TRICARE Overview

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Across
  1. 3. Extended Care Health Option an extra financial benefit for active duty family members with a qualifying condition
  2. 7. Approval given by the managed care support contractor after review of submitted documentation to ensure the requested service is a TRICARE-covered benefit and medically necessary for the diagnosis submitted.
  3. 8. TRICARE "PPO" health plan
  4. 13. active duty member, retiree, or deceased active duty member or retiree, of a Uniformed Service upon whose status his or her family members’ eligibility for TRICARE is based.
  5. 16. The DoD’s managed health care program for Service members and their families, retirees and their families, survivors, and other TRICARE-eligible beneficiaries
  6. 18. Biological child of an eligible sponsor before the are registered in DEERS and enrolled in a TRICARE plan.
  7. 19. A geographic area determined by the Government for civilian contracting of medical care and other services for TRICARE-eligible beneficiaries.
Down
  1. 1. a geographic are greater than 50 miles from a live and work address
  2. 2. Defense Enrollment Eligibility Reporting System,
  3. 4. Defense Health Agency Great Lakes acts as the intermediary between contractors, civilian providers and sponsors command for fitness for duty
  4. 5. TRICARE "HMO" like health plan
  5. 6. Point of service out of pocket costs for a Prime enrolled beneficiary to self refer to a provider without a referral from the PCM/Treating provider
  6. 9. Determined by sponsor branch of service
  7. 10. An organization with which DHA has entered into a contract for delivery of and/or processing of payment for health care services, and the performance of related support activities,
  8. 11. A service member serving on active duty for more than 30 consecutive days
  9. 12. A process established by the contractor to inform beneficiaries of the availability of the TRICARE program, facilitate enrollment in the program, and maintain enrollment records.
  10. 14. The providers or facilities the managed care support contractor has contracted with to provide health care services to TRICARE eligible beneficiaries at a pre-negotiated rate as the total charge for services provided .
  11. 15. non-sponsor beneficiary listed under the sponsor in DEERS
  12. 17. HNFS subcontracted claims player