TRICARE Prime: How to Enroll
American Forces Press Service
WASHINGTON, June 8, 1998 If you've decided to enroll in TRICARE Prime, DoD's managed health care option for service families, you may be wondering how to go about it.
For the most part, active duty service members are automatically enrolled in TRICARE Prime and are assigned to a primary care manager, generally at a military medical facility. Service members in the National Capital Region were asked to select their own primary care manager because of the presence of numerous military medical facilities in the area.
For all other eligible persons including family members enrollment in Prime is voluntary and can be accomplished any time of the year. None of the three TRICARE options -- Prime, Extra or Standard -- has pre-existing-condition limitations.
If you live in an area that offers TRICARE Prime and you haven't already received an enrollment packet, call your regional TRICARE contractor and ask for one by mail. You can't enroll by telephone -- you have to fill out an application form and send it in. Call your nearest health benefits adviser for the phone number of the nearest TRICARE service center, or check with your local telephone company's directory assistance service. You can also visit a TRICARE service center to pick up an information packet.
Read the instructions in the packet about selecting your primary care manager. List your choice on the enrollment application. In some locations, military medical facilities may have reached their enrollment capacity, and your only choice then may be a civilian primary care manager.
Fill out the TRICARE Prime enrollment application, sign and date it. Mail it in the envelope provided. If you have to pay an enrollment fee -- all nonactive-duty families and individuals do -- include a check or money order or pay by credit card. Don't send cash. The application also explains how you can pay the enrollment fee in four equal quarterly installments.
Your TRICARE Prime benefits begin after your enrollment fee has been credited and your application has been processed. Shortly after application processing, you'll receive by mail a TRICARE Prime identification card and other information regarding your enrollment.
If the contractor receives your application by the 20th of the month, coverage under Prime begins on the first day of the following month. If your enrollment is received after the 20th of the month, your enrollment in Prime will become effective on the first day of the month after next. That is, if the TRICARE contractor gets your application on June 19, your enrollment in Prime begins July 1; if the contractor gets your application June 21, your enrollment begins Aug. 1.
You don't enroll in TRICARE Extra. Instead, you receive care on a case-by-case basis by choosing a health care provider from a list, or network, of doctors participating in the plan. Your cost sharing is discounted and you don't have to file claims. TRICARE Extra's annual outpatient deductibles are the same as for TRICARE Standard (formerly CHAMPUS).
You can quit TRICARE Prime after 12 months' continuous enrollment or if you move out of the service region.
If you want out at any other time, you must get approval from either the local military medical facility's commander, if you live within the facility's ZIP code service area (called a "catchment" area), or your TRICARE region's military "lead agent," if you don't live within a catchment area. Though your request may be approved, your enrollment fees aren't refunded. If you're making quarterly payments, however, you can skip any remaining installments.
If you aren't moving or you quit Prime before your enrollment anniversary date, you're barred from re-enrollment for 12 months. An exception to this is retirees in TRICARE Prime who are recalled to active duty -- the contractor will prorate their enrollment fee and refund the unused portion. The recalled member's family can disenroll without a 12-month "lockout" period or may enroll as the family of an active-duty service member.