HealthCare
On this page:
- Overview
- Routine Health Care
- Specialty Care
- Emergency Care
- Comprehensive Physical Exams
- Mental Health Care
- Prescriptions
- Contact Information
Overview
As an active duty Commissioned Corps officer, you do not have health insurance. You have a healthcare entitlement that keeps you fit for duty. All officers receive their healthcare from TRICARE, the Department of Defense (DoD) worldwide health care program for AD) and retired uniform service members and eligible beneficiaries. For more information on TRICARE, see the TRICARE Links page.
Health care is provided through one of two TRICARE programs based on the location of your home and duty station in relation to a Military Treatment Facility (MTF).
- Health care for officers within a catchment area (an area defined by ZIP codes that generally falls within a 40-mile radius of an inpatient MTF) will be provided by the local MTF via enrollment in TRICARE Prime.
- Health care for officers outside of a catchment are eligible for TRICARE Prime Remote (TPR) and will receive their healthcare through a civilian Primary Care Manager (PCM).
Note: Officers located in the Atlanta Metropolitan area are offered a choice between the TRICARE Prime and TRICARE Prime Remote coverage.
Your entitlement pays for 100 percent of TRICARE's maximum allowable charge for services rendered. Never pay the difference between the amount a provider charges and TRICARE's maximum allowable charge. In other words, you should never be balanced billed. However, if you use Other Health Insurance (OHI) outside of your entitlement, you will be responsible for all charges incurred. Furthermore, TRICARE will not be responsible for follow-up care or any negative after effects of a condition or injury sequelae associated with care received through OHI. For active duty officers, TRICARE is always the first payer and never cost-shares with private insurance companies.
If you have any questions regarding your healthcare entitlement to include (but not limited to) your PCM, referrals, OHI, bills and/or Explanation of Benefits (EOBs) please call your Health Benefits Advisor or a Service Point of Contact (SPoC) at the Medical Affairs Branch. Contact information can be found under the Active Duty Health Benefits Contact Information section.
Routine Health Care
Routine healthcare is defined as routine medical care provided by a PCM, in an office setting, to treat symptomatic, chronic or acute illnesses and diseases. Your PCM is usually a physician or other privileged medical professional, a team of providers, or a clinic (either civilian, or at a military medical facility) that provides and coordinates all of your health care needs.
Routine medical care includes (but is not limited to)
- Simple laboratory tests
- Noninvasive radiology and minor surgical procedures performed on an out-patient basis
- Preventive care measures such as physicals required by PHS
- Immunizations.
All nonroutine/specialty care requires a referral from your PCM. However, female officers may see a gynecologist for a routine annual exam, Pap smear, and mammogram (age dependent) without a referral from their PCM.* All officers are entitled to one routine eye exam per year, conducted by an optometrist and/or ophthalmologist, without referral from their PCM.*
*Note: These preventive services are offered under TRICARE Prime Remote and must be conducted by a network provider that accepts TRICARE Prime.
Your PCM will also keep track of your need for preventive-care services and maintain your medical records. He or she may notify you when you're due for a particular exam, service, test, or periodic screening.
For forms related to routine healthcare, please visit the Forms page.
Specialty Care
Specialty care is healthcare provided by a specialist that cannot be provided by your PCM. Your PCM will either provide the care you need or will refer you to a specialist.
IMPORTANT: You cannot receive care from a specialist without a referral from your PCM and be covered under TRICARE. You must first contact your PCM. Be sure a referral has been obtained and approved (authorized) before you seek specialty care.
For forms related to specialty care, please visit the Forms page.
Emergency Care
Go to the nearest military or civilian emergency room or urgent care center (or call 9-1-1) and provide your active duty and/or TRICARE enrollment card(s).
Per TRICARE, emergency care is generally defined as the sudden and unexpected start of a medical condition, or the acute (or intense) worsening of an ongoing (chronic) condition that is threatening to life, limb, or sight requiring treatment to relieve suffering from painful symptoms. If you think it is serious, go to the nearest emergency room.
You do not need to call your PCM before seeking emergency care. However, you or someone on your behalf should notify your PCM within 24 hours or as soon as possible.
For forms related to emergency care, please visit the Forms page.
Comprehensive Physical Exams
For officers enrolled in TRICARE Prime Remote, physical exams required for
- Assimilation
- 5-year periodic exam
- Separation
- Retirement
must be obtained through your PCM. For officers enrolled in TRICARE Prime, physicals must be obtained through the local MTF. Please reference the Commissioned Corps Management Information System (CCMIS) website (formerly DCP) or contact the Medical Affairs Branch for proper forms to be completed during your physical and for any questions regarding your physical exam.
For forms related to comprehensive physical exams, please visit the Forms page.
Mental Health Care
If you are in need of mental health care, please call the TRICARE administrator for the region where you reside to inquire how mental health care is accessed. Each region has different criteria for accessing mental health care. Referral from your PCM is required for an initial consultation.
TRICARE North:
Health Net Federal Services, Inc.
1-800-TRICARE
1-800-874-2273
TRICARE South:
ValueOptions
1-800-700-8646
TRICARE West:
TriWest Healthcare Alliance
1-888-TRIWEST
1-800-874-9378
Prescriptions
Active Duty Commissioned Officers are never charged for prescribed medications as long as they are filled at a TRICARE authorized pharmacy or MTF.
Contact Information
Please contact a Medical Affairs Branch TRICARE Service Point of Contact (SPoC), to answer any questions.
Office of Commissioned Corps Support Services (OCCSS)
Medical Affairs Branch (MAB)
5600 Fishers Lane, Room 4C-04
Rockville, MD 20857-0001
Voice: 1-800-368-2777
Option #2 – TRICARE SPoC
Option #3 – Physicals/Immunizations
Fax: 1-800-733-1303
CDC Health Benefits Advisor
LCDR Anissa Davis
Voice: (404) 498-1818
Fax: (404) 498-1815
E-mail: AADavis@cdc.gov
Comprehensive information regarding your healthcare entitlements as a Commissioned Corps officer can be found on TRICARE's website.