Chapter 11 - TRICARE and CHAMPVA Flashcards

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.

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.