Prime vs Standard Cost & Benefit Comparison For · PDF filePrime vs Standard Cost & Benefit...
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Prime vs Standard Cost & Benefit Comparison For Retirees and Family Members TRICARE Prime TRICARE Standard* Annual Deductible $0 $150/person or $300/family Annual Enrollment Fees $230/person or $460/family N/A Office Visit $12 per visit (You pay $12 for office visits regardless of what the provider charges TRICARE) 25% cost-share per visit (If provider is paid $100 for an office visit, TRICARE pays $75 and you pay $25) Ambulatory Surgery (Outpatient) Care $25 25% cost-share Hospital (Inpatient) Care $11 per day ($25 minimum charge) $535 per day or 25% cost-share (whichever is less), plus 25% cost-share of professional fees Emergency Room Visit $30 25% cost-share Urgent Care Visit $12 25% cost-share Ambulance Services $20 25% cost-share Family Therapy (Behavioral Health) Visit $25 25% cost-share Clinical Preventive Services** $0 25% cost-share Eye Exams Covered every two years for age 3 and over Not covered for any beneficiary over age 6. Claims Filed for you by your provider – you have no paperwork. Some providers require that you file your own TRICARE claims, receive reimbursement and then pay the provider. However, you might be required to pay the provider for all services up front. Access To Care Network Providers Network providers are contracted specifically for TRICARE. These providers are required to adhere to office appointment access standards as well. Non-Network Providers Non-network providers are TRICARE- authorized, but are not contracted specifically for TRICARE. Provider Flexibility If you are not satisfied with your network provider, you can self-refer to any TRICARE-authorized, non-network provider under the Point of Service Option. Higher costs apply. Choose any TRICARE-authorized provider, but pay lower costs when using a network provider. *Note: TRICARE Extra has 20% cost-shares. Hospital (Inpatient) Care is $250 per day or 25% cost-share (whichever is less), plus 20% cost-share of professional fees. **Clinical preventive services include cancer screening, clinical preventive exams (physicals), cardiovascular screening, eye exams (see above), hearing screening, immunizations, infectious disease screening, mammograms, pap smears, and well-child care. TRICARE Prime offers enhanced services over TRICARE Standard. HE0808x026x0808
Transcript of Prime vs Standard Cost & Benefit Comparison For · PDF filePrime vs Standard Cost & Benefit...
Prime vs Standard Cost & Benefit Comparison For Retirees and Family Members
TRICARE Prime TRICARE Standard*Annual Deductible $0 $150/person or $300/family
Annual Enrollment Fees $230/person or $460/family N/A
Office Visit $12 per visit
(You pay $12 for office visits regardless of what the provider charges TRICARE)
25% cost-share per visit
(If provider is paid $100 for an office visit, TRICARE pays $75 and you pay $25)
Ambulatory Surgery (Outpatient) Care
$25 25% cost-share
Hospital (Inpatient) Care $11 per day
($25 minimum charge)
$535 per day or 25% cost-share (whichever is less), plus 25% cost-share of professional fees
Emergency Room Visit $30 25% cost-share
Urgent Care Visit $12 25% cost-share
Ambulance Services $20 25% cost-share
Family Therapy (Behavioral Health) Visit
$25 25% cost-share
Clinical Preventive Services** $0 25% cost-share
Eye ExamsCovered every two years for age 3 and over
Not covered for any beneficiary over age 6.
ClaimsFiled for you by your provider – you have no paperwork.
Some providers require that you file your own TRICARE claims, receive reimbursement and then pay the provider. However, you might be required to pay the provider for all services up front.
Access To Care
Network Providers Network providers are contracted specifically for TRICARE. These providers are required to adhere to office appointment access standards as well.
Non-Network Providers Non-network providers are TRICARE- authorized, but are not contracted specifically for TRICARE.
Provider Flexibility
If you are not satisfied with your network provider, you can self-refer to any TRICARE-authorized, non-network provider under the Point of Service Option. Higher costs apply.
Choose any TRICARE-authorized provider, but pay lower costs when using a network provider.
*Note: TRICARE Extra has 20% cost-shares. Hospital (Inpatient) Care is $250 per day or 25% cost-share (whichever is less), plus 20% cost-share of professional fees.
**Clinical preventive services include cancer screening, clinical preventive exams (physicals), cardiovascular screening, eye exams (see above), hearing screening, immunizations, infectious disease screening, mammograms, pap smears, and well-child care. TRICARE Prime offers enhanced services over TRICARE Standard.
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