Tricare Standard Copay

1. Tricare Cost Share 2021

Annual deductibles apply to network and non-network providers for outpatient services only.

• Deductibles must be met before TRICARE benefits are payable.
• Once the deductible is met, cost-shares apply.
• Network providers can collect at a minimum the copayment at the time of service. A provider may also collect the outstanding balance of the deductible. The explanation of benefits (EOB) will inform the beneficiary and provider of the allowed amount and patient responsibility.
• Deductibles apply to the catastrophic cap.
• TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve deductibles do not apply to preventive services.
  • Exception: Deductibles will apply to routine eye examinations (when covered), school physicals and assignment-ordered physicals, when performed by non-network providers.

A beneficiary's deductible is determined by the sponsor's initial enlistment or appointment date:

• Copayments are per occurrence or per visit. Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services. Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
• Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19.

If you wish to reinstate your TRICARE Select Group A coverage, you must now call us before June 30 at (800) 444-5445. Continued Health Care Benefit Program (CHCBP) CHCBP is a premium-based plan that offers temporary transitional health coverage for 18 to 36 months after TRICARE eligibility ends. It acts as a bridge between military. Tricare Select is a fee-for-service insurance plan that lets you see any doctor. This plan is available to family members, veterans, and retirees.

• Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
• Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.

TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)

TRICARE Select (not including TRICARE Young Adult)

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)

TRICARE Young Adult

The TRICARE Young Adult deductible is based on the sponsor's status.

Covered Services

Urgent care is care you need for a non-emergency illness or injury. You need urgent care treatment within 24 hours, and you shouldn't have to travel more than 30 minutes for the care. You typically need urgent care to treat a condition that:

• Doesn’t threaten life, limb or eyesight.
• Needs attention before it becomes a serious risk to health.

Examples may include things like a high fever or sprained ankle.

Nurse Advice Line

If it's after hours or you're not sure if you need to see a doctor, call TRICARE's Nurse Advice Line 24/7. Call 1-800-TRICARE (874-2273) — Option 1 to talk to a registered nurse who can:

• Answer your urgent care questions
• Give you health care advice
• Help you find a doctor
• Schedule next-day appointments at military hospitals and clinics

The Nurse Advice Line is available to all TRICARE beneficiaries in the U.S. except those enrolled in the US Family Health Plan. Beneficiaries who live overseas can call the Nurse Advice Line for health care advice when traveling in the U.S., but must coordinate care with their Overseas Regional Call Center.

TRICARE Prime PlansTRICARE Prime plans include: TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime

¹If you are a family member or retiree and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.

TRICARE Select and All Other TRICARE Plans

³You will pay network or non-network copayments or cost-shares, depending on the type of provider you see.

US Family Health Plan

Urgent Care Overseas

⁴If you are enrolled in a TRICARE Prime plan and seek urgent care from a non-network provider outside of a TRICARE authorized urgent care center, you will have to pay point-of-service option cost-shares.

⁵Active Duty Service Members must follow up with their PCM when they receive care outside of a military hospital or clinic, in accordance with DoD and Service regulations.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 6/18/2020

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Tricare Cost Share 2021