Chapter 13

Created by amymac 

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Beneficiary

Person entitled to benefits or proceeds of an insurance policy or will

Catastrophic Cap

Maximum cost limit placed on out of pocket expenses for covered medical bills for TRICARE.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

Until recently, provided medical coverage for the
families of the various uniformed government services, including the armed forces; many changes have taken place in the military healthcare system
in the past several years. The most important of these changes is the transition from CHAMPUS to the TRICARE healthcare system

Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA)

Healthcare for veterens with 100% service-related disabilities and their families

Cost Share

The amount of healthcare charges that are the resposibility of the sponsor or family mamber.

Defense Enrollment Eligiblity Reporting System (DEERS)

A support office for TRICARE. Sponsors and familiy members can contact DEERS to check the status of enrollment or inquire about plan benefits.

Military Treatment facility (MTF)

government facility providing medical services for members and dependents of the Uniformed Services

Nonavailability Statement (NAS)

Document that must be obtained through the DEERS office in order for a sponsor or family member to see a civilian provider or be treated in a nonmilitary facility.

Palmetto Government Benefits Administrators (PGBA)

Claim processor for TRICARE's northern region of US

Primary Care Manager (PCM)

Provider who coordinates and manages the care of TRICARE beneficiaries

Sponsor

For the TRICARE program, the service person (active duty, retired, or deceased) whose relationship makes the patient (dependent) eligible for TRICARE

TRICARE

A government health program that serves dependents of active-duty service members, military retirees and their families, some former spouses, and survivors of deceased military members; formerly called CHAMPUS.

TRICARE Extra

A preferred provider option through which, rather than an annual fee, yearly deductible is charged. Healthcare is delivered through a network of civilian healthcare providers who accept payments from TRICARE and provide services at negotiated, discounted rates.

TRICARE Prime

A voluntary HMO-type option for TRICARE beneficiaries that offers preventative care and routine physical exams. Each person is provided a PCM

TRICARE Prime Remote

a TRICARE plan that provides no-cost health care through civilian providers for eligible service members and their families who are on remote assignment

TRICARE Prime Remote for Active Duty Family Members (TPRADFM)

Healthcare plan for family members of active duty service personnel who are assigned a permanent station. No out-of-pocket expense.

TRICARE Senior Prime

TRICARE Senior Prime Healthcare coverage for Medicare-eligible beneficiaries ages 65 and older.

TRICARE Standard

TRICARE Standard A fee-for-service health plan for families of active duty personnel and retirees that goes into effect when treated by a civilian provider. Most enrollees pay an annual deductible. In addition to the deductible, families of active duty members pay 20% of out-of-pocket expenses, while retirees and their families and former spouses pay 25% of out-of-pocket expenses for medical services.

Wisconsin Physicians Services (WPS)

Claims processor for all TRICARE Senior Prime claims

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