Tricare Military Insurance
General Overview
Tricare is the insurance offered to all military personnel and their covered dependents. This coverage is generally only active as long as the military sponsor is on active-duty. The sponsor will have coverage throughout his or her lifetime if he or she retires from the military. The sponsor's spouse will also be covered and any non-married dependents will be covered until they are 21 years of age.
Details of Coverage
The military sponsor and his or her dependents are encouraged to receive their medical services in a military medical facility. If the medical service the patient needs is unavailable or not within immediate reach such as in an emergency or if the military facility is too far then the sponsor and his or her dependents can seek medical treatment in a civilian facility. The cost to the patient for civilian service varies depending on whether the sponsor is still on active duty or retired from the military. Per the Tricare Providers Handbook, available on the
Humana Tricare website, as well as flyers and brochures to help providers understand how to verify Tricare coverage, costs, and billing information. The Sponsor and his dependents can elect either Tricare Standard, Tricare Elect or Tricare Prime. Each has it's own associated rules and cost to the patients. They function similar to regular commericial, PPO coverage and HMO coverage respectively. The cost of the coverage is free however the sponsor and beneficiaries will have associated deductibles and cost-shares for covered services. Most services received in a civilian medical facility may need a referral and/or a "Certificated of Medical Necessity".
Veteran's Benefits
Veteran's benefits are only available to veterans at a veteran's facility. In some cases if the patient needs to be treated for a service-connected injury or medical condition not able to be treated at the Veteran's Medical Facility and is approved the civilian medical facility will be paid at the approved rate with no cost to the patient.
CHAMPVA
CHAMPVA coverage is sponsored by the Department of Veteran's Affairs and is for the military members immediate family. To qualify for coverage the military member must have received an service related injury, illness or death during their military service but do not qualify for Tricare coverage. The spouse is covered throughout her life time , unless she remarries before the age of 55 and children are covered to the age of 18 unless full-time in college and not married.
The cost for coverage is free however the patients have an annual deductible and costshares for covered services and at medical facilities that accept Tricare/Champva assistments. If the medical facility does not accept assignment then the patient may be liable for entire costs. You will find more information at the
Department of Veteran's Affairs website.