Voluntary health maintenance organization–type option for TRICARE beneficiaries. TRICARE Prime works like a civilian health maintenance organization (HMO) to control costs. Beneficiaries are assigned a primary care manager (PCM) at a military treatment facility (MTF). (In some areas, PCMs are civilian network providers.) The PCM handles all routine health care. If the beneficiary needs care that the PCM does not offer, he or she will give the beneficiary a referral. Then the managed care support contractor (MCSC) finds the most appropriate provider and location for additional care. With TRICARE Prime, beneficiaries have expanded health care benefits in addition to the core benefits and freedom to choose civilian providers (at a higher cost) when they use the point-of-service (POS) option.

Program designed for active duty service members who work and live more than 50 miles or 1 hour from military treatment facilities (military hospitals and clinics).

Large geographical sections in the United States in which states are merged. Figure T-1 shows the locations of the states in these regions. Also see fiscal intermediary (FI) . Map of TRICARE West Region, North Region, and South Region, which shows states that have been merged into each of the regions.

Office staffed by TRICARE Health Care Finders and beneficiary service representatives that has information for beneficiaries about TRICARE Prime enrollment, Health Care Finder (HCF) services, and more.

Health care program offered to spouses and dependents of service personnel with uniform core health care benefits and fees implemented nationwide by the federal government; also known as “the old CHAMPUS program.” Standard allows beneficiaries to see any TRICARE-certified (authorized), non-network civilian providers. Beneficiaries pay an annual deductible and a 25% cost share of covered treatment and services.

Health insurance that generally pays what is left over after TRICARE Standard pays a beneficiary’s covered benefits. Such a policy may cover certain cost-share amounts.

Particular level when an insurance company is responsible for payment of benefits with a stated minimum premium.

In a life insurance policy, provision that pays an amount (three times the face value) in addition to the policy’s basic death benefit if death is due to an accident. There are exclusions for the type of accident and time and age limits (e.g., the insured must die within a specific number of days of the accident and be of a certain age or younger).

Type of managed care plan that allows a member a choice of one of three service alternatives (health maintenance organization [HMO], preferred provider organization [PPO], or traditional indemnity plan) each time he or she requires medical care. Scope of covered services is the same for each option, but the level of cost shared by the enrollee is different among the options. Also called point-of-service (POS) program .