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TRICARE Program

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Beneficiary Types TRICARE Plans Administered by TriWest in West Region Beneficiary Rights TRICARE Eligibility Verifying Benefit Coverage

Beneficiary Types

TRICARE offers comprehensive medical and behavioral health benefits to all TRICARE beneficiaries. Beneficiary types include:

  • Sponsors – active duty, retired, and Guard/Reserve Members
  • Family members – spouses and children who are registered in Defense Enrollment Eligibility Reporting System (DEERS)

It is important to be aware of the TRICARE program plan options available according to beneficiary category. To view the most current information on these plans, please reference the links below.

Plan Link to More Information
TRICARE Prime https://www.tricare.mil/Plans/HealthPlans/Prime
TRICARE Prime Remote https://www.tricare.mil/Plans/HealthPlans/TPR
TRICARE Prime Overseas https://www.tricare.mil/Plans/HealthPlans/TPO
TRICARE Prime Remote Overseas https://www.tricare.mil/Plans/HealthPlans/TPRO
TRICARE Select https://www.tricare.mil/Plans/HealthPlans/TS
TRICARE Select Overseas https://www.tricare.mil/Plans/HealthPlans/TSO
TRICARE For Life https://www.tricare.mil/Plans/HealthPlans/TFL
TRICARE Reserve Select https://www.tricare.mil/Plans/HealthPlans/TRS
TRICARE Retired Reserve https://www.tricare.mil/Plans/HealthPlans/TRR
TRICARE Young Adult https://www.tricare.mil/Plans/HealthPlans/TYA
US Family Health Plan https://www.tricare.mil/Plans/HealthPlans/USFHP

TRICARE Prime and TRICARE Prime Remote (TPR) are managed care options offering the most affordable and comprehensive coverage. Active duty service members (ADSM) must enroll in TRICARE Prime or TPR. Active duty family members (ADFM), retirees and their families, and others may choose to enroll in a TRICARE Prime or TRICARE Select option.

When on active duty orders for more than 30 consecutive days, National Guard and Reserve members are covered as ADSMs and must enroll in TRICARE Prime or TPR. During activation, their eligible family members are covered as ADFMs and may enroll in TRICARE Prime, TPR, or TRICARE Select.

The following table provides a summary of the TRICARE plans administered by TriWest for the West Region.

TRICARE plans administered by TriWest for the West Region
Plans Description Availability Provision of Care Features
TRICARE Prime A managed care option offering the most affordable and comprehensive coverage. In the United States in Prime Service Areas
  • Get most care provided by assigned Primary Care Manager (PCM) (military or network provider)
  • PCM refers to specialists for care they cannot provide
  • Enhanced vision coverage and preventive services
  • Time and distance access standards
  • Fewer out-of-pocket costs
  • Beneficiary does not file claims (in most cases)
TRICARE Prime Remote A managed care option offering the most affordable and comprehensive coverage to active duty families in remote U.S. locations. In designated remote U.S. locations more than 50 miles from an MTF
  • Get most care provided by assigned PCM (network provider, if available, otherwise any TRICARE-authorized provider)
  • PCM refers to specialists for care they cannot provide
  • Enhanced vision coverage and preventive services
  • Time and distance access standards
  • Fewer out-of-pocket costs
  • Beneficiary does not file claims (in most cases)
TRICARE Select A preferred provider network option available to eligible beneficiaries not enrolled in TRICARE Prime (except ADSMs and TRICARE For Life beneficiaries). Offers the most freedom of choice. United States
  • Get care from any TRICARE-authorized provider (network or non-network)
  • Referrals not required
  • Some services require prior authorization
  • Costs vary depending on type of provider
  • Beneficiary may have to pay for services when received and file for reimbursement
TRICARE Reserve Select A preferred provider network option available to qualified National Guard and Reserve members. Worldwide
  • Get care from any TRICARE-authorized provider (network or non-network)
  • Referrals not required
  • Some services require prior authorization
  • Must qualify
  • Costs vary depending on type of provider
  • Beneficiary may have to pay for services when received and file for reimbursement
TRICARE Retired Reserve A preferred provider network option available to qualified retired Reserve members. Worldwide
  • Get care from any TRICARE-authorized provider (network or non-network)
  • Referrals not required
  • Some services require prior authorization
  • Must qualify
  • Costs vary depending on type of provider
  • Beneficiary may have to pay for services when received and file for reimbursement
TRICARE Young Adult (Select) A preferred provider network option available to qualified adult children of eligible sponsors. Worldwide
  • Get care from any TRICARE-authorized provider (network or non-network)
  • Referrals not required
  • Some services require prior authorization
  • Must qualify
  • Referrals not required, but some care may require prior authorization
  • Beneficiary may have to pay for services when received and file for reimbursement
TRICARE Young Adult (Prime) A managed care option offering the most affordable and comprehensive coverage available to qualified adult children of eligible sponsors. In the United States in Prime Service Areas
  • Get most care from assigned PCM (military or network provider)
  • PCM refers to specialists for care they cannot provide
  • Must qualify
  • Enhanced vision coverage and preventive services
  • Time and distance access standards
  • Fewer out-of-pocket costs
  • Beneficiary does not file claims (in most cases)
TRICARE Young Adult (Prime Remote) A managed care option offering the most affordable and comprehensive coverage in remote U.S. locations available to qualified adult children of eligible sponsors. In designated remote U.S. locations more than 50 miles from an MTF
  • Get most care provided by assigned PCM (network provider, if available, otherwise any TRICARE-authorized provider)
  • PCM refers to specialists for care they cannot provide
  • Must qualify
  • Only available to children of active duty service members enrolled in TRICARE Prime Remote
  • Time and distance access standards
  • Fewer out-of-pocket costs
  • Beneficiary does not file claims (in most cases)

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Beneficiary Rights

TRICARE beneficiaries have the right to:

  • Accurate, easily understood information so they can make informed decisions about their TRICARE health plan, providers, and facilities.
  • A choice of health care providers that ensures access to high-quality health care.
  • Emergency health care services when and where they need it. Coverage of emergency services is available without authorization if beneficiary has reason to believe their life is in danger or they would be seriously injured or disabled without immediate care.
  • Understand their diagnosis, treatment, or prognosis, as explained by their provider.
  • Fully participate in all decisions about their care. If beneficiaries cannot make their own decisions, they have the right to be represented by someone else. This could be a family member or conservator.
  • Considerate, respectful care from all members of the health care system. Beneficiaries are protected against discrimination based on:
    • Race
    • Ethnicity
    • National origin
    • Religion
    • Sex
    • Age
    • Mental or physical disability
    • Sexual orientation
    • Genetic information
    • Source of payment
  • Communicate confidentially with their health care team and have their confidential information protected by law.
  • Review, copy, and request amendments to their medical records.
  • A fair and efficient process for resolving differences with their health plan, health care providers, and the institutions that serve them.

Visit https://www.tricare.mil/ for more information about beneficiary rights.

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TRICARE Eligibility

TRICARE is the uniformed services  health program for active duty service members (ADSM), active duty family members (ADFM), , National Guard and Reserve members and their families, survivors, certain former spouses, Medal of Honor recipients and their families, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS). See https://www.tricare.mil/Plans/Eligibility for more information.

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Verifying Benefit Coverage

Civilian providers can use the TriWest online Referral and Authorization Decision Support (RADS) tool online (specific link to be updated prior to start of health care delivery) to determine if an approval from TriWest is required. The online tool also provides procedure codes, services, and procedure coverage information.

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Updated: 12/30/2024 3:01:27 PM