A place for civilian medical care

A place where medical care is provided to military personnel and their families (correct)

A private clinic for reservists

A hospital exclusive to veterans

What does cost-share refer to in TRICARE?

The amount the patient is responsible for, which is either 20 or 25%.

What is TRICARE?

The Department of Defense's health insurance plan for military personnel and their families.

What is TRICARE Extra?

A managed care plan with no annual enrollment fee where services are provided at civilian facilities. Signup and view all the answers

What is TRICARE Standard?

A fee-for-service program covering medical services provided by civilian physicians. Signup and view all the answers

What is the function of the Defense Enrollment Eligibility Reporting System (DEERS)?

It is a government database that contains information about patient eligibility for TRICARE. Signup and view all the answers

What is TRICARE Prime?

A managed care plan providing most services at military treatment centers. Signup and view all the answers

What is a catastrophic cap?

An annual limit on the total medical expenses that an individual or family may pay in one year. Signup and view all the answers

What was CHAMPUS?

The Department of Defense's health insurance plan for military personnel and their families replaced in 1998. Signup and view all the answers

What is the role of a Primary Care Manager (PCM)?

To coordinate and manage a patient's medical care under a managed care plan. Signup and view all the answers

What is a nonavailability statement?

An electronic document stating that the service required is not available at the local military treatment facility. Signup and view all the answers

What is TRICARE for Life?

A program for individuals age 65 and over eligible for both Medicare and TRICARE. Signup and view all the answers

What is CHAMPVA?

The government's health insurance program for veterans with 100% service-related disabilities. Signup and view all the answers

Who is referred to as a sponsor in TRICARE?

The uniformed services member whose status makes family members eligible for TRICARE coverage. Signup and view all the answers

What is TRICARE Reserve Select (TRS)?

Coverage for reservists available for purchase by certain National Guard and Reserve members. Signup and view all the answers

Study Notes

TRICARE Overview

TRICARE is the Department of Defense's health insurance plan for military personnel and their families.
Eligibility for TRICARE is managed by the Defense Enrollment Eligibility Reporting System (DEERS).
Services must be rendered by authorized providers; participating providers accept TRICARE's allowable charge as full payment.

TRICARE Plans

TRICARE Prime: A managed care plan primarily using military treatment facilities, requiring a Primary Care Manager (PCM). Active-duty members are automatically enrolled.
TRICARE Extra: Managed care plan with services at civilian facilities, no annual enrollment fee.
TRICARE Standard: Fee-for-service program that covers civilian medical services when MTFs are unavailable, paying 80% of covered charges.
TRICARE for Life: For individuals aged 65 and over eligible for both Medicare and TRICARE, allowing care at MTFs, with Medicare as the primary payer.
TRICARE Reserve Select (TRS): Premium-based health plan for certain National Guard and Reserve members activated after September 11, 2001.

Other Terms

Military Treatment Facility (MTF): Facilities providing medical care to military members and their families.
Cost-Share: The percentage (20% or 25%) of provider charges the patient is responsible for as coinsurance.
Catastrophic Cap: The maximum annual amount TRICARE beneficiaries pay for deductibles and cost-shares.
Primary Care Manager (PCM): Coordinates a patient's medical care within a managed care plan.
Nonavailability Statement: Electronic document confirming the required service is not available at the local MTF.

CHAMPVA

The Civilian Health and Medical Program of the Department of Veterans Affairs provides health insurance for veterans with 100% service-related disabilities and their families. Participants pay 25% of covered charges.
CHAMPUS: The former health insurance program for military personnel and their families, replaced in 1998.

Additional Concepts

Sponsor: The uniformed services member whose status grants eligibility for TRICARE coverage to family members.

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Description

Test your knowledge of TRICARE and CHAMPVA with these flashcards based on Chapter 11. Each card covers essential terms and definitions relevant to military healthcare. Perfect for students and professionals seeking to understand military medical benefits.