TRICARE — Glossary

Base Realignment and Closure (BRAC) site – a military base that has been closed or targeted for closure by the Base Realignment and Closure Commission.

Catastrophic Cap – the maximum out-of-pocket expense in any fiscal/enrollment year for TRICARE beneficiaries.

Catchment Area – the area defined by USPS Zip Codes within a 40-mile radius of a Military Treatment Facility.

Medical book and stethoscope.

Claims Processor – the contractor that handles a particular region's TRICARE claims.

Coordination of Benefits (COB) – the process governing the payment of claims when you have a source of coverage in addition to TRICARE. Your other health insurance policy will pay for your benefits first; TRICARE coverage will be secondary.

Copayment – a flat-dollar amount (instead of a percentage of the total cost) that you pay for a prescription or medical service, usually paid directly to the provider at the same time you receive service.

Cost-share – the portion of the allowable charge for medical services that you pay. Your cost-share is one of your out-of-pocket expenses.

Customer Service Representatives (CSR) – call center who assist you with enrollment, Primary Care Manager selection, benefit interpretation and any other matters that affect your access to health care.

Deductible – a dollar amount of medical expenses you pay first before health benefits begin. If you are a TRICARE Prime enrollee and you receive care that is not arranged by your Primary Care Manager, you must satisfy a deductible with the Point-of-Service option. TRICARE Prime coverage that is coordinated by your Primary Care Manager has no deductible.

Defense Enrollment Eligibility Reporting System (DEERS) – a computerized database that lists all Active Duty and Retired military personnel and their dependents who are eligible for TRICARE benefits. Remember to check DEERS periodically to make sure your information is accurate and up to date. Contact the DEERS Telephone Center at 1-800-538-9552 between 6:00 a.m. and 5:00 p.m. (PST) Monday through Friday.

Emergency – a sudden or unexpected condition or the acute worsening of a chronic condition that is threatening to life, limb or sight requiring immediate medical treatment to relieve suffering from painful symptoms. Medical emergencies include heart attacks, poisoning, convulsions, kidney stones and other acute conditions. Pregnancy-related medical emergencies must involve a sudden or unexpected medical complication that puts the mother, the baby or both at risk.

Enrollment Portability – allows TRICARE Prime enrollees to transfer health care coverage to another TRICARE Prime region.

Health Benefit Advisors – military personnel stationed at the Military Treatment Facilities who are available to assist you with appointments, Non-Availability Statements and benefit interpretation.

Health Care Finder (HCF) – a medical clinician that specializes in authorizing certain medical procedures, physician referrals, hospital admissions and other medically necessary treatments.

Health Enrollment Assessment Review (HEAR) Form – a confidential questionnaire that assesses your current health status and habits.

Military Health System (MHS) – the total system of health of the U.S. uniformed services. The Military Health System includes Military Treatment Facilities as well as various programs in the civilian health care market like TRICARE.

Military Treatment Facility (MTF) – a medical treatment center located on a military installation.

National Mail Order Pharmacy Program – a pharmacy benefit offered to eligible beneficiaries. Certain restrictions apply. Call 1-800-903-4680 for further information.

Network – a group of military and civilian credentialed health care providers who have signed agreements to provide services or supplies to TRICARE Prime and Extra beneficiaries at a negotiated rate. The TRICARE network includes doctors, hospitals, pharmacies and other health care professionals. Network professionals will handle claims and other paperwork for you, and will receive payment directly from the claims processor.

Non-Availability Statement (NAS) – a certification from a military hospital that indicates you may seek care from a civilian facility.

Non-Network Providers

  • Non-authorized, non-participating health care providers who are not TRICARE Certified. Beneficiaries are responsible for the bill in full.
  • Authorized, non-participating health care providers who are TRICARE Certified but do not agree to accept TRICARE maximum Allowable Charge (TMAC) for services. You may be billed for services up to 115% of TMAC.
  • Authorized, participating health care providers who are TRICARE Certified who agree to accept TRICARE Maximum Allowable Charge (TMAC) and submit claim forms for beneficiaries.

Other Health Insurance (OHI) – any source of health benefits other than TRICARE. These sources may include group employers, associations or private insurers. Other health insurance does not include TRICARE Supplemental Insurance of Medicaid.

Point-of-Service (POS) Option – a special type of coverage that applies only when a TRICARE Prime enrollee receives non-emergency care that has not been coordinated by a Primary Care Manager.

Primary Care Manager (PCM) – the TRICARE Prime Network physician or physician team who is assigned to you to provide your basic medical care and to arrange any specialist of hospital care you need. You receive maximum coverage under TRICARE Prime when your Primary Care Manage coordinates your care.

Program for Persons with Disabilities – a federal program coordinated in TRICARE Northeast by Sierra Military Health Services, Inc. For more information call a Health Care Finder at 1-888-333-4522. This program is for Active Duty family members only.

Split Enrollment – if family members do not live together, they can split enrollment among two or more TRICARE regions when each lives in different Prime Service Areas within the United States. (Ex: The sponsor lives in Maryland, and the spouse and children live in North Carolina) Split Enrollment allows military retirees and their dependents to enroll in TRICARE Prime in different TRICARE regions without paying a separate enrollment fee in each area. (There are no fees for Active Duty Service Members or their dependents.)

TRICARE Maximum Allowable Charge (TMAC) – the amount the U.S. government deems "customary and reasonable," which TRICARE uses to calculate the benefits it pays.

TRICARE Prime Network Providers – health care providers who are credentialed and have signed a contract with TRICARE to provide services and supplies to beneficiaries at a negotiated rate. TRICARE Prime Network providers submit Claim Forms for beneficiaries.

TRICARE Prime Remote (TPR) – a special version of the TRICARE benefit for Active Duty Service Members and their eligible family members who live and work away from military installations.

TRICARE Supplemental Insurance – health benefit programs designed specifically to supplement TRICARE benefits. They cover certain cost-share amounts paid by TRICARE eligible beneficiaries.

Urgent Care – medical attention for a condition that, while not life or limb-threatening, could become more serious if not treated. Some examples of urgent care might include eye or ear infections and suspected bladder infections.

page last modified on: 3/27/2017

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