1. Evaluation of the TRICARE Program FY 2011 WHAT IS TRICARE? TRICARE is a family of health plans for MHS. TRICARE responds to the challenge of maintaining medical combat readiness while providing the best health services for all eligible beneficiaries. The TRICARE plans integrate and supplement the MHS capability in providing health benefits in peacetime for all eligible beneficiaries. TRICARE brings together the worldwide health resources of the Army, Navy, Air Force, Coast Guard and commissioned corps of the Public Health Service (often referred to as “direct care”), and supplements this capability with network and non-network civilian health professionals, hospitals, pharmacies, and suppliers (referred to as “purchased care”) to provide better access and high-quality service, while maintaining the capability to support military operations. In addition to receiving care from military treatment facilities (MTFs), where available, TRICARE offers beneficiaries three primary options:  TRICARE Standard is the non-network benefit, formerly known as Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), open to all eligible DoD beneficiaries, except Active Duty Service members (ADSMs). Beneficiaries who are eligible for Medicare Part B are also covered by TRICARE Standard for any services covered by TRICARE but not covered by Medicare. Once eligibility is recorded in the Defense Eligibility Enrollment Reporting System (DEERS), no further application is required from our beneficiaries to obtain care from TRICARE-authorized civilian providers. An annual deductible (individual or family) and cost shares are required.  TRICARE Extra is the network benefit for beneficiaries eligible for TRICARE Standard. When non-enrolled beneficiaries obtain services from TRICARE network professionals, hospitals, and suppliers, they pay the same deductible as TRICARE Standard; however, TRICARE Extra cost shares are reduced by 5 percent. TRICARE network providers file claims for the beneficiary.  TRICARE Prime is the HMO-like benefit offered in many areas. Each enrollee chooses or is assigned a primary care manager (PCM), a health care professional who is responsible for helping the patient manage his or her care, promoting preventive health services (e.g., routine exams, immunizations), and arranging for specialty provider services as appropriate. Access standards apply to waiting times to get an appointment and waiting times in doctors’ offices. A point-of-service (POS) option permits enrollees to seek care from providers other than the assigned PCM without a referral, but with significantly higher deductibles and cost shares than those under TRICARE Standard.  Other plans and programs: Some beneficiaries may qualify for other benefit options depending on their location, Active/Reserve status, and/or other factors. These plans and programs provide additional benefits or offer benefits that are a blend of the Prime and Standard/Extra options with some limitations. Some examples are: Dental benefits (military dental treatment facilities [DTFs], claims management for Active Duty using civilian dental services, as well as the premium-based TRICARE Dental Program [TDP] and the TRICARE Retiree Dental Program [TRDP]) Pharmacy benefits in MTFs, via TRICARE retail network pharmacies, and through the TRICARE Pharmacy Home Delivery program (formerly called TRICARE Mail Order Pharmacy) Overseas purchased care and claims processing Services Programs supporting Reserves, including the premium based TRS program and the Transitional Assistance Management Program (TAMP) Supplemental programs including TRICARE Prime Remote (TPR) in the United States and overseas, DoD-VA sharing arrangements, joint services, and claims payment Uniformed Services Family Health Plan (USFHP) Continued Health Care Benefits Program Clinical and educational services demonstration programs (such as chiropractic care and autism services demonstrations). Introduction 11