h. Catchment Area. The catchment area is the existing statuatory designation
of the geographical area primarily served by an MTF. The catchment area is defined i n
law as the area within approximately 40 miles of a medical facility of the uniformed
The TRICARE PROGRAM
a. TRICARE is implemented under the statutory authority of title 10, U.S.C.
sections 1099 (health care enrollment), 1097 (alternative contracts for health care
delivery and financing), and 1096 (resource sharing agreements). The National
Defense Authorization Act for FY 1995 amended title 10, U.S.C. section 1097 to
authorize the Secretary of Defense to provide for coordination of health care services
provided in the MTF with health care services provided with any contract or agreement
with a civilian managed care contractor. These public laws are subject to change and
fees are subject to modifications.
b. TRICARE is implemented through execution of a region-by-region contract.
The regional contractor becomes the fiscal intermediary for payment of all TRICARE
claims for that region. TRICARE includes establishment of a comprehensive enrollment
system; creation of a triple option benefit, including a Uniform HMO Benefit; and a
series of functions to coordinate care between military and civilian delivery systems,
including Resource Sharing Agreements, Health Care Finding, Primary Care for the
Uniformed Services (PRIMUS) and Navy Care (NAVCARE) Clinics, prescription
pharmacy services, and a consolidated schedule of charges.
(1) In TRICARE regions, the commanders of selected MEDCENs are
designated as Lead Agents for TRICARE regions overseeing managed care support
(2) TRICARE establishes a basic structure of health care enrollment. All
CHAMPUS eligible beneficiaries become participants in TRICARE and are classified
into one of four groups:
(a) AD members, all of whom are automatically enrolled in TRICARE
Prime, an HMO-type option;
(b) TRICARE Prime enrollees, who (except for AD members) must be
(c) TRICARE Standard and Extra participants, which includes all
CHAMPUS-eligible beneficiaries who do not enroll in TRICARE Prime; or
(d) MEDICARE-eligible beneficiaries and other non-CHAMPUS-eligible
DOD beneficiaries, who, although not eligible for TRICARE Prime, may participate in
features of TRICARE.