1-14. FAMILY MEMBERS OF ACTIVE DUTY PERSONNEL
a. General. As stated earlier, TRICARE is essentially a supplemental program
to the uniformed services direct medical care system. When medical care is received
from civilian sources, a TRICARE beneficiary is responsible for payment of certain
deductible and cost-sharing amounts in connection with otherwise covered services and
supplies. By statute, this joint financial responsibility between the beneficiary (or
sponsor) and TRICARE is more favorable for family members of active duty than for
other classes of beneficiaries.
b. Annual Fiscal Year Deductible for Outpatient Services and/or Supplies.
Figures 1-2 and 1-3 provide a graphic illustration of sources and costs of benefits.
Active-Duty Family Members
TRICARE
TRICARE
Prime
Prime
TRICARE
TRICARE
E-1 thru E-4
E-5 & Up
Extra
Standard
None
None
Annual
0/ individual or
0/
Deductible
0/family
individual or
for E-5 & above;
0/family
/0 for E-4
for E-5 &
& below
above;
/0 for
E-4 & below
Civilian
/visit
/visit
l5% of negotiated
20% of
Outpatient
fee
allowable
Visit
charge
Civilian
/day
/day
Greater of or
Greater of
Inpatient
(
(
.90/day
or
Admission
minimum)
minimum)
.90/day
Civilian
/day
/day
/day
/day
Inpatient
Mental
Health
Figure 1-2. Cost-sharing under TRICARE -
Active-Duty Family Members
MD0755
1-17