STEP 1: ELIGIBILITY

Determining if you are eligible for Tricare benefits is the first step in obtaining medical treatment. Proper registration in the Defense Enrollment Eligibility Reporting System (DEERS) is the key to receiving timely and effective Tricare benefits. DEERS is a worldwide, computerized database of uniformed services members (sponsors), their familymembers, and others who are eligible for military benefits, including Tricare.

All sponsors (Active Duty, Retired, National Guard or Reserve) are automatically registered in DEERS. However, the sponsor must register eligible family members. Registration of all members of the family is critical to obtaining medical treatment.

To get information about updating personal information and links to DEERS sites, go to www.tricare.mil⁄mybenefit⁄ home⁄overview⁄Eligibility⁄ DEERS⁄Updating. You mayalso go online at https:⁄⁄www.dmdc.osd.mil ⁄appj⁄address⁄indexAction.do.

An in-person DEERS request is done through the nearest uniformed services personnel office or ID card-issuing facility. To locate the nearest facility, visit www.dmdc.osd.mil⁄ rsl⁄owa⁄home. You may call the Defense Manpower Data Center Support Office at 800-538-9552 to update your addresses, e-mail addresses and phone numbers. (TTY⁄TDD for the deaf: 866-363-2883)

You should update your record in the Defense Enrollment Eligibility Reporting System (DEERS) whenever you experience any of the following life events (this list is not all-inclusive):

• Change in sponsor’s status
• Retiring or separating from active duty
• National Guard or Reserve member activation or deactivation
• Change in service status (e.g. enlisted to officer, branch change)
• Getting married or divorced
• Having a baby or adopting a child (Note: DEERS registry is a separate step and is required before you can enroll a child in Tricare Prime.)
• Moving to a new location for any reason
• Becoming entitled to Medicare regardless of age (either you or a family member)
• Death of sponsor or family member

STEP 2: WHICH TRICARE BENEFITS IS BEST FOR YOU?

Every beneficiary’s situation is different. Tricare offers several plan options to meet your health care needs. Most beneficiaries choose to receive their care through Tricare Prime however, Tricare Standard⁄Extra offer great flexibility to meet your health care needs.

Health Beneficiary Services at the National Naval Medical Center is located in Bldg 9, 1st floor, near the Customer Service Desk and Tricare Service Center. A Beneficiary Counseling and Assistance Coordinator (BCAC) can inform and guide you through choosing the appropriate Tricare Program. You may also call 301-295-5143 to speak with a BCAC. Hours of operation are Monday through Friday from 7:30 a.m. to 4 p.m. For more information on Health Beneficiary Services please visit: www.bethesda.med.navy.mil⁄.

Tricare Prime

Tricare Prime is a health maintenance organization (HMO)-type option. Most of your health care is provided at military treatment facilities or through a network of civilian providers established by the regional Tricare contractor. Tricare Prime is available to Active Duty Service Members (ADSM), Active Duty Family Members (ADFM), retiree and eligible family members (regardless of age) who are not eligible for Medicare, Medicare-eligible beneficiaries under age 65, Congressional Medal of Honor Recipients and their family members, and certain former spouses of active or retired service members.

You may select or be assigned a primary care manager (PCM). Your PCM will provide most of your care and refer you for services he or she cannot provide. Active Duty Service Members are required to enroll in Tricare Prime.

Tricare Prime is usually best if you: do not have other health insurance (OHI); want to easily control your health care costs; want only small or no co-pays.

Tricare Prime Remote (TPR) offers Active Duty Families who reside and work in remote stateside locations access to the same health care benefits as those who live in a Prime service area. For more information on the TPR program please contact your regional TRICARE contractor.

TRICARE Prime Remote is available to ADSM’s who live and work more than 50 miles or an hour’s drive from a military treatment facility (MTF), and ADFM’s who reside with an ADSM who live and work more than 50 miles or an hour’s drive from an MTF.

Tricare Standard⁄Extra

Tricare Standard is a fee-for-service option. When you use Tricare Standard, you have more choice in providers since you can seek care from any Tricare-authorized provider (network or non-network), however you will pay higher out-of-pocket costs.

To reduce your out-of-pocket costs, use the Tricare Extra option by seeking care Tricare network providers. Using Tricare Extra is like using a Preferred Provider Option (PPO). When using Tricare Standard⁄Extra beneficiaries are responsible for meeting annual deductibles before Tricare will share costs. To find a list of network providers please contact your managed care support contractor.

Tricare Standard is usually best if you: have other health insurance; reside in a rural area where Prime is not available; prefer to manage your own care without referrals and authorizations; travel extensively; prefer a broad choice of providers; or do not use Military Treatment Facility (MTF) for healthcare.

Tricare Standard⁄Extra is available to ADFM’s, ADFM’s who reside with an ADSM who live and work more than 50 miles or an hour’s drive from an MTF, retirees and their family members, Congressional Medal of Honor Recipients and their family members, and certain former spouses of active or retired service members.
Other Health Insurance (OHI)

If you are thinking about cancelling your Other Health Insurance (OHI) consider the following: you may not be able to re-enroll in your current plan until a future open enrollment period; you may not be able to re-enroll due to pre-existing conditions; or you may lose other benefits associated with the health care coverage, such as long-term disability insurance, group life insurance, dental benefits, or vision benefits.

Uniformed Services Family Health Plan

Uniformed Services Family Health Plan (USFHP), a Department of Defense-contracted health plan, is made available by non-profit health care providers, referred to as Designated Providers, in six service areas across the country. USFHP provides benefits using the TRICARE Prime co-pay structure for its enrollees, including enrollees who are Medicare-TRICARE dual eligible. USFHP offers comprehensive health coverage and pharmacy benefits provided through networks of private physicians and hospitals in each USFHP program area. Johns Hopkins Medicine serves as the Maryland, D.C., and parts of Pennsylvania, Virginia, and West Virginia designated provider.

The Johns Hopkins Uniformed Services Family Health Plan is open to active duty family members, retirees, their spouses, and unmarried dependent children (until age 21 or 23); eligible unremarried former spouses of active-duty or retired service members; survivors of deceased active duty or retired service members who are not re-married; National Oceanic Services (NOS) members who retired prior to July 19, 1963, or who have had continuous service since that date, and their family members; retired lighthouse keepers and their family members; and qualifying active duty personnel and Guard and Reserve and their family members during TAMP.

For more information about eligibility and enrollment, including a searchable ZIP code database, visit www.usfhp.com.

Tricare for Life and Tricare Plus, what is thedifference?

Tricare for Life
Tricare for Life (TFL) is Tricare’s Medicare-wraparound coverage available to all Medicare-eligible Tricare beneficiaries, regardless of age, provided they have Medicare Parts A and B. Tricare is second payer to Medicare for services covered by Medicare and Tricare; this means that Tricare pays most of the costs not covered by Medicare, eliminating many out-of-pocket costs (cost shares and deductibles). TFL is also available to Congressional Medal of Honor Recipients and their family members, and certain former spouses of active or retired service members.

Tricare Plus
Tricare Plus is a program that allows beneficiaries who normally are only able to get care at a military treatment facility (MTF) on a space-available basis to enroll and receive primary care appointments at the MTF within the same primary care access standards as beneficiaries enrolled in a TRICARE Prime option.

National Naval Medical Center is proud to offer the Tricare Plus program to eligible beneficiaries who were enrolled in Tricare Prime and receiving their primary care at NNMC Bethesda prior to turning age 65. For more information or to enroll beneficiaries should contact the Health Beneficiary Services Division at 301-295-5143 and is located in Bldg. 9 on the 1st floor between the Customer Service Desk and the Tricare Service Center.

Tricare Plus is not a health plan; it is simply a way to access primary care at an MTF. Your enrollment in Tricare Plus will be reflected in the Defense Enrollment Eligibility Reporting System (DEERS). Tricare Plus does not guarantee access to specialty care at the MTF where you are enrolled.

You may still get care from Medicare and⁄or civilian providers. Tricare Standard and Extra or Medicare rules apply. For beneficiaries who are entitled to Medicare Part A and who have Medicare Part B coverage, Tricare is the second payer to Medicare for Tricare-covered services.

Tricare for Life benefits are not affected by enrollment in the Tricare Plus program. If eligible, you can participate in both programs. Tricare Plus will cover your primary care provided at an MTF and Tricare for Life will cover care that is not available at the MTF.

For more information on Medicare please visit: www.medicare.gov or you may contact Health Beneficiary Services at 301-295-5143.

Dental Options

Active duty service members, including activated National Guard or Reserve members, receive dental care through their service at either a military dental treatment facility, through the Tri-Service Remote Dental Program or through theTricare Global Remote Overseas Call Center depending on their location and their Tricare plan.

The Tricare Dental Program is a voluntary, premium-based dental insurance plan administered by United Concordia Companies, Inc., (United Concordia). The Tricare Dental Program is available to the following beneficiaries: Active duty family members, family members of National Guard and Reserve members, members of the National Guard and Reserve (who are not on active duty orders), and Inactive Ready Reserve members. Beneficiaries must have at least 12 months of obligation left. For more information please call Stateside: 800-866-8499, Overseas: 888-418-0466 or 717-975-5017 or visit www.tricaredentalprogram.com⁄tdptws⁄ home.jsp.

The Tricare Retiree Dental Program, administered by Delta Dental of California, is available to retired service members and their family members, retired National Guard or Reserve members and their family members, Medal of Honor recipients and their families, and survivors. For more information please contact 888-838-8737 or visit www.trdp.org.

STEP 3: ENROLLMENT TO TRICARE PRIME/CHOOSING A PRIMARY CARE MANAGER (PCM)

1. Online through the Beneficiary Web Enrollment Web Site
Log on to the Beneficiary Web Enrollment Web site at https:⁄⁄www. dmdc.osd.mil⁄appj⁄bwe⁄ and update yourpersonal information anytime, day or night.

2. Via the Mail
Download a copy of the ‘‘Tricare Prime Enrollment Application and PCM Change Form from” from www.tricare.mil by clicking on the My Benefit module. Look under‘‘Downloads” on the top of the page to download the form. You can also request an application from your regionalcontractor. Complete the application and follow the directions for returning the application to your regional contractor through the mail.

3. Visit a Tricare Service Center
You can visit any TRICARE Service Center at www.tricare.mil⁄contactus⁄, pick up a copy of the ‘‘Tricare PrimeEnrollment Application and PCM Change Form,” complete the form and submit it to the Tricare Service Center representatives. After your regional contractor processes yourapplication, you will receive a welcome letter identifying your PCM along with an enrollment card for each family member that has been enrolled. Your Tricare Prime start date will be printed on your enrollment card. Additionally, you’ll receive a copy of the ‘‘TRICARE Prime Handbook.”

Please keep a copy of your enrollment application untilyou have received your enrollment card. If you must seek care before receiving your card, contact your regionalcontractor to verify your Tricare Prime start date and PCM assignment.

4. Choosing a PCM
Honoring your preferences for assignment to a PCM depends upon availability and capacity of the provider. Contact your Tricare Service Center, preferred MTF or Uniformed Services Family Health Plan Member service for availability of PCMs.

Primary Care at the National Naval Medical Center can be accessed through the following clinics: Pediatrics, Adolescents, Medical Home, Internal Medicine, and Executive Health (Flag Officer Equivalent). Children under the age of 13 can access primary care from the Pediatrics clinic. Children between the ages of 13-21 may access primary care from the Adolescent clinic. Adults age 18 and above may access primary care from the Internal Medicine or Medical Home Clinics.

Medical home is a team approach to your health care. In a primary health care setting, Medical Home is patient-centered and compassionate. As patient, you partner with your primary care manager (PCM) and healthcare Team. Together we all work to coordinate the services you need for your best overall health. Medical Home is dedicated to improving healthcare access by ensuring the following:

• Same-day access for urgent healthcare needs. Guaranteed! Your PCM or another Team provider will see you within 24 hours.
• Timely routine and follow-up care. Your medical needs will be monitored. In many cases, you will be proactively contacted to schedule convenient follow-up appointments.
• Hassle-free booking for follow-up and specialty appointments coordinated by your Medical Home Team. You willno longer need to call the Call Center to schedule appointments.

5. Primary Care Manager (PCM) Changes
Call Managed Care Support Contractor, currently Health Net, at 877-TRICARE (874-2273) to request a change in your PCM.

STEP 4: HOW DO I MAKE AN APPOINTMENT AT THE MILITARY TREATMENT FACILITY?

To schedule an appointment with your Primary CareManager (PCM) follow these steps:

1. Call the Appointment Call Center:
Local: (301) 295-NAVY (6289)
Toll-free: (866) NAVY-MED (628-9633)
Hours: Monday through Friday: 6 a.m. to 6:00 p.m.

2. Tricare Online gives you freedom to schedule appointments anytime, not just during business hours. Please visit https:⁄⁄www.tricareonline.com for more information.

3. Using NNMC Online at: www.bethesda.med.navy.mil ⁄patient⁄health_care⁄medical_services⁄internal_medicine⁄medical_home.aspx, you can do a number of exciting things online. Any established beneficiary who is a registered patient at NNMC Internal Medicine, Adolescents⁄PEDS, Executive Health, HEME⁄ONC and USUHS can use this service to: request your next appointment; refill medication refills; receive your test and lab results; maintain a personal health record; communicate with your healthcare team about non-urgent symptoms from anywhere with an Internet connection; skip unnecessary office visits and avoid telephone hassles; access health information to manage your health.

Your referral to a specialty clinic follows these steps:
1. When a specialty clinic is located at your Military Treatment Facility (MTF) or a nearby MTF: After your provider submits a referral for specialty care, please wait 48-72 hours before calling the Call Center to schedule your specialty appointment: 866-NAVYMED (866-628-9633).

2. If a specialty appointment is not available at your MTF or any local MTF, your referral will be forwarded to the MCSC by the NNMC Referral Management Center to locate a specialist in the civilian network: You will receive a letter from the MCSC to inform you of an available specialist in the civilian network. The MCSC will verify that the service can be paid under your Tricare benefit. The MCSC will verify the appointment is available within four weeks. You will schedule the appointment directly with the specialist’s office. Please notify the MCSC of the appointment date: 877-TRICARE (877-874-2273) to help get the specialist’s consultation information to your PCM.

3. Referral expiration: Your referral or consult expires 28 days from the date it was written. If an appointment has not been made within the 28 days, you may need to contact your Primary Care Manager (PCM) for a new referral. The MCSC for further information and assistance: 877-TRICARE (877-874-2273).

4. Need to change or cancel your appointment? At National Naval Medical Center Bethesda, call 866-NAVYMED (866-628-9633). With a civilian doctor, call the doctor’s office directly. Then please notify MCSC of your appointment change: 877-TRICARE (1-877-874-2273).

5. Experiencing difficulty? Contact the Tricare contractor at 877-TRICARE (877-874-2273) to check on the status of your referral; to obtain the provider information if you have not received your letter from the MCSC within 5-7 business days; or to request a different doctor if needed.

Please check-in for your appointment 15 minutes prior to the scheduled time and allow for delays due to parking andconstruction.

STEP 5: HOW DO I RECEIVE AFTER HOURS CARE?

ONE CALL DOES IT ALL!
Beneficiaries enrolled to NNMC and its branch clinics may make an appointment by speaking to a Primary Care Manager (PCM) after hours or by getting authorization for urgent care after hours. Please call either of the following numbers: 301-295-NAVY (6289) or 866-NAVYMED (628-9633).

During working hours Monday through Friday from 6 a.m. until 6 p.m., the Patient Appointment Call Center’s (PACC) live agents will make your appointment ... or find someone who can.

After hours, the same number will forward you to an answering service that will assist you in speaking to the PCM on call to address your urgent health care concerns. (Direct line: 800-747-3661)

If urgent care is indicated by the PCM and care within NNMC is not an option (because it is after hours, you are out of the area, etc.), dial 877-Tricare for assistance in locating a TRICARE authorized care facility nearest you. Tell the agent you have spoken to the PCM on call and they have authorized Urgent Care (Remember, no authorization is needed for emergency care, dial 911 or go to the nearest emergency room.).

STEP 6: HOW DO I FILL MY PRESCRIPTIONS?

Tricare offers several convenient ways for you to have prescriptions filled depending on your family’s specific needs. You can have prescriptions filled at any of these pharmacies, based on your specific situation, and you can use more than one option at a time.

Military Treatment Facility Pharmacy: Least expensiveoption with no out-of-pocket costs. You may have prescriptions filled (up to a 90-day supply for most medications) at a military treatment facility (MTF) pharmacy free of charge.

° Pharmacy at NNMC, Bethesda, MD: Location: Bldg. 9, 2nd Floor. Main Pharmacy located at top of escalators. From 2nd deck of Visitors’ Garage cross skywalk into Bldg. 9; Pharmacy on right. Prescription Refills (call 24⁄7): 800-377-1723. Satellite Pharmacy Refill Pick- up: 301-295-6873. Prescription Questions: 301-295-2124. Hours of Operation: Closed Sunday and all Federal Holidays; open Monday through Friday 7:30 a.m. to 8:30 p.m.; Saturday: 8 a.m. to noon.

° Satellite Pharmacy at NNMC, Bethesda, MD: Location: Bldg. 142, 1st Floor. From Wisconsin Ave., enter northgate on North Wood Rd. Left on Palmer Rd North; changes name to Taylor Rd. Pass Naval Medical Research Institute on right; Bldg 142 on right. Satellite Pharmacy Refill Pick-up: 301-295-6873. Hours of Operation: Monday through Friday, 8 a.m. to 6 p.m.; Saturday: 8 a.m. to noon

° Refills: order medication refills via the NNMC Public Web site at www.bethesda.med.navy.mil⁄. Click on the‘‘Prescription Refill” link under Quick Links on the left side of the home page or you can order refills through the Medical Home’s link: www.bethesda.med.navy. mil⁄patient⁄health_care⁄medical_services⁄internal_medicine⁄medical_home.aspx.

• TRICARE Mail Order Pharmacy Program: Safe, convenient and the most cost-effective option when a military pharmacy is not available. Express Scripts, Inc.; Stateside: 866-DoD-TMOP (866-363-8667) Overseas: 866-ASK-4PEC (866-275-4732) http:⁄⁄member.express scripts.com⁄dodCustom⁄welcome.do.
• TRICARE Retail Pharmacy program: Fast and convenient ...more than 54,000 network pharmacies in the U.S. and U.S. Territories. Express Scripts, Inc. 866-DoD-TRRx (866-363-8779) http:⁄⁄member.express-scripts.com⁄dod Custom⁄welcome.do.
• Non-Network Pharmacy: This is the most expensive option for you. You may have to pay for the total amount of the prescription first and then file a claim with the pharmacy contractor to receive a partial reimbursement after your deductible is met. If you are filling prescriptions in the U.S., Guam, Puerto Rico, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands, visiting a non-network pharmacy should be your last option.