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TRICARE Standard and TRICARE Standard Overseas

TRICARE Standard is a premium health care plan that allows you to choose any TRICARE Standard authorized provider.  It allows beneficiaries a greater degree of freedom in selecting providers, regardless of their affiliation or location.  It is also available to a larger portion of the military community than TRICARE Prime, excluding active-duty service members. However, it is the most expensive of all of the plans, requiring varying deductibles, copayments, and up to 15 percent in charges that exceed the allowable amount as determined by the TRICARE provider.

TRICARE Standard Overseas provides the same coverage as TRICARE Standard, and is the only option available to TRICARE beneficiaries not eligible for TRICARE Prime Overseas or TRICARE Prime Remote Overseas.

TRICARE Standard, Extra, and Plus Eligibility

  • Active duty family members
  • Retired service members and their families
  • Family members of activated Guard/Reserve members
  • Non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
  • Retired Guard/Reserve members at age 60 and their families
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

TRICARE Standard Coverage Summary

TRICARE Standard provides beneficiaries the ultimate flexibility available through TRICARE, allowing you to choose any authorized provider without consulting a Primary Care Manager.  It is not subject to the geographical limitations that TRICARE Prime is, meaning that deployment overseas will not require new enrollment, and coverage is available when traveling for personal reasons all over the globe.

What’s Included in your TRICARE Standard plan: No fee is required for TRICARE Standard, and the choice of providers and locations is subject to fewer limitations than other plans.  All DEERs-enrolled family members, including retirees and their families, are automatically enrolled in TRICARE Standard.  There is no minimum enrollment period for TRICARE Standard, so you can opt out for a different plan at any time.  You are eligible to use TRICARE Extra, and you have the option to seek treatment at military treatment facilities if you wish (though TRICARE Prime beneficiaries are given priority at MTFs), and you are eligible to use TRICARE Extra as well.

TRICARE Standard pays for 80 percent of the permitted costs for the families of active-duty servicemembers and 75 percent of the permitted costs for services for retirees and their families.

What’s Not Included in your TRICARE Standard Plan: An annual deductible is required before coverage starts, and varies according to rank and status (i.e. active-duty, Guard/Reserve, or retired) of the sponsor.  You will be responsible for the remaining 20 percent of costs for treatment (25 for retirees and their families), and you will be also responsible for any additional costs if the amount charged for a specific treatment exceeds the permitted cost established by your TRICARE contractor for that treatment (called the “appropriate level of care”.)

A critical difference between TRICARE Prime and TRICARE Standard is that you will be responsible for most of the documentation required to receive coverage.  You will also need to file your own claims through TRICARE, as you will not have a designated Primary Care Manager.  Claims must be filed individually, or there may be problems in processing them.

Use DD Form 2642, “Patient’s Request for Medical Payment”, when submitting all claims to TRICARE.  The form is available at http://www.dtic.mil/whs/directives/forms/eforms/dd2642.pdf.

Third Party Payments for Treatment

When filing a claim with TRICARE, you must make sure that other possible methods of payment are considered in order to make sure that your claim is successfully processed.  If you have any civilian health insurance, or are covered under a civilian spouse’s insurance plan, you must submit your claim through that plan first.  Failure to do so may result in your claim being rejected by TRICARE or in delayed payment of a  claim.

If treatment is the result of an accident where another party may be liable, you must also attach a DD Form 2527, “Statement of Personal Injury – Possible Third Party Liability”.  The form is available at http://www.dtic.mil/whs/directives/forms/eforms/dd2527.pdf.

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