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A Primer on TRICARE Prime

By Doug Gillert
National Guard Bureau

WASHINGTON, April 3, 1998 – If you're an active duty service member, you're automatically enrolled in the DoD managed health care plan, TRICARE Prime. Your spouse and children have to elect Prime enrollment, but the good news is, Prime is free to service members and their families.

If you're retired from the military, you can still enroll in Prime. Annual cost of $230, or $460 for you and eligible family members.

To be eligible for Prime, you also have to be registered with the Defense Enrollment Eligibility Reporting System. This includes new babies and adopted children. To register or update DEERS information, go to the nearest military personnel office. Then go to the nearest TRICARE service center to sign up for Prime.

Once in Prime, you'll be assigned to a primary care manager -- a team of physicians, nurses, physician assistants and technicians who will manage your health care. They, in turn, will refer you for specialty care within a provider network.

You have to enroll in Prime for a full year, but if you move during that year to a different area where Prime is available, you can transfer your enrollment by visiting the TRICARE service center at the new location. If you need health care before the enrollment is transferred, you must get authorization. Call the health care finder in your old service area. You'll get this number when you initially enroll. Without authorization, you'll have to share costs under the point-of-service option.

You can exercise a "point-of-service" option to obtain non-emergency care without a referral from your primary care manager, inside or outside the provider network. However, using this option costs money. You'll pay a deductible ($300 for one, $600 for the family), 50 percent of allowable charges, plus other costs billed by the provider.

You don't need authorization if you need emergency care, including hospitalization, outside your Prime enrollment area. Get the care you need, then notify your primary care manager or health care finder within 24 hours. This also applies to temporary duty travelers.

For nonemergency medical care outside your Prime service area, first call your primary care manager or health care finder.

All referrals for specialized and inpatient care under Prime require care authorization. Your primary care manager will coordinate the care through the health care finder.

If you find all these requirements bewildering, you're probably not alone. Confusing terms and requirements aside, however, patients continue giving TRICARE Prime high marks. Responses to surveys sent to patients in 1997 show that overall satisfaction with military health care surpasses the national average. And most TRICARE enrollees indicate they will re-enroll in the program.

That doesn't mean it can't get better, and TRICARE is taking steps to improve. The newly formed TRICARE Management Activity will improve the efficiency of its health care apparatus, officials said. Meanwhile, two new TRICARE dental plans will provide coverage for reservists and retirees, and DoD will soon begin demonstrating its ability to deliver cost-effective health care to retirees over age 65.

At the annual TRICARE conference here in February, Defense Undersecretary Rudy deLeon said the military still needs to improve access to care, care of older patients and care of troops in the field.

Navy Surgeon General Vice Adm. Harold Koenig said the TRICARE benefit must be delivered uniformly across the system so that beneficiaries can expect and receive the same level of health care anywhere.

Air Force Surgeon General Lt. Gen. Charles Roadman urged the military medical community to look at health care from their patients' perspective and become passionately dedicated to giving the best service they can.

For more information about Prime and other TRICARE programs, contact the TRICARE service center in your area or the health benefits office at a military medical treatment facility.

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