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A TRICARE Guide Understanding Behavioral HealthCommon Concerns, Helpful Resources, and How Your Benefits Work for You
November 2009
An Important Note about TRICARE Program Information
At the time of printing, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law. Changes to TRICARE programs are continually made as public law is amended. Military treatment facility guidelines and policies may be different than those outlined in this publication. For the most recent information, contact your TRICARE regional contractor, TRICARE Service Center, or local military treatment facility.
For information about Patient Rights and Responsibilities, visit www.tricare.mil/patientrights.
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Table of ContentsTRICARE and Your Behavioral Health ...................................3
IfYouNeedHelpRightNow.......................................................4 Don’tWaitforanEmergency.......................................................5 Using thisGuide...........................................................................5
Understanding Behavioral Health ........................................6
StressandtheTollItTakes..........................................................6 RecognizingSignsandSymptoms..............................................11 CommonBehavioralHealthConditions.....................................12
Covered Services, Limitations, and Exclusions ..................16
OutpatientServices......................................................................16 InpatientServices........................................................................20 Exclusions...................................................................................23 Costs............................................................................................24
Who to See for Care ............................................................26
BehavioralHealthCareProviderTypes.....................................26 SelectingaProvider....................................................................27 BeforeYouTravel.......................................................................28
Getting Care .........................................................................30
ActiveDutyServiceMember.....................................................32 ActiveDutyFamilyMember......................................................38 NationalGuardorReserveMemberorFamilyMember.............46 RetiredServiceMemberorFamilyMember..............................52 Medicare-EligibleTRICAREBeneficiary..................................58
Your Right to Privacy ...........................................................63
MedicalRecordsandPrivacy.....................................................63 HIPAAandPrivacy....................................................................63 ReleaseofRecordsandPersonalHealthInformation.................64 Alcohol,DrugAbuse,andMentalHealthAdministrationReorganizationActof1992...........................64
www.tricare.mil
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For Information and Assistance ......................................... 65
TRICAREinYourRegion..........................................................65 OtherBehavioralHealthResources.............................................70 RecommendedReadingList.......................................................71 OnlineBehavioralHealthResources..........................................72
Acronyms ............................................................................. 74
Glossary ............................................................................... 76
List of Tables ........................................................................ 81
Index .................................................................................... 82
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TRICARE And youR bEhAvIoRAl hEAlTh
TRICARE and Your Behavioral HealthBehavioralhealthisatermusedinterchangeablywithmentalhealth.Unfortunately,manypeoplearestillreluctanttoseekbehavioralhealthcarebecausethey’reafraida“stigma”surroundsbehavioralhealthproblems.
Noonequestionstheneedformedicalcareforasprainedarmoraheartproblem.However,whenpeopleexperienceemotionalproblemstheymayfeelembarrassedandafraidtoseekhelpwhenthetroublingsignsfirstsurface.Sometimes,peopletrytoconvincethemselvestheproblemswillgoawayontheirown—theyjusthaveto“toughitout”untilthathappens.Someemotionaldifficultieswill goawaywithtime.But,justlikeaheartconditionthat’signored,somebehavioralhealthproblemsworsenifleftuntreated.Don’tletthishappentoyou.
Ourmilitaryleadership,fromthesecretaryofdefensedownthechainofcommand,recognizestheneedforaddressingbehavioralhealthcareissuesformenandwomeninuniform,theirfamilies,andretirees.TworecentDepartmentofDefense(DoD)initiativesincludenewpost-traumaticstressdisorder(PTSD)treatmentprogramsforreturningservicemembersandexpandedcounselingforservicemembers,retirees,andtheirfamilies.
AdditionalDoDeffortsareunderwaytobattlethestigmaanddiscriminationsurroundingpsychologicaldisordersandencourageservicemembersandfamiliestoseekbehavioralhealthcare.Forinstance,theMentalHealthSelf-AssessmentProgram(www.militarymentalhealth.org/welcome.asp),anonlineresourcefundedbyDoDForceHealthProtectionandReadiness,offersanonymousself-assessmenttoolstohelpyouandyourfamilymembersidentifypossiblebehavioralhealthsymptomsandprovidesguidanceonhowtogethelp.
Thisprogramalsopromotesthenecessityofobtainingbehavioralhealthcareinitseducationalvideo,A Different Kind of Courage: Safeguarding and Enhancing Your Psychological Health.
www.tricare.mil
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Toviewthevideoandtakeadvantageoftheself-assessmenttools,visit www.mentalhealthscreening.org/military.ForadditionalDoDresourcesdesignedtoassistyouingettingthecareandsupportyoudeserve,visitwww.warriorcare.mil.
Reversingyearsofstigma,adoptingnewwaysofrecognizingbehavioralhealthcareneeds,andmakingpositivechangeswilltaketime.However,thechangehasstartedandprogressisbeingmade.Itisinthebestinterestofsoldiers,theirfamilies,andthemilitarytoseekhelpratherthanignorebehavioralhealthproblemsthatcanputallatrisk.
If You Need Help Right Now
Toooften,apersonfailstoreachoutforhelpuntilheorsheisinthemidstofacrisis.Ifyouhavepickedupthisguidebecauseyoufeelasthoughyouoraclosefamilymemberneedshelprightnow,don’t wait until the situation worsens.Here’swhatyoushoulddo.
If it is an emergency, call 911 or go directly to the closest emergency care or psychiatric health care facility.Anemergencymeansthatthephysicalwell-beingofanindividualorthosearoundhimorherisatrisk.
In the U.S., you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4889.Thishotlineisa24-hour,toll-freesuicidepreventionserviceavailabletoanyoneinsuicidalcrisis.Youwillberoutedtotheclosestpossiblecrisiscenterinyourarea.Yourcallisfreeandconfidential.VeteranslivingintheU.S.maycall1-800-273-TALK (1-800-273-8255) and press “1”toreachtheDepartmentofVeteransAffairs(VA)hotline,whichisstaffedbybehavioralhealthprofessionalswhoworkcloselywithlocalVAbehavioralhealthcareproviders.Note:ThisnumberisnotfreeofchargeifdialedfromoutsidetheU.S.
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TRICARE And youR bEhAvIoRAl hEAlTh
Don’t Wait for an Emergency
Ifyoursituationisnotanemergency,readthisguidetolearnaboutthebehavioralhealthcareinformationandservicesthatareavailabletoyou.Ifyou’restillconcernedorfeelingasthoughyouneedtotalktoaprofessional,TRICAREcoversthoseservices.
Using this Guide
Thisguideisintendedtohelpyouunderstandsomeofthemorecommonbehavioralhealthissues,aswellaswhentoseekcare.TheguideprovidesvaluableinformationaboutyourTRICAREbenefit,guidelinesaboutwhenyoumayneedreferralsandauthorizationforcare,andwhotocontactforhelp.You’llalsofindeasy-to-understandinformationaboutconditions,symptoms,andpossiblewarningsigns.
Manypeoplethinkonlyapsychiatristorpsychologistcanprovidebehavioralhealthcare.Thereareactuallyseveraldifferenttypesofproviders,andthisguidewillhelpyouunderstandhowtofindoneandlearnwhattypesoftreatmentareavailable.
TheGetting Caresectionprovidesabreakdownofcareaccessguidelinesbyyourbeneficiarytypeandprogramoption.Youcanalsoreadaboutlifeeventscommontoeveryoneorchallengesandconcernsspecifictomilitaryfamilies.
Your Right to Privacyisasectiondetailingyourprivacyrightsandhowyourmedicalandbehavioralhealthrecordsareused.
RefertotheFor Information and Assistancesectionofthisguideforimportantcontactinformationandhelpfulresources,includingalistofrecommendedreadingandotherresources.
Keepinmindthatthisguideisonlyaninformationalresource.Itisnotasubstituteforprofessionalcare.Nevertrytodiagnoseyourselforalovedonebasedoncertainsymptomsorbehaviors.Alwaysleavediagnosisandtreatmenttotheexpertswhoarewaitingtohelp.
www.tricare.mil
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Understanding Behavioral Health
Stress and the Toll It Takes
Militarylifeischallengingandoftenunpredictableforservicemembersandtheirfamilies.Frequentdeployments,moves,andextendedseparationsarejustafewexamplesofthestressesservicemembersandtheirfamilymembersface.Addtothatthedailysituationsthatcreatestressforeveryone:jobfrustrations,problemsatschool,financialandmedicalhealthworries.It’snotuncommonfortheseissuestoleadtofeelingsofanxiety,anger,orsadness.
Whenstressisminimizedorwell-managed,thesefeelingswillcomeandgo,butultimatelyshouldpass.Whensomeoneisexposedtolong-termstress,seriousphysical,emotional,andbehavioralhealthissuescanresult.
Stresscanweakenyourimmunesystem,makingithardertofightdiseases.Becauseitcanmakeyoumoodyandtense,yourrelationshipsmaysuffer,andyourperformanceatworkorschoolmaydecline.Ifstresspersistswithouttreatment,itcanleadtodepressionandmoreseriousbehavioralhealthconditions.
Stress and the Deployment Life Cycle
Deployment,perhapsthemostchallengingpartofmilitarylife,canbeanemotionalrollercoasterridepackedwithunpredictablechallengesforservicemembersandtheirfamilies.Theseemotionalexperiencesarenormalreactionstochange,andevenjustknowingwhattoexpectcanhelplessenthenegativeimpactofthosechallenges.
Thefollowinginformationoffersinsightintowhatyoumaybefeelingandtipsformanagingthetransitionsthatoccurduringthedeploymentlifecycle.Takenoteifanyoftheseemotionaldifficultieslastforanextendedperiodoftime.Ifso,itmaybetimetoseekprofessionalassistance.
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Pre-Deployment: The Stress of Saying Goodbye
What to Expect:Oftenthemostdifficultstageofthedeploymentcycle,thepre-deploymentphasefindsmilitaryfamiliesstrugglingtomakethingswork.Beforedeployment,familiesfindthemselvesrunningextraerrands,settinguptheirfinancesforthenextyear,andpreparingchildrenforthechange.Additionally,servicemembersspendagoodbitoftimeawayfromhomepreparingandtrainingfortheupcomingdeployment.Asaresult,militaryfamiliesexperiencetension.Couplesmayfeelasiftheyarearguingallofthetime.Childrenmaythrowtantrums,orontheoppositeextreme,actasthoughtheydon’tcareaboutthedeployment.
What to Do:Thesedifficultiesarenormalpriortodeployment.Normallifeexperienceshowsthatpeopletendtoarguejustpriortoananticipatedseparation.However,it’simportanttoresolveissuesbeforedeploymenttomaintainpositiverelationshipsduringtheseparation.Apositiveenvironmentwillmakethetransitionmuchsmootherforeveryoneinvolved.
Deployment: Maintaining Normal Activities
What to Expect:Thedeploymentstagecreatesmixedemotionsformilitaryfamilies.Servicemembersmayfeelsad,numbtothedeployment,alone,orabandoned.Atthesametime,thespousemayfeeldisorientedoroverwhelmedwithadditionalresponsibilities.Childrenalsofeeltheeffectsofdeploymentandmayhavedifficultysleeping.Theymayfeelanxious,fearful,lonely,orcomplainofphysicalsymptoms,suchasfrequentstomachaches.
What to Do:Tosuccessfullynavigatethedeploymentphase,it’simportantthatyouandyourfamilymembersmaintainanormalroutine.Servicememberscantakeupahobbyduringdeployment,whilespousesandchildrenshoulddowhattheycantosticktotheirnormalactivities.“HelpingKidsPasstheTimeWhileYou’reApart”onthefollowingpageofferssomeideasforhelpingchildrenthroughthedeploymentphase.
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www.tricare.mil
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Helping Kids Pass the Time While You’re Apart
Listedhereareafewideasforhelpingchildrenpositivelyfocustheirenergyandemotionsduringdeployment:
Havefamilyfunnights.•
Makeavideoofthefamilyduringthedeployment.•
Hostboardgametournaments.•
Createascrapbooktogether.•
Encouragethemtotakeupanewactivity(• e.g., sports or dancing).
Findanorganizationinyourcommunityandsuggestthey•volunteerafewtimesaweek.
Keepatimelineofimportanteventstosharepost-deployment.•
Sustainment and Post-Deployment: Returning to Routine
What to Expect:Astimepasses,militaryfamiliesbecomeaccustomedtotheirnewroutinesandlearntocopewiththeseparation.Afterafewbumpsalongtheway—missedphonecalls,familyemergencies,andlong-distancechallenges—eventually,thetimecomesfortheservicemembertocomehome.
Returninghomecanpresentawholenewsetofchallengesforamilitaryfamily.Establishedroutinesaredisrupted.Theservicemembermayhavedifficultyreconnectingwiththefamily,andthespousemaynotwanttogiveuptheresponsibilitiesheorshehastakenon.
What to Do:Duringthisstage,itisimportantforfamiliestotakeitslowlyandbecomereacquaintedwitheachother.Forspouses,communicationisextremelyimportantduringthisperiod.It’svitaltoclearlycommunicatewhatrolechangeshaveoccurredduringdeploymentanddiscusswhatchangesshouldbemadenowthattheservicememberishome.
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undERsTAndIng bEhAvIoRAl hEAlTh
Thepost-deploymentphasemayposespecialchallengesforchildren.Youngerchildrenmaynotremembertheservicememberastheirparent.Olderchildrenmayrequirealotofattention,whileteenagersmayappeartonotevencarethattheparenthasreturnedhome.Letchildrensettheirownpace.Intime,thecomfortofhavingmomordadbackhomewillreturn.
The Basics of Self-Care
Duringdifficulttimes,suchasdeploymentsorotherdisruptiveperiods,it’simportantforeveryonetomaintainawell-balancedroutine.Listedhereareafewtipsonjusthowtodothat:
Spendtimewithyourfamily.•
Keepyourspiritsup.Takeawalk,rideabike,orfrequent•thegym.
Dosomethingforyou.•
Getplentyofrest.•
Establishanetworkofsupport.Thiscanbefamily,friends,ora•supportgrouponbase.
Makeplanstopassthetimewhileyou’reawayfromyourloved•ones.Familymemberscantakeatripandservicememberscantakeupahobby.
Trytoavoidthesecommonpitfalls:
Rumorsandlossoftrust•
Over-interpretingarguments•
Refusingtoacceptchangesinyourrelationships•
Duringdeployments,puttingtoomuchimportanceonthedateof•returnbecausedatescanchange
Overspending•
www.tricare.mil
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Self-Help Tips for Managing Your Stress
Therearemanywaystomanagestress.Trythesetechniques:
Getmoresleepandrest.•
Avoidalcoholandtobacco.•
Discontinueordecreasecaffeineintake.•
Eatabalanceddiet.•
Taketimetoexerciseregularly,aloneorwithyourfamily.•
Tryanewhobby.•
Buildastrongnetworkoffriendsandfamilywithwhomyou•cantalk.
Keepajournal.•
Spendtimewithlovedones.•
Findtimetobealoneandrelaxortrymeditation.•
Manageyourtimewell—avoidoverschedulingyourdayand•makelists.
Periodicallycleanandorganizeyourpersonalspace.•
Makeanefforttofocusonthepositiveaspectsofasituation.•
Trytofindhumorinsituationsand/orwatchafunnytelevision•showregularly.
Get Self-Help Online at www.afterdeployment.org
Duringpost-deploymenttransitions,returningservicemembersandtheirfamiliescantakeadvantageofinteractivebehavioralhealthinformationatwww.afterdeployment.org.Theuser-friendlysiteoffersconfidentialeducationaboutahostofimportanttopics,including:stress,itstriggers,andhowtomanageit;workconflicts;reconnectingwithfamilyandfriends;moods;anger;sleep;andspecialdeploymentchallengesfacedbychildren.Privacyisnotaconcernbecauseyoudon’tneedtoregistertoaccesstheWebsite.Justcreateausernameandpasswordtoexplorethevaluabletoolsandinformationavailableatwww.afterdeployment.org.
Practicingself-helpmethodsshouldlessenoratleasthelpyoucopewithnormalstress.Iftheydon’tseemtowork,itmightbeagoodideatoseekprofessionalassistancefromahealthcareprovider.
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Recognizing Signs and Symptoms
Beingawareofhowyoufeeliskeytorecognizingsignsofstress.Itiscommontofeelanxious,sad,orevenangry,especiallybefore,during,andafterdeployment,apermanentchangeofstation,retirement,orotherstressfulevents.Thequestionis,howlongdothosefeelingslast?Iftheyoranyofthefollowingcommonsignsandsymptomspersistformorethanafewweeks,youshouldconsiderseekingprofessionalassistance:
Lackofenergy•
Difficultysleepingorsleepingtoomuch•
Rapidweightlossorgain•
Reducedperformanceathomeoratwork•
Irritability•
Lossofappetite•
Anxiety•
Beawarewhenyourfeelingsbegintonegativelyaffectyourabilitytoperformdailyactivities.Takenotewhen:
At work: • Youcan’tconcentrateandhavedifficultycompletingtasks.
At home: • Youhavedifficultywithorlackenergyforeverydayactivities,suchascaringforyourhome,payingbills,orkeepingupyourpersonalappearance.
In relationships: • Youcan’tholdconversationswithfriendsoryoufeeldisconnectedfromyourfamilymembersandfriends.
Your children: • Yourchildisfearfulofnewpeopleorsituations,hasdifficultyatschool,isactingoutathome,haslostinterestinsportsorhobbies,orexpresseslowself-esteemandself-criticism.
undERsTAndIng bEhAvIoRAl hEAlTh
www.tricare.mil
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Common Behavioral Health Conditions
Whenemotionalproblemssurface,it’snotuncommontosimplydenythatsomethingiswrong.However,ignoringsuchsignsandsymptomscanincreaseyourchanceofdevelopinganyofthefollowingmoreseriousconditions.Likeanymedicalailment,behavioralhealthconditionsarebesttreatedwhendetectedearly.Thefollowingareshortdescriptionsthatdefinecommonbehavioralhealthconditions.
Anxiety Disorder:Anxietyisacommonemotion,oftenfeltwhenfacingaproblemorwhenmakinganimportantdecision.Youshouldbealertifanxietybeginstoaffectyourabilitytoleadanormallife.Feelingsofpanic,fear,anduneasinesslastinglongerthanafewweekscanbesignsofananxietydisorder—amuchmoreseriouscondition.
Attention Deficit Hyperactivity Disorder (ADHD):ADHDaffectschildren,andsomeofitssymptomsincludedifficultypayingattention,focusingontasks,orsittingforevenashortperiodoftime.Ifleftuntreated,ADHDcancauseproblemsathome,school,work,andinrelationships.
Depression:Clinicaldepressionismorethanjustfeelingsadafteradifficultperiod.Depressionmaybediagnosedwhenfeelingsofsadness,loss,andhopelessnesslastlongerthanatypicalperiodofgrief.Undiagnoseddepressioncanleadtomoreseriousbehavioralhealthissues.Somesignsandsymptomsofdepressioninclude:
Sadness•
Lossofenjoymentinthingsthatwereoncepleasurable•
Lossofenergy•
Feelingsofhopelessnessorworthlessness•
Difficultyconcentrating•
Difficultymakingdecisions•
Insomniaorexcessivesleep•
Upsetstomachanddigestiveproblems•
Sexualproblems(• e.g., decreased interest in sex)
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Achesandpains(• e.g., recurrent headaches)
Changesinappetitecausingweightlossorgain•
Thoughtsofdeath,suicide,orself-mutilation•
Self-mutilationorattemptingsuicide•
Eating Disorders: Feelingsofstress,anxiety,anddepressioncanleadtoeatingdisorders.Individualswithaneatingdisordercanuseeating,purging,orseverelyrestrictingtheirdietasawaytocopewithamoreseriousproblem.Eatingdisordersfallintothreecategories:
Anorexianervosa:Severelylimitingtheamountoffood•that’seaten
Bulimianervosa:Eatinglargeamountsoffoodinashorttime•andtheneliminatingit
Bingeeatingdisorder:Uncontrollableeatingresultingin•weightgain
Mild Traumatic Brain Injury (TBI):MildTBIisaninvisibleyetphysicalinjurythatmaybecausedbybeingclosetoanexplosionorablowtothehead.TosufferfrommildTBI,youdonotneedtohavebeenvisiblyharmedorevenknockedunconscious.Ifyouwerenearanexplosionorsufferedablowtotheheadandexperiencesymptomssuchaspoorconcentration,anxiety,fatigue,andlackofenergy—considertalkingtoyourdoctor.
Post-Traumatic Stress Disorder (PTSD):Servicemembersareoftensubjecttotraumaticeventswhiledeployed.Memoriesofcombatexperiencescanremainburieddeepinthesubconsciousandunexpectedlyemergeupontransitionbackintocivilianlife.Youmayexperienceflashbacks,nightmares,anxiety,andirritability.Youmayalsofeelexhaustedbecauseyou’reusingallofyourmentalenergytodealwiththethreatofthosere-emergingexperiences.
It’snormaltoexperienceadegreeofpost-traumaticstresswhenreturningfromdeployment.Thetimetoseektreatmentiswhentheseexperiencespersist,occurfrequently,andaffectyourabilitytoleadanormallife.
undERsTAndIng bEhAvIoRAl hEAlTh
www.tricare.mil
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Substance Use Disorder:Undiagnosedstress,anxiety,anddepressioncanleadtoabuseofalcoholordrugs—asubstanceusedisorder.Individualswhousealcoholordrugsasameansofcopingmaybeathighriskforsuicidalbehavior.Forthemostsuccessfultreatmentofsubstanceusedisorder,earlydetectionisthekey.Afewbehaviorstowatchforare:
Thesubstancebeingtakeninincreasinglylargeramounts•(including excessive amounts of alcohol or abuse of prescription medications)
Unsuccessfuleffortsatcuttingdownorcontrollingtheamount•ofthesubstanceused
Agreatdealoftimespentonactivitiesnecessarytoobtainthe•alcoholordrugs
Substanceusecontinuesdespitenegativeconsequences•
Aggressivenessandincreasedirritability•
Hopelessness,depression,orsuicidalbehavior•
Avoidingfriendsorfamilyinordertodrinkortakedrugs•
Takingunnecessaryrisks•
Suspensionfromschoolorwork•
Suicidal Thoughts:Stress,anxiety,anddepressionincreasethelikelihoodofsuicidalthoughtsand/orattempts.Untreated,theseconditionscancauseanindividualtofeelisolatedandbelievetheyhavenowheretoturn.Ifyoubelieveyouknowsomeonewhoisathighriskforsuicide,payattentiontotheseriskfactors:
Previoussuicideattempt(s)•
Historyofbehavioralhealthdisorders,particularlydepression•
Historyofalcoholandsubstanceabuse•
Familyhistoryofsuicide•
Troubleaccessingbehavioralhealthcare•
Recentstressorloss•
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Alongwiththesecommonriskfactors,therearenumeroussuicidewarningsigns:
Withdrawalfromfriendsorfamily•
Deepsadness•
Droppinghintsofself-loathing•
Puttingpersonalaffairsinorder•
Changeineatingorsleepinghabits•
Rebelliousbehavior•
Drugandalcoholabuse•
Unusualneglectofpersonalappearance•
Significantpersonalitychange•
Lossofinterestinpleasurableactivities•
Increasedinterestindeath•
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www.tricare.mil
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Covered Services, Limitations, and ExclusionsAvarietyofbehavioralhealthresourcesareavailabletohelpyou.ThissectionexplainsTRICARE’sbehavioralhealthcarebenefits—what’scoveredandwhatisn’tcovered,aswellasgeneralcostdetails.Thesebenefitsapplyregardlessofyourprogramoptionorlocation,unlessotherwisenoted.Note:Ifyouareanactivedutyservicemember(ADSM),militarytreatmentfacility(MTF)guidelinesmaydifferfromthoseoutlinedinthissection.RefertoyourMTForMilitaryMedicalSupportOfficeservicepointofcontactfordetails.Formoredetailedinformationorforhelpwithaquestionthatthisguidehasn’tanswered,contactyourlocalTRICAREregionalcontractor,TRICAREServiceCenter(TSC),TRICAREGlobalRemoteOverseas(TGRO)AlarmCenter,orTRICAREAreaOffice(TAO).ContactinformationislistedintheFor Information and Assistancesection.
Outpatient Services
Referralsandauthorizationsmayapplyforcertainoutpatientservices(does not apply to ADSMs receiving care at an MTF).Careaccessandrulesvarybybeneficiarytype,location,andTRICAREprogramoption.RefertotheGetting Caresectionforthosedetails.
Psychotherapy
Psychotherapyisaninterpersonal,discussion-basedtypeofbehavioralhealthcare.Whenmedicallyorpsychologicallynecessarytotreatabehavioralhealthdisorder,outpatientandinpatientpsychotherapyiscovered.Outpatientpsychotherapyiscovereduptotwosessionsperweekinanycombinationofindividual,family,collateral,orgroupsessions.Inpatientpsychotherapyiscovereduptofivesessionsperweekinanycombinationofsessions.Thedurationandfrequencyofadditionalcareisdependentuponmedicalnecessity.Thefollowingtypesoftherapysessionsarecovered:
Individual Psychotherapy: • Therapymaybeusedforadultsandchildrentoeaseemotionalissues,reverseorchangetroublingbehavior,andencouragepersonalitygrowthanddevelopment.
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CovEREd sERvICEs, lImITATIons, And ExClusIons
Sessionsarecoveredupto60minutes;crisissessionsmayextendupto120minutes.Note:Individualpsychotherapyisnotacoveredbenefitforapatientwithadiagnosisofsubstanceabuseunlessthepersonalsohasamentaldisorderdiagnosis.
Play Therapy: • Aformofcoveredindividualpsychotherapyusedtodiagnoseandtreatchildren.
Family or Conjoint Psychotherapy: • Therapyisdesignedtotreattheentirefamily.Regularsessionsarecoveredforupto90minutes;crisissessionsmayextendupto180minutes.
Group Psychotherapy: • Sessionsarecoveredforupto90minutes.
Collateral Visits: • Acollateralvisitisnotatherapysession.Thesevisitsareusedtogatherinformationandtoimplementtreatmentgoals.Collateralvisitsarecountedasindividualpsychotherapysessionsandcanlastupto60minutes.Beneficiarieshavetheoptionofcombiningacollateralvisitwithanotherindividualorgrouppsychotherapyvisit.
Psychoanalysis
Psychoanalysisdiffersfrompsychotherapyandrequirespriorauthorization.Afterpriorauthorizationisobtained,itiscoveredwhenadministeredbyagraduateorcandidateofapsychoanalytictraininginstitution.
Psychological Testing
Psychologicaltestingandassessmentiscoveredonlywhenprovidedinconjunctionwithpsychotherapy.Testingislimitedtosixhoursperfiscalyear(October 1–September 30).Anytestingmorethansixhoursrequiresareviewformedicalnecessity.
Medication Management
Ifyouaretakingprescriptionmedicationsforabehavioralhealthcarecondition,youmustbeunderthecareofaproviderwhoisauthorizedtoprescribethosedrugs.Yourproviderwillmanagethedosageanddurationofyourprescription.
www.tricare.mil
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TRICARE Assistance Program
TheTRICAREAssistanceProgram(TRIAP)isaWeb-basedprogramthatusesaudio-visualandinstantmessagingfeaturestoprovideonlineaccesstocounselingforshort-term,non-medicalissues.ThefollowingstatesideTRICARE-eligiblebeneficiariesmayuseTRIAP:
ADSMs•
Activedutyfamilymembers(ADFMs)(• Spouses of any age are eligible, but dependent family members must be age 18 and older.)
TRICAREReserveSelect(TRS)enrollees(• age 18 and older)
TransitionAssistanceManagementProgram(TAMP)enrollees•(age 18 and older)
Ifyouareeligible,youcanuseyourhomecomputertocontactlicensedbehavioralhealthcareprofessionals24hoursaday,sevendaysaweek.Youcanhaveaprivate,solution-focuseddiscussionwithaTRIAPcounseloraboutmanyday-to-dayissues,including:
Stressmanagement(• work, family, personal)
Familydifficultiesandpressure•
Deploymentsandotherfamilyseparations•
Relationshipsandmarriage•
Parent-childcommunication•
Self-esteem•
TRIAPservicesdonotrequirereferralsorauthorizations,butyouwillneedaphoneandacomputer.YoumayaccessTRIAPanunlimitednumberoftimes,andservicesareconfidentialandnon-reportable(not documented on your military record).TRIAPservicesdonotincludemedicationmanagement,financialcounseling,oremergencycare.Ifnecessary,aTRIAPcounselorcanreferyouforhigher-levelbehavioralhealthcare,whichmayincludeface-to-facecounseling.
Visitwww.tricare.mil/TRIAPformoreinformationaboutTRIAPbenefitsandrequirements.TorequestTRIAPservices,contactyourregionalcontractor.
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CovEREd sERvICEs, lImITATIons, And ExClusIons
Telemental Health Program
TheTelementalHealthprogramusessecureaudio-visualconferencingtoconnectqualifyingbeneficiarieswithoffsiteTRICARE-authorizedproviders.ThefollowingstatesideTRICARE-eligiblebeneficiariesmayusetheTelementalHealthprogram:
TRICAREPrime-enrolledADSMsandADFMs•
TRICAREStandardandTRICAREExtrabeneficiaries•
TRSenrollees•
TRICAREPrime-enrolledretireesandfamilymembers•
TheTelementalHealthprogramprovidesmedicallynecessarybehavioralhealthservices,including:
Clinicalconsultation•
Individualpsychotherapy•
Psychiatricdiagnosticinterviewexamination•
Medicationmanagement•
TelementalHealthinteractionmayinvolvesecuretwo-wayaudio-visualvisitsbetweenpatientsandmedicalprofessionals.BeneficiariescanaccesstheseservicesbyvisitingTRICARE-authorizedTelementalHealth-participatingfacilitiestocontact,viaatelecommunicationssystem,TRICAREnetworkprovidersatremotelocations.Fromtheiroffsitelocation,TelementalHealthproviderscanevaluate,treat,andreferyouforfurthercare.
TRICAREbehavioralhealthcarereferralandauthorizationrequirementsandlimitationsapply.ADSMsmusthaveareferralfromtheirMTFprimarycaremanager,SPOC,orMTFbehavioralhealthcareclinicpriortoobtainingcivilianbehavioralhealthcare.IfyouareaTRICAREPrime-enrolledADSMorADFM,therearenoassociatedcost-sharesorchargesforTelementalHealthservices.TRICAREStandardandExtra,TRICAREPrimeretireesandtheirfamilies,andTRSenrolleesmustpayapplicablecost-shares,deductibles,andcopayments.TelementalHealthavailabilityislimitedtoareaswhereparticipatingsitesarelocated.
www.tricare.mil
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FormoreinformationaboutTelementalHealth,visittheMental Health and BehaviorWebpageatwww.tricare.milorcontactyourregionalcontractor.ContactinformationisavailableintheFor Information and Assistancesectionofthishandbook.
Inpatient Services
Availability,careaccess,referral,andauthorizationrequirementsforinpatientservicesmayvarybybeneficiarytype,location,andTRICAREprogramoption.RefertotheGetting Caresectionforthosedetails.Note:Priorauthorizationisrequiredforall nonemergencyinpatientbehavioralhealthcareservices.Inemergencysituations,authorizationisrequiredforcontinuedstay.Note:ADSMswhoreceivecareatanMTFdonotrequirepriorauthorization.
Acute Inpatient Psychiatric Care
Patientsmaybereferredtoacuteinpatientpsychiatriccareiftheirdoctorbelievestheyhaveabehavioralhealthdisorderthatthreatenstheirphysicalwell-beingtotheextentthat24-hourmedicalandpsychiatriccareisneeded.
Benefit Limits:
Patients19andolderarelimitedto30daysperfiscalyear(FY)*•orinanysingleadmission.
Patients18andyoungerarelimitedto45daysperFY*orinany•singleadmission.
* The FY is October 1–September 30. Day limits may be waived if determined to be medically or psychologically necessary.
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CovEREd sERvICEs, lImITATIons, And ExClusIons
Psychiatric Partial Hospitalization Program
Apsychiatricpartialhospitalizationprogram(PHP)isrecommendedwhenyourphysicianbelievesitisnecessarytostabilizeacriticalbehavioralhealthdisorderortotransitionfromaninpatientprogramtoanoutpatientprogram.
Treatment Frequency:APHPisatreatmentsettingprovidingmedicaltherapeuticservicesatleastthreehoursperday,fivedaysperweek.Treatmentmayincludeday,evening,night,andweekendprograms.
Benefit Limit:TRICAREprovidesupto60daysofcoverageperFY(full- or half-day program)inaTRICARE-authorizedprogramforbehavioralhealthdisorders.PHPtreatmentforadiagnosisofasubstanceusedisorderislimitedtotherehabilitationtreatmentmaximumoutlinedin“SubstanceUseDisorders.”PHPcaredoes notcounttowardthe30-or45-daylimitforacuteinpatientpsychiatriccare.Note:Atthetimeofprinting,alimitednumberofTRICARE-certifiedPHPswereavailableandwereonlyavailableintheU.S.anditsterritories.
Residential Treatment Center Care
Residentialtreatmentcenters(RTCs)provideextendedcareforchildrenandadolescentswhohavepsychologicaldisordersrequiringtreatmentinatherapeuticenvironment.
Benefit Limit:TRICAREcoversupto150daysinaTRICARE-authorizedRTCandmaycovermoreifthecareismedicallyorpsychologicallynecessary.
RTCcareisnotcoveredinemergencies,andadmissionprimarilyforsubstanceabuseisnotauthorized.Caredoes not counttowardthe30-or45-daylimitforacuteinpatientpsychiatriccare.YourTRICAREbenefitprovidesRTCcareuptoage21;however,mostRTCsdonotacceptindividualsolderthanage17.Note:Atthetimeofprinting,RTCswereonlyavailableintheU.S.anditsterritories.
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Substance Use Disorders
Substanceusedisordersincludealcoholordrugabuseordependence.ServicesareonlycoveredbyTRICARE-authorizedinstitutionalproviders—anauthorizedhospitaloranorganizedtreatmentprograminanauthorizedfree-standingorhospital-basedsubstanceusedisorderrehabilitationfacility(SUDRF).Treatmentincludesdetoxification,rehabilitation,andoutpatientindividual,group,andfamilytherapy.
Benefit Limit:TRICAREcoversthreesubstanceusedisorderrehabilitationtreatmentsinalifetimeandoneperbenefitperiod.Abenefitperiodbeginswiththefirstdateofthecoveredtreatmentandends365dayslater.
Detoxification (Emergency Inpatient)
TRICAREcoversemergencyinpatientchemicaldetoxificationtreatmentwhenthepatient’sconditionrequiresthepersonnelandfacilitiesofahospitalorSUDRF.UptosevendaysperepisodeiscoveredinaTRICARE-authorizedfacility.TRICAREmaycovermoredaysifdeterminedtobemedicallyorpsychologicallynecessary.Inpatientdetoxificationcarecountstowardthe30-or45-daylimitforacuteinpatientpsychiatriccare,butnottowardtherehabilitationlevelofcare.
Rehabilitation
Rehabilitationofasubstanceusedisordermayoccurinaninpatientorpartialhospitalizationsetting.TRICAREcovers21daysofrehabilitationperbenefitperiodinaTRICARE-authorizedfacility,whetheraninpatientorpartialhospitalizationoracombinationofboth.Inpatientdaysforrehabilitationcounttowardthe30-or45-daylimitforacuteinpatientpsychiatriccareandpartialhospitalizationdayscounttowardthe60-daylimitforpartialhospitalization.
Outpatient Care
OutpatientcaremustbeprovidedinanindividualorgroupsettingbyanapprovedSUDRF(free-standing or hospital-based).Benefitlimitsareasfollows:
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Individualandgrouptherapy:Upto60visitsperbenefitperiod•(only within the SUDRF)
Familytherapy:Upto15visitsperbenefitperiod•
Limitsmaybewaivedifmorevisitsaredeemedmedicallyorpsychologicallynecessary.
Exclusions
ThefollowingbehavioralhealthcareservicesarenotcoveredunderTRICARE.This list is not intended to be all-inclusive.
Aversiontherapy(• including electric shock and the use of chemicals for alcoholism, except for disulfiram, which is covered for the treatment of alcoholism)
Behavioralhealthcareservicesandsuppliesrelatedsolelyto•obesityand/orweightreduction
Bioenergetictherapy•
Biofeedbackforpsychosomaticconditions•
Carbondioxidetherapy•
Counselingservices,suchasnutritionalcounseling,stress•management,maritaltherapy,orlifestylemodifications
Custodialnursingcare•
Diagnosticadmissions•
Educationalprograms•
Environmentalecologicaltreatments•
Experimentalprocedures•
Eyemovementdesensitizationandreprocessing(EMDR)•
Filialtherapy•
Guidedimagery•
Hemodialysisforschizophrenia•
Intensiveoutpatienttreatmentprogram•
Marathontherapy•
Megavitaminororthomoleculartherapy•
CovEREd sERvICEs, lImITATIons, And ExClusIons
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NarcotherapywithLSD•
Primaltherapy•
Psychosurgery(• Surgery for the relief of movement disorders, electroshock treatments, and surgery to interrupt the transmission of pain along sensory pathways are not considered psychosurgery.)
Rolfing•
Sedativeactionelectrostimulationtherapy•
Servicesandsuppliesthatarenotmedicallyorpsychologically•necessaryforthediagnosisandtreatmentofacoveredcondition
Sexualdysfunctiontherapy•
Servicesandsuppliesrelatedto“stopsmoking”regimens•
Telephonecounseling(• except for geographically distant family therapy related to RTC treatment)
Therapyfordevelopmentaldisorderssuchasdyslexia,•developmentalmathematicsdisorders,developmentallanguagedisorders,anddevelopmentalarticulationdisorders
Traininganalysis•
Transcendentalmeditation•
Ztherapy•
Costs
Yourfinancialresponsibilityforbehavioralhealthcareservicesdependsonyourbeneficiarycategory,whichTRICAREoptionyouuse,andthetypeofprovideryousee.Forspecificcostdetails,visitwww.tricare.mil/costs.
BeneficiariesenrolledinaTRICAREPrimeoption,exceptADSMs,maybesubjecttopointofservice(POS)chargesiftheyobtainnonemergencycarewithoutappropriatereferralsorauthorizations.Seeyourprogramoption’sguidelinesregardingreferralsandauthorizationsintheGetting Care section.
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BeneficiarieseligibletoseekcarefromaU.S.non-networkprovideroranoverseashostnationprovidermayberequiredtopayforservicesthenfileaclaimwithTRICAREforreimbursement.Reimbursementisbasedonthedatetheservicewasrendered.Regardlessofthecurrencyusedforreimbursement,TRICAREwillnotreimburseforanydifferencesduetochangesincurrencyvalue(e.g., U.S. dollar, host nation currency).
Fileanynecessaryclaimstotheareawhere you live,notwhereyoureceivedthecare.Note:TRICAREForLifebeneficiariesshouldfileclaimsbasedonwheretheyreceivedcare.VisittheWisconsinPhysiciansServiceWebsiteatwww.TRICARE4u.comfordetails.
U.S.non-networkprovidersmaychargeupto15percentabovewhatTRICAREpays(the TRICARE-allowable charge).Youareresponsibletopaythesechargesalongwithanyapplicablecost-shareanddeductibleamounts.
Someoverseasprovidersmaychargemorethan15percentabovetheTRICARE-allowablechargefortheirservices.YoumayberesponsibleforanydifferencebetweentheTRICARE-allowablechargeandthebilledamountaprovidermaycharge,unlessyouusetheservicesofaparticipatingprovider.AparticipatingprovideragreestoaccepttheTRICARE-allowablecharge,plusthepatient’scost-shareaspaymentinfullfortheservicesrendered.Participatingprovidersmayparticipateonaclaim-by-claimbasis.YouarealwaysencouragedtofindthoseproviderswhoagreetoaccepttheTRICARE-allowablechargeandanycost-shareordeductibleamountsforwhichyouareresponsibleaspaymentinfull.
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Who to See for Care
Behavioral Health Care Provider Types
Therearemanytypesofproviderswhodeliverbehavioralhealthcareservicesandsomemayprovidespecificservices.ThefollowingprovidertypesmaybeauthorizedbyTRICARE:
Psychiatrists and Other Physicians: • Theseprovidersmayperformpsychotherapyandcounseling,aswellasmanagemedication.
Clinical Psychologists: • Clinicalpsychologistsperformpsychotherapy,psychologicaltesting,andcounselingservices,butcannotgenerallyprescribemedication.Note:IntheU.S.,somestatesallowpsychologiststoprescribemedications.Contactyourregionalcontractorforguidelinesinyourarea.
Certified Psychiatric Nurse Specialists: • Certifiedpsychiatricnursespecialistsprovidetherapytoindividualswithdiagnosedpsychiatricdisordersortoindividualsatriskforbehavioralhealthproblems.Nursespecialistsmayperformpsychotherapyandmanagemedications.
Licensed Clinical Social Workers: • Master’sdegreelevelclinicalsocialworkerscanperformpsychotherapyandcounselingservices,butcannotprescribemedication.
Certified Marriage and Family Therapists: • Marriageandfamilytherapistsperformindividualcounselingandfamilytherapy,butcannotprescribemedication.Inorderforservicestobecovered,marriageandfamilytherapistsmustbeTRICARE-authorizedprovidersandhaveaparticipationagreementwithTRICARE.
Counselors: • Counselorscanperformtherapeuticcounselingservicesunderthesupervisionofaphysician,butcannotprescribemedication.Youmusthaveareferralfromyourphysiciantovisitabehavioralhealthcarecounselor,licensedorcertifiedmentalhealthcounselor,orapastoralcounselor.
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Selecting a Provider
Findingabehavioralhealthcareprovidermaybeaseasyastalkingtoyourprimarycaremanager(PCM)orfamilyphysician.Youcanalsocontactyourregionalcontractor,localTRICAREServiceCenter(TSC),orlocalTRICAREGlobalRemoteOverseas(TGRO)AlarmCenter(as applicable)forassistance.
Ifyoudon’tknowyourU.S.regionoroverseasarea,youcanfindalistofserviceareasatwww.tricare.mil.
Questions to Ask
Ifyoudecidetoseeabehavioralhealthcareprovider,thereareimportantquestionstoask.Alistofsuggestedquestionsfollows.Note:OverseasbehavioralhealthcareprovidersmayfollowdifferingtreatmentguidelinesthanU.S.providers.
Costs
DoyouparticipateinTRICARE?•
Whatareyourfees,includingchargesformissedsessions?•
Experience
Howlonghaveyoubeenlicensed?•
Howlonghaveyoubeeninpractice?•
Howmuchexperiencehaveyouhadassessingandtreatingmy•particularproblem?
Howmuchexperiencehaveyouhadassessingandtreating•peoplelikeme(e.g., gender, age, ethnic group, disability status)?
Treatment Approach
Howoftenwillwemeet?•
Howlongwillmytreatmenttake?•
Willanyoneelseparticipateinmytreatment(• e.g., spouse, children, or others)?
Whatapproacheswouldyouusetotreatmyproblem?•
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WhathappensifyourapproachesdonothelpmeorIfeelworse?•
WhathappensifIhaveacrisisduringtreatment?•
InformationaboutassistanceinfindingaprovidercanbefoundintheGetting Caresection.Lookforyourbeneficiarytypeandprogramoption.
Before You Travel
Ifyouareplanningtotravelandthinkyoumayneedbehavioralhealthcareservices,makealistofthefollowingcontactinformationfortheareawhereyou’llbetravelingandtakeitwithyou:
YourPCM,primarycareprovider,USFamilyHealthPlan•(USFHP)contact,orexistingbehavioralhealthcareprovider(as applicable)
Localmilitarytreatmentfacility:Visit• www.tricare.mil/mtfforlocations.
LocalTRICAREregionalcontractor(• if applicable)*
LocalTRICAREServiceCenter(TSC):Visit•www.tricare.mil/contactusforU.S.locationsorwww.tricare.mil/overseastscforoverseaslocations.
RegionalBehavioralHealthCareProviderLocatorand•AppointmentAssistanceLine*
LocalTRICAREAreaOffice,TGROAlarmCenter,orthe•PuertoRicoCallCenter(as applicable):SeeFigures7.2,7.3,and7.4intheFor Information and Assistancesectionforcontactinformation.
ApplicableMilitaryMedicalSupportOffice(MMSO)service•pointofcontact(SPOC):SeeFigure7.5intheFor Information and Assistancesection.
Regionalclaimsprocessorandclaims-filingaddressforthearea•whereyoulive:Visitwww.tricare.mil/claimsfordetails.
* See Figure 7.1 in the ForInformationandAssistance section.
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WisconsinPhysiciansService:SeeFigure7.6inthe•For Information and Assistancesection.
Yourotherhealthinsurance(OHI)carrier,ifapplicable•
CanadianForcesHealthFacility:Visit•www.tricare.mil/tlac/canada_cfhf.cfmforlocations.
NearestU.S.EmbassyorConsulate:Visit• www.usembassy.gov forlocations.
ValueOptions:SeeFigure7.6inthe• For Information and Assistancesection.
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Getting CareHowyouaccessbehavioralhealthcaredependsonthreefactors:thetypeofbeneficiaryyouare,yourTRICAREprogramoption,andyourlocation.Thesectionsthatfollowarenamedbybeneficiarytype.LookforthesectionthatappliestothetypeofbeneficiaryyouarethenfollowtheguidelinesforyourspecificTRICAREprogramoption.
About situations: At the beginning of each beneficiary section, you’ll notice one or two brief situations describing common behavioral health concerns. Most of these situations could apply to anyone although some may be more common among military families. If you feel that any of these situations sound familiar, don’t try to diagnose what may be causing the problem. If the problems persist, consider seeking help or urge your loved one to seek help.
Thebeneficiarytypescoveredinthissectionare:
ActiveDutyServiceMember•
ActiveDutyFamilyMember•
NationalGuardorReserveMemberorFamilyMember•
RetiredServiceMemberorFamilyMember•
Medicare-EligibleTRICAREBeneficiary*•
* Medicare is your primary insurer. Follow the guidelines for your Medicare health plan. For details, contact your Medicare plan administrator, call Medicare at 1-800-633-4227, or visit www.medicare.gov. If you are under age 65, covered by Medicare, and also enrolled in TRICARE Prime, Medicare is still your primary insurer unless your Medicare benefits are exhausted. In that event, follow the TRICARE Prime guidelines under “Retired Service Member or Family Member.”
Yourlocation,aswellasyoureligibilitystatus,canalsodeterminehowyouaccessbehavioralhealthcare.Forexample:
US Family Health Plan beneficiaries:• TheUSFamilyHealthPlan(USFHP)isaTRICAREPrimeoptionavailableinsixgeographicareasacrosstheU.S.IfyouareaUSFHPbeneficiary,contactUSFHPfordetailsonbehavioralhealthcareaccessguidelinesat1-800-748-7347orvisitwww.usfamilyhealthplan.org.
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TRICARE-eligible survivors: • Ifyouareaneligibletransitionalsurvivorofadeceasedactivedutysponsor(including National Guard or Reserve members who served on active duty for more than 30 consecutive days),youhavethesamecareaccessandrequirementsasanyactivedutyfamilymember(ADFM)solongasyouremaineligibleforTRICAREtransitionalsurvivorbenefits.
Duringthistransitionalsurvivorperiod,followthebeneficiaryguidelinesunder“ActiveDutyFamilyMember.”Afterthefirstthreeyears,eligiblesurvivingspousescontinuetoreceivesurvivorbenefits,butatretiredfamilymemberrates;theyshouldfollowthebeneficiaryguidelinesunder“RetiredServiceMemberorFamilyMember.”Formoresurvivorbenefitdetails,visitwww.tricare.mil/survivors.
TRICARE-eligible Medal of Honor recipients and eligible •family members:IfyouareaMedalofHonorrecipientandremainonactiveduty,youshouldfollowthebeneficiaryguidelinesunder“ActiveDutyServiceMember,”andyourfamilyshouldfollow“ActiveDutyFamilyMember”guidelines.Ifyouhaveseparatedfromactiveduty,youandyourfamilymembersshouldfollowthebeneficiaryguidelinesunder“RetiredServiceMemberorFamilyMember.”
Whetheryouexperienceabehavioralhealthemergencyorneedoutpatientbehavioralhealthcare,theinformationinthefollowingsectionsprovidesdetailsonwhattodoandwheretofindhelp.
ThefollowingcareaccessguidelinesapplyonlytoyourTRICAREbenefit.Ifyouhaveotherhealthinsurance(OHI),yourOHIisyourprimaryinsurer,andTRICAREpaysaftertheOHI.CheckwithyourOHIforanybehavioralhealthcareauthorizationrequirements.WhentheOHIpaysfirst,TRICAREpriorauthorizationrulesdonotapply.Note:NationalhealthinsuranceprogramsoverseasareconsideredOHI.Ifyouareenrolledinsuchprograms,seekguidancefromanoverseasTRICAREServiceCenter(TSC)beforeobtaininghealthcarefromahostnationprovider.
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Active Duty Service Member
Situation 1: Ever since that truck backfired the other day and I almost hit the deck, I can’t stop thinking about it. I haven’t slept well and every little thing makes me jumpy. what’s wrong with me?
Situation 2: I thought I’d get over losing my buddies by now. how long is sadness supposed to last?
Theseconcernsarenotuncommonamongactivedutyservicemembers.Traumaticexperiencesduringdeploymentcanbetriggeredbyeverydayeventsathome.Inaddition,griefhasnotimetable—howlongitlastsisdifferentforeveryone.However,thereareprovenmethodsfordealingwithtraumaandgriefinpositiveways.
Communicationisanecessity.Keeptalking.Ifyou’veestablishedyourbaseofsupport—friends,family,commanders—usethatsupport.Don’tshutyourselfofffromthoseyouneedandthosewhoneedyou.Communicationisparticularlyvitalduringthelongseparationsmilitaryfamiliesendureduringdeployments.
Ifyoufindcopingwithlife’schallengestobeincreasinglydifficultorifyou’reworriedaboutalovedone,talktoyourprimarycareproviderabouttheproblem.Remember,you’renotaloneandhelpisavailable.
Program Option and Location Determine Care Access
Howyouaccessbehavioralhealthcaredependsonyourprogramoptionandlocation.Asanactivedutyservicemember(ADSM),youmayhavecoverageunderoneofthefollowingprogramoptionsdependingonwhereyouliveorarestationed:
TRICARE Prime: • AvailableinmanyareasintheU.S.
TRICARE Prime Remote (TPR): • AvailableindesignatedareasintheU.S.
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TRICARE Overseas Program (TOP) Prime: • AvailableinmanyareasoutsidetheU.S.
TRICARE Global Remote Overseas (TGRO): • Availableinoverseasremotelocations
Getting Care, Referrals, and Authorizations
Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonyourlocation.Ifyouseekbehavioralhealthcarethroughamilitarytreatmentfacility(MTF),referralsorauthorizationsarenotrequired.Ifyouseeknonemergencycarefromacivilianprovider(care outside of an MTF),areferralorauthorizationisrequiredforfitness-for-dutypurposes.
Dependingonyourprogramoption,yourlocalMTF,TRICAREServiceCenter(TSC),TGROAlarmCenter,orTRICAREAreaOffice(TAO)canassistwithbenefitquestions.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.
Note:IfyouandyouraccompanyingfamilymembersliveinCanadaandareenrolledinoreligibleforTOPPrime,youshouldseekspecialtycarethroughyourCanadianForcesHealthFacility.Ifcareisnotavailableatthelocalfacility,allcareisprovidedbycivilianprovidersorfacilities.
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U.S. TRICARE Prime Option ADSMs: Nonemergency Inpatient Admissions
AllnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourMTFPCMorMMSOSPOC(for TPR beneficiaries).
U.S. TRICARE Prime Option ADSMs: Outpatient Care
YoudonotneedareferraltoreceivebehavioralhealthcareatanMTF.However,forciviliancare,referralsarerequiredfromyourMTFPCM(or MMSO SPOC if enrolled in TPR).Ifnoproviderislistedonyourreferral,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheregioninwhichyouareseekingcare.SeeFigure5.1onthefollowingpageforadditionaloutpatientcaredetails.
U.S. TRICARE Prime Option ADSMs: Emergency Care
In Your Home Area or Traveling in the U.S.
Dial911orgotothenearestemergencyroom.•
Referralsorpriorauthorizationsare• notrequired.*
Contactyourprimarycaremanager(PCM),orMilitary•MedicalSupportOffice(MMSO)servicepointofcontact(SPOC)within24hoursorthenextbusinessday.
While Traveling Overseas
Gotothenearestemergencycarefacility,andcontactthe•localTGROAlarmCenterassoonaspossibleafterseekingcareorpriortomakingpayment.InPuertoRico,callthePuertoRicoCallCenter.
Referralsorpriorauthorizationsare• notrequired.*
* If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or MMSO SPOC (forTPRbeneficiaries) within 24–72 hours of the admission.
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1. Contact the facility to schedule an appointment.
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TOP Prime and TGRO ADSMs: Emergency Care
In Your Home Area or Traveling Overseas
Gotothenearestemergencycarefacility.Contactyour•MTFprimarycaremanager(PCM)orTGROAlarmCenterassoonaspossibleafterreceivingcareorpriortomakingpayment.*
InPuertoRico,contactthePuertoRicoCallCenter.•
While Traveling in the U.S.
Call911orgotothenearestemergencyroom.*•
Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaims.
* Referrals or prior authorizations are not required. If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or TGRO Alarm Center within 72 hours of the admission.
Who to See At Home or Traveling in the U.S. Traveling Overseas
MTF Provider
•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1
•Referralnot required
•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1
•Referralnotrequired
Civilian Provider
•MTFPCMreferralorMMSOSPOCauthorizationis required
•MTFPCMreferralorMMSOSPOCauthorizationis required•ContactlocalTGROAlarmCenterforassistance•InPuertoRico,contactPuertoRicoCallCenter
Figure 5.1U.S. TRICARE Prime Option ADSMs: Outpatient Care
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TOP Prime and TGRO ADSMs: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.WhiletravelingintheU.S.,gotothenearestMTFfornonemergencycare.IftheMTFcannotprovidethecareyouneed,youwillbereferredtoaciviliancareprovider.TolocateanMTF,visitwww.tricare.mil/mtf.Exception:WhilevisitingtheU.S.,ADSMsenrolledtotheLatinAmericaandCanada(TLAC)TGROregionmustcontacttheTLACTGROAlarmCenterat1-800-834-5514toobtainauthorizationsforallnonemergencycare.
Authorizationsforoverseasadmissionsareissuedasfollows:
TOP Prime ADSMs• (except in Puerto Rico):TAOissuestheauthorization.
TOP Prime ADSMs in Puerto Rico:• PuertoRicoCallCenterissuestheauthorization.
TGRO ADSMs:• TGROAlarmCenterissuestheauthorization.
TOP Prime and TGRO ADSMs: Outpatient Care
YoudonotneedareferraltoreceivebehavioralhealthcareatanMTF.However,forciviliancare,referralsorauthorizationsarerequiredfromyourMTFPCMorTGROAlarmCenter(or Puerto Rico Call Center while in Puerto Rico).WhentravelingintheU.S.,gotothenearestMTFforanynecessaryoutpatientcare.IftheMTFcannotprovidethecare,youwillbereferredtoacivilianprovider.TolocateanMTF,visitwww.tricare.mil/mtf.Exception:WhilevisitingtheU.S.,ADSMsenrolledtotheTLACTGROregionmustcontacttheTLACTGROAlarmCenterat1-800-834-5514toobtainpriorauthorizationsforallnonemergencycare.SeeFigure5.2onthefollowingpageforadditionaldetails.
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1. Contact the facility to schedule an appointment. If no MTFs are available in your area, contact the TGRO Alarm Center (orPuertoRicoCallCenterwheninPuertoRico) for assistance.
2. If the MTF cannot provide the care, you will be referred to an appropriate civilian provider. While visiting the U.S., ADSMs enrolled to the TLAC TGRO area must contact the TLAC TGRO Alarm Center at 1-800-834-5514 to obtain prior authorizations for all nonemergency care (includesoutpatientcare).
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Who to See At Home or Traveling Overseas Traveling in the U.S.
MTF Provider
•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1
•Referralorpriorauthorizationnotrequired
•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1,2
•Referralorpriorauthorization notrequired
Civilian Provider
•MTFPCM,TGROAlarmCenter,orPuertoRicoCallCenterreferralorpriorauthorizationrequired•ContactlocalTGROAlarmCenterorTSCtofindaprovider
•MTForTGROAlarmCenterreferralorpriorauthorizationrequired•Afterreceivingreferral,youmaycallregionalBehavioralHealthCareProviderLocatorandAssistanceLine
Figure 5.2TOP Prime and TGRO ADSMs: Outpatient Care Ac
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Active Duty Family Member
Situation 1: my granddaughter began wetting the bed after her parents were deployed. she hasn’t done that since she was potty trained. six-year-olds aren’t supposed to wet the bed, are they?
Situation 2: for a while, everything was great after my husband came back. It was like we were kids again, holding hands wherever we went. now he hardly talks to me, except to argue. what’s happening to us?
Deployments,orlengthyseparationsofanykind,arestressfulfortheentirefamily.Althoughveryyoungchildrenmaynotfullyunderstandthedangersinvolvedifaparentisdeployed,theycansensetheanxietyofothers.Justseeingtroublingnewsfootagecanbeemotionallyupsetting,andnotjustforachild.
Whenfamiliesarereunited,it’snotuncommonforthemtoexperiencea“honeymoon”period,duringwhicheverythingseemsfine.Butseveralmonthsaftertheservicememberreturns,theexperiencesheorshefacedwhileawaycombinedwiththefrustrationsofeverydaylivingcancreatestress.
Timeisagreathealer,butsometimesit’snotenough.Youshouldn’toverreactifafamilymemberappearstroubled,butyoualsoshouldn’tassumethatignoringaproblemwillmakeitgoaway.Ifdiscussionwithyourlovedonedoesn’thelp,talktoyourdoctor.
Program Option and Location Determine Care Access
Howyouaccessbehavioralhealthcaredependsonyourprogramoptionandlocation.Asanactivedutyfamilymember(ADFM),youmayhavecoverageunderoneofthefollowingprogramoptionsdependingonwhereyoulive:
TRICARE Prime: • AvailableinmanyareasintheU.S.
TRICARE Prime Remote for Active Duty Family Members •(TPRADFM):AvailableindesignatedareasintheU.S.toeligiblefamilymemberswhoseactivedutysponsorsareenrolledinTRICAREPrimeRemote.
TRICARE Standard and TRICARE Extra: • AvailableintheU.S.
TRICARE Overseas Program (TOP) Prime:* • AvailableinmanyareasoutsidetheU.S.
TRICARE Global Remote Overseas (TGRO):* • Availableinoverseasremotelocations.
TRICARE Overseas Program (TOP) Standard: • AvailableoutsidetheU.S.
* Family member eligibility is usually contingent upon command sponsorship for these programs. Note: National Guard and Reserve members and their family members who are covered as ADFMs under the Transitional Assistance Management Program (TAMP) are not eligible for these programs.
Getting Care, Referrals, and Authorizations
Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonwhereyouliveortravel.Priorauthorizationmayberequiredforcertainservices.Forpriorauthorizationdetailsforyourarea,contactyourregionalcontractor,TRICAREServiceCenter(TSC),orTRICAREAreaOffice(TAO).IfyouareenrolledinaTRICAREPrimeprogramoption,followtherulesofyourprogramtoavoidpointofservice(POS)fees.Visitwww.tricare.milfordetails.Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossible.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.
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U.S. TRICARE Prime Option ADFMs: Emergency Care*
In Your Home Area or Traveling in the U.S.
Dial911orgotothenearestemergencyroom.•
While Traveling Overseas
Gotothenearestemergencycarefacilityorcontactthe•localTGROAlarmCenterforassistance.
* Referrals or prior authorizations are not required for emergency care. Contact your primary care manager (PCM) or primary care provider within 24 hours or the next business day for care coordination. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.
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U.S. TRICARE Prime Option ADFMs: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissions requirepriorauthorizationfromyourregionalcontractor.
U.S. TRICARE Prime Option ADFMs: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMarenotrequired.However,aPCMorphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Ifnoproviderislistedonyourreferral,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheregioninwhichyouareseekingcare.Forotheroutpatientservices,priorauthorizationmayberequired.SeeFigure5.3foradditionaldetails.
1. The FY is October 1–September 30.2. While traveling, routine care is not normally authorized. To avoid POS charges,
you must see a network provider in the U.S. When traveling overseas, contact your PCM or regional contractor when seeking care to avoid POS charges.
Who to See At Home or Traveling in the U.S. Traveling Overseas
MTF or Civilian Provider
•Mayself-refertoanetworkproviderforfirst8visitsperbeneficiaryperFY1,2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY1,2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits•ContactlocalMTF,TSC,orTAOtofindaprovider
Figure 5.3U.S. TRICARE Prime Option ADFMs: Outpatient Care
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TOP Prime and TGRO ADFMs: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.Authorizationsareissuedasfollows:
TOP Prime ADFMs• (overseas admissions, except in Puerto Rico):TAOissuestheauthorization.
TOP Prime ADFMs in Puerto Rico:• PuertoRicoCallCenterissuestheauthorization.
TGRO ADFMs• (overseas admissions):TGROAlarmCenterissuestheauthorization.
All ADFMs traveling in the U.S.:• ValueOptionsissuestheauthorization.
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In Your Home Area or Traveling Overseas
Gotothenearestemergencycarefacility.*•
ContactyourPCMorTGROAlarmCenterassoonas•possibleafterreceivingcareorpriortomakingpayment.InPuertoRico,contactthePuertoRicoCallCenter.*
While Traveling in the U.S.
Dial911orgotothenearestemergencyroom.*•
Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaimstoWisconsinPhysiciansService.
* Referrals or prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or TGRO Alarm Center within 72 hours of the admission.
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TOP Prime and TGRO ADFMs: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMorTGROAlarmCenterarenotrequired.However,aPCM,TGROAlarmCenter,orphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).WhentravelingintheU.S.,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheU.S.regioninwhichyouareseekingcare.Forotheroutpatientservices,priorauthorizationmayberequired.SeeFigure5.4foradditionaldetails.
1. TOP Prime-enrolled ADFMs living in Canada who accompany their active duty sponsor should seek specialty care through their Canadian Forces Health Facility. If care is not available at the local facility, all care is provided by civilian providers or facilities.
2. POS charges may apply in your area for nonemergency care without appropriate authorization. Contact your local TSC or TAO for details. The FY is October 1–September 30.
Who to See At Home1 or Traveling Overseas Traveling in the U.S.
MTF or Civilian Provider
•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY2
•PriorauthorizationrequiredfromPCMorTGROAlarmCenterforninthandanysubsequentvisits•InPuertoRico,contactPuertoRicoCallCenter
•Mayself-refertoaTRICAREnetworkproviderforfirst8visitsperbeneficiaryperFY2
•PriorauthorizationfromValueOptionsrequired forninthandanysubsequentvisits
Figure 5.4TOP Prime and TGRO ADFMs: Outpatient Care
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U.S. TRICARE Standard ADFMs: Nonemergency Inpatient Admissions
All nonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.
U.S. TRICARE Standard ADFMs: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationis notrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Forotheroutpatientservices,priorauthorizationfromyourregionalcontractormayberequired.SeeFigure5.5onthefollowingpageforadditionaldetails.
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In Your Home Area or Traveling in the U.S.
Call911orgotothenearestemergencyroom.*•
While Traveling Overseas
Gotothenearestemergencycarefacility.*•
Forassistance,contactthenearestMTF,TSC,TAO,U.S.•EmbassyorConsulate,orvisityourTAO’sWebsite.
* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.
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1. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.
2. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider. The FY is October 1–September 30.
TOP Standard ADFMs: Emergency Care*
In TRICARE Eurasia-Africa
Gotothenearestemergencycarefacility.•
ContactlocalMTF,TSC,orTAOtofindaprovider.•
In TRICARE Latin America and Canada†
Gotothenearestemergencycarefacility.•
ContactValueOptionstoobtainpriorauthorizationfor•inpatientadmissions,partialhospitalization,andresidentialtreatmentcenterservicesinU.S.territories.
In TRICARE Pacific
Gotothenearestemergencycarefacility.•
ContactyourlocalTSCorTAOforassistance.•
While Traveling in the U.S.
Call911orgotothenearestemergencyroom.• ‡
* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from the TAO within 72 hours of the admission.
† In Guantanamo Bay, seek care from the U.S. Naval Hospital.
‡ Use your overseas residential address when receiving care or filing claims.
Who to See At Home or Traveling in the U.S. Traveling Overseas1
MTF or Civilian Provider(MTF care is on a space-available basis)
•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
Figure 5.5U.S. TRICARE Standard ADFMs: Outpatient Care
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TOP Standard ADFMs: Nonemergency Inpatient Admissions
All nonemergency inpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmissionfromtheTAOforoverseasadmissions(except in Puerto Rico)orfromValueOptionsforadmissionsintheU.S.orPuertoRico.
TOP Standard ADFMs: Outpatient Care
Priorauthorizationisnotrequiredforoutpatientcare.However,aphysicianreferralis required for all visits tocounselorswhorequirephysiciansupervision (e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).CheckwithyourlocalTSCorTAOforphysicianreferralorauthorizationdetails.SeeFigure5.6foradditionaldetails.
1. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.
2. To find a provider, contact the nearest MTF or TSC or visit www.tricare.mil/findaprovider.
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Who to See At Home or Traveling Overseas Traveling in the U.S.
MTF or Civilian Provider(MTF care is on a space-available basis)
•Mayself-refertoahostnationprovider1
•Priorauthorizationnotrequired
•Mayself-refertoanyTRICARE-authorizedprovider2
•Priorauthorizationnotrequired
Figure 5.6TOP Standard ADFMs: Outpatient Care
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National Guard or Reserve Member or Family Member
Situation 1: I’m exhausted all the time. I sleep, but not enough, I guess. It’s really hard for me to follow what people are saying and I’m messing up at work. maybe some sleeping pills will help me rest and then I’ll feel better.
Situation 2: The other day a car cut me off in the parking lot and dad blew up! I didn’t know what to do when he charged out of the car, ran over to the other car, and started screaming at the driver through the window. dad’s always been so cool and controlled. I was very scared. when he came back to our car, he kept saying everything’s okay. but is it?
Therecouldbeanumberofreasonsforsevereexhaustion,andsomeonesufferingfromsuchasymptomshouldn’ttrytodiagnosewhat’swrongorexplainawaythecause.Extremeandpersistentfatiguecouldhaveaphysicaloremotionalsource.It’samistaketotryand“treat”thesymptomsonyourown.
Overreactionstoroutinesituationsaren’talwaysexpressedthroughanger.Apersoncouldlaughorcryatanentirelyinappropriatemoment.Suchbehavioralchangescanbewarningsignsofemotionalorphysicaldistress.Ifyouorsomeoneyouknowisexperiencingunusualfeelingsorbehavior,discussyourconcernswithaprofessionalqualifiedtodiagnosesymptomsandhelpyouworktowardrelievingthem.
Activation Status Determines TRICARE Eligibility and Care Access
Pre-Activation Benefit
Ifyouareissueddelayed-effective-dateactivedutyordersformorethan30consecutivedaysinsupportofacontingencyoperation,youandyourfamilymaybecomeeligibleforTRICAREpre-activationbenefitsbeginningonthedateyourorderswereissuedor90daysbeforeyoureporttoactiveduty,whicheverislater.Ifyourordersarecancelledbeforeyoureportforactiveduty,TRICAREcoverageendsforyouandyourfamilyonthedatetheordersarecancelled.IfyouareeligibleforTRICAREpre-activationbenefits,youhave
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accesstothesamebenefitsasanactivedutyservicemember(ADSM)andyoureligiblefamilymembershaveaccesstothesamebenefitsasactivedutyfamilymembers(ADFMs).Seethebehavioralhealthcareaccessguidelinesunder“ActiveDutyServiceMember”and“ActiveDutyFamilyMember”respectively.
During Activation
YouhaveaccesstothesamebenefitsasanADSMandshouldseekbehavioralhealthcareservicesfromamilitarytreatmentfacility(MTF)orsimilarmilitary-operatedhealthfacility.Forbehavioralhealthcareaccessguidelinesduringyouractivationperiod,seeyourprogramoptionunder“ActiveDutyServiceMember”earlierinthissection.
Your Family’s Eligibility
Dependingonthelengthofyouractivation,yourfamilymembersmaybeeligibleforADFMbenefits.Contactyourservicepersonnelofficefordetails.ForADFMbehavioralhealthcareaccessguidelines,see“ActiveDutyFamilyMember.”
When Deactivated
ContactyourservicepersonnelofficeorvisittheGuardandReserveWebPortalathttps://www.dmdc.osd.mil/Guard-ReservePortaltodetermineyoureligibilityforthefollowingprograms:
Transitional Assistance Management Program (TAMP): • Provides180daysofcoverageforyouandyoureligiblefamilymembersbeginningonyourreleasefromactivedutydate.UnderTAMP,youmayenrollinTRICAREPrimeorTRICAREOverseasProgram(TOP)Prime(if you live overseas in a TRICARE Prime Service Area).IfyouchoosenottoenrollinaTRICAREPrimeoption,youmaybecoveredunderTRICAREStandardandTRICAREExtraorTOPStandard(if you live overseas).IfcoveredunderTAMP,youandyourfamilymembersareconsideredADFMsduringtheTAMP-eligibleperiodandshouldfollowtheguidelinesforyourprogramoptionunder“ActiveDutyFamilyMember.”
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Continued Health Care Benefit Program (CHCBP): • OncetheTAMPperiodends(or within 60 days of your separation date if you are not eligible for TAMP),youandyoureligiblefamilymemberscanelectCHCBPcoverage,whichprovidesbetween18to36months(depending on eligibility)ofpurchased,premium-basedhealthcarecoveragein90-dayincrements.YoumustcontinuepayingyourmonthlypremiumstokeepCHCBPcoverage.CHCBPoffersbenefitssimilartoTRICAREStandardandTRICAREExtra.
CHCBPbeneficiariesshouldfollowthebehavioralhealthcareaccessguidelinesinthis“NationalGuardorReserveMemberorFamilyMember”section.ForotherCHCBPdetails,call1-800-444-5445.Note:MTFcareisavailabletoCHCBPbeneficiariesonlyintheeventofanemergency.
TRICARE Reserve Select (TRS): • Ifyouandyourfamilymembersqualify,TRSprovidescoveragesimilartoTRICAREStandardandTRICAREExtra.YoumustpaymonthlypremiumstomaintainTRScoverage.Toapplyonline,visittheTRSWebsiteathttps://www.dmdc.osd.mil/appj/trs.Fordetailscontactyourregionalcontractor(U.S. beneficiaries)orValueOptions(overseas beneficiaries).TRSbeneficiariesshouldfollowthebehavioralhealthcareaccessguidelinesinthis“NationalGuardorReserveMemberorFamilyMember”section.
Note:IfyouareaNationalGuardorReservememberwhowasactivatedbyfederalordersandservedonactiveduty,youmayqualifyforveteranstatusforDepartmentofVeteransAffairs(VA)purposes.FordetailsaboutyourpossibleeligibilityforVAbenefits,contactyourregionalVAmedicalcenter.Visitwww.va.govforlocations.IfyouqualifyforbothVAandTRICAREbenefits,youmayseekcareundereitherprogram.
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Location Determines Care Access
Yourprogramoptionandlocationdetermineyourcareaccess.ThefollowingguidelinesareforTRICARE-eligibleNationalGuardandReservememberswhoarenot activated or covered under TAMP.Inthiscase,youandyoureligiblefamilymembersarecoveredundereither:
CHCBP: • AvailableintheU.S.andoverseas
TRS: • AvailableintheU.S.andoverseas
Underbothplans,youcanseeanyTRICARE-authorizedprovider.However,youpayreducedcostswhenyouseeaTRICAREnetworkprovider,whereavailable.
Getting Care, Referrals, and Authorizations
Usethefollowingguidelinestoaccesscaredependingonwhereyouliveortravel.Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossibleafterreturningtotheU.S.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.
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CHCBP and TRS Beneficiaries: Emergency Care
In the U.S.
Dial911orgotothenearestemergencyroom.*•
Overseas
Gotothenearestemergencycarefacility.*•
ContactthenearestTRICAREServiceCenter(TSC),•TRICAREAreaOffice(TAO),U.S.EmbassyorConsulate,orvisityourlocalTAO’sWebsitetofindaprovider.
* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor (U.S.beneficiaries) or the TAO (overseasbeneficiaries) within 24–72 hours of the admission.
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CHCBP and TRS Beneficiaries: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorization.PriorauthorizationsforadmissionsofU.S.TRSbeneficiariesareissuedbytheregionalcontractor.PriorauthorizationsforadmissionsofoverseasTRSbeneficiariesandCHCBPbeneficiariesareissuedbyValueOptions.
CHCBP and TRS Beneficiaries: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationisnotrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).
PriorauthorizationsforU.S.TRSbeneficiariesseekingcareintheU.S.oroverseasareissuedbytheregionalcontractor.PriorauthorizationsforCHCBPbeneficiaries(U.S. or overseas)areissuedbyValueOptions.Priorauthorizationsmayalsoberequiredforotheroutpatientservices.CheckwithyourregionalcontractororyourlocalTSCorTAOfordetails.SeeFigure5.7onthefollowingpageforadditionaloutpatientcaredetails.
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1. MTF outpatient care is not available to CHCBP beneficiaries. 2. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO,
U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.3. TRS beneficiaries residing overseas do not require prior authorizations for
outpatient care.
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Who to See In the U.S. Overseas
MTF1 or Civilian Provider
•Mayself-refertoanyTRICARE-authorizedproviderperbeneficiaryperFYforfirst8visits2
•Priorauthorizationrequiredforninthandanysubsequentvisits
•Mayself-refertoahostnationproviderperbeneficiaryperFYforfirst8visits2,3
•Priorauthorizationrequiredforninthandanysubsequentvisits3
Figure 5.7CHCBP and TRS Beneficiaries: Outpatient Care NA
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Retired Service Member or Family Member
Situation 1: my wife has been feeling a little down, but now she doesn’t want to get out of bed in the morning. I have to coax her to get up. she used to take such good care of herself. And me. now she doesn’t even care about her appearance. something’s definitely wrong.
Situation 2: Ever since I retired, I feel out of place. does what I do matter anymore?
Everyonegetsdowninthedumpsnowandthen.Evenlifechangescancausestress,anxiety,ordepression,whichisnormal.Butwhenthe“blues”persistandstartlimitingaperson’sabilitytofunctionnormally,itcouldbeasignofamoreseriousconditionthatrequiresprofessionalassistance.
Program Option and Location Determine Care Access
Asaretiredservicememberorretireefamilymember,youmaybecoveredbyoneofthefollowingprograms:
TRICARE Prime: • AvailableinmanyareasintheU.S.
TRICARE Standard and TRICARE Extra: • AvailableintheU.S.
TRICARE Overseas Program (TOP) Standard: • Availableoverseas
Note:Ifyouareaservicememberwhoseparatedorwasreleased(but did not retire)fromactivedutyserviceduetoadiseaseordisabilityconnectedtoyourmilitaryservice,youmayalsobeeligibleforDepartmentofVeteransAffairs(VA)benefitsinadditiontoyourTRICAREbenefits.Ifeligible,youcanreceivecareundereitherprogram.ForVAbenefiteligibilitydetails,contactyourregionalVAmedicalcenter.
IfyouoraTRICARE-eligiblefamilymemberisalsoeligibleforMedicarebenefits,see“Medicare-EligibleTRICAREBeneficiary”laterinthissectionforcareaccessguidelines.
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Getting Care, Referrals, and Authorizations
Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonwhereyouliveortravel.Priorauthorizationisrequiredforcertainservices.Forpriorauthorizationdetailsforyourarea,contactyourregionalcontractor,TRICAREServiceCenter(TSC),orTRICAREAreaOffice(TAO).IfyouareenrolledinTRICAREPrime,followtherulesofyourprogramtoavoidpointofservice(POS)fees.Fordetails,visitwww.tricare.mil.
Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossible.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.
U.S. TRICARE Prime Retirees and Families: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.
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In Your Home Area or Traveling in the U.S.
Dial911orgotothenearestemergencyroom.•
While Traveling Overseas
Gotothenearestemergencycarefacility.• †
* Referrals or prior authorizations are not required for emergency care. Contact your primary care manager (PCM) within 24 hours or the next business day. If admitted, work with the facility to obtain a prompt continued stay from your regional contractor within 24–72 hours of the admission.
† Contact the nearest military treatment facility (MTF), TRICARE Service Center (TSC), TRICARE Area Office (TAO), U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.
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U.S. TRICARE Prime Retirees and Families: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMarenotrequired.However,aPCMorphysicianreferralis required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservices.SeeFigure5.8foradditionaldetails.
1. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.
2. While traveling, routine care is not authorized and POS charges may apply. Contact your PCM or regional contractor when seeking care out of your home area.
Who to See At Home or Traveling in the U.S. Traveling Overseas
MTF or Civilian Provider(MTF care is on a space-available basis)
•Mayself-refertoaTRICAREnetworkproviderforfirst8visitsperbeneficiaryperFY1,2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY1,2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
Figure 5.8U.S. TRICARE Prime Retirees and Families: Outpatient Care
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U.S. TRICARE Standard Retirees and Families: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.
U.S. TRICARE Standard Retirees and Families: Outpatient Care
Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationisnotrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservices.SeeFigure5.9onthefollowingpageforadditionaldetails.
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U.S. TRICARE Standard Retirees and Families: Emergency Care*
In Your Home Area or Traveling in the U.S.
Call911orgotothenearestemergencyroom.•
While Traveling Overseas†
Gotothenearestemergencycarefacility.•
Contactthenearestmilitarytreatmentfacility(MTF),•TRICAREServiceCenter(TSC),TRICAREAreaOffice(TAO),U.S.EmbassyorConsulate,orvisityourlocalTAO’sWebsitetofindaprovider.
* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.
† TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.
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1. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.
2. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.
Who to See At Home or Traveling in the U.S. Traveling Overseas1
MTF or Civilian Provider(MTF care is on a space-available basis)
•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY2
•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits
Figure 5.9U.S. TRICARE Standard Retirees and Families:Outpatient Care
TOP Standard Retirees and Families: Emergency Care*
In TRICARE Eurasia-Africa
Gotothenearestemergencycarefacility.• †
In TRICARE Latin America and Canada
Gotothenearestemergencycarefacility.• †
In Guantanamo Bay: • SeekcarefromtheU.S.NavalHospital.
In TRICARE Pacific
Gotothenearestemergencycarefacility.•
While Traveling in the U.S.
Call911orgotothenearestemergencyroom.•
Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaims.
* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your local TRICARE Service Center (TSC) or TRICARE Area Office (TAO) within 72 hours of the admission.
† Contact your local military treatment facility (MTF), TSC, or TAO to find a provider.
TOP Standard Retirees and Families: Nonemergency Inpatient Admissions
Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.TheTAOissuesauthorizationsforoverseasadmissions.ValueOptionsissuesauthorizationsforU.S.admissions(includes partial hospitalization and residential treatment centers, where available).
TOP Standard Retirees and Families: Outpatient Care
Priorauthorizationisnotrequiredforoutpatientcare.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).SeeFigure5.10foradditionaldetails.
1. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider. The FY is October 1–September 30.
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gETTIng CARE
Who to See At Home or Traveling Overseas Traveling in the U.S.
MTF or Civilian Provider(MTF care is on a space-available basis)
•Mayself-refertoahostnationprovider1
•Priorauthorizationnotrequired
•Mayself-refertoanyTRICARE-authorizedprovider1
•Priorauthorizationnotrequired
Figure 5.10TOP Standard Retirees and Families: Outpatient Care
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Medicare-Eligible TRICARE Beneficiary
Situation: what good am I to anyone stuck in this wheelchair? I’m so dependent on my daughter. wouldn’t she be better off without this burden?
Dealingwithadisabilityortheweaknessthatoftencomeswithagecantakeitstollonthepersonsufferingfromtheaffliction,theirfamilymembers,andcaregivers.Ifyouorafamilymemberexperiencesfeelingsofhopelessness,worthlessness,orlosetheabilitytocopewithdailyfrustrationsandsetbacks,helpisavailable.Talktoyourfamilyphysician.Heorshemaybeabletoassistorreferyoutoabehavioralhealthcareprovider.
In the U.S. and its territories:*Intheselocations,MedicareisyourprimaryinsurerandyoumustfollowMedicareguidelinesforaccessingcare.TRICAREForLife(TFL)isyoursecondaryinsurer,unlessyouhaveotherhealthinsurance(OHI).IfyouhaveOHI,TRICAREpaysafterbothMedicareandtheOHI.
WhenMedicareistheprimarypayerforoutpatientorinpatientbehavioralhealthcareservices,TRICAREdoesnotrequirereferralsorpriorauthorizations.However,ifTRICAREbecomestheprimarypayer(e.g., Medicare benefits are exhausted, Medicare is unavailable, services or providers are not covered by Medicare),TRICARE’spriorauthorizationrulesapply.Visitwww.tricare.mil/tflfordetails.Note:Whenfilingclaims,filethemwiththeTFLclaimsprocessor,WisconsinPhysiciansService(WPS).Forcontactinformation,seeFigure7.6intheFor Information and Assistance section.
Outside the U.S. and its territories:*EventhoughyouareaMedicare-eligiblebeneficiary,Medicaredoesnotpayforservicesintheselocations.UnlessyouhaveOHI,TRICAREistheprimarypayerunderTFL,andyouareresponsibleforthesameannualdeductibleandcost-sharesasaTRICAREStandardretiree.
* The U.S. territories are American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.
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Note:IfaprivateinsurancecompanyhandlesyourMedicareplan(e.g., Medicare advantage plan),orifyouhaveOHI,contactthatcarrierfordetails.ContactinformationreferencedinthissectioncanbefoundintheFor Information and Assistancesection.
Getting Care and Authorizations
U.S. TFL Beneficiaries: Nonemergency Inpatient Admissions
WhenTRICAREisyourprimaryinsurer,allnonemergencyinpatientbehavioralhealthcareadmissionsoverseasorintheU.S.anditsterritoriesrequirepriorauthorizationfromyourregionalcontractor(includes partial hospitalization and residential treatment center services, where available).
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In Your Home Area or Traveling in the U.S.†
Call911orgotothenearestemergencyroom.•
While Traveling Overseas
Gotothenearestemergencycarefacility.•
Contactthenearestmilitarytreatmentfacility(MTF),•TRICAREServiceCenter(TSC),TRICAREAreaOffice(TAO),orU.S.EmbassyorConsulatetofindaprovider.
* Prior authorizations are not required by TRICARE for emergency care. However, if you are admitted and when TRICARE is the primary payer, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.
† Includes care received in U.S. territories.
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U.S. TFL Beneficiaries: Outpatient Care
WhenMedicareistheprimarypayer,TRICAREdoesnotrequirepriorauthorizationforoutpatientcare.
HoweverwhenTRICAREistheprimarypayer:
Priorauthorizationis• notrequiredforthefirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY).
Aphysicianreferral• is required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).
Priorauthorization• is requiredforanyvisitsbeyondthefirsteightself-referredoutpatientbehavioralhealthcarevisitsperbeneficiaryperFY.
Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservicesreceived.SeeFigure5.11foradditionaldetails.
1. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, or the nearest U.S. Embassy or Consulate to find a provider.
Who to SeeAt Home or Traveling in the U.S. or in U.S. Territories
Traveling Overseas
Civilian Provider
•Medicareisyourprimarypayer•RefertoMedicareguidelines•SeekcarefromanyMedicare-participatingornonparticipatingprovider•PriorauthorizationsnotrequiredfromregionalcontractorunlessTRICAREpaysfirst
•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY1
•Priorauthorizationsrequiredfromregionalcontractorforninthandanysubsequentvisits•FileclaimsdirectlywithWPS
Figure 5.11U.S. TFL Beneficiaries: Outpatient Care
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Overseas TFL Beneficiaries: Nonemergency Inpatient Admissions
WhenTRICAREisyourprimaryinsurer,allnonemergencyinpatientbehavioralhealthcareadmissions requireauthorizationfromyourTAOwithin72hoursoftheadmission(includes partial hospitalization and residential treatment center services, where available).
Overseas TFL Beneficiaries: Emergency Care*
In TRICARE Eurasia-Africa
Gotothenearestemergencycarefacility.•
Ifunabletoreceivecare,contactthelocalMTFor•TRICAREAreaOffice(TAO)Eurasia-AfricaforreferraltoaU.S.behavioralhealthcarefacility.
In TRICARE Latin America and Canada
Gotothenearestemergencycarefacility.• †
IfunabletoreceivecareinPuertoRico,ValueOptionsmay•referyoutoaU.S.behavioralhealthcarefacility.
In TRICARE Pacific
Gotothenearestemergencycarefacility.• †
Traveling in the U.S.
Call911orgotothenearestemergencyroom.•
Medicarebecomesyourprimaryinsurer.Useyouroverseas•addresswhenreceivingcareorfilingclaims.
* Prior authorization for emergency care is only required by TRICARE when admitted or for continued stay and if TRICARE is the primary payer. File claims for care received with WPS.
† To find a provider, contact your local TRICARE Service Center (TSC) or TAO.
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Overseas TFL Beneficiaries: Outpatient Care
WhenMedicareistheprimarypayer,TRICAREdoesnotrequirepriorauthorizationforoutpatientcare.
WhenTRICAREistheprimarypayer,priorauthorizationisnotrequired;however,aphysicianreferralis required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).SeeFigure5.12foradditionaloutpatientcaredetails.
Who to See At Home or Traveling Overseas Traveling in the U.S.
Civilian Provider
•Priorauthorizationnotrequired•ContactnearestTSC,TAO,orU.S.EmbassyorConsulatetofindaprovider
•SeekcarefromanyMedicare-participatingornonparticipatingprovider•RefertoMedicareguidelines
Figure 5.12Overseas TFL Beneficiaries: Outpatient Care
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Your Right to Privacy
Medical Records and Privacy
TRICAREtakestheresponsibilityofprotectingyourmedicalrecordsseriously.Yourmedicalrecordsmaybepaperrecordsstoredatamilitarytreatmentfacility(MTF)ortheofficeofaTRICARE-authorizedorUSFamilyHealthPlanprovider.OrtheymaybeelectronicrecordsstoredintheMilitaryHealthSystem’sdatabase.Nomatterwhereyourrecordsarelocated,theuseanddisclosureofmedicalinformationisregulatedbyTRICAREpolicyandtheHealthInsurancePortabilityandAccountabilityAct(HIPAA).
EachMTFhasadesignatedprivacyofficertoanswerquestionsyoumayhaveaboutyourpatientrightsandtoensurethathealthcareinformationremainsprivate,butavailabletoyouandyourprovider.KeepinmindthatifyouseecivilianTRICAREnetworkprovidersoutsideoftheMTF,theymayhavetheirownprivacypractices.Itisimportanttocarefullyreadanyinformationaboutprivacypractices.
Ifyouthinkyourprivacyrightshavebeenviolated,youmaysubmitawrittencomplainttoyourMTF,TRICAREManagementActivity(TMA)PrivacyOfficer,orregionalcontractor.
HIPAA and Privacy
In1996,CongressenactedHIPAAtocombatfraudandabuse,improveportabilityofhealthinsurancecoverage,andsimplifyhealthcareadministration.AllmilitaryandcivilianhealthcareplansandproviderswhoelectronicallyconductcertainfinancialandadministrativetransactionsmustcomplywithHIPAA.
TolearnmoreaboutyourprivacyrightsunderHIPAA,visitwww.tricare.mil/hipaa.QuestionsregardingHIPAAissuesmaybesenttoPrivacymail@tma.osd.mil.
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Release of Records and Personal Health Information
Uponrequest,yourproviderwillgiveyouacopyofyourmedicalrecords.Youmaybeaskedtogiveidentifyinginformation,suchasyourdateofbirth,SocialSecuritynumber,orphotoidentification,foryourprotection.
Ifyouwouldlikesomeoneelsetohaveacopyof,oraccessto,yourmedicalrecords,youwillneedtocompleteandsubmitaformauthorizinganypersonwhomyoudesignatetohaveaccesstoyourinformation.Theseformsvarybyregion.ContactyourregionalcontractororTRICAREAreaOffice(TAO)fordetails.
Yourauthorizationisrequiredforanyuseordisclosureofyourhealthinformation,exceptwhenrequiredtocarryouttreatment,payment,healthcareoperations,fitness-for-dutydeterminations,oranyothercircumstancesconsideredappropriateandnecessaryasoutlinedintheMilitary Health System Notice of Privacy PracticesandincompliancewithHIPAAprivacyandsecurityrules.TodownloadacopyoftheMilitary Health System Notice of Privacy Practices,visitwww.tricare.mil/mybenefit/home/Medical/RecordsAndPrivacy.
Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992
TheAlcohol,DrugAbuse,andMentalHealthAdministration(ADAMHA)ReorganizationActof1992placesspecificrequirementsuponfederalagenciesfortheconfidentialityanddisclosureofrecordscontainingtheidentity,diagnosis,prognosis,ortreatmentofanybeneficiaryinconnectionwithasubstanceabuse,alcoholism,oralcoholabuseprogram.
TRICAREcontractorsestablishandmaintainproceduresandcontrolsforthepurposeofassuringtheconfidentialityofbeneficiaryrecords.DisclosureofinformationcontainedwithincontractorrecordsisonlyprovidedinaccordancewithDepartmentofDefense(DoD)privacyregulations.
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For Information and Assistance
TRICARE in Your Region
TheTRICAREprogramismanagedinfourregions—threeU.S.regionsandoneoverseasregiondividedintothreeareas.
U.S. Regions
TRICAREregionalcontractorscanassistyouwithenrollment,referralandauthorizationguidelines,claimsprocessing,andcustomerservicedetails.Forstatesservedineachregion,visitwww.tricare.mil/mybenefit.Figure7.1onthefollowingpagelistsU.S.regionalcontractorcontactinformation.
Note:TRICAREbeneficiariesenrolledintheUSFamilyHealthPlan(USFHP)shouldfollowUSFHPguidelinesforaccessingcare.Call1-800-74-USFHP (1-800-748-7347)orvisitwww.usfamilyhealthplan.orgfordetails.
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1. This service is available only to active duty service members (ADSMs) and active duty family members (ADFMs) enrolled in a TRICARE Prime option. Note: ADSMs must have a military treatment facility primary care manager referral or Military Medical Support Office service point of contact authorization before calling these lines.
U.S. Region Regional Contractor
TRICARE North Region
HealthNetFederalServices,LLC•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-877-747-9579(8 a.m.–6 p.m. Eastern Time)1
•Generalinformation:1-877-TRICARE(1-877-874-2273)•TRICAREReserveSelect:1-800-555-2605•www.healthnetfederalservices.com
TRICARE South Region
HumanaMilitaryHealthcareServices,Inc.•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-877-298-3514(8 a.m.–7 p.m. Eastern Time)1
•GeneralinformationandContinuedHealthCareBenefitProgram(CHCBP):1-800-444-5445•Activedutyprograms:1-877-249-9179•NationalGuardandReserve:1-877-298-3408•WarriorNavigationandAssistanceProgram:1-888-4GO-WNAP(1-888-446-9627)•www.humana-military.com
TRICARE West Region
TriWestHealthcareAllianceCorp.•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-866-651-4970(8 a.m.–6 p.m. in all West region time zones)1
•BehavioralHealthContactCenter:1-888-TRIWEST(1-888-874-9378)•Generalinformation:1-888-TRIWEST(1-888-874-9378)•TriWestBehavioralHealthCrisisLine:1-866-284-3743•www.triwest.com
Figure 7.1TRICARE Regional Contractors
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Overseas Region
TheTRICAREoverseasregionisdividedintothreeareas:TRICAREEurasia-Africa,TRICARELatinAmericaandCanada(TLAC),andTRICAREPacific.
ExceptinPuertoRico,regionalcontractorsarenotavailabletoassistyouinoverseasareas.Instead,contactthelocalmilitarytreatmentfacility(MTF),TRICAREAreaOffice(TAO),orTRICAREGlobalRemoteOverseas(TGRO)AlarmCenter(if eligible)forassistance.InPuertoRico,contactthePuertoRicoCallCenter.SeeFigures7.2,7.3,and7.4forthesecontacts.
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TRICARE Eurasia-Africa(Europe, Africa, and the Middle East)
TAO—Eurasia-Africa•Stateside:1-888-777-8343,option1•Commercial:011-49-6302-67-7433/7434•DSN:496-7433/7434•E-Mail:teoweb@europe.tricare.osd.mil•www.tricare.mil/eurasiaafrica
TRICARE Latin America and Canada(Central and South America, the Caribbean Basin, Canada, Puerto Rico, and the Virgin Islands)
TAO—TLAC•Stateside:1-888-777-8343,option3•Commercial:1-706-787-2424•DSN:773-2424•E-Mail:taolac@tma.osd.mil•www.tricare.mil/tlac
TRICARE Pacific(Australia, Guam, Japan, Korea, New Zealand, and Western Pacific remote countries)
TAO—Pacific•Stateside:1-888-777-8343,option4•Commercial:011-81-6117-43-2036•DSN:643-2036•E-Mail:TPAO.CSC@med.navy.mil•www.tricare.mil/pacific
Figure 7.2TRICARE Area Offices (TAOs)
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Additional Resources and Contacts
Figures7.5and7.6listadditionalresourcestoassistyou.
Eurasia-Africa TGRO Alarm Center
•Commercial:011-44-20-8762-8133•E-Mail:tricarelon@internationalsos.com
TLAC TGRO Alarm Center
•Stateside:1-800-834-5514•E-Mail:tricarephl@internationalsos.com
Pacific TGRO Alarm Centers
Singapore •Commercial:011-65-6-338-9277•E-Mail:sin.tricare@internationalsos.com
Sydney•Commercial:011-61-2-9273-2760•E-Mail:sydtricare@internationalsos.com
Figure 7.3TRICARE Global Remote Overseas (TGRO) Alarm Centers
Canadian Forces Health Facility Locator
•www.tricare.mil/tlac/canada_cfhf.cfm
Puerto Rico Call Center
•Stateside:1-800-700-7104
U.S. Naval Hospital, Guantanamo Bay
•Commercial:011-53-99-72110or011-53-99-72360
Figure 7.4Other Overseas Contacts
Army, Air Force, Navy, Marine Corps
•1-888-MHS-MMSO(1-888-647-6676)
Coast Guard •1-888-MHS-MMSO(1-888-647-6676)•1-800-9HBA-HBA(1-800-942-2422)
National Oceanic and Atmospheric Administration
•1-800-662-2267
U.S. Public Health Service
•1-800-368-2777,option2
Figure 7.5Military Medical Support Office Service Points of Contact
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Beneficiary Web Enrollment (BWE)
•https://www.dmdc.osd.mil/appj/bwe/
Defense Enrollment Eligibility Reporting System (DEERS)
•www.tricare.mil/deers
Guard and Reserve Web Portal
•https://www.dmdc.osd.mil/Guard-ReservePortal
Medicare •Stateside:1-800-633-4227•www.medicare.gov
Military Medical Support Office (MMSO)
•Stateside:1-888-MHS-MMSO(1-888-647-6676)•www.tricare.mil/mmso
MTF Locator •www.tricare.mil/mtf
Network Provider Locator
•www.tricare.mil/findaprovider
TRICARE Reserve Select Web Application
•https://www.dmdc.osd.mil/appj/trs
TRICARE Survivors Benefits Information
•www.tricare.mil/survivors
TRICARE Web Site •www.tricare.mil
U.S. Embassy or Consulate Locator
•www.usembassy.gov
US Family Health Plan (USFHP)
•Stateside:1-800-748-7347•www.usfamilyhealthplan.org
ValueOptions •Stateside:1-800-700-8646
Wisconsin Physicians Service (WPS)
•Stateside:1-866-773-0404•Stateside(TTY/TDD):1-866-773-0405•Overseas(Eurasia-Africa/Pacific):1-608-301-2310•Overseas(TLAC/Puerto Rico):1-608-301-2311•www.TRICARE4u.com
Figure 7.6Other Helpful Resources
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Other Behavioral Health Resources
Defense and Veterans Brain Injury Center:CollaborateswiththeDepartmentofDefense,theDepartmentofVeteransAffairs,andcivilianpartnerstoserveactivedutyservicemembers(ADSMs)andveteranswithtraumaticbraininjury(TBI).Tolearnmore,visitwww.dvbic.org,call1-800-870-9244,orsendane-mailtoinfo@dvbic.org.
Department of Veterans Affairs (VA):OffersenhancedenrollmentbenefitsandafullrangeofVAhealthcareservicestoeligibleveterans(including Operation Enduring Freedom and Operation Iraqi Freedom veterans)forfiveyearsafterdischargefromthemilitary.ContactyourregionalVAmedicalcenterforfurtherdetailsorvisitwww.va.gov.
Mental Health Self-Assessment Program:Providesfree,voluntary,andanonymousonlineandtelephoneself-assessments.Oncetheassessmentiscompleted,informationonwheretogoforafullevaluationisprovided.Alsoavailableistheeducationalvideo,A Different Kind of Courage: Safeguarding and Enhancing Your Psychological Health.Formoreinformation,visitwww.mentalhealthscreening.org/militaryorcall1-877-877-3647.
Military & Family Life Consultants (MFLCs): SupportADSMs,NationalGuardandReservemembers,andtheirfamiliesbyprovidingdirect,face-to-face,non-medicalcounselingandeducationregardingdailylifestressorsrelatedtodeploymentandreintegration.MFLCsaddressconcernsofstress,relationships,familyproblems,financialissues,griefandloss,conflictresolution,andtheemotionalchallengesoftransitioningfromcombatbacktocivilianlife.Formoreinformation,visitwww.mhngs.comorcall1-800-646-5613.
Military OneSource:Offersuptosix,cost-free,confidentialcounselingsessionstoeligiblemilitarypersonnelandtheirfamilymembers.Counselingisavailableinpersonorbyphoneandaddressesshort-termissues,suchasgriefandloss,deployment
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adjustment,work/lifemanagement,andcombatstress.Visitwww.militaryonesource.comorcall1-800-342-9647.
Note for ADSMs: ReceivingareferralfromaMilitaryOneSourceconsultanttoaMilitaryOneSourcecounselorisnotthesameasbeingreferredbyyourprimarycaremanager(PCM)orobtainingapprovalfromyourMMSOservicepointofcontact.NotifyyourPCMbeforeseekingcivilianbehavioralhealthcare.
Recommended Reading List
Books for Children
Love, Lizzie: Letters to a Military Mom • byLisaTuckerMcElroy
My Life—A kid’s journal • availableontheHealthNetWebsiteatwww.healthnetfederalservices.com
The Kissing Hand • byAudreyPenn
We Serve Too! A Child’s Deployment Book • byKathleenEdlick
When Dad’s at Sea • byMindyPelton
Deployment Materials
Help from Home • videosavailableontheTriWestWebsiteatwww.triwest.com.
Helping Children Cope During Deployment • byUniformedServicesUniversityoftheHealthSciences
Military Youth Coping with Separation: When Family Members •Deploy(forteens)andMr. Poe and Friends Discuss Reunion After Deployment(elementaryagechildren)bytheAmericanAcademyofPediatrics(AAP).ViewthevideosontheAAPMilitaryYouthDeploymentSupportWebsiteathttp://www.aap.org/sections/uniformedservices/ deployment/index.html.
Single Parenting While Your Partner Is Deployed • byCeridianCorporation
Support the Child Whose Military Parent Is Deploying: Tips for •ParentsbyDr.ThomasHardaway
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Online Behavioral Health Resources
Air Force Crossroads: • Onlinecommunitynetworkofferingabroadrangeofinformationandservices.Visitwww.afcrossroads.com.
Deploymentkids.com: • Activitiesforkidsduringaparent’sdeployment.Visitwww.deploymentkids.com.
Military.com: • Offersinformationregardingdeployments,pay,benefits,andmore.Visitwww.military.com.
Military Child Education Coalition: • Informationforparents,teachers,andcounselors,plusresourcesthatprovidesupportforchildrenduringdeployment.Visitwww.militarychild.org.
National Guard Family Program: • Facilitateseducation,outreachservices,andpartnershipstoenhancequalityoflifeforNationalGuardmembersandtheirfamiliesandcommunities.Visitwww.guardfamily.org.
National Military Family Association: • Informationaboutdeploymentsandstress.ClickonDeployment and Youatwww.nmfa.org.
Operation Healthy Reunions: • Provideseducationandhelpscombatthestigmaofbehavioralhealthissuesamongservicemembers,theirfamilies,andmedicalstaff.Visitwww.nmha.org/reunions.
Our Survivors: • U.S.Armyresourceforsurvivorsofdeceasedservicemembersprovidingavarietyofbehavioralhealthresources.Alsooffersa“GuideforFamiliesofFallenSoldiers.”Visitwww.armyfamiliesonline.org.
Reserve Component Resource Center: • InformationabouttheresourcesavailabletohelpNationalGuardandReservefamilieswhilemembersareonactiveduty.Visitwww.pdhealth.mil/reservist/families.asp.
Sesame Workshop • ®: Bilingualmultimediaoutreachprogram,createdbySesameStreet®,designedtosupportmilitaryfamilieswithchildrenbetweentheagesof2and5affectedbydeployments.Visitwww.sesameworkshop.org/tlc.
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The Navy and Marine Corps Public Health Center: • HealthpromotionWebsitefeaturingasectioncalled“MindingYourMentalHealth™.”Visitwww.nmcphc.med.navy.mil/hp/mmh.
Tragedy Assistance Program (TAPS) for Survivors: • Offerspeersupportandassistancetosurvivorsofdeceasedmilitaryservicemembersthroughawidevarietyofprograms.Visitwww.taps.orgformoreinformation.
U.S. Army HOOAH for Health Web Site: • Includesanentiresectiondevotedtomaintainingahealthymind.Visitwww.hooah4health.com/mind.
Warriorcare.mil:• Arangeofonlineresourcestoassistservicemembersandtheirfamilies.Visitwww.warriorcare.mil.
Zero to Three • ®:Informationaboutthedeploymentcycleandwhattoexpect.Visitwww.zerotothree.org.
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AcronymsADFM ActiveDutyFamilyMemberADHD AttentionDeficitHyperactivityDisorderADSM ActiveDutyServiceMemberBCAC BeneficiaryCounselingandAssistanceCoordinatorCHCBP ContinuedHealthCareBenefitProgramCMFT CertifiedMarriageandFamilyTherapistDCAO DebtCollectionAssistanceOfficerDEERS DefenseEnrollmentEligibilityReportingSystemDoD DepartmentofDefenseECT ElectroconvulsiveTherapyFY FiscalYearHIPAA HealthInsurancePortabilityandAccountability
Actof1996LOD LineofDutyMMSO MilitaryMedicalSupportOfficeMTF MilitaryTreatmentFacilityOHI OtherHealthInsurancePCM PrimaryCareManagerPHP PartialHospitalizationProgramPOS PointofServicePSA PrimeServiceAreaPTSD Post-TraumaticStressDisorderRTC ResidentialTreatmentCenterSPOC ServicePointofContactSUDRF SubstanceUseDisorderRehabilitationFacilityTAMP TransitionalAssistanceManagementProgramTAO TRICAREAreaOfficeTBI TraumaticBrainInjuryTFL TRICAREForLifeTGRO TRICAREGlobalRemoteOverseasTLAC TRICARELatinAmericaandCanadaTMA TRICAREManagementActivityTOP TRICAREOverseasProgramTPR TRICAREPrimeRemote
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TPRADFM TRICAREPrimeRemoteforActiveDutyFamilyMembers
TRIAP TRICAREAssistanceProgramTRS TRICAREReserveSelectTSC TRICAREServiceCenterU.S. UnitedStatesUSFHP USFamilyHealthPlanVA DepartmentofVeteransAffairsWPS WisconsinPhysiciansService
ACRonyms
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GlossaryAuthorization
Authorizationsmustbeobtainedpriortocertainservicesbeingrenderedorwithin24hoursofanemergencyadmission.Failuretoobtainanauthorizationwhenrequiredmayresultinadenialofpaymentforthoseservices.
Beneficiary
AbeneficiaryisapersonwhoiseligibleforTRICAREbenefits.Beneficiariesincludeactivedutyfamilymembers(ADFMs)andretiredservicemembersandtheirfamilies.Familymembersincludespousesandunmarriednaturalchildrenorstepchildrenuptotheageof21(or 23 if full-time students at accredited institutions of learning).Seewww.tricare.milforothereligiblebeneficiarycategories.
Continued Health Care Benefit Program (CHCBP)
Apremium-basedhealthcareprogramyoumaypurchaseafterthelossofTRICAREeligibilityifyouqualify.TheCHCBPofferstemporarytransitionalhealthcoverageandmustbepurchasedwithin60daysafterTRICAREeligibilityends.
Cost-Share
Acost-shareisthepercentageorportionofcoststhatthebeneficiarywillpayforinpatientoroutpatientcare.
Deductible
TheannualamountabeneficiarymustpayforcoveredoutpatientbenefitsbeforeTRICAREbeginstosharecosts.
Defense Enrollment Eligibility Reporting System (DEERS)
Adatabaseofuniformedservicesmembers(sponsors),familymembers,andothersworldwidewhoareentitledunderlawtomilitarybenefits,includingTRICARE.BeneficiariesarerequiredtokeepDEERSupdated.DEERSistheofficialsystemofrecordforTRICAREeligibility.Seewww.tricare.mil/deersformoreinformation.
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Designated Provider
UndertheUSFamilyHealthPlan(USFHP),designatedproviders(DPs),formerlyknownasuniformedservicestreatmentfacilities,areselectedcivilianmedicalfacilitiesaroundtheU.S.assignedtoprovidecaretoeligibleUSFHPbeneficiaries—includingthosewhoareage65andolder—wholivewithintheDParea.AttheseDPs,theUSFHPprovidesTRICAREPrimebenefitsandcost-sharesforeligiblepersonswhoenrollinUSFHP,includingthosewhoareMedicareeligible.
Enrollee
ATRICAREbeneficiarywhohaselectedtoenrollinaTRICAREprogramoption(e.g., TRICARE Prime, TRICARE Prime Remote, TRICARE Overseas Program Prime).
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HIPAAwasintroducedtoimproveportabilityandcontinuityofhealthinsurancecoverageinthegroupandindividualmarkets;tocombatwaste,fraud,andabuseinhealthinsuranceandhealthcaredelivery;topromotetheuseofmedicalsavingsaccounts;toimproveaccesstolong-termcareservicesandcoverage;tosimplifytheadministrationofhealthinsurance;andforotherpurposessuchasprivacy.
Military Treatment Facility (MTF)
Amedicalfacilityoperatedbythemilitary(e.g., hospital, clinic).
National Guard and Reserve
TheNationalGuardandReserveincludestheArmyNationalGuard,theArmyReserve,theNavyReserve,theMarineCorpsReserve,theAirNationalGuard,theAirForceReserve,andtheCoastGuardReserve.
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Network Provider
Anetworkproviderisaprofessionalorinstitutionalproviderwhohasacontractualrelationshipwiththeregionalcontractortoprovidecareatacontractedrate.AnetworkprovideragreestofileclaimsandhandleotherpaperworkforTRICAREbeneficiaries,andtypicallyadministerscaretoTRICAREPrimebeneficiariesandthoseTRICAREStandardbeneficiariesusingTRICAREExtra.AnetworkprovideracceptstherateTRICAREallows(TRICARE-allowable charge)aspaymentinfullforservicesrendered.
Non-Network Provider
Anon-networkproviderisonewhohasnocontractualrelationshipwiththeregionalcontractor,butisauthorizedtoprovidecaretoTRICAREbeneficiaries.Therearetwotypesofnon-networkproviders—participatingandnonparticipating.
Other Health Insurance (OHI)
Anynon-TRICAREhealthinsurancethatisnotconsideredasupplement.Thisinsuranceisacquiredthroughanemployer,entitlementprogram,orothersource.Underfederallaw,TRICAREisthesecondarypayertoallhealthbenefitsandinsuranceplans,exceptforMedicaid,TRICAREsupplements,theIndianHealthService,orotherprogramsorplansasidentifiedbytheTRICAREManagementActivity(TMA).
Point of Service Option
Thepointofservice(POS)optionallowsTRICAREPrimeenrolleestoreceivenonemergencycarefromanyTRICARE-authorizedproviderwithoutreceivingaprimarycaremanager(PCM)referral.ThePOSoptionhashigherout-of-pocketcostsandisnotavailabletoactivedutyservicemembers(ADSMs).
Primary Care Manager (PCM)
ATRICAREciviliannetworkproviderormilitarytreatmentfacility(MTF)providerwhoprovidesprimarycareservicestoTRICAREbeneficiaries.APCMiseitherselectedbythebeneficiaryorassignedbyanMTFcommanderorhisorherdesignatedappointee.TRICAREPrimeRemote(TPR)beneficiariesmaychooseaTRICARE-authorizedproviderifanetworkproviderisnotavailable.
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Prior Authorization
Areviewdeterminationmadebyalicensedprofessionalnurseorotherhealthcareprofessionalforrequestedservices,procedures,oradmissions.Authorizationsmustbeobtainedpriortocertainservicesbeingrenderedorwithin24hoursofanemergencyadmission.Failuretoobtainapriorauthorizationwhenrequiredmayresultinadenialofpaymentforthoseservices.
Referral
Theactorinstanceofreferringabeneficiarytoanotherauthorizedproviderfornecessarymedicalorbehavioralhealthcaretreatment.
Regional Contractor
See“TRICARERegionalContractors.”
Service Point of Contact
Theuniformedservicesofficeorindividualresponsibleforauthorizingcivilianhealthcareforactivedutyservicemembers(ADSMs)enrolledinTRICAREPrimeRemote(TPR).
Sponsor
Theactivedutyservicemember(ADSM)orretireethroughwhomfamilymembersareeligibleforTRICARE.
Transitional Assistance Management Program (TAMP)
Transitionalhealthcareforcertainuniformedservicesmembers(and eligible family members)whoseparatefromactiveduty.
TRICARE-Authorized Provider
AproviderwhomeetsTRICARE’slicensingandcertificationrequirementsandhasbeencertifiedbyTRICAREtoprovidecaretoTRICAREbeneficiaries.IfyouseeaproviderwhoisnotTRICARE-authorizedandcanneverbecertified,youareresponsibleforthefullcostofcare.TRICARE-authorizedprovidersincludedoctors,hospitals,ancillaryproviders(laboratories and radiology centers),andpharmacies.TherearetwotypesofTRICARE-authorizedproviders:networkandnon-network.
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TRICARE Area Office (TAO)
TheseofficesarelocatedineachoverseasareatoassistyouwithTRICAREoverseasprograms.
TRICARE Regional Contractors
CivilianpartnerswhoprovidehealthcareservicesintheTRICAREregions(i.e., Health Net Federal Services, LLC; Humana Military Healthcare Services, Inc.; TriWest Healthcare Alliance Corp.).
US Family Health Plan (USFHP)
ProvidestheTRICAREPrimemanagedcareoptionthroughnetworksofcommunity-based,not-for-profithealthcaresystemsinsixareasoftheUnitedStates.USFHPisnotavailableoverseasandenrollmentisrequired.YoumustberegisteredintheDefenseEnrollmentEligibilityReportingSystem(DEERS)andresideinoneofthedesignatedUSFHPserviceareas.USFHPenrolleesarenoteligibleforcareatmilitarytreatmentfacilities(includes pharmacy services).
81
List of TablesFigure 5.1U.S.TRICAREPrimeOptionADSMs:
OutpatientCare...........................................................35
Figure 5.2TOPPrimeandTGROADSMs:OutpatientCare...........................................................37
Figure 5.3U.S.TRICAREPrimeOptionADFMs:OutpatientCare...........................................................40
Figure 5.4TOPPrimeandTGROADFMs:OutpatientCare...........................................................42
Figure 5.5U.S.TRICAREStandardADFMs:OutpatientCare...........................................................44
Figure 5.6TOPStandardADFMs:OutpatientCare....................45
Figure 5.7CHCBPandTRSBeneficiaries:OutpatientCare...........................................................51
Figure 5.8U.S.TRICAREPrimeRetireesandFamilies:OutpatientCare...........................................................54
Figure 5.9U.S.TRICAREStandardRetireesandFamilies:OutpatientCare...........................................................56
Figure 5.10TOPStandardRetireesandFamilies:OutpatientCare...........................................................57
Figure 5.11U.S.TFLBeneficiaries:OutpatientCare....................60
Figure 5.12OverseasTFLBeneficiaries:OutpatientCare............62
Figure 7.1TRICARERegionalContractors................................66
Figure 7.2TRICAREAreaOffices(TAOs)................................67
Figure 7.3TRICAREGlobalRemoteOverseas(TGRO) AlarmCenters..............................................................68
Figure 7.4OtherOverseasContacts..............................................68
Figure 7.5MilitaryMedicalSupportOffice ServicePointsofContact..........................................68
Figure 7.6OtherHelpfulResources............................................69
lIsT of TAblEs
www.tricare.mil
82
IndexA
Activedutyfamilymember(ADFM),18–19,30–31,38–45,47,66,76
Activedutyservicemember(ADSM),16,18–20,24,30–32,34–37,47,66,70–71,78–79
Alcohol,DrugAbuse,andMentalHealthAdministrationReorganizationActof1992,64
Alcoholabuse,15,64Alcoholism,23,64Anorexianervosa,13Anxiety,6,11–14,38,52AttentionDeficitHyperactivityDisorder(ADHD),12Authorizations,5,16–20,24,31,33–37,39–45,49–51,53–62,64–66,76,79
Aversiontherapy,23
B
Behavioralhealthcareadmissions,34,36,40–41,43,45,50,53,55,57,59,61
Behavioralhealthcareservices,20,23–24,26,28,47,58BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine,28,34,37,40,42,66
Bingeeatingdisorder,13Bioenergetictherapy,23Bulimianervosa,13
C
Carecoordination,39Certifiedmarriageandfamilytherapist,26Certifiedpsychiatricnursespecialists,26Clinic,19,35,37,77Clinicaldepression,12Collateralvisits,17Commandsponsorship,39Conjointpsychotherapy,17
83
Consulate,29,43–45,49,51,53–57,59–60,62,69ContinuedHealthCareBenefitProgram(CHCBP),48–51,66,76Cost-share,19,25,43–44,55–56,58,76–77Counselors,18,26,40,42–43,45,50,54–55,57,60,62,71–72Currency,25
D
Deductible,19,25,58,76DefenseEnrollmentEligibilityReportingSystem(DEERS),69,76,80
Delayed-effective-orders,46DepartmentofVeteransAffairs(VA),4,48,52,70Deployment,6–11,13,18,32,38,70–73Depression,6,12–14,52Designatedproviders,77Detoxification,22Developmentaldisorders,24Disability,27,52,58Disulfiram,23Drugabuse,22,64
E
Eatingdisorders,13Electroshock,24Electrostimulationtherapy,24Eligibility,18–19,25,30–31,33,38–39,46–49,52,69,76,80Emergency,4–5,18,20,22,31,34–35,39,41,43–44,48–49,53,55–56,59,61,76,79
Environmentalecologicaltreatments,23Exclusions,16,23–24Experimentalprocedures,23Eyemovementdesensitizationandreprocessing(EMDR),23
F
Familytherapy,22–24,26Fitness-for-duty,33,64Fraud,63,77
IndEx
www.tricare.mil
84
G
Grouptherapy,23GuardandReserveWebPortal,47,69
H
HealthInsurancePortabilityandAccountabilityAct(HIPAA),63–64,77
HealthNetFederalServices,LLC(HealthNet),66,71,80Hostnationprovider,25,31,44–45,51,54,56–57,60HumanaMilitaryHealthcareServices,Inc.(HumanaMilitary),66,80
I
Inpatientadmissions,34,36,40–41,43–45,50,53,55,57,59,61Inpatientbehavioralhealthcare,20–22,34,36,40–41,43,45,50,53,55,57–59,61,76
Inpatientpsychotherapy,16Inpatientservices,20
L
Licensedclinicalsocialworkers,26Licensedorcertifiedmentalhealthcounselor,26,40,42–43,45,50,54–55,57,60,62
M
Marathontherapy,23Maritaltherapy,23,26Medicalnecessity,16–17,19–24Medicare,30,52,58–62,69,77Medicationmanagement,17–19,26Megavitamin,23MentalHealthSelf-AssessmentProgram,3,70Mildtraumaticbraininjury(TBI),13Military&FamilyLifeConsultants(MFLCs),70MilitaryHealthSystemNoticeofPrivacyPractices,64MilitaryMedicalSupportOffice(MMSO),16,28,34–35,66,68–69,71
85
MilitaryOneSource,70–71Militarytreatmentfacility(MTF),16,19–20,28,33–37,40–45,47–48,51,53–57,59–61,63,66–67,69,77–78,80
MTFcare,44–45,48,54,56–57
N
Narcotherapy,24NationalGuardandReserve,30–31,39,46,48–49,66,70,72,77NationalSuicidePreventionLifeline,4Networkproviders,19,40,42,49,54,63,69,78–79Nonemergencycare,20,24,33–34,36–37,40–43,45,50,53,55,57,59,61,78
Non-networkproviders,25,78–79Nonparticipatingproviders,60,62,78
O
Otherhealthinsurance(OHI),29,31,58–59,78Out-of-pocketcosts,78Outpatientbehavioralhealthcare,21–23,31,34–37,40,42–45,50–51,54–58,60,62,76
Outpatientpsychotherapy,16Outpatientservices,16,40,42–43,50,54–55,60Overseas,16,25,27–28,31,33–37,39–45,47–57,59–62,65,67–69,80
P
Partialhospitalization,21–22,44,57,59,61Participatingprovider,25,60,62,78Pastoralcounselors,26,40,42–43,45,50,54–55,57,60,62Physicianreferral,26,40,42–43,45,50,54–55,57,60,62Pointofservice(POS),24,39–40,42,53–54,78Post-traumaticstressdisorder(PTSD),3,13Pre-activationbenefits,46Primaltherapy,24Primarycaremanager(PCM),19,27–28,34–37,39–42,53–54,66,71,78
IndEx
www.tricare.mil
86
Primarypayer,30–31,58–62PrimeServiceArea,47Priorauthorization,17,19–20,24,31,33–37,39–45,49–51,53–62,66,76,79
Privacyofficers,63Psychiatrist,5,26Psychoanalysis,17Psychologicaltesting,17,26Psychologist,5,26Psychosurgery,24Psychotherapy,16–17,19,26PuertoRicoCallCenter,28,34–37,41–42,67–68
R
Regionalcontractor,16,18,20,26–28,39–40,43–44,48–50,53–56,59–60,63–67,78–80
Rehabilitation,21–22Residentialtreatmentcenter(RTC),21,24,44,57,59,61Retiredservicemember,30–31,52,76Retiree,3,19,53–58,79Retireefamilymember,52Rolfing,24
S
Schizophrenia,23Servicepointofcontact(SPOC),16,19,28,34–35,66,68,71,79Sexualproblems,12Sexualdysfunction,24Smokingcessation,24SocialSecuritynumber,64Sponsor,31,38–39,42,76,79Stress,6–7,10–11,13–14,18,23,38,52,70–72Substanceabuse,14,17,21,64Substanceusedisorder,14,21–22Suicide,4,13–15Survivors,31,69,72–73
87
T
TelementalHealthProgram,19–20Telephonecounseling,24TOPPrime,33,35–37,39,41–42,47,77TOPStandard,39,44–45,47,52,56–57Traininganalysis,24Transcendentalmeditation,24TransitionalAssistanceManagementProgram(TAMP),18,39,47–49,79
Traumaticbraininjury(TBI),13,70TRICARE-allowablecharge,25,78TRICARE-authorizedprovider,19,22,26,40,42,44–45,49,51,56–57,63,78–79
TRICAREAreaOffice(TAO),16,28,33,36,39–45,49–51,53–57,59–62,64,67,80
TRICAREAssistanceProgram(TRIAP),18TRICAREEurasia-Africa,44,56,61,67–69TRICAREExtra,19,39,43–44,47–48,52,55–56,78TRICAREForLife(TFL),25,58–62TRICAREGlobalRemoteOverseas(TGRO),16,27–28,33–37,39,41–42,67–68
TRICARELatinAmericaandCanada(TLAC),36–37,44,56,61,67–69
TRICAREManagementActivity(TMA),63,78TRICAREOverseasProgram(TOP),33,35–37,39,41–42,44–45,47,52,56–57,77
TRICAREPacific,44,56,61,67–69TRICAREPrime,19,24,30,32,34–35,38–40,47,52–54,66,77–78,80
TRICAREPrimeRemote(TPR),32,34,38,77–79TRICAREPrimeRemoteforActiveDutyFamilyMembers(TPRADFM),38
TRICAREregionalcontractors,16,18,20,26–28,39–40,43–44,48–50,53–56,59–60,63–67,78–80
TRICAREReserveSelect(TRS),18–19,48–51,66,69TRICAREReserveSelect(TRS)Webapplication,69
IndEx
88
TRICAREServiceCenter(TSC),16,27–28,31,33,37,39–40,42–45,49–51,53–57,59–62
TRICAREStandard,19,39,43–44,47–48,52,55–56,58,78TriWestBehavioralHealthCrisisLine,66TriWestHealthcareAllianceCorp.(TriWest),66,71,80
U
USFamilyHealthPlan(USFHP),28,30,63,65,69,77,80U.S.Embassy,29,43–45,49,51,53–57,59–60,62,69
V
ValueOptions,29,41–42,44,48,50,57,61,69VAhotline,4
W
WisconsinPhysiciansService(WPS),25,29,41,58,60–61,69
Z
Ztherapy,24
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