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Tricare Program and Benefits

 
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Home > Info for Patients & Community > TRICARE > Tricare Program and Benefits
 
The U.S. Naval Hospital and the 18th Medical Group are pleased to introduce you to TRICARE Pacific and assist with your enrollment into TRICARE Pacific Prime. TRICARE Pacific Logo

TRICARE Program & Benefits

TRICARE Programs TRICARE Benefits

Forms

What should I do?
Prime   Enrollment When I travel back to the states?
Standard Internationl SOS Disenrollment When I travel in Asia?
Plus Program for Persons with Disabilities (PFPWD) PCM Change When I leave family members back in the states?
TRICARE for Life (TFL) DEERS Claim Form When I have a baby?
AD Dental (UCCI) Retiree Information When I send my child to college?
Retiree Dental (Delta Dental) When my address or phone number changes?

 

TRICARE Pacific Eligibility

  • TRICARE Prime: Currently, only active duty personnel and their spouses and children are eligible to enroll in TRICARE Prime on Okinawa.  TRICARE Prime patients have medical priority over TRICARE Standard in military treatment facilities.
  • TRICARE Standard: Active duty family members who do not enroll in TRICARE Prime can still be seen in military treatment facilities at a lower priority than Prime enrollees or can use TRICARE Standard for civilian care. Military retirees are eligible for space-available care in military treatment facilities and those under age 65 can use TRICARE Standard for civilian care.
  • TRICARE For Life (TFL) is a permanent healthcare benefit. No TRICARE For Life beneficiary card is necessary for eligible beneficiaries to receive reimbursement for covered services, and no enrollment is required. However, to be eligible for the expanded TFL coverage, retirees, eligible family members and survivors, age 65 and over, need to be registered in DEERS and have a valid military ID card. They must have Medicare Part A, and be enrolled in Medicare Part B.
  • TRICARE Plus is an enrollment option for persons who are eligible for care in Military Treatment Facilities (MTF), if one is available. Beneficiaries who are eligible for care in MTFs, other than active duty members, are eligible for enrollment in TRICARE Plus. However, beneficiaries who are enrolled in an HMO or similar program (including TRICARE Prime, an employer sponsored HMO plan or a Medicare+Choice plan) are not eligible for TRICARE Plus because they have established a primary care relationship with another provider. Currently, enrollment in TRICARE Plus in Okinawa is limited to USAF eligible beneficiaries on Kadena Air Base only.
  • NOT ELIGIBLE FOR TRICARE: Military retirees age 65 and up, dependent parents and parents-in law are eligible for space-available direct care only in military treatment facilities. DODDS, civil service and contract employees may also receive space available care at military treatment facilities as pay patients.

TRICARE Options

Active duty members are automatically enrolled in TRICARE Prime when they turn in their health record at their assigned clinic. Active duty family members may choose to enroll in TRICARE prime to enjoy enhanced access to military healthcare and reduced cost of civilian care. Those who do not enroll in TRICARE Prime will still have access to care at military clinics, but with a lower priority than those enrolled in Prime, and are covered under TRICARE Standard if they need to obtain care from civilian providers. Features of the two options are:

With TRICARE Prime, your family members enroll with a Primary Care Manager (PCM) who will be responsible for providing or arranging all of their health care needs. If the PCM is unable to provide the care needed, your family members will be referred to a specialist within the military health care system or to a local civilian network provider. There is no enrollment fee and you will only enroll once during your tour on Okinawa. Family members enrolled in TRICARE Prime receive the extra benefit of having all copayments for civilian care on Okinawa waived and low out-of-pocket expenses when receiving care in the United States

TRICARE Standard is the new name for CHAMPUS. Just as in the United States, this option is only available to those who do not enroll in Prime. There is also no need to enroll in Standard to use it. Those who choose to use this option for civilian outpatient care are responsible for an annual deductible of $150.00 for an individual or $300.00 for a family ($50/100.00 for E-4 or below) and a 20% cost share of the charges above that amount.

TRICARE For Life (TFL): Provides expanded medical coverage for Medicare-eligible retirees (including retired guard members and reservists), family members, and survivors who are age 65 years and older through the military's health care program. The TFL program will make TRICARE available, as a secondary payer to Medicare, which means TRICARE, will pay most of the costs not covered by Medicare. For retirees on Okinawa, since Medicare does not apply, TRICARE will continue to be the first payer for civilian health care needs, deductibles, and cost shares may apply. All eligible retirees and their family members could be seen at an MTF on a "space available basis."

TRICARE Plus: The TRICARE Plus program is a local military treatment facility (MTF) based primary care enrollment program and not a comprehensive health care program. TRICARE eligible beneficiaries not enrolled in TRICARE Prime will be given the opportunity to enroll for MTF primary care. TRICARE Plus members receive primary care appointments within the TRICARE access standards. It includes designation of a primary care provider and use of referral procedures for specialty care, when available, in the MTF or civilian network. TRICARE Plus enrollment will be annotated in DEERS. For care from civilian providers, TRICARE Plus has no effect and TRICARE Standard/Extra rules will apply for most enrollees. For services payable by Medicare, Medicare rules will apply with TRICARE as second payer for TRICARE covered services and supplies. Specialty care in the MTF will be based on referrals from the primary care provider. There is no lock-in and no enrollment fee for TRICARE Plus.

TRICARE Prime Access to Care Standards

  • Within 24 hours - Acute illness (Early intervention required - urgent)
  • One week - Routine visit (Intervention required, but non-urgent)
  • Four weeks - Well visit (Health maintenance and prevention - non-urgent)
  • Four weeks - Specialty referral

 

Primary Care Manager (PCM) Designation - Family members may select a provider at any of the following clinics:

Dialing Instructions Appointments Information
Kadena Aerospace Medicine (18th Medical Group) 630-4305 630-4305
Kadena Family Practice (18th Medical Group) 630-4817 630-4889
Kadena Pediatrics (18th Medical Group) 630-4817 630-4542
Bush Branch Medical Clinic (Camp Courtney) 622-7633 622-7348
Evans Branch Medical Clinic (Camp Foster) 645-7376 645-7617
Kinser Branch Medical Clinic (Camp Kinser) 637-3995/1723 637-1250
U.S. Naval Hospital Pediatrics (Camp Lester) 643-7304 643-7308
U.S. Naval Hospital Internal Medicine (Camp Lester) 643-7715 643-7478
U.S. Naval Hospital Family Practice (Camp Lester) 643-7517 643-7225

Accessing Civilian Healthcare on Okinawa

Contact your designated PCM if you need civilian healthcare. Civilian healthcare on Okinawa is fully reimbursable for TRICARE Prime enrollees as long as they are referred by their PCM. Okinawan providers will require payment in cash at time of service. You may then bring the bill in to the Health Benefits Advisor (Naval Hospital 643-7499) to file a reimbursement claim. If you obtain civilian medical care in the community without formal referral by your PCM, you will be responsible for an annual deductible of $300.00 per person or $600.00 per family per year and a 50% cost share under the TRICARE Prime Point of Service Option.

 

Accessing Civilian Healthcare Outside Okinawa

While on leave outside Okinawa, you will retain your TRICARE Prime coverage. While in CONUS, no authorization from your PCM is required for emergent and urgent care. If available, seek care from the nearest military treatment facility, or if it is not practical, from a civilian healthcare provider. If you need assistance, you may call the 1-800 number in the TRICARE Region you are visiting and ask to speak to a healthcare finder. You will be reimbursed for all authorize care under the TRICARE program. Claims for civilian care outside Okinawa should be filed through the Naval hospital’s Health Benefits Advisor upon return to Okinawa. TRICARE Pacific Prime enrollees submit all claims to Wisconsin Physicians Services, Foreign Claims, PO Box 7985, Madison, WI 53707-7985 (608) 224-2727 or 224-2728.

 

PCS Transfer

When transferring, you will remain enrolled in TRICARE Prime until you enroll at your next duty station. Until that time, you must identify yourself as enrolled in TRICARE Pacific on Okinawa and process all claims through Wisconsin Physicians Services.

 

TRICARE Prime Enrollment

  • At the TRICARE Service Center - you may enroll at the USNH Okinawa or 18th Medical Group Kadena TRICARE Service Center.
  • By mail - If you understand your TRICARE benefits, please complete the enrollment form and return by mail. No postage is required when mailed on Okinawa.
  • Web Site - You can download the enrollment Form from our web site at www.oki.med.navy.mil and mail it to the TRICARE Service Center.

For additional information or assistance, or to arrange group briefings, please contact the U.S. Naval Hospital TRICARE Service Center at 643-7539 (fax 643-7638 - e-mail NHOkiTRICARE@med.navy.mil) or the 18th Medical Group at 630-4515.  Click here for dialing instructions.

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