If you are active duty military or a member of an active-duty military family living overseas, you have three options for receiving health care: TRICARE Overseas Program (TOP) Prime, TOP Standard and TOP Prime Remote There are important differences between the three. The TRICARE Overseas Program (TOP) regional contractor is International SOS Government Services, Inc.
There are also TRICARE programs for overseas retirees (TRICARE For Life), Selected Reserve and their family members assigned overseas (TRICARE Reserve Select®), Retired Reserve and their families (TRICARE Retired Reserve®), young adults (TRICARE Young Adults) and a continued health care benefit program that offers temporary transitional coverage after (CHCBP) TRICARE eligibility ends.
For full details of the various programs and other important information you can download a pdf of the TRICARE® Overseas Program Handbook here.
You can also download a TOP Country Specific Wallet card (pdf format) here. (Scroll to bottom)
Active Duty Members
All active duty members must enroll in TOP Prime upon assignment to the theater. Active duty members will primarily see military physicians at Military Treatment Facilities (MTFs) and may be referred to host-nation specialists on the local economy as required.
Active Duty Family Members
Active duty family members must choose between TOP Prime or TOP Standard. If you choose TOP Standard, no enrollment is necessary. To obtain coverage under TOP Prime you must be command sponsored and complete an enrollment form at the TRICARE Service Center. Normally, the enrollment for both active duty members and their families is done during in-processing. For those who do not attend a formal in-processing, enrollment may be completed at the local TRICARE Service Center as soon as possible after arrival to avoid potential out of pocket expenses.
There are several reasons why a family member should consider enrolling in TOP Prime:
Primary Care Manager
If you enroll in TOP Prime you will know your Primary Care Manager (PCM) by name. A PCM is a provider who will take care of you on a regular basis and manage your care even when referred to a specialist.
Priority for Care
If you choose to enroll in TOP Prime you will be provided the highest priority for care in the MTFs.
Enhanced Preventive Medicine Benefits
You will enjoy access to specific preventive medicine benefits. The philosophy and focus behind TOP Prime is to keep you healthy and encourage you to live a healthy lifestyle, not to simply treat diseases and conditions when they occur. Preferred Provider Networks (PPN)
TOP Prime enrollees will have access to both military medical facilities and networks of local host-nation providers managed by the TOP Prime Contractor, International SOS. Wherever possible or available, most of your care will be provided by the PCM to whom you are assigned. If specialized care is not available within the MTF your PCM will refer you to specialists within the PPN. Providers of the PPN are screened for quality and agree to file TRICARE claims for Prime patients. In most cases, these providers will speak English, but when they don't bilingual patient liaisons are available in most locations to serve as interpreters.
Access to Care Standards
The Department of Defense has published access standards for all TRICARE Prime enrollees: one day for urgent care, whether primary or specialty; one week for a routine primary visit; four weeks for a health prevention visit (e.g. pap smear); and four weeks for routine specialty care. MTFs must meet these access standards or refer enrollees to a preferred provider within the network.
What Do You Need To Do?
If you need more information or wish to enroll in TOP Prime, you should simply contact the nearest TRICARE Service Center. After enrolling a TOP Prime enrollment card will be mailed to you.
Family members who are not eligible or choose not to enroll in TOP Prime will automatically be covered by TOP Standard. Coverage is automatic as long as your information is current in the Defense Enrollment Eligibility Reporting System (DEERS). There are no enrollment fees for this program. TRICARE Standard is a fee for service program that provides flexibility for members to see most civilian medical providers as needed, without authorization. With this flexibility come some out-of-pocket expenses such as deductibles and percentage cost-shares. Appointments at military treatment facilities are on a space available basis.
TOP Standard may be the decision for you if you prefer to receive your care directly from the host nation provider of your choice.
TRAVELING WITH TRICARE
When you are covered by TOP Standard or enrolled in TOP Prime, your TRICARE benefit is always available to you, whether you are traveling on vacation, whether you stay in Eurasia-Africa, travel to another overseas area or head back to the states. However, your Prime enrollment protects you even further by ensuring priority care at all military medical facilities and prevents you from incurring high-cost medical bills when you are away from home.
TOP Prime Enrollees
TOP Prime enrolled members needing emergency medical care while traveling should obtain care from the nearest military or civilian medical facility and contact International SOS immediately following the emergency episode. Authorization is not needed for emergency care. If required to pay up-front for the service International SOS will assist with claims filing procedures.
Traveling In Eurasia-Africa or Other Overseas Locations
As a TOP Prime enrolled member, your medical benefit covers you wherever you travel overseas. If you are not certain where to go, contact International SOS or the nearest TRICARE Service Center regarding local networks of civilian providers. You may also search for TOP preferred providers at www.tricare-overseas.com/Provider.htm.
Pre-authorization is required for all non-emergent civilian care received overseas. You must contact the TOP contractor, International SOS, before care is rendered for assistance with pre-authorization. See www.tricare-overseas.com/contactus for country specific toll free numbers. Obtaining pre-authorization will ensure your claims are processed without problems. Non-emergent care claims submitted without an authorization will be paid at the Point of Service (POS) rate, which includes a high deductible and cost share.
If you are referred to a member of the preferred provider network, the physician may submit your claim to ISOS/WPS. Prime beneficiary claims for authorized, covered services will be paid in full. Standard beneficiaries do not require pre-authorization for most services. Covered services will be paid after deductibles and cost-shares are taken into consideration. It is not uncommon for overseas, non-network providers to require payment up-front before the delivery of care. If this occurs, patients should file a claim for reimbursement after the fact.
Traveling in the USA
If you need emergency medical care when traveling in the USA, you are not required to seek authorization for care. For emergency care engage the 911 services or go to the nearest emergency room. Contact International SOS immediately following emergency care. For urgent care, if available, go to the nearest MTF. If a MTF is not available take the following steps:
- Call the applicable toll-free number for the region in which you are seeking care to find out if there is a TRICARE network provider located near you.
- TRICARE North - 1-877-TRI-CARE (874-2273); www.hnfs.net
- TRICARE South - 1-800-444-5445; www.humana-military.com
- TRICARE West - 1-888-TRI-WEST (874-9378); www.triwest.com
- If there is no network provider, make sure the civilian provider you choose accepts the TRICARE allowable charges as payment in full. Otherwise, you may be responsible for 15% of the TRICARE allowable charges.
- Contact International SOS for pre-authorization for all non-emergent care.
- If the provider "accepts" TRICARE they should file the claim for you. If the provider does not "accept" TRICARE you may be expected to pay first and then file the claim for yourself. In either event all claims for family care in the US should be mailed to ISOS/WPS Overseas Claims department.
Traveling Outside the Region for Over 60 Days
If you will be traveling away from your Prime enrolled location for a period that exceeds 60 days, you should transfer your Prime enrollment, if available. To transfer your Prime enrollment you must complete an enrollment form with the new TRICARE region by contacting either a local TSC or the regional contractor (contact info above). The TRICARE representative should assist you with choosing a new Primary Care Manager and provide information on the local civilian network of providers. When you return to Eurasia-Africa you will again need to contact your TOP TSC to transfer your Prime enrollment back to the overseas location. By doing this you ensure no gaps in your Prime coverage. If Prime is not available where you are staying you will need to disenroll from TOP Prime and use your TRICARE Standard benefit.
Children Attending School in the USA
Children of active duty members assigned overseas who attend school or college in the USA must transfer their Prime enrollment to the region that services the area where they are attending school, if Prime is available. If TRICARE Prime is not available in their area, they must disenroll from TOP Prime but will be covered by TRICARE Standard. Standard coverage is automatic as long as your information is current in DEERS. Visiting students or other eligible family members may re-enroll in TOP Prime if they are still command sponsored and live with their active duty sponsor on an overseas assignment. When returning to school in the US, the TOP TRICARE Service Center needs to be notified and if re-enrolling to Prime in the U.S., the CONUS contractor will need an updated enrollment form.
Note: Children of retirees who are enrolled in TRICARE Prime in the states but spend their summers in Eurasia-Africa should notify their regional TRICARE office for assistance with Prime disenrollment.
U.S. Prime Enrolled Members Visiting in Eurasia-Africa
If a U.S. Prime enrolled member (active duty family member or retiree/family member) is visiting in Eurasia-Africa for a short stay, they may remain enrolled to Prime in their U.S. region. However, if they need non-emergent, civilian medical care they must have authorization from the TOP contractor, International SOS. Claims will process as Point of Service applying high deductibles and cost shares if pre-authorization is not obtained. Emergency care does not require authorization but International SOS should be contacted prior to seeking any necessary follow up care.
Overseas retirees and their eligible family members enjoy many of the same TRICARE healthcare options as retirees living in the states, but there are differences. The biggest is that TRICARE Prime is not available to retirees or retired family members staying overseas. The type of TRICARE benefits available to you may depend on where you live, what type of military treatment facility (if any) is near you, and your own personal healthcare choices. As TRICARE Standard members you will be responsible for deductibles and cost shares. You may be required to pay up-front for medical care and file your own claims for reimbursement. See your Beneficiary Counseling and Assistance Coordinator (BCAC) at your local TRICARE Service Center, contact the Global TRICARE Service Center by calling (215) 942-8393, or see www.tricare-overseas.com/contactus for country specific toll free numbers.
Medicare Eligible Members
Retirees or retired family members who are eligible for Medicare due to age or disability use the TRICARE for Life benefit. There are no enrollment fees for this program but you are required to enroll in Medicare Part B and pay Medicare Part B monthly fees. Check with the Social Security Administration, on line at www.ssa.gov, call 1-800-772-1213, or visit Medicare online at www.medicare.gov for more information about enrolling to Medicare Part B and the monthly fees that will apply to you. You may also contact your nearest U.S. Embassy/Consulate Federal Benefits Unit for assistance. Medicare does not reimburse for care received overseas therefore, TRICARE may be the primary payer for overseas care. As we will not have Medicare to partner any costs with us, claims for overseas care will process as TRICARE Standard applying deductibles and cost shares.
Using Military Treatment Facilities (MTF)
Appointments may be available at military treatment facilities on a space available basis. The number one priority of MTFs overseas is to maintain the mission readiness of active duty members. Maintaining this readiness means taking care of active duty personnel and their family members first, and there are limited numbers of military clinics and hospitals overseas to accomplish this.
Military hospital and clinic Commanders in Eurasia-Africa work hard to provide you access to military facilities as often as possible. Depending on where you live, you may be able to enroll in a program that provides you with access to a MTF and their Primary Care Managers. This program is called TRICARE Plus.
TRICARE Plus is a military treatment facility primary care enrollment program that is offered at select facilities around Eurasia-Africa. If you are eligible for care in a MTF you may inquire about TRICARE Plus enrollment availability with that particular MTF.
Bear in mind that this applies for overseas residing members. If you are enrolled in TRICARE Prime or a Medicare HMO in the continental U.S. you are not eligible for overseas TRICARE Plus enrollment. If you cannot enroll or choose not to enroll in TRICARE Plus, it does not affect TRICARE For Life benefits or other existing programs you may be signed up for. Eligible beneficiaries with existing relationships with primary care providers at military treatment facilities will have the first opportunity to enroll as long as the facility has the capacity and resources to offer the TRICARE Plus program.
Retiree Catastrophic Cap
Another significant benefit for the retiree population is the TRICARE Catastrophic Cap of $3,000. A "catastrophic cap" is the maximum amount of out-of-pocket expenses a family will incur during any one fiscal year. This includes the family's annual deductible and cost shares for covered medical care received during the fiscal year. Once the "cap" has been reached, TRICARE will pay in full for covered care provided during the rest of that fiscal year. This can drastically reduce your out-of-pocket medical care costs.
TRICARE YOUNG ADULT
According to the TRICARE Handbook The TRICARE Young Adult (TYA) program is a premium-based health care plan available for purchase by qualified dependents. Until reaching age 26, adult-age dependents may purchase TYA coverage based on the eligibility established by their uniformed service sponsor and where they live. Command sponsorship is required for TYA Prime enrollment overseas. TYA includes medical and pharmacy benefits, but excludes dental coverage. Visit www.tricare.mil/TYA/ for information about TYA coverage.
Persons needing overseas emergency medical care in Eurasia-Africa. may call the Medical Assistance Number at +44-20-8762-8133 or log onto www.tricare-overseas.com/contactus for country specific toll free numbers. These are the first places for you to turn for answers.
Persons may well have many healthcare related questions. For this reason, TRICARE Service Centers have been established at all military treatment facilities. Check the base/installation phone listings for the number to call for the closest Service Center.
For additional information please visit the website at: www.tricare-overseas.com
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