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Prescription Status Track
Project HIE STANDARD
, formerly known as the
Civilian Health and Medical Program of the Uniformed Services
), is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component. The TRICARE program is managed by TRICARE Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities.
Historically, health care for military personnel and their dependents was provided in military medical facilities on a "space-available" basis. After World War II and the Korean War, access to care in military facilities became increasingly unavailable due to resource constraints and growing demands on the system. To address this problem, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the Secretary of Defense to contract with civilian health care providers. This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966
In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices — a health maintenance organization-like option called CHAMPUS Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called CHAMPUS Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost shares and deductibles.
Although DOD’s initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net) covering California and Hawaii, was received. Foundation delivered services under this contract between August 1988 and January 1994.
In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DoD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as TRICARE, the United States was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under TRICARE, seven managed care support contracts were awarded covering DOD’s 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare-eligible, and "TRICARE Reserve Select" in 2005.
Although TRICARE has many different insurance options available, listed below are the newest and most common health care plans that are available to eligible personnel, their spouse and their dependents.
TRICARE Standard provides a similar benefit to the original CHAMPUS program and is available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under TRICARE Standard, beneficiaries can use any civilian health care provider that is payable under TRICARE regulations. The beneficiary is responsible for payment of an annual deductible and coinsurance, and may be responsible for certain other out-of-pocket expenses. There is no enrollment fee for TRICARE Standard.
TRICARE Standard beneficiaries can elect to use the TRICARE Extra option by using a civilian health care provider from within the regional contractor's provider network. In this way, TRICARE Extra represents a preferred provider organization (PPO). When using TRICARE Extra, the beneficiary's coinsurance amount is reduced by at least five percentage points. There is no fee for use of the TRICARE Extra benefit other than the coinsurance.
TRICARE Prime is a health maintenance organization (HMO) style plan available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under TRICARE Prime, beneficiaries must choose a primary care physician and obtain referrals and authorizations for specialty care. In return for these restrictions, beneficiaries are responsible only for small copayments for each visit. There is an annual enrollment fee for TRICARE Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members.
TRICARE Young Adult (TYA)
TRICARE Young Adult allows adult children over the age of 21 (or 23, if enrolled in a full-time course of study at an approved higher education institution) to purchase TRICARE coverage after eligibility for "regular" TRICARE coverage ends
Eligible depedents for the TRICARE Young Adult Plan must have a TRICARE eligible sponsor, be umarried, not eligible for regular TRICARE coverage or their own employer-sponsored health care coverage, and under 26 years of age.
TYA began coverage for eligible, enrolled members on May 1, 2011. This plan offers TRICARE Standard coverage for monthly premiums of $186. While it does include medical and pharmacy benefits, it does not include dental. A premium-based TRICARE Prime benefit will be available later 2011.
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