or premiums and out-of-pocket costs you may have with your TRICARE plan. Worth noting is that many TRICARE members confuse the term “referral” with “authorization.” A referral is when your primary care manager (PCM) or provider sends you to another provider for care. Prior authorization is a review of a requested health care service by your regional contractor to see if TRICARE will cover it. If so, your contractor will first try to refer you to a military hospital or clinic. If unavailable, you will be referred to a network provider (in your region). For more information, visit “Find A Doctor” on the TRICARE website. Also visit Tricare.mil/Plans/ComparePlans for details on fee information. TRICARE PRIME TRICARE Prime is a managed care option with the most affordable and comprehensive coverage. Enrollment is mandatory for Active Duty service members and the preferred option for many eligible beneficiaries. There is no enrollment fee or annual deductible for Active Duty families. Prime provides enhanced vision coverage and preventative services. Your provider will file claims for you (in most cases) and you’ll have fewer out-of-pocket costs. Most TRICARE Prime care is received from your Primary Care Manager (PCM). This military or network provider refers you to specialists for care he/she cannot provide, works with your regional contractor for referrals and authorizations, accepts copayments and files claims for you. While the TRICARE Prime program offers the most comprehensive health care benefit, it has some restrictions. Visit Tricare.mil/Plans/Enroll/Prime to see who is qualified and additional details. TRICARE SELECT Replacing TRICARE Standard and Extra, TRICARE Select is a self-managed, fee-for-service preferred provider network plan available to all Non-Active Duty beneficiaries. It differs from TRICARE Standard through a “fixed fee” for care received from network providers. TRICARE Select also requires enrollment with a fee, but only for service members and families entering Active Duty on or after Jan. 1, 2018. TRICARE Select allows choosing any TRICARE authorized provider for services covered by TRICARE, and to do so without a referral. But in some cases, you may need prior authorization. You can also receive additional preventive care services from a network provider (previously only under TRICARE Prime). However, TRICARE will only reimburse care received from authorized providers, and you may have to pay an annual enrollment fee. With the TRICARE Select system, users will be able to switch only during annual Open Season enrollment or when they have a Qualifying Life Event. Visit Tricare.mil/Plans/Enroll/Select. TRICARE FOR LIFE Available worldwide, TRICARE For Life (TFL) offers secondary coverage to Medicare for all beneficiaries who have both Medicare Part A and B. Medicare provides coverage in the U.S. and U.S. Territories. In all other overseas locations, TRICARE is the primary payer. With TFL, you may visit any authorized provider, have no claims to file (in most cases) and have minimal out-of-pocket costs aside from Medicare Part B premium and enrollment fee. For details on what is covered by TFL, Medicare or both, please visit Tricare.mil/Plans/HealthPlans/TFL. Note that Group A retirees are required to pay enrollment fees. In areas without Medicare, TRICARE is the primary provider. For further information and assistance, contact TFL contractor Wisconsin Physicians Service (WPS) at (866) 773-0404 or visit Tricare4u.com. TRICARE EXTENDED CARE HEALTH OPTION (ECHO) The Extended Care Health Option (ECHO) provides financial assistance to beneficiaries with special needs for an integrated set of services and supplies. To use ECHO, qualified beneficiaries must be enrolled in the Exceptional Family Health Care 158
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