Standard Option
Annual Outpatient Deductible
When you select the Standard Option, you must meet the annual outpatient deducible each fiscal year (October 1 - September 30) before cost-sharing begins:
- Active duty sponsor:
- Rank E4 and below: $50 per individual/$100 per family
- Rank E5 and above: $150 per individual/$300 per family
- All others: $150 per individual/$300 per family
The annual outpatient deductible is waived for family members of National Guard/Reserve members who are called to active duty for more than 30 days in support of a contingency operation.
Cost Shares
You're responsible to pay a cost share based on the type of care and type of provider (network vs. non-network). Non-network providers may charge up to 15% above the TRICARE allowable charge. You are also responsible for these extra charges.
Costs effective October 1, 2011
Type of Care |
Cost Share |
|
Children of Active Duty Service Members and Sponsors Using TRICARE Reserve Select |
All Others including |
|
Ambulance Services |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Ambulatory (same day) Surgery |
$25 per visit
|
Network Provider: Non-network Provider: Overseas Provider: |
Behavioral Health |
Outpatient:
Hospitalization:
|
Outpatient:
Hospitalization:
|
Clinical Preventive Services $0 for colorectal, breast, cervical and prostate cancer screenings; immunizations; and well-child visits for children under age 6. For all other preventive services: |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Emergency Room Visit |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Home Health Care Not covered overseas |
$0 |
$0 |
Hospice Care Not covered overseas |
$0 |
$0 |
Hospitalization |
$17.05 per day ($25 minimum)
|
Network Provider: Non-network Provider: Overseas Provider: |
Lab & X-Ray Services |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Maternity Care |
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.
Office visits for delivery planned in a TRICARE-authorized birthing center.
Office visits for delivery planned at home or another setting.
|
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.
Office visits for delivery planned in a TRICARE-authorized birthing center, at home or another setting.
|
Outpatient Visit |
Network Provider: Non-network Provider: Overseas Provider: |
Network Provider: Non-network Provider: Overseas Provider: |
Skilled Nursing Care |
$17.05 per day ($25 minimum)
|
Network Provider: Non-network Provider: Overseas Provider: |
Last Modified:May 30, 2012
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