| 1Active duty service member |
TRICARE Prime plansTRICARE Prime plans include: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime |
$0 |
$0 |
$0 |
$0 |
| 2Active duty family member |
TRICARE Prime plans |
$04 |
$0 |
$0 |
$0 |
| TRICARE Standard PlansTRICARE Standard Plans include: TRICARE Standard and Extra, TRICARE Standard Overseas and TRICARE Young Adult-Standard |
E4 & below:
$50 per individual, but no more than $100 per family
E5 & above:
$150 per individual, but no more than $300 per family |
Network:
15% of negotiated feeThe discounted rate network providers agree to accept for covered services.
Non-network:
20% of allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges.
|
Network:
15% of negotiated fee
Non-network:
20% of allowable charge
|
$18.20 per day
($25 minimum charge) |
| 3Retired service members, families & others |
TRICARE Prime plans |
$04
|
$12 per visit |
$12 per visit |
$11 per day
($25 minimum charge) |
| TRICARE Standard plans |
$150 per individual; no more than $300 per family |
Network:
20% of negotiated fee
Non-network:
25% of allowable charge |
Network:
20% of negotiated fee
Non-network:
25% of allowable charge |
Network:
20% of the total + 20% for separately billed services
Non-network:
High Volume Hospitals: 25% hospital specific per diem + 25% for separately billed services
Low Volume Hospitals: $235 per day or 25% of the billed charges, whichever is less + 25% for separately billed services
Residential Treatment Centers: 25% of the allowed amount
|
| Guard/Reserve members & their families |
TRICARE Reserve Select |
E4 & below:
$50 per individual, but no more than $100 per family
E5 & above:
$150 per individual, but no more than $300 per family |
Network:
15% of negotiated fee
Non-network:
20% of allowable charge |
Network:
15% of negotiated fee
Non-network:
20% of allowable charge
|
$18.20 per day
($25 minimum charge)
|
| TRICARE Retired Reserve |
$150 per individual; no more than $300 per family |
Network:
20% of negotiated fee
Non-network:
25% of allowable charge
|
Network:
20% of negotiated fee
Non-network:
25% of allowable charge
|
Network:
20% of the total + 20% for separately billed services
Non-network:
High Volume Hospitals: 25% hospital specific per diem + 25% for separately billed services
Low Volume Hospitals: $235 per day or 25% of the billed charges, whichever is less + 25% for separately billed services
Residential Treatment Centers: 25% of the allowed amount |