TRICARE Standard Overseas Program 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 TRICARE Standard Overseas.
TRICARE Standard Overseas meets the requirements for minimum essential coverage under the Affordable Care Act.
If you are an active duty family member, you may use TRICARE Standard Overseas 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 TRICARE Prime Overseas and are covered by TRICARE Standard Overseas or TRICARE For Life.
Eligibility for TRICARE Standard Overseas
If you are a non-command-sponsored active duty family member who resides overseas, you are eligible for TRICARE Standard Overseas only. Uniformed Services retirees and their family members are eligible to use TRICARE Standard Overseas 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 TRICARE For Life.
Reserve/National Guard Eligibility for TRICARE Standard Overseas
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 TRICARE Prime Overseas or use TRICARE Standard Overseas, 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 TRICARE Standard Overseas.
Accessing Health Care
The TRICARE Standard Overseas 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 TRICARE Standard Overseas in the Philippines, you must select a provider who is certified. If you need help finding a TRICARE Standard Overseas 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).
TRICARE Standard Overseas 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 TRICARE Standard Overseas. 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 Overseas. The catastrophic cap limits beneficiaries’ out-of-pocket expenses for TRICARE each fiscal year.
Active Duty Family Members
Retirees and Their Family Members
|Annual Deductible Per Fiscal Year||
||$150 per person $300 per family|
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, TRICARE Standard Overseas may be the right choice for you, especially if you prefer to receive care directly from host-nation providers.
TRICARE Overseas Standard Provider Fraud and Abuse
If you use TRICARE Standard Overseas, 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.