E TRICARE Overseas Program Standard | Military.com

TRICARE Overseas Program Standard

TRICARE Overseas Program Standard is similar to the TRICARE Standard program offered stateside, including cost-shares and deductibles. Active duty family members living overseas with their sponsors, who have relocated with service sponsored/funded orders, may choose between TOP Prime and TOP Standard.

If you are an active duty family member, you may choose between using TOP Prime and/or TOP Standard if:

  • You live overseas with your sponsor, and
  • Your sponsor has relocated with Service-sponsored/funded orders.

Retirees and their families who reside overseas are not eligible to enroll in TOP Prime and are only covered by TOP Standard.

Eligibility for TOP Standard

If you are a non-command-sponsored active duty family member who resides overseas, you are eligible for TOP Standard only. Uniformed Services retirees and their family members are eligible to use TOP Standard while living in overseas areas. Although Medicare services are unavailable overseas, retirees and their family members entitled to Medicare Part A must be enrolled in Medicare Part B in order to retain TRICARE eligibility and use TOP Standard. 

Reserve/National Guard Eligibility for TOP Standard
If you are a National Guard or Reserve family member who lives overseas with your sponsor at the time they are activated, you may choose whether to enroll in TOP Prime or use TOP Standard, if he or she is called to active duty for more than 30 days.   National Guard and Reserve members and eligible family members who reside overseas during the 90-day early TRICARE benefit period are eligible for TOP Standard. 

Accessing Health Care
The TOP Standard option is a fee-for-service program. Enrollment is not required and you may receive care from any host-nation provider for TRICARE-covered benefits. When using TOP Standard in the Philippines, you must select a provider who is certified. If you need help finding a TOP Standard provider you may contact the nearest:

  • Military treatment facility (MTF) (www.tricare.mil/mtf);
  • TRICARE Service Center (TSC); or
  • American Embassy Health Unit to find a host nation provider www.usembassy.gov (to get embassy phone numbers).
TOP Standard does not generally require referrals for specialty care. You may need to get prior authorization for some procedures. Check with the appropriate TRICARE area office for details about procedures that require prior authorization. 
Costs and Fees
You will be responsible for annual deductibles and cost-shares when you use TOP Standard. You may be required to pay for care up front and file claims yourself. Claims must be filed within one year of the date of service or within one year of the date of inpatient discharge. You can download a DD Form 2642 (patient’s request for medical payment) from the TRICARE Web site at www.tricare.mil/forms, or you may contact your TRICARE area office to get information regarding your local TSC or TOP point of contact for further claims assistance. When filling out patient information on the claim form, you should use your overseas mailing address. Using a U.S. address will result in payment problems. You should attach photocopies of fully itemized bills from the provider showing the cost for each service or item provided and copies of the receipt if you have already paid the bill. If the bill was already paid, write that clearly on the claim form. You should retain a copy of the completed DD Form 2642 and all original invoices and receipts. The following chart lists the costs currently associated with TRICARE Standard for fiscal year 2011. The catastrophic cap limits beneficiaries’ out-of-pocket expenses for TRICARE each fiscal year.  
TOP Standard
Active Duty Family Members
Retirees and Their Family Members
Annual Deductible Per Fiscal Year
  • E–4 and below
    • $50 per person
    • $100 per family
  • E–5 and above
    • $150 per person
    • $300 per family
$150 per person $300 per family  
Cost-share
  • Civilian Outpatient Visit: 20% of covered services
  • Civilian Inpatient Admission: $16.85 per day or $25 minimum, whichever is greater
  • Civilian Inpatient Behavioral Health: $20 per day
  • Civilian Outpatient Visit: 25% of covered services
  • Civilian Inpatient Admission: 25% of institutional charges; 25% of covered services and professional fees
  • Civilian Inpatient Mental/Behavioral Health: 25% of institutional charges; 25% of covered service and professional charges
Catastrophic Cap Per Fiscal Year$1,000$3,000

 

The fiscal year is Oct. 1–Sept. 30. Cost-share amounts are subject to change each fiscal year. You may visit www.tricare.mil/costs for the most up-to-date cost information.   Despite its increased out-of-pocket costs, TOP Standard may be the right choice for you, especially if you prefer to receive care directly from host-nation providers.

TOP Standard Provider Fraud and Abuse
If you use TOP Standard, you should be aware of fraud and abuse and the steps to take in the event that you suspect suspicious activity.

  • Fraud occurs when a person or organization deliberately deceives others to gain an unauthorized benefit.   
  • Abuse is the improper or excessive use of program benefits, resources or services by providers or beneficiaries.  
Anyone can identify potential fraud and/or abuse. You should look for anything that “doesn’t look right.” The types of activities that should be reported include:
  • A provider billing for services when services were not rendered;
  • Services billed do not match the services rendered;
  • A provider waiving copayments or deductibles; and/or
  • Someone who is not TRICARE eligible who receives benefits.

If you need to report suspected fraud and/or abuse, send as much information as possible in writing to:  
ATTN: TRICARE Program Integrity
1717 W. Broadway
P.O. Box 7635
Madison, WI
53707 USA 

See also: MTF Locator Web page

Connect
Get the

Military Report

Sign-up
Newsletter
Deployment Center
headerLegislativeCenter

Legislative Center

Read More at Legislative Center
© 2014 Military Advantage
A Monster Company.