TRICARE is the Department of Defense's health care system for active duty and retired uniformed services members, their families, and survivors. TRICARE combines military health care resources and civilian health care providers authorized by TRICARE to receive reimbursement. Authorized civilian providers include:

• Network providers – those who have negotiated discount agreements with TRICARE
• Participating providers – those non-network providers who have agreed to accept  TRICARE-allowable charges as payment in full
• Non-participating providers – those who do not accept TRICARE-allowable charges as payment in full; they may charge patients up to 15 percent more than the allowed charges, as well as require patients to file their own claims and wait for reimbursement

TRICARE is the Department of Defense's health care system for active duty and retired uniformed services members, their families, and survivors. TRICARE combines military health care resources and civilian health care providers authorized by TRICARE to receive reimbursement. Authorized civilian providers include:

• Network providers – those who have negotiated discount agreements with TRICARE
• Participating providers – those non-network providers who have agreed to accept  TRICARE-allowable charges as payment in full
• Non-participating providers – those who do not accept TRICARE-allowable charges as payment in full; they may charge patients up to 15 percent more than the allowed charges, as well as require patients to file their own claims and wait for reimbursement

TRICARE offers three health care options to active duty family members living in the United States and certain overseas location. They vary according to cost, flexibility, and availability. Family members with special needs may receive care under one of these TRICARE options. TRICARE beneficiary eligibility status is determined by the Services and maintained in the Defense Enrollment Eligibility Reporting System (DEERS).

• TRICARE Prime – TRICARE Prime is a managed care option similar to a civilian health maintenance organization. Beneficiaries receive their care from a Military Treatment Facility (MTF), or through the regional contractor's provider network.
• TRICARE Extra – TRICARE Extra is a preferred-provider option that allows active duty family members to receive care from the network of providers with whom TRICARE has negotiated discounted costs.
• TRICARE Standard – Formerly known as CHAMPUS, TRICARE Standard is a fee-for-service option that allows active duty family members to receive care from any TRICARE-authorized provider.

TRICARE offers three health care options to active duty family members living in the United States and certain overseas location. They vary according to cost, flexibility, and availability. Family members with special needs may receive care under one of these TRICARE options. TRICARE beneficiary eligibility status is determined by the Services and maintained in the Defense Enrollment Eligibility Reporting System (DEERS).

• TRICARE Prime – TRICARE Prime is a managed care option similar to a civilian health maintenance organization. Beneficiaries receive their care from a Military Treatment Facility (MTF), or through the regional contractor's provider network.
• TRICARE Extra – TRICARE Extra is a preferred-provider option that allows active duty family members to receive care from the network of providers with whom TRICARE has negotiated discounted costs.
• TRICARE Standard – Formerly known as CHAMPUS, TRICARE Standard is a fee-for-service option that allows active duty family members to receive care from any TRICARE-authorized provider.

Within the United States, TRICARE is organized into three geographic health care service regions—North, South, and West. Each region is administered by a TRICARE Regional Office, with support from civilian health care contractors who are selected through a competitive procurement process. Each TRICARE region offers the same choices for health care plans and coverage. TRICARE beneficiaries living overseas have fewer options. The TRICARE website has links to websites for North, South and West regions, plus contact information for TRICARE overseas regions — Pacific, Europe, Canada/Latin America, and Puerto Rico/Virgin Islands.

Within the United States, TRICARE is organized into three geographic health care service regions—North, South, and West. Each region is administered by a TRICARE Regional Office, with support from civilian health care contractors who are selected through a competitive procurement process. Each TRICARE region offers the same choices for health care plans and coverage. TRICARE beneficiaries living overseas have fewer options. The TRICARE website has links to websites for North, South and West regions, plus contact information for TRICARE overseas regions — Pacific, Europe, Canada/Latin America, and Puerto Rico/Virgin Islands.

TRICARE Reserve Select is a premium-based TRICARE health plan offered for purchase by certain members and former members of the Reserve Component and their families, if specific eligibility requirements are met. The Reserve Components include the Army National Guard, Air National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and Coast Guard Reserve.

TRICARE Reserve Select is a premium-based TRICARE health plan offered for purchase by certain members and former members of the Reserve Component and their families, if specific eligibility requirements are met. The Reserve Components include the Army National Guard, Air National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and Coast Guard Reserve.

TRICARE beneficiaries who become entitled to Medicare Part A due to age, disability, or end-stage renal disease, and who pay Medicare Part B premiums, receive coverage under TRICARE For Life. TRICARE For Life acts as a second payer for TRICARE and Medicare covered services in the same manner as a supplemental health care policy. For services covered under one program but not the other, beneficiaries are responsible for any deductibles and cost shares not covered.

TRICARE beneficiaries who become entitled to Medicare Part A due to age, disability, or end-stage renal disease, and who pay Medicare Part B premiums, receive coverage under TRICARE For Life. TRICARE For Life acts as a second payer for TRICARE and Medicare covered services in the same manner as a supplemental health care policy. For services covered under one program but not the other, beneficiaries are responsible for any deductibles and cost shares not covered.

The certificate of creditable coverage is a document that serves as evidence of prior health care coverage for reducing how much or how long a health care plan can exclude a person from coverage for a preexisting health condition.  For former TRICARE beneficiaries, the certificate serves as evidence for a new insurance carrier that beneficiaries had previous health care coverage under TRICARE, for the period noted on the certificate.

The certificate of creditable coverage is a document that serves as evidence of prior health care coverage for reducing how much or how long a health care plan can exclude a person from coverage for a preexisting health condition.  For former TRICARE beneficiaries, the certificate serves as evidence for a new insurance carrier that beneficiaries had previous health care coverage under TRICARE, for the period noted on the certificate.

TRICARE policy requires service members with overseas orders to verify command sponsorship for accompanying family members for enrollment in TRICARE Prime Overseas, including TRICARE Prime Remote Overseas. When TRICARE Standard beneficiaries seek care overseas, they may have to pay the entire bill at the time of service and then file a claim for reimbursement. Under TRICARE Standard, family members must pay an annual deductible and cost shares each time they get care outside of the Military Treatment Facility (MTF). TRICARE Standard and Plus beneficiaries are only eligible for space-available care an MTF overseas. More information on Command Sponsorship is available on TRICARE's website.

TRICARE policy requires service members with overseas orders to verify command sponsorship for accompanying family members for enrollment in TRICARE Prime Overseas, including TRICARE Prime Remote Overseas. When TRICARE Standard beneficiaries seek care overseas, they may have to pay the entire bill at the time of service and then file a claim for reimbursement. Under TRICARE Standard, family members must pay an annual deductible and cost shares each time they get care outside of the Military Treatment Facility (MTF). TRICARE Standard and Plus beneficiaries are only eligible for space-available care an MTF overseas. More information on Command Sponsorship is available on TRICARE's website.

In 2005, TRICARE replaced the Program for Persons with Disabilities with ECHO. ECHO provides financial assistance to eligible beneficiaries who qualify, based on specific mental or physical disabilities, and offers services and supplies not available through the basic TRICARE program. ECHO supplements the benefits of the basic TRICARE program option that eligible family members use.

In 2005, TRICARE replaced the Program for Persons with Disabilities with ECHO. ECHO provides financial assistance to eligible beneficiaries who qualify, based on specific mental or physical disabilities, and offers services and supplies not available through the basic TRICARE program. ECHO supplements the benefits of the basic TRICARE program option that eligible family members use.

To be eligible for ECHO benefits, families must be enrolled in their Service's Exceptional Family Member Program (EFMP). If families qualify for special needs benefits, they should speak to an EFMP representative, who will ensure their proper enrollment in EFMP and provide them the appropriate ECHO contact information. In order to qualify for ECHO benefits, dependents of an active duty service member must have a qualifying condition. Special needs families can contact their regional managed care support contractor to determine program eligibility and details.

To be eligible for ECHO benefits, families must be enrolled in their Service's Exceptional Family Member Program (EFMP). If families qualify for special needs benefits, they should speak to an EFMP representative, who will ensure their proper enrollment in EFMP and provide them the appropriate ECHO contact information. In order to qualify for ECHO benefits, dependents of an active duty service member must have a qualifying condition. Special needs families can contact their regional managed care support contractor to determine program eligibility and details.

Yes. Sponsors must pay part of the monthly authorized expenses for their family member to receive benefits under ECHO.  For information related to costs associated with ECHO, visit the TRICARE website.

Yes. Sponsors must pay part of the monthly authorized expenses for their family member to receive benefits under ECHO.  For information related to costs associated with ECHO, visit the TRICARE website.

Several treatments, therapies and interventions, known as Educational Interventions for Autism Spectrum Disorders (EIA), are available and have been shown to reduce or eliminate specific problem behaviors and teach new skills to individuals with autism. These EIA services are not covered under basic TRICARE coverage (TRICARE Prime, Extra, Standard), and only partially covered through TRICARE ECHO. The Enhanced Access to Autism Services Demonstration allows eligible beneficiaries to have access to a greater range of existing evidence-based EIA services through an expanded network of educational intervention providers. The Enhanced Access to Autism Services Demonstration began on March 15, 2008 and is only available in the fifty United States and the District of Columbia. Additional information can be found on the TRICARE Autism Services Demonstration website.

Several treatments, therapies and interventions, known as Educational Interventions for Autism Spectrum Disorders (EIA), are available and have been shown to reduce or eliminate specific problem behaviors and teach new skills to individuals with autism. These EIA services are not covered under basic TRICARE coverage (TRICARE Prime, Extra, Standard), and only partially covered through TRICARE ECHO. The Enhanced Access to Autism Services Demonstration allows eligible beneficiaries to have access to a greater range of existing evidence-based EIA services through an expanded network of educational intervention providers. The Enhanced Access to Autism Services Demonstration began on March 15, 2008 and is only available in the fifty United States and the District of Columbia. Additional information can be found on the TRICARE Autism Services Demonstration website.

Mental health care is not classified as a TRICARE special needs program, but benefits can be confusing for special needs families unless the beneficiary has a serious mental illness that qualifies for care under TRICARE ECHO. Mental health care covered under the TRICARE Basic Program has the following restrictions:

• The TRICARE contractor must pre-authorize as medically necessary:
  • inpatient care
  • care at residential treatment facilities
  • extensions to TRICARE annual limits on inpatient care
  • outpatient mental health care exceeding two outpatient visits per week or eight outpatient visits per year
  • The annual limit on inpatient care is:
    • Thirty days for patients over the age of nineteen
    • Forty-five days for patients under the age of nineteen
    • One hundred and fifty days for inpatient care in residential treatment centers (available only to those under the age of twenty-one)
    • Seven (7) days detox and twenty-one (21) days rehabilitation for substance abuse

Mental health care is not classified as a TRICARE special needs program, but benefits can be confusing for special needs families unless the beneficiary has a serious mental illness that qualifies for care under TRICARE ECHO. Mental health care covered under the TRICARE Basic Program has the following restrictions:

• The TRICARE contractor must pre-authorize as medically necessary:
  • inpatient care
  • care at residential treatment facilities
  • extensions to TRICARE annual limits on inpatient care
  • outpatient mental health care exceeding two outpatient visits per week or eight outpatient visits per year
  • The annual limit on inpatient care is:
    • Thirty days for patients over the age of nineteen
    • Forty-five days for patients under the age of nineteen
    • One hundred and fifty days for inpatient care in residential treatment centers (available only to those under the age of twenty-one)
    • Seven (7) days detox and twenty-one (21) days rehabilitation for substance abuse

The disorders that qualify for TRICARE mental health care benefits involve clinically significant behavioral or psychological patterns and impaired ability to function appropriately. They are listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) and include conditions such as depression, anxiety, obsessive-compulsive disorder, bipolar disorder, schizophrenia, attention deficit disorders, and autism. TRICARE mental health benefits do not cover treatment for marital problems, weight loss, sexual dysfunction, certain personality disorders, or special learning disabilities. Beneficiaries who need counseling for behavioral or emotional difficulties that are not covered under TRICARE may be referred to Military OneSource.

The disorders that qualify for TRICARE mental health care benefits involve clinically significant behavioral or psychological patterns and impaired ability to function appropriately. They are listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) and include conditions such as depression, anxiety, obsessive-compulsive disorder, bipolar disorder, schizophrenia, attention deficit disorders, and autism. TRICARE mental health benefits do not cover treatment for marital problems, weight loss, sexual dysfunction, certain personality disorders, or special learning disabilities. Beneficiaries who need counseling for behavioral or emotional difficulties that are not covered under TRICARE may be referred to Military OneSource.

Reauthorized in 2004, the IDEA is the legislation that gives children with disabilities the right to a Free Appropriate Public Education (FAPE) including related services necessary to meet their educational goals. IDEA Part C requires that infants and toddlers who are or may become developmentally delayed due to cognitive, physical, communicative, social, emotional, or adaptive impairment also receive early intervention services (EIS). EIS and special education related services are often medical, diagnostic, or therapeutic in nature and provided by health care providers. They must be identified in the Individualized Family Service Plan for EIS or in a student's Individualized Education Program. IDEA legislation intends for these services to be provided at no cost to families (except where a state has established a system of payments by families, including a schedule of sliding fees).

Reauthorized in 2004, the IDEA is the legislation that gives children with disabilities the right to a Free Appropriate Public Education (FAPE) including related services necessary to meet their educational goals. IDEA Part C requires that infants and toddlers who are or may become developmentally delayed due to cognitive, physical, communicative, social, emotional, or adaptive impairment also receive early intervention services (EIS). EIS and special education related services are often medical, diagnostic, or therapeutic in nature and provided by health care providers. They must be identified in the Individualized Family Service Plan for EIS or in a student's Individualized Education Program. IDEA legislation intends for these services to be provided at no cost to families (except where a state has established a system of payments by families, including a schedule of sliding fees).

States may request and receive annual funding for IDEA Part C services, but they do not always fully cover direct services by health care providers. Instead, states will share the cost of direct services such as medical treatment, physical therapy, and speech therapy with TRICARE, Medicaid, private insurance, and other sources. The most recent IDEA legislation stipulates that TRICARE will pay its share first, but only for services that are medically or psychologically necessary and otherwise a TRICARE benefit. TRICARE cost-sharing determinations are on a case-by-case basis. Services included on the Individualized Education Program for special education students from age three to twenty-one are paid for by state educational agencies through contracts or other arrangements, and TRICARE is involved only when it is determined that the necessary services are not available or adequate.

States may request and receive annual funding for IDEA Part C services, but they do not always fully cover direct services by health care providers. Instead, states will share the cost of direct services such as medical treatment, physical therapy, and speech therapy with TRICARE, Medicaid, private insurance, and other sources. The most recent IDEA legislation stipulates that TRICARE will pay its share first, but only for services that are medically or psychologically necessary and otherwise a TRICARE benefit. TRICARE cost-sharing determinations are on a case-by-case basis. Services included on the Individualized Education Program for special education students from age three to twenty-one are paid for by state educational agencies through contracts or other arrangements, and TRICARE is involved only when it is determined that the necessary services are not available or adequate.

In locations where the Department of Defense (DoD) educates children of active duty service members (and DoD civilians overseas), the DoD is also responsible for early intervention and related services. Established to meet requirements of IDEA for early intervention and related services, EDIS clinics are organized under Army, Navy and Air Force medical departments at CONUS installations with DoD schools and within assigned geographic areas of responsibility overseas. EDIS clinics overseas are staffed with comprehensive teams of professionals in early childhood special education, occupational therapy, physical therapy, social work, speech-language pathology, audiology, psychology, child psychiatry, and developmental pediatrics. In CONUS locations, some EDIS services may be purchased by DoD from the local community. EDIS services are completely separate from and are unrelated to TRICARE benefits.

In locations where the Department of Defense (DoD) educates children of active duty service members (and DoD civilians overseas), the DoD is also responsible for early intervention and related services. Established to meet requirements of IDEA for early intervention and related services, EDIS clinics are organized under Army, Navy and Air Force medical departments at CONUS installations with DoD schools and within assigned geographic areas of responsibility overseas. EDIS clinics overseas are staffed with comprehensive teams of professionals in early childhood special education, occupational therapy, physical therapy, social work, speech-language pathology, audiology, psychology, child psychiatry, and developmental pediatrics. In CONUS locations, some EDIS services may be purchased by DoD from the local community. EDIS services are completely separate from and are unrelated to TRICARE benefits.

Assistive technology is any device which helps an individual with an impairment to perform tasks of daily living. There is a wide range of types of devices in assistive technology from low tech, homemade aids to sophisticated electronic equipment. The Individuals with Disabilities Education Act states that students who need assistive technology are entitled to the aids, devices, and assistive technology services that are necessary for the student to benefit from a Free Appropriate Public Education.

Assistive technology is any device which helps an individual with an impairment to perform tasks of daily living. There is a wide range of types of devices in assistive technology from low tech, homemade aids to sophisticated electronic equipment. The Individuals with Disabilities Education Act states that students who need assistive technology are entitled to the aids, devices, and assistive technology services that are necessary for the student to benefit from a Free Appropriate Public Education.

The Department of Defense (DoD) established CAP in 1990 to improve accessibility for people with disabilities throughout the DoD. The TRICARE Management Activity, a field activity in the Office of the Assistant Secretary of Defense (Health Affairs), serves as the executive agent for CAP. CAP provides assistive technology and accommodations to ensure people with disabilities have equal access to the information environment and opportunities in DoD and throughout the federal government.

The Department of Defense (DoD) established CAP in 1990 to improve accessibility for people with disabilities throughout the DoD. The TRICARE Management Activity, a field activity in the Office of the Assistant Secretary of Defense (Health Affairs), serves as the executive agent for CAP. CAP provides assistive technology and accommodations to ensure people with disabilities have equal access to the information environment and opportunities in DoD and throughout the federal government.

In October 2000, the National Defense Authorization Act granted CAP the authority to provide assistive technology, devices, and services to any department or agency in the federal government upon the request of the head of the agency. CAP also provides assistive technology accommodations and support to returning wounded service members in their recovery, rehabilitation, transition and employment phases as well as provide assistance with installation Exceptional Family Member Programs.

In October 2000, the National Defense Authorization Act granted CAP the authority to provide assistive technology, devices, and services to any department or agency in the federal government upon the request of the head of the agency. CAP also provides assistive technology accommodations and support to returning wounded service members in their recovery, rehabilitation, transition and employment phases as well as provide assistance with installation Exceptional Family Member Programs.

TRICARE ECHO has a Durable Equipment Benefit (TRICARE Policy Manual 6010.54-M, Chapter 9, Section 14.1) that can provide eligible beneficiaries with assistive technology such as  computer software or peripheral devices to make a computer functional for a beneficiary and electrical/mechanical lifts to ease access to a beneficiary's home. Installation service providers should encourage families who may need assistive technology, such as augmentative communication devices, to speak to their Primary Care Managers about Durable Equipment that also may be available via TRICARE Prime or Standard.

TRICARE ECHO has a Durable Equipment Benefit (TRICARE Policy Manual 6010.54-M, Chapter 9, Section 14.1) that can provide eligible beneficiaries with assistive technology such as  computer software or peripheral devices to make a computer functional for a beneficiary and electrical/mechanical lifts to ease access to a beneficiary's home. Installation service providers should encourage families who may need assistive technology, such as augmentative communication devices, to speak to their Primary Care Managers about Durable Equipment that also may be available via TRICARE Prime or Standard.

Parents must submit a custody document or power of attorney form to the family members' TRICARE Regional Contractors to authorize access to or release of claims, enrollment information, referrals and/or authorization information. Service members should be sure to include contact information, their name, their Social Security number, and the entire legal document. If there are still questions about this process, each Military Treatment Facility (MTF) has a designated privacy officer who can help. Additionally, this release does not apply to eligible family members eighteen years of age or older who must themselves authorize release of health care related information to anyone other than themselves.

Parents must submit a custody document or power of attorney form to the family members' TRICARE Regional Contractors to authorize access to or release of claims, enrollment information, referrals and/or authorization information. Service members should be sure to include contact information, their name, their Social Security number, and the entire legal document. If there are still questions about this process, each Military Treatment Facility (MTF) has a designated privacy officer who can help. Additionally, this release does not apply to eligible family members eighteen years of age or older who must themselves authorize release of health care related information to anyone other than themselves.

If a spouse's hometown is in a TRICARE Prime service area within the same TRICARE Region, continuing a family's TRICARE Prime coverage is simple. Family members should change their family's personal information in the Defense Enrollment Eligibility Reporting System (DEERS) using one of two methods:

• visit the TRICARE Beneficiary Web Enrollment (BWE) site to make the changes
• submit a Department of Defense Form (DD Form) 2876, TRICARE Prime Enrollment Application and Primary Care Manager (PCM) Change Form to a regional contractor 

A common mistake Prime enrollees make is not changing their PCM upon moving and receiving health care in the new location without a referral, which results in higher point of service (POS) costs. It is very important that families select their new PCM to provide and coordinate their health care in the new location. Until this is done, be sure to coordinate the family's health care with the previous PCM to avoid POS costs. 

If the hometown is in a different TRICARE Region, but still in a TRICARE Prime service area, the above two methods can be used to update a family's enrollment. If a TRICARE Prime Enrollment Application and PCM Change Form is used, families should be sure to submit it to the new regional contractor after arriving in the new location. Families should not transfer enrollment before moving. Family members must continue to coordinate care with the family's previous PCM until the PCM changes are made. The new PCM change will take effect on the day it is received by the new regional contractor. 

If a family will be living in a non-TRICARE Prime service area and do not qualify for TRICARE Prime Remote for Active Duty Family Members, they will need to dis-enroll from TRICARE Prime after arriving at the new location. Families can do this by submitting a TRICARE Prime Dis-enrollment Application Form to their current regional contractor. Once a family is dis-enrolled from TRICARE Prime, their coverage will switch to TRICARE Standard and TRICARE Extra. Additional information on TRICARE enrollment can be found on the TRICARE website.

If a spouse's hometown is in a TRICARE Prime service area within the same TRICARE Region, continuing a family's TRICARE Prime coverage is simple. Family members should change their family's personal information in the Defense Enrollment Eligibility Reporting System (DEERS) using one of two methods:

• visit the TRICARE Beneficiary Web Enrollment (BWE) site to make the changes
• submit a Department of Defense Form (DD Form) 2876, TRICARE Prime Enrollment Application and Primary Care Manager (PCM) Change Form to a regional contractor 

A common mistake Prime enrollees make is not changing their PCM upon moving and receiving health care in the new location without a referral, which results in higher point of service (POS) costs. It is very important that families select their new PCM to provide and coordinate their health care in the new location. Until this is done, be sure to coordinate the family's health care with the previous PCM to avoid POS costs. 

If the hometown is in a different TRICARE Region, but still in a TRICARE Prime service area, the above two methods can be used to update a family's enrollment. If a TRICARE Prime Enrollment Application and PCM Change Form is used, families should be sure to submit it to the new regional contractor after arriving in the new location. Families should not transfer enrollment before moving. Family members must continue to coordinate care with the family's previous PCM until the PCM changes are made. The new PCM change will take effect on the day it is received by the new regional contractor. 

If a family will be living in a non-TRICARE Prime service area and do not qualify for TRICARE Prime Remote for Active Duty Family Members, they will need to dis-enroll from TRICARE Prime after arriving at the new location. Families can do this by submitting a TRICARE Prime Dis-enrollment Application Form to their current regional contractor. Once a family is dis-enrolled from TRICARE Prime, their coverage will switch to TRICARE Standard and TRICARE Extra. Additional information on TRICARE enrollment can be found on the TRICARE website.