(3) TRICARE establishes a triple option benefit. All beneficiaries continue to
be eligible to receive care in MTFs but AD family members who enroll in TRICARE
Prime option will have priority over all other non AD beneficiaries.
(a) Enroll to receive health care in an HMO-type program called
(b) Use the civilian preferred provider network on a case-by-case basis,
under TRICARE Extra.
(c) Receive care from non-network providers and have the services
reimbursed under TRICARE Standard.
(4) Prime enrollees receive a PCM, obtain most of their care within a provider
network, and pay reduced cost shares when they receive care from civilian network
providers. Prime enrollees retain freedom to utilize non-network civilian providers, but
will pay cost shares considerably higher than under TRICARE Standard.
(5) TRICARE Standard and Extra beneficiaries will pay standard CHAMPUS
cost sharing, except that their cost share will be lower when they opt to use the
preferred provider network under TRICARE.
(6) TRICARE implements coordinated care between military and civilian
health care systems through:
(a) Resource sharing agreements.
(b) Health care finding.
(c) Quality and utilization management services for military and civilian
(d) Special pharmacy programs for areas affected by base realignment
and closure actions. These pharmacy programs include special eligibility for some
(e) TRICARE outpatient clinics providing primary care resources.
(TRICARE provides a transitional authority for continued operation of PRIMUS and
c. TRICARE reduces beneficiary out-of-pocket costs for civilian sector care (for
example, TRICARE Extra and TRICARE Prime). Under TRICARE Prime, the cost
sharing requirements are replaced for CHAMPUS beneficiaries who enroll.
Beneficiaries not enrolled in TRICARE Prime reduce out-of-pocket costs under
CHAMPUS, for example, the pharmacy program), access to network providers and
TRICARE Outpatient Clinics, on a space-available basis.