TRICARE Special Programs

Army National Guard: Active Duty Under Title 10 USC or Title 32 USC (Full-Time National Guard Duty)

Benefit Fact Sheet

Summary

TRICARE offers Special Programs for certain health conditions, populations, or concerns. Some Special Programs:

  • Have specific eligibility requirements based on your plan, beneficiary category, or status.

  • Are for specific beneficiary populations while others offer services for specific health conditions.

  • Are limited to a certain number of participants or to a certain geographic location.  

Eligibility

TRICARE Special Programs have specific eligibility requirements based on your plan, beneficiary category, or status.

Benefit Highlights

TRICARE Special Programs:

Autism Care Demonstration
The TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) services for all eligible TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). 

  • The demonstration began July 25, 2014 and will continue through December 31, 2023. 

How it Works

Getting care through the demo is a three-step process:

  1. Get Diagnosed

  2. Get a Referral and Authorization

  3. Schedule an Appointment

Click here to learn more about Getting Care

Cancer Clinical Trials
TRICARE covers participation in National Cancer Institute (NCI)-sponsored Phase I, Phase II, and Phase III studies for all beneficiaries who are selected to participate. Coverage includes:

  • All medical care and testing needed to determine eligibility.

  • All medical care needed during the study, including:

    • Purchasing and administering approved chemotherapy agents

    • All inpatient and outpatient care

    • Diagnostic and laboratory services

How it Works

If your doctor thinks you may benefit from a trial, they will:

  • Consult with a cancer clinical trial case manager (at NCI or your regional contractor)

  • Determine which, if any, phase is appropriate

  • Get prior authorization for your participation

If you're selected, you'll have an assigned case manager to help you through the process.

Costs

TRICARE covers the costs for screening tests to determine eligibility for the clinical trial and the costs of participating in the cancer clinical trials.

TRICARE Prime Pilot Demonstration – Atlanta
If you live in the Atlanta area and enrolled in TRICARE Prime or TRICARE Select, TRICARE is starting a demonstration pilot where you may choose to enroll in Kaiser Permanente, a TRICARE Prime option. If you’re eligible, you can enroll during TRICARE Open Season. TRICARE Open Season was from November 11 - December 9, 2019.

Your enrollment will take effect on January 1, 2020.

You can also enroll up to 90-days after a Qualifying Life Event.

How does the pilot work?

TRICARE’s East region contractor is Humana Military. They are partnering with Kaiser Permanente to offer a Prime option. This means you will access Kaiser Permanente's network of providers, specialists, and hospitals in the Atlanta area.

For more information, visit Kaiser Permanente.

Chiropractic Health Care Program
The Chiropractic Health Care Program covers chiropractic care at designated military hospitals and clinics for:

  • Active Duty Service members

  • Activated Guard/Reserve members

All other beneficiaries can be referred to non-chiropractic health care services (e.g., physical therapy or orthopedics) or can get chiropractic care in the local community at their own expense.

Getting Chiropractic Care

  • Your primary care manager (PCM) decides if chiropractic care is required. 

  • You'll be screened to rule out any medical conditions that would prohibit chiropractic care. 

  • If appropriate, your PCM will refer you to a chiropractor for treatment.

  • Your PCM decides on the duration and frequency of chiropractic services.

Combat-Related Special Compensation Travel Benefit
If you have to travel more than 100 miles for specialty care related to your Combat-Related disability, the Combat-Related Special Compensation (CRSC) travel benefit reimburses your travel expenses.

You may qualify for the CRSC travel benefit if you:

  • Are a retired Service member

  • Were awarded a Combat-Related Special Compensation

To qualify, you must:

  • Get retired, retired retainer or equivalent pay

  • Be awarded a CRSC determination letter from your service’s CRSC Board identifying your Combat-Related disability or disabilities

  • Live in the United States

  • Be covered by TRICARE Select or TRICARE for Life

  • Get a referral from your provider for specialty care related to the Combat-Related disability

  • Travel more than 100 miles from your referring provider's office to get the care

Note: If you're enrolled in TRICARE Prime or the US Family Health Plan, you qualify for the TRICARE Prime Travel Benefit, so you won't qualify for the CRSC Travel Benefit.

Only costs for actual travel expenses such as lodging, fuel (rather than mileage), meals, parking, tolls or other costs associated with getting the specialty care.

  • You must use the least costly mode of transportation 

  • Government rates are used to estimate the reasonable costs for allowable expenses

Continued Health Care Benefit Program
The Continued Health Care Benefit Program (CHCBP) is a premium-based plan that:

  • Gives you temporary health coverage for 18-36 months when you lose eligibility for TRICARE. 

  • Acts as a bridge between military health benefits and your new civilian health plan.

  • Provides the same coverage as TRICARE Select, including prescriptions.

  • Gives you minimum essential coverage required by the Affordable Care Act, but it is temporary. You should consider your options for when CHCBP ends.

If you qualify, you can purchase the CHCBP within 60 days of the loss of TRICARE eligibility.

Extended Care Health Option
The Extended Care Health Option (ECHO) provides financial assistance to beneficiaries with special needs for an integrated set of services and supplies.

To use ECHO, qualified beneficiaries must:

  • Be enrolled in the Exceptional Family Member Program (EFMP) through the sponsor's branch of service. Sometimes, enrollment in the EFMP may be waived, for example when the sponsor’s branch of service doesn't provide the EFMP, or when the beneficiary resides with the custodial parent who isn't the active duty sponsor. Contact your regional contractor for more information.

  • Register for ECHO with case managers in each TRICARE region

The following beneficiaries who are diagnosed with moderate or severe intellectual disability, a serious physical disability, or an extraordinary physical or psychological condition may qualify for ECHO:

  • Active duty Family members

  • Family members of activated National Guard/Reserve members

  • Family members who are covered under the Transitional Assistance Management Program

  • Children or Spouses of former Service members who are victims of abuse and qualify for the Transitional Compensation Program

  • Family members of deceased active duty sponsors while they are considered "transitional survivors."

  • The qualifying Family member’s disability must be entered properly in DEERS to have access to ECHO services.

Children may remain eligible for ECHO beyond the usual age limits in some circumstances. If you or your provider believes a qualifying condition exists, talk to a case manager or with your regional contractor to determine eligibility for ECHO benefits.

Provisional Coverage Program
The Provisional Coverage Program covers some services and supplies.

What do I need to know about the Provisional Coverage Program?

  • We require pre-authorization for all services and supplies in the program. It doesn't matter which TRICARE plan you're using.

  • Provisional coverage for any approved service or supply can last up to five years.

  • Provisional coverage for any approved service or supply may end before five years. We'll give timely notification of when it will end.

  • We'll determine if the service or supply becomes a permanent TRICARE benefit. We'll do this before the five year provisional coverage period ends.

Currently Approved for Provisional Coverage

3-D Mammography (Digital breast tomosynthesis) (Effective January 1, 2020 through December 31, 2024)

Starting January 1, 2020, TRICARE will cover annual 3-D mammography screenings if you’re a woman who is:

  • Age 40 or older, or 

  • Age 30 or older and at high risk (15% or more lifetime risk of breast cancer).

Your provider must first get pre-authorization from your regional contractor. For more information about mammograms in general, visit the mammography page. 

Platelet Rich Plasma (PRP) Injections (Effective October 1, 2019 through September 30, 2024)

TRICARE may cover PRP injections if you're diagnosed with:

  • Mild to moderate chronic osteoarthritis of the knee

  • Lateral epicondylitis, also known as "tennis elbow"

However, you must meet additional certain criteria for coverage. Call your regional contractor for more information.

Transitional Assistance Management Program
The Transitional Assistance Management Program (TAMP) provides 180 days of premium-free transitional health care benefits after regular TRICARE benefits end.

Sponsors and eligible Family members may be covered by TAMP if the sponsor is:

  • Involuntarily separating from active duty under honorable conditions including:

    • Members who receive a voluntary separation incentive (VSI), or

    • Members who receive voluntary separation pay (VSP) and aren't entitled to retired or retainer pay upon separation.

  • A National Guard or Reserve member separating from a period of more than 30 consecutive days of active duty served for a preplanned mission or in support of a contingency operation.

  • Separating from active duty following involuntary retention (stop-loss) in support of a contingency operation

  • Separating from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency operation

  • Receiving a sole survivorship discharge

  • Separating from regular active duty service and agree to become a member of the Selected Reserve of a Reserve Component. The Service member must become a Selected Reservist the day immediately following release from regular active duty service to qualify.

TAMP eligibility is determined by the Services and documented in the Defense Enrollment Eligibility Reporting System (DEERS). TAMP eligibility can be viewed online via MilConnect. Service members should check with their Service personnel departments for information or assistance with TAMP eligibility.

TRICARE Plus
TRICARE Plus is a primary care program offered at some military hospitals and clinics.

  • Each hospital or clinic leader decides if TRICARE Plus is available.

  • You must enroll to participate.

  • Your enrollment is only for the hospital or clinic where you enrolled.

  • Contact your local military hospital or clinic to see if they offer the program.


Who can Enroll?

You can enroll in TRICARE Plus if you're:

  • TRICARE-eligible and not enrolled in a TRICARE Prime Plan, the US Family Health Plan or a civilian or Medicare Health Maintenance Organization

  • A dependent parent or parent-in-law.

Have enrollment questions? Contact your local military hospital or clinic.

TRICARE Plus gives you access to get primary care at your military hospital or clinic. You pay nothing out-of-pocket.

Primary Care

Make an appointment with your primary care provider by:

Specialty Care

TRICARE Plus doesn’t cover specialty care.

If you’re a dependent parent or parent-in-law, TRICARE won’t pay for care by civilian providers, even if the military hospital or clinic refers you for care. You’re responsible for the full cost of the care.

Women, Infants and Children Overseas Program
The Women, Infants, and Children (WIC) Overseas Program provides you and your Family with several important benefits:

  • Nutritious food

  • Tips on how to prepare balanced meals

  • Nutrition and health screenings

  • Other resources that help you and your family lead healthier lives

The WIC Overseas Program is available to eligible participants living overseas*, including:

  • Civilian employees

  • Department of Defense contractors

  • Family members

  • Members of the uniformed services

*If you're using WIC in the U.S., you can continue your participation in the WIC Overseas program without having to re-qualify. Once you transfer overseas, contact your local WIC Overseas office to make arrangements to switch to WIC Overseas drafts.

WIC Overseas counselors determine eligibility for the program by evaluating income, Family size, and certain other criteria.

Once you or a Family member is certified by a WIC Overseas counselor, you or the Family member can enroll in the program. Your WIC Overseas counselor will determine how long you can participate in the program. Those who may be eligible for the WIC Overseas Program include:

  • Expectant mothers during pregnancy and throughout the first six weeks after giving birth*

  • Mothers until the infant is six months old if bottle-feeding or one year old if breast-feeding

  • Infants and Children until the end of the month in which they turn age five

*After six weeks, mothers must contact a WIC Overseas counselor and reapply under either the bottle-feeding or breast-feeding category.

Contact your local WIC Overseas office to see if you and your Children are eligible for WIC Overseas nutritional benefits. A WIC Overseas counselor will help you determine if you qualify and, if so, will help you get started.

Additional Information
Document Review Date: 06 March 2020