Vha Directive 1660.06 Va-Tricare Network Agreements

Health care in MHS is managed by regional networks TRICARE, composed of 380,000 civilian and military health care providers under three major programs – TRICARE Prime, TRICARE Standard and TRICARE Extra. 1.5 All active members use TRICARE Prime, which is similar to a health organization, as participants choose a primary care manager to coordinate their health care.1,5 All active members are PrimeARE Tricare. All MHS recipients, with the exception of active service members, are entitled to triCARE, formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), which is a non-network benefit requiring annual deductible and cost-sharing. MHS recipients eligible for Medicare Part B are subject to the TRICARE standard for services that are not covered by Medicare. TRICARE Extra is the network advantage for standard tricare recipients who pay the same deductible as standard tricare subscribers, but their share of costs is 5% lower than the TRICARE standard. At the end of gJ 2016, 1.9 million beneficiaries were in TRICARE Standard or Extra.5 TRICARE For Life for MHS receivers that registered both Medicare Part A as B. They do not pay a TRICARE registration fee, only Medicare Part A and B monthly premiums. End gJ 2016, 2.1 million beneficiaries were enrolled in TRICARE For Life.5 With nearly 364,000 GJ2016,5 TRICARE Reserve Select is a premium plan for reserve and national guard members, who are not active or are covered by the temporary assistance management program or the health benefits of federal employees. With more than 7,000 listings in the GJ2016.5 tricARE Retired Reserve is available a premium-based plan for retired Reserve and National Guard members, Under the age of 60 and not eligible for active retirement or federal health care.6 Young adults TRICARE allows adult military children to purchase TRICARE coverage after the end of their dependent military coverage at age 21 (or 23 if they are enrolled in university). The right to TRICARE Young Adult is possible until the age of 26 for an unmarried adult child.

TRICARE Young Adult has had more than 38,000 registrations at GJ2016.5.7 MHS consists of two components – direct and acquired care – and supports an average of 20,000 weekday hospitalizations and 1.9 million ambul visits direct care is provided in 669 military treatment centres (FTMs), including 54 hospitals, 363 medical clinics and 282 dental clinics.2 Active members have privileged access to military health care and are entitled to treatment in an MTF. Tricare premium beneficiaries are the closest priority for care compared to standard TRICARE and TRICARE extra receptors.1 A supplement to direct care, Acquired care is provided in civilian medical facilities (i.e. non-MHS) of civilian providers, who are licensed by tricare regional networks and paid for by MHS, health care in contractors.2 The acquired care component includes TRICARE North (Health Net Federal Services), TRICARE South (Humana Military), TRICARE West (United Health Care Military and Veterans) and TRICARE Overse 1 During in fiscal 2013, the supply network comprised approximately 478,000 civilian providers and 3,310 acute hospitals1 and reached 554,439 civilian hospitals. Providers and 3,789 acute hospitals in fiscal 2016.5 In GJ2014, the acquired care workload included 401,000 hospitalizations and 31.6 million outpatient encounters.5 , age group, race/ethnicity and some primary behavioural diagnoses, including mental health and SSUs (i.e., a primary diagnosis of MDC 19 and MDC 20 during separate visits).