TRICARE Select

Army National Guard: Active Duty Under Title 10 USC

Benefit Fact Sheet

Summary

In 2018, TRICARE Select replaced TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is for TRICARE-eligible beneficiaries who are not able to, or choose not to, enroll in a TRICARE Prime option and who are not entitled to Medicare. This program lets you manage your own health care and get care from any TRICARE-authorized provider without a referral. Like TRICARE Prime options, enrollment in TRICARE Select is required. Active Duty Service members may not use TRICARE Select, but their Family members are able to elect TRICARE Select.

TRICARE Select requires enrollment in the Defense Enrollment Eligibility Reporting System ( DEERS) and reoccurring annual enrollment during the open season in November and December. If you are enrolled in Select during the year, no additional enrollment action is necessary during future open seasons as it is assumed you automatically will continue in the Select plan until you choose otherwise.

You will have lower out-of-pocket costs if care is provided by a TRICARE network provider. Some services require prior authorization. You can also receive certain services from non-network, TRICARE-authorized providers, but will pay higher cost sharing amounts for out-of-network care. Care received from non-authorized, non-network providers will not be reimbursed by TRICARE.

Beginning in January 2018, DFAS will provide IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former Spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2017. An IRS Form 1095 documents you (and your Family members, if applicable) have the minimum essential coverage. These forms will document the information that DFAS will provide to the IRS on yourself and your authorized Family members. The forms will be required to be reported with your 2017 federal tax return. DFAS will provide you with IRS Form 1095 series forms no later than 31 January 2018.

Tricare beneficiaries who were eligible for and/or enrolled in Tricare as of 31 December 2017, were automatically enrolled in their respective plans 1 January. Because 2018 is a transition year, Tricare beneficiaries are allowed to make changes to their enrollment all year, to help beneficiaries adjust to making their health care choice.

Those entering the military on or after 1 January 2018, or changing status (i.e., from active duty to retired) should make sure they and their eligible family members are enrolled in the Tricare program of their choice. Those who don’t enroll may only receive care at a military clinic or hospital on a space-available basis, and medical care by civilian providers wouldn’t be covered.

Beneficiary Groups

Starting January 1, 2018, you will fall into one of two categories based on when your sponsor became affiliated with the Uniformed Services, either through enlistment or appointment:

  • If your sponsor’s initial enlistment or appointment occurred before January 1, 2018, you are in Group A.

  • If your sponsor’s initial enlistment or appointment occurred on or after January 1, 2018, you are in Group B.

Group A and Group B have different enrollment fees and out-of-pocket costs.

If you have TRICARE Select, you must pay enrollment fees, unless you are:

  • An active duty family member

  • A transitional survivor

  • In Group A

Payment Type:

When You Submit Your Enrollment Form:

Annual

  • Single: $450

  • Family: $900

  • Your fee is prorated from your enrollment date to December 31st.

  • You can only pay your annual fee with a debit or credit card.

  • After that, your annual payment is due on January 1st each year.

Quarterly

  • Single: $112.50

  • Family: $225

  • Your quarterly fee is prorated to cover the period until the next calendar year quarter (January 1, April 1, July 1 or October 1).

  • After that, your quarterly payment is due the first of each quarter.

  • You can pay your quarterly fee with a debit card, credit card or through an electronic funds transfer (EFT).

Monthly

  • Single: $37.50

  • Family: $75

  • Pay your first three months with a personal check, cashier's check, traveler's check, money order, debit card or credit card.

  • After that, set up an allotment or EFT to pay your monthly enrollment fees.

Learn more about TRICARE enrollment changes.

Eligibility

Army National Guard Federal Active duty Service members must enroll in TRICARE Prime and are not eligible for TRICARE Select. Dependent parents or parents-in-law are not eligible, though Family members may be eligible.

During the early-eligibility period, National Guard Service members may be eligible for TRICARE Select, but cannot enroll in TRICARE Prime until the Service member reaches his or her final destination. The early eligibility period begins when activated for more than 30 days in support of a contingency operation. The Service member is eligible for benefits after he or she receives delayed effective date orders, up to 90 days before he or she activates or mobilizes.

Family members - Spouses, survivors, and unmarried Children - have the choice of enrolling in TRICARE Prime or using TRICARE Select and TRICARE Extra.

Enrollment is required for Family members - Spouses, survivors, and unmarried Children - who are properly registered in the Defense Enrollment Eligibility Reporting System ( DEERS ). TRICARE Select enrollment page: https://tricare.mil/Plans/Enroll/Select

A valid uniformed services ID card serves as proof of eligibility to receive health care coverage under TRICARE Select. The ID card is, in effect, a form of insurance card, and beneficiaries should have it with them when seeking medical care as proof of eligibility.

The National Defense Authorization Act (NDAA) FY 2011 gave the DoD the authority to expand benefits to qualified dependents that lose TRICARE eligibility and are under the age of 26. Young adults can purchase TRICARE Young Adult and pay monthly premiums.

Benefit Highlights

GETTING CARE WITH TRICARE SELECT

With TRICARE Select, you can get care from any TRICARE-authorized network provider without a referral or prior-authorization, in most situations. You will have lower out-of- pocket costs if you use a TRICARE-authorized network provider versus a TRICARE-authorized non-network provider. If you choose a non-authorized non-network provider, you will not be reimbursed by TRICARE.

To find a TRICARE network provider, go to https://tricare.mil/findaprovider or call your regional contractor.

ENROLLMENT COSTS

There is no yearly enrollment fee for Active Duty Family members. For retirees, their families and others, you may have enrollment fees based on when you or your sponsor entered active duty. For cost details, go to https://tricare.mil/costs .

COSTS FOR COVERED CARE

With TRICARE Select, you pay a yearly deductible and per-visit copayments or cost-shares. You’ll fall into one of two groups based on when you or your sponsor entered active duty. This group will determine your costs. When following the rules of your program option, your out-of-pocket expenses will be limited to your catastrophic cap. Nonparticipating non-network providers may charge up to 25 percent above the TRICARE-allowable amount. You’re responsible for this amount, plus your deductible and copayments or cost-shares. For costs, go to https://tricare.mil/costs .

FILING CLAIMS

Submit claims to the regional contractor for the area where you live. In the U.S. and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands), claims must be filed within one year of the date of service or date of inpatient discharge. You’re responsible for confirming your claims are received. For assistance, call your regional contractor.

INVITE YOUR PROVIDER TO BECOME TRICARE-AUTHORIZED

If your provider isn’t TRICARE-authorized, but wants to see TRICARE patients, tell your provider he or she can do so without signing a contract with your regional contractor. Most providers with a valid professional license (issued by a state or a qualified accreditation organization) can become TRICARE-authorized and then TRICARE will pay them for covered services. Go to https://tricare.mil/findaprovider and click “learn more.”

A "catastrophic cap" is the annual upper limit a Family will have to pay for TRICARE Select-covered services in any fiscal year. The catastrophic cap for Families of active duty Service members is $1,000. All others have a catastrophic cap of $3,000. The catastrophic cap applies only to allowable charges for covered services. The catastrophic cap does not apply to services that are not covered, POS charges, cost-share amounts, and the additional 20% that nonparticipating providers may charge above the allowable charge.

The chart below shows the Cost Shares for National Guard/Reserve Members and Their Families effective January 1, 2018:

Service

Cost

Annual Deductible

Group A:

  • Individual: $150

  • Family: $300

Group B:

  • Network:

    • Individual: $150

    • Family: $300

  • Non-Network:

    • Individual: $300

    • Family: $600

Note: Non-active duty family members in Group B are subject to separate in-network and out-of-network deductibles. Reaching the deductible level of one does not remove the need to pay for the other.

Ambulance Services

Group A:

  • Network: $98

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $60

  • Non-Network: 25% of allowable charge

Ambulatory Surgery (Same Day)

Group A:

  • Network: 20% of negotiated fee

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $95

  • Non-Network: 25% of allowable charge

Mental Health (Inpatient)

Group A:

  • Network: 20% of the total + 20% for separately billed services

  • Non-network:
    High Volume Hospitals : 25% hospital specific per diem + 25% for separately billed services

    Low Volume Hospitals : 25% of the billed charges ($241 per day maximum) + 25% for separately billed services

Group B:

  • Network: $175 per admission

  • Non-network:
    High Volume Hospitals : 25% hospital specific per diem + 25% for separately billed services

    Low Volume Hospitals : 25% of the billed charges ($241 per day maximum) + 25% for separately billed services

Mental Health (Partial Hospitalization)

Group A:

  • Network: $28 (Primary) or $41 (Specialty) per visit

  • Non-network:

    25% of allowable charge

Group B:

  • Network: $25 (Primary) or $40 (Specialty) per visit

  • Non-network:

    25% of allowable charge

Mental Health (Outpatient)

Group A:

  • Network: $28 (Primary) or $41 (Specialty) per visit

  • Non-network:

    25% of allowable charge

Group B:

  • Network: $25 (Primary) or $40 (Specialty) per visit

  • Non-network:

    25% of allowable charge

Clinical Preventive Services

Network:$0
Non-network: $0 for the following services:

  • Cancer screenings* (colorectal, breast, cervical, prostate)

  • Immunizations*

  • Well-child care for children under age 6 (birth through age 5)

*This includes the office visit for beneficiaries age 6 and older when a covered cancer screening or immunization is provided during the visit.

For all other preventive services, non-network: 25% of allowable charge

DME, Prosthetic Devices, Medical Supplies

Network: 20% of negotiated fee
Non-Network: 25% of allowable charge

Emergency Services

Group A:

  • Network: $109

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $80

  • Non-Network: 25% of allowable charge

Home Health Care

$0

Note: You may have separate costs for additional services when receiving home health care. For example, DME, drugs, vaccines, orthotics/prosthetics, and nutritional therapy, among others.

Hospice Care

$0

Hospitalization (Inpatient Care)

Group A:

  • Network: 25% of allowable hospital charge ($250 per day maximum) plus 20% of allowable charge for separately billed services

  • Non-Network: 25% of allowable hospital charge ($901 per day maximum) plus 25% of allowable charge for separately billed services

Group B:

  • Network: $175 per admission

  • Non-Network: 25% of allowable charge

Immunizations

$0

Laboratory and X-ray

Network: $0
Non-Network: 25% of allowable charge

Maternity (office visits and hospitalization for delivery planned in a hospital in an inpatient setting)

Group A:

  • Network:

    • 25% of allowable hospital charge ($250 per day maximum) plus 20% of allowable charge for separately billed services

  • Non-Network:

    • 25% of allowable hospital charge ($901 per day maximum) plus 25% of allowable charge for separately billed services

Group B:

  • Network: $175 for hospital admission

  • Non-Network: 25% of allowable charge

Maternity (office visits for delivery planning in a TRICARE-authorized birthing center)

Group A:

  • Network: 20% of negotiated fee for delivery

  • Non-Network: 25% of allowable charges

Group B:

  • Network: $95 for delivery

  • Non-Network: 25% of allowable charges

Maternity (office visits for delivery planned at home or other setting)

Group A:

  • Network: $35 (Primary) or $45 (Specialty)

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $25 (Primary) or $40 (Specialty)

  • Non-Network: 25% of allowable charge

Newborn Care

Group A:

  • Network:

    • Days 1 - 3: $0

    • Day 4+: 25% of allowable hospital charge ($250 per day maximum) plus 20% of allowable charge for separately billed services

  • Non-Network:

    • Days 1 - 3: $0

    • Day 4+: 25% of allowable hospital charge ($250 per day maximum) plus 25% of allowable charge for separately billed services

Group B:

  • Network: $0

  • Non-Network: 25% of allowable charge

Note: If any family member is enrolled in TRICARE Prime, the newborn is also covered by Prime for up to the first 90 days and costs are $0.

Outpatient Visit

Group A:

  • Network:

    • Primary Care: $28

    • Specialty Care: $41

  • Non-Network: 25% of allowable charge

Group B:

  • Network:

    • Primary Care: $25

    • Specialty Care: $40

  • Non-Network: 25% of allowable charge

Skilled Nursing (Inpatient)

Group A:

  • Network: 25% of allowable hospital charge ($250 per day maximum) plus 20% of allowable charge for separately billed services

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $50 per day

  • Non-Network: 20% of allowable charge ($300 per day maximum)

Only available in the U.S. and U.S. Territories.

Urgent Care

Group A:

  • Network: $28

  • Non-Network: 25% of allowable charge

Group B:

  • Network: $40

  • Non-Network: 25% of allowable charge

Additional Information

For more information, please visit the TRICARE Select webpage maintained by the TRICARE Management Activity:
https://tricare.mil/select

TRICARE Select Enrollment, Disenrollment, and change Form:
http://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd3043-1.pdf

TRICARE DEERS Information:
https://tricare.mil/DEERS

TRICARE Stateside and Overseas Guides:
https://tricare.mil/Publications

TRICARE Plans Overview Fact Sheet:
https://tricare.mil/-/media/Files/TRICARE/Publications/Misc/Plans_Overview.ashx

TRICARE Choices in the United States Handbook:
https://tricare.mil/-/media/Files/TRICARE/Publications/Handbooks/Choices_HB.ashx

Document Review Date: 02 August 2018