There are three TRICARE options in the Western Pacific: Prime, Standard, and Plus.
TRICARE Prime
It is ONLY available to Active Duty and their family members. The TRICARE Prime option provides the most comprehensive health care benefits at the lowest cost of the three TRICARE options available in the Western Pacific.
Chief among the many features of TRICARE Prime is guaranteed access to care in a timely manner at military treatment facilities or our civilian provider network. Priority for treatment in military hospitals and clinics will be given to participants enrolled in TRICARE Prime. Furthermore, care will be provided according to strict time standards.
Another key feature of TRICARE Prime is that all enrollees will be assigned a primary care manager. A PCM is a health care professional or medical team who patients see first for their health care needs. PCMs will refer patients who require services beyond their scope of practice to either military or civilian medical specialists.
Who Is Eligible to Enroll in TRICARE Prime? All active duty military personnel are eligible and are automatically enrolled in TRICARE Prime at their nearest Medical Treatment Facility. Family members of active duty sponsors may also enroll in TRICARE Prime. DoD civilians, contractors, retirees, and their family members cannot currently enroll in TRICARE Prime in the Western Pacific.
Why Select TRICARE Prime? This option is best for families who want guaranteed access to the most benefits. First priority for care at military hospitals and clinics will be given to those enrolled in TRICARE Prime with a primary care manager at that facility.
How Much Does It Cost? There is no TRICARE Prime annual enrollment fee for active duty personnel or their families. With TRICARE Prime, coverage begins immediately, as there is no annual deductible that must be paid before benefits begin.
Outpatient visits to military hospitals and clinics for Prime enrollees require no payment. Visits to specialists outside an MTF within the Western Pacific require no deductible/co-payment. Family members of active duty personnel enrolled in TRICARE Prime who are assigned inpatient care at a civilian hospital within the Western Pacific incur no deductible/co-payment. Patients are still responsible for non-covered items, such as documentation fee, personal hygiene items (diapers, toilet paper) and telephone bills.
Primary Care Managers- PCMs are the single point-of-contact for non-emergency healthcare for enrollees in TRICARE Prime. PCMs may be family practitioners, pediatricians, or other medical professionals, or they may be a team of doctors who will work together to provide continuity of health care.
PCMs will provide and coordinate care, maintain health records, and recommend preventive and wellness services. He or she will also arrange for specialists or for hospital admission, when necessary.
Receiving Care In TRICARE Prime - Eligible beneficiaries enrolled in TRICARE Prime will receive all their non-emergency care from their primary care manager. While enrolled in TRICARE Prime, they will no longer be eligible for TRICARE Standard.
If Prime enrollees need specialty care, their PCM will refer them. In many cases, this care will be available through a military hospital. If the care needed is not available at a military hospital, their PCM will refer them to receive care from a civilian specialist.
It is very important to remember that in order to receive coverage for specialty care (military or any other beneficiary enrolled in TRICARE), it must be arranged and approved by International SOS.
Guaranteed Access to Care - All beneficiaries are guaranteed access to care. That care will be provided in military treatment facilities, or at a civilian network office or clinic.
For less urgent care, such as a recurring backache, you will be given an appointment to see a health professional within one week. For routine requirements, such as for a diagnostic test or exam, you will be seen within 28 days.
Focus on Preventive Care - With an emphasis on keeping families healthy, TRICARE Prime includes a variety of preventive and wellness services at no additional charge. Examples of such services include: eye exams, immunizations, hearing screenings, mammography, pap smears, prostate exams and other cancer-prevention and early diagnosis exams.
Out-of-Area Care - If you should need non-emergency medical care while you're away from home but still in Japan, it will be covered providing you obtain prior approval from your Primary Care Manager (042-552-2510, after dial tone extension 5-6478). Care authorization is required for all routine medical care received out of the area or at another facility. No pre-authorization is required for emergencies.
Enrolled beneficiaries who seek non-emergency care without prior approval will automatically be using what is called the TRICARE Point-of-Service option. This option requires payment of an annual deductible of $300 for an individual enrollee or $600 per family, plus 50 percent or more of visit or treatment fees.
Beneficiaries enrolled in TRICARE Prime who require emergency care should seek that care at the nearest civilian or military treatment facility.
International SOS (Singapore) - This service is available to active duty service members and families who are TDY/TAD, deployed or simply on leave in Pacific areas where a Military Treatment Facility is not available. International SOS can assist you in obtaining urgent and emergency medical and dental care. If is not available to obtain routine visits or treatment. If you need urgent medical or dental care in remote Pacific locations, International SOS can provide several valuable services. By calling collect at 65-6-338-9277 (24 hours per day, 7 days a week), before receiving care you can:
- Find a qualified health care provider
- Avoid paying up front for care
- Avoid filing claims
Otherwise, you can expect to pay the host nation provider at the time of service. Then you will need to file the claim with the TRICARE region where you are enrolled.
TRICARE Standard Overseas
TRICARE Standard Overseas provides comprehensive coverage in all overseas areas. The TRICARE Extra option is not available overseas.
Enrollment is not required. Coverage is automatic as long as your information is current in the Defense Enrollment Eligibility Reporting System
Eligible Beneficiaries:
All eligible beneficiaries except active duty service members.
Availability:
Overseas
Coverage:
TRICARE Standard Overseas provides comprehensive health coverage including:
- Emergency Care
- Outpatient Visits
- Preventive Care (wellness exams, immunizations, etc.)
- Hospitalization
- Maternity Care
- Mental/Behavioral health
- Prescriptions
Getting Care:
Schedule an appointment with any overseas provider. You will never need a referral for anytype of care (routine, urgent or specialty) but you may need to have prior authorization from the overseas contractor for some types of services.
Out-of-Pocket Costs:
Costs vary based on the sponsor's military status. After you've met an annual deductible, you're responsible to pay a cost share (or percentage).
Is TRICARE Standard Overseas Right for You?
TRICARE Standard Overseas may be your only option when you live overseas. If you're an active duty family member, you'll save money and have priority for care if you enroll in either TRICARE Prime Overseas or TRICARE Prime Remote Overseas. Be sure to get command-sponsored so you have the option.
TRICARE Plus
TRICARE Plus is a program that allows beneficiaries who normally are only able to get care at a military treatment facility on a space-available basis to enroll and receive primary care appointments at the MTF within the same primary care access standards as beneficiaries enrolled in a TRICARE Prime option. For example, if available at their local MTF, retirees and retiree family members using TRICARE For Life can enroll in TRICARE Plus and be guaranteed a routine appointment within one week, the same access standard as beneficiaries enrolled in a Prime option
Getting Care with TRICARE Plus:
TRICARE Plus is not a health plan; it is simply a way to access primary care at MTFs. Your enrollment in TRICARE Plus will be reflected in the Defense Enrollment Eligibility Reporting System (DEERS), but you can still get care as you normally would through your regular TRICARE plan. Through TRICARE Plus, you will receive primary care at the MTF with the same access standards as TRICARE Prime enrollees and will pay no out-of-pocket costs.