Retirees, Their Family Members and Others
TRICARE
TRICARE
TRICARE
Standard
Prime
Extra
(CHAMPUS)
Annual
None
0/ individual
0/ individual or
Deductible
or 0/family
0/family
Annual
0/individual
None
None
0/family
Enrollment
Fees
25% of allowed charges
Civilian
20% of
Provider Co-
negotiated fees
Pays:
Outpatient
Visit
Emergency
Care
Mental
Health Visit
Civilian
/day
Lesser of
Lesser of 0/day or 25%
Inpatient
( minimum)
0/day or
of billed charges plus 25%
Cost-Share
25% of billed
of allowed professional
charges plus
fees
20% of allowed
professional
fees
Civilian
/day
of
Lesser of 7/day or 25%
Inpatient
institutional &
of institutional &
Mental
professional
professional charges
Health
charges
Figure 1-3. Costsharing under TRICARE-Retirees,
Their Family Members, and Others
MD0755
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